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Daily Briefing Covid-19 [20th Mar 2020]

Morning folks, - Another day of splendid isolation in Shadbolt Towers awaits. Thankfully, I have the enforced long-term company of the delightfully cheerful (so far) Mrs Shadbolt. - This update will be more MS and less of me making sideswipes at the Buffoon and the Orange Genius. I think we all realise that we have managed to elect the two people who have the least utility possible in a crisis. ---------- MS NEWS ---------- Interview 2 with Prof Gavin Giovannoni was done yesterday. Fascinating stuff came out of it and it is probably going to be published (Dropped is the new hipster term, apparently) later today. - The Main Takeaways: - Your MS service is changing. A lot and soon. Prof G himself expects to be told by his boss to report for duty in the full spaceman get up and start doing critical care asap. I was talking to my nurse 2 days ago and he said similar. The atmosphere in the hospitals is a mixture of anticipation/the calm before the storm/the lull before the battle (insert chosen metaphor here) type thing. - Certain essential things like must-do infusions, monitoring of bloods (you may hear it referred to as pharmacovigilance - a fancy way of saying 'keep an eye on things') are being moved to different locations that don't have an A+E and are not going to be hot spots for risk. - The de-risking strategy is much wider and the telephone will become the primary tool for first line, non-urgent healthcare. - Personally, I think there are a significant amount of people out there - MS or whatever - where the idea that their needs have suddenly tumbled into a back-seat hasn't really kicked-in. Our NHS does not have any over-capacity. Indeed, quite the opposite. Everyone who remembers how to take a pulse and do CPR is being redeployed to the front lines. There is a genuine and honestly held belief that we are going to go "Full-Italy" in a matter of days. - If you do not appear that you are going to die without immediate medical intervention then you will get the advice to stay home, take paracetamol, drink plenty of fluids (not malt-whisky @highlander. Wrong type of fluid) and rest. - Enough of the Doom & Gloom though. It is looking increasingly like that MS and being on a DMT - in regards to Covid-19 - may be a good thing. - If you have MS but for whatever reason you are not on a DMT then your risks are in line with everyone else regarding Covid-19. You are no better or no worse off. It is your own health and the sate of play at chez nous that matters. - If you get Covid-19 (and it is likely that most of us will at some point) then it appears that the real issues come from when the body's immune response goes too far in the wrong direction. Auto-immune damage. from an over-active immune system. Something we are all v. familiar with! - If you are on the 1st generation old school therapies of beta-interferon (Rebif) or glatiramer acetate (Copaxone) then although they are NOT immunosuppressants they have a mild immunmodulatory effect and may help to mitigate the body's overreaction. - If you are a 2nd or 3rd Gen drug - see this list here: https://tinyurl.com/uj84qsb ( @sfrox was right on this yesterday - good spot!) many of them are better immunosuppressants which seems to be a *good thing* in so far as they help dampen down the body's overreaction to the virus. - Lymphocytes are a thing. Gavin explains the levels in the forthcoming video which will be on the forum as well as all the other social media channels. - NONE of this is certain. More and more anecdotal reports (Twitter #MSCOVID19 ) are surfacing pf patients on the entire spectrum of meds catching Covid-19 and doing no worse than similar people that are not on a DMT or have MS _ MS itself does not make you more susceptible. Not washing your hands, not social distancing, carrying on as normal does make you more susceptible and also indicates that you aren't that bothered being a person who spreads it about. I have had to have strong conversations (along with my brother who is a medical professional) with our parents. We are staggered because they are really laissez-faire. Not because we are moralising finger-waggers but because you only need to see what has happened in Italy. The Italians are pleading with us not to make the same mistakes they did and restrict movement to essential workers only as soon as possible. My mum has a gardening business in BC (Canada) and they are like we were a fortnight ago. It'll all blow over. I did a bit of math, pointed out their ratio of critical care beds to the population is not sufficient if it goes mad but it falls on deaf ears. - I am quite frustrated. It feels like trying to reason with a Donald Trump/Nigel Farage supporter and I am reminded of the phrase, "Never argue with an idiot. They will drag you down to their level and beat you with experience." - I guess that the vast majority of us in the MS community are a little more sensitised so see things through a more up-to-date lens. Maybe I'm just Chicken Little? Though, based on the math and the evidence I don't think so. - Government type news? - More of the same in the UK. No major changes. Yes, they promise to throw money at this. No, whatever the Buffoon says, it will not be sent packing in 12 weeks. Yes, you need to severely restrict your movements and contact. Severely. Think punch and not tickle.The supermarkets are getting on it with special hours for the elderly and vulnerable and rationing of essentials. - People are AWESOME - I love the stories coming out of random acts of kindness and thoughtfulness. The mad sweary old ladies doing Catherine Tate style rants to camera (see Twitter for many funny memes) and recalling WW2, there are entire hashtags devoted to the Isolation Olympics with amusing videos of creative ways to spend your time in lockdown. - We've got this people. MS means that we are used to isolation, not going out, not seeing all the people we want, being on drugs that may help us in the face of Covid-19. - LINKS - All this not technical enough for you? Fear not -an hour long medical briefing here: https://multiplesclerosisacademy.org/2020/03/19/webinar-prof-giovannoni-managing-ms-remotely-during-the-covid-19-pandemic/ - In light of the fact that MS services will not be as easily accessible, Prof G has just whipped up (who the hell just whips up a website in a day? Really, who does this?) a fantastic website for MS patients. THIS IS A MUST READ - https://sites.google.com/giovannoni.net/clinicspeak-dmt/home - comments are welcome. To the website, not me! - A few funny pics - https://www.thepoke.co.uk/2020/03/18/simply-9-funny-pictures-stockpiling-self-isolation-make-day-better/ - Sad that your favourite festival is cancelled? https://www.facebook.com/ItsGoneViralOfficial/videos/220295729338859/?__so__=permalink&__rv__=related_videos - Keep Smiling. Keep Buggering On. This too will pass.

Thank you for my early morning pep talk @dominics - brilliant. Only disappointing point was your clarification of “fluids” - think I may have been going wrong there...! Cheers!


@jojok - sorry to disappoint re fluids. I have some particularly nice Bourbon that, if it all goes pear shaped, I will try and disinfect my throat with. In other news - if you don't ask, you don't get. I asked Dr Aaron Boster to talk with Shift.ms and share another perspective on the COVID-19 madness. He said yes. I am interviewing him middle of next week so expect to see that video late next week. - FOMO - fear of missing out. We have been contacted by the UK MS-Register to interview their medical lead. If you haven't signed up to the register then go and have a hard look at yourself in the mirror and repeat 'shame, shame, shame' :-) If you were wondering what I am on about, sign up and do your bit for the entire MS community. https://ukmsregister.org/ -