Neeta Garg, MD on Navigating MS Care During the Pandemic

In this podcast, Dr Garg gives an overview of the impact of the COVID-19 pandemic on multiple sclerosis care, including telemedicine, hospital visits, disease-modifying therapies, and more. 

For more podcasts like this, visit Neurology Consultant.

Neeta Garg, MD, is a multiple sclerosis specialist and director of Quality and Patient Safety in the Department of Neurology at the University of Miami Miller School of Medicine.

TRANSCRIPT:

Christina Vogt: Hello everyone, and welcome back to another podcast. I’m Christina Vogt, associate editor of the Consultant360 Specialty Network. I’m joined by Dr Neeta Garg, who is a multiple sclerosis specialist and director of Quality and Patient Safety for the Department of Neurology at the University of Miami Miller School of Medicine. Today, we’ll be discussing multiple sclerosis care during the COVID-19 pandemic. So, Dr Garg, could you discuss how the pandemic has affected patients with MS and overall MS care?

Dr Garg: Yes. So, as you know, the COVID-19 pandemic is pretty widespread. It's all over the world, and we see it impacting MS care everywhere, and especially in the US, where the infection rate is fairly high. So, the first thing that happened when this pandemic started to unfold in the US was that we had to sort of close down our shops, clinics and non-urgent services. That meant the patients had limited access to in-person visits, even though we continue to have some outpatient operations, even during lockdown period starting in mid-March till recently.

Most patients were afraid to come in for in-person visits, and also given the limited availability and also concerns for healthcare providers in terms of exposure, there was overall preference for teleneurology or telehealth visits, which means remote visits, where you have patients interviewed through a video chat or platform like Zoom, and that was the way we were seeing patients during the lockdown or when COVID-19 restrictions are in place for stay-home instructions for most of us. And that has continued, I would say, till date. We still haven't opened our clinic fully but are in process of opening, and, I hope and expect that we will resume the normal operation for outpatient clinic over the next 2 to 3 months.

Now, I think telehealth provided a good platform and, given the situation, it has really worked well for providers and for the patients with the limitation of probably new patient appointments. As you know, neurology is a specialty where encounter or interaction with the patient in person face-to-face has lot of value, and you can get more information seeing the patient and doing a thorough exam. And also, there's some other things that you can really gauge from body language or other things that you encounter or observe during an in-person visit. So that's been kind of the downside or disadvantage of not having outpatient clinic working as we normally do for patients coming in–come in, and we see them and evaluate them face-to-face.

And other aspect of impact on MS patients during the COVID-19 pandemic has been limited availability of lab testing and MRI imaging, which is crucial for MS patients, as you know. These medications that we use to treat MS, so called disease-modifying therapies–many of them are immune-based therapies having side effects that need to be monitored through regular and periodic blood testing, lab testing, and also MRI imaging to observe or screen for any new lesions which may indicate disease activity, or sometimes they are just routine surveillance MRIs just to make sure patients are doing well. And also in case of new symptoms, which may indicate ongoing exacerbation of relapse, again, an MRI be indicated.

So, for first few weeks when everything goes down around mid-March the MRI studies were only being done on a very selective basis, and most of the non-urgent or non-acute emergency MRIs are not being done. So, that was another way that it impacted MS patients’ care. You could argue that any patient who needed urgent MRI could always go to the emergency room, but keep in mind that also increases the risk for patients, especially MS patients who are on drugs that can lower their immune protection against infections and being in the emergency room or in the hospital can further increase the exposure and risk for these patients, given that if they have to go in for testing, such as MRI, because of limited availability of these testing otherwise.

The other aspect of the COVID-19 impact on MS could be related to medication modification or risk of disease-modifying therapies in the face of the ongoing pandemic. The other thing we were thinking again–potentially, people with MS could be having more infections or coming to hospital with acute relapses because of either infection causing more relapses or some other factors causing more symptoms, because a lot of stress going on and anxiety and people not working. So, we didn't see any increase per se in MS-related hospital visits because of relapse or worsening symptoms.

One thing I forgot to mention about impact of COVID in MS is, many of the patients who used to be on medications are having difficulty maintaining therapies because of the work situation. As you know, many people lost their jobs or are not working full-time, and therefore their insurance status has changed to either no health insurance or having limited health insurance and benefits that may not cover these expensive MS drugs. I've had instances in recent weeks of patients calling and canceling their appointments, because they don't have insurance anymore. And some of them actually came off medications, because they couldn't afford because of not having insurance. We do have some assistance programs through the drugmakers and we try to help the best we can but that's another aspect that has affected MS patients during this pandemic.

Christina Vogt: Thanks again for joining me today, Dr Garg. For more podcasts like this, visit Consultant360.com.