For good reasons, our patients are concerned.
And part of the reason for some patients now is that some of the mask mandates have been lifted in different states, and there's not really a lot of physical distancing happening in some places. Newsome: Yes, we still are facing that challenge. Are you still seeing a reluctance on the part of your patients to take part in physical therapy at a center or aqua therapy? But one of them was the one about nonpharmacologic treatments and the fact that a lot of our patients were reluctant for them to continue when they would be out in the public. I know we'll likely talk about vaccines (getting our patients vaccinated), certain therapies, and/or dose-adjusting some treatments.Ĭross: That was a good point you made - well, multiple good points. As we are right now, in sort of that third stage of the pandemic, I feel like I'm getting back to how we were treating people pre-pandemic, with some caveats. That has helped provide a higher level of care for many of our patients. For those patients who maybe are at higher risk to have bad outcomes with COVID, we're trying to use telemedicine to supplement some of our in-person visits. We've been utilizing telemedicine, and this is where I think telemedicine is quite helpful. In the latter part of the pandemic, now that we've learned as much as we have, we're trying to get people back to the physical therapist and aqua therapy if we feel that they're safe to do so. Probably the biggest factor here in my clinic is that a lot of our patients have not had the opportunity to do some of the nonpharmacologic interventions, like the physical therapy, the occupational therapy - things that I feel really impact the person's quality of life. I had to backpedal a little bit to say we have to look at the individual situation should we look at treating people a little bit differently if we're going to escalate treatment?
Of course, we then found out, that there are certain classes of medications that may put people at risk to have more severe outcomes if they got COVID. Then I started to feel like, okay, let's get back into the pre-pandemic way of treating patients, where maybe we wouldn't hold back necessarily on escalating treatment if it was needed. We were holding tight on medications, not switching people to stronger therapies, even at the time where we felt that maybe they needed to be switched because we didn't know what would happen if our patient got COVID-19 would they end up having a serious outcome? And then as some of the observational studies started to churn out information, like the COViMS Registry and the Italian Registry, we started to learn a little bit more, like how MS in and of itself doesn't seem to put people at risk to contract COVID, or if they were to get COVID, to have more severe outcomes. In the early part of the pandemic, when we didn't know how COVID-19 was going to affect our patients, it was, "Geez, is my patient who has MS at risk?" Forget about the therapy the person is on does MS in and of itself put someone at greater risk to have bad outcomes with COVID-19? And then you add on a therapy. I'll try to break it into the early part of the pandemic, when we didn't really know much of anything and then the intermediate pandemic and then where we are now. What are the top things you think have changed in your care of MS patients due to the pandemic? Cross: Well, you've certainly played more than just a little bit of a role, but we'll move on to the topic at hand, which is MS and COVID-19 and the pandemic.