Table 1.

Lesson learnt from COVID-19 for improving MS care.

Problem	Challenge	Opportunity
▪Insufficient evidence on risk factors for severe COVID-19 outcomes ▪Lack of epidemiological data on the effects of SARS-CoV-2 infection on MS course and incidence	▪Sharing data across different countries to provide answers	▪Creation of ad hoc big data networks to generate real world evidence and drive advancement in MS research
▪Lack of evidence on long COVID in MS	▪Dissecting the contribution of long COVID symptoms to the global disability burden of people with MS	▪Provide unifying hypotheses for the pathobiology of long COVID and MS and their overlapping features
▪Blunted humoral response to COVID-19 vaccines while receiving specific DMTs	▪Fixed timing of vaccination before and after specific DMTs ▪Extra-doses of vaccines for the most fragile patients	▪Creation of a personalized ‘disease card’ reporting infection and immunisation history
▪Vaccination hesitancy and lack of standardization in the use of antiviral drugs	▪Data collection using appropriate methodology in large MS cohorts	▪Dissemination of results on vaccines safety and use of antivirals among the general population and health professionals
▪Interruption of clinical visits, paraclinical assessments and treatment administration during lockdown	▪Telemedicine for follow-up visits, certificates, prescription renewal ▪On-demand re-dosing of specific DMTs ▪Flexible dosing regimen (when possible)	▪Ameliorating digital infrastructures and cybersecurity; establishing guidelines to govern telehealth ▪Approaching to precision medicine by validation of lab biomarkers to establish tailored dosing regimen and improve the risk:benefit ratio of DMTs
▪Disruption of rehabilitation services	▪Delivering home-based, alternative rehabilitation strategy	▪Development and validation of tele-rehabilitation, web-based program to enhance PA, exergames, handheld application for cognitive training