Table 1.
Stratification of COVID-19 Risk in Multiple Sclerosis Patients
| Risk Factor | Low Risk (Social Distancing) | Intermediate Risk (Social Stringency) | High Risk (Shielding) |
|---|---|---|---|
| Age93–95 | <40 years | 40–49 years | ≥50 years |
| Comorbidities96 (eg, diabetes mellitus, hypertension, cardiovascular disease) |
Absent | One | Two or more |
| Smoking97 | Non-smokers | – | Smokers |
| Type of MS10,98 | RRMS on one of the low-risk medications | RRMS on one of the intermediate-risk medications | SPMS/PPMS (EDSS >4) |
| Ambulation index score11,98,99 | 0–3 (walks independently) | 4–5 (unilateral support or bilateral support, walks 25 feet in ≤20 seconds) | 6–9 (bilateral support, walks 25 feet in >20 seconds or unable to walk 25 feet, uses wheelchair on occasions/most of the time or restricted to it) |
| Bulbar or respiratory symptoms related to MS99,100 | No bulbar symptoms | Bulbar symptoms | Bulbar and respiratory symptoms |
| Pregnancy101 | – | Yes | – |
| Obesity102 (body mass index) | Normal or overweight (18.5−29.9 kg/m2) | Obese (30–39.9 kg/m2) | Morbidly obese (≥40 kg/m2) |
| Disease-modifying therapies99 | Interferons, glatiramer acetate, natalizumab, dimethyl fumarate, teriflunomide | Alemtuzumab or cladribine in the past 6 months, fingolimod, ocrelizumab or rituximab in the past 12 months | Alemtuzumab or cladribine in the past 12 weeks, AHSCT in the past 12 months, any other immunosuppressant |
| Lymphopenia2,29,93 | Grade 0–1 | Grade 2 | Grade 3–4 |
| Visited or living in a high-risk area for COVID-19103 | No | Yes (≥14 days) | Yes (˂14 days) |
| Working in a health-care facility104 | No | – | Yes |
Abbreviations: AHSCT, autologous hematopoietic stem cell transplantation; COVID-19, coronavirus disease 2019; EDSS, Expanded Disability Status Scale; MS, multiple sclerosis; PPMS, primary progressive multiple sclerosis; RRMS, relapsing–remitting multiple sclerosis; SPMS, secondary progressive multiple sclerosis.