Untangling the Relationship Between NMOSD and COVID-19

Across the often insufferable world of social media platforms such as TikTok, occasionally, a healthcare-related trend deserves a second look. One of these trends is a group of young people who felt that the period coinciding with the global pandemic from 2020 to 2022 went by as a blur; it appeared that they remembered who they were prepandemic and post, but little else in between.

This phenomenon has been coined “Covid amnesia.” It appears to be the result of the world having moved on so quickly from the pandemic (ie, quickly returning to large-scale concerts and tourism) that hardly anyone seems to have the appetite to discuss the suffocating years between 2020 and 2022.

Some psychiatrists see this phenomenon as a means to avoid talking about traumatic events. In a rushed bid to return to normalcy, public discourse on the pandemic has largely vanished from view. Having been held back for years, many have chosen to leave the chaos and the heartbreak behind and forge a new path forward. 

Nevertheless, the academic dissection of the worst pandemic in a century has animated researchers; this is evidenced by the considerable quantity of academic work being published in the period that followed. In stark contrast with the general public, researchers feel that the cooled-down atmosphere of today is perfect for picking apart various aspects of the pandemic and to advocate for evidence-based policy changes slowly. 

COVID-19 and NMOSD 

The general strategy during the pandemic was to shield vulnerable/elderly populations from any possible contact with COVID-19; this was seen as necessary to preserve life. At the top of the list of vulnerable individuals are patients suffering from chronic neuro-inflammatory disorders such as multiple sclerosis and neuromyelitis optica spectrum disorder (NMOSD). 

Read more about NMOSD etiology 

Statistical studies seem to lend validity to these concerns; patients with these disorders had higher hospitalization rates, and patients with greater disability scores were likely to suffer from severe COVID-19. Vaccines, however, have tremendously altered the medical landscape for the better. Nevertheless, anomalies remained among patients with these disorders compared with the general population. 

Eisler and colleagues conducted a study about how the various treatments for multiple sclerosis and NMOSD come together in influencing outcomes during the pandemic. They carried out a single-center, observational study in a multiple sclerosis center in Switzerland and published their findings in the Journal of Clinical Medicine. For this study, they collected extensive clinical information from participants, including vaccination status. 

Among 352 patients with multiple sclerosis/NMOSD, 315 were vaccinated with mRNA vaccines. Overall, 134 had at least 1 experience of COVID-19. Researchers found that patients who were older, had a higher Expanded Disability Status Scale score, and a positive vaccination status had a lower risk of contracting COVID-19; inversely, individuals treated with antiCD20 appear to be at an increased risk of contracting COVID-19. 

NMOSD Complicating Vaccinations 

Although the medical community is overwhelmingly in favor of vaccines due to the benefit it confers to society as a whole, including to those who choose to remain unvaccinated, we should be clear-eyed about how certain negative factors are associated with COVID-19 vaccines.

In a letter to the editor of Multiple Sclerosis and Related Disorders, Josef Finsterer of the Neurology and Neurophysiology Center in Vienna, Austria, contends that there are considerable case studies documenting patients with newly developed NMOSD after a SARS-CoV-2 vaccination. He cites examples of patients who seemingly develop NMOSD out of the blue after receiving various COVID-19 vaccinations. 

“It is well known that SARS-CoV-2 vaccinations can trigger relapses of NMOSD,” he wrote. “In a study of 30 patients with aquaporin (AQP)-IgG positive NMOSD, 1 of 26 patients (4%) experienced a relapse within 1 month of the SARS-CoV-2 vaccination.” 

However, public information campaigns in many parts of the world appeared to direct all individuals to receive a COVID-19 vaccine, regardless of preexisting vulnerabilities. In fact, a digital COVID-19 vaccine passport was almost a prerequisite entry pass for most facilities in Malaysia, where I reside; conscientious objectors would find themselves unable to maneuver freely in their own country for months until vaccine mandates were relaxed.

All individuals were encouraged to get the vaccine, even those deemed vulnerable because the potential benefits outweighed any risks. Whether this statement can bear the intense academic scrutiny coming its way is yet to be seen. 

Read more about NMOSD treatment 

Because a lot of evidence for and against COVID-19 vaccines appear anecdotal in nature, much more research is needed to separate fact from fiction. Public health policies implemented during the pandemic will doubtlessly be discussed for years to come.

Granted, the COVID-19 pandemic caught the world unprepared. However, its relationship to autoimmune disorders deserve full exploration. Only then can we devise better guidelines if the next pandemic arrives and provide the public with solid, science-backed data about how to prevent infection and protect vulnerable individuals at the same time. 

This article originally appeared on Infectious Disease Advisor