Impact of the first COVID-19 pandemic wave on the Scottish Multiple Sclerosis Register population [version 1;peer review: awaiting peer review]

Background: The impact of the coronavirus disease 2019 (COVID-19) pandemic on people with multiple sclerosis (MS) is a major current concern, in particular the risk of death Here we describe the impact of the first wave of COVID-19 infections (Mar 2020-July 2020) on the Scottish MS Register (SMSR) population, a cohort of 4702 individuals with MS, all newly diagnosed in the past decade Methods: We established a clinician alert system, linking the SMSR with the Electronic Communication of Surveillance in Scotland (ECOSS) This allows identification of patients within this cohort who had a positive SARS-CoV-2 PCR test The SMSR was also linked to death records from National Records Scotland Results: Of 4702 people with MS, 246 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR tests were performed, of which 17 were positive The proportion of positive tests were similar to the general Scotland population (Observed PCR confirmed cases = 17, expected = 17 5, O/E = 0 97, 95% CI: 0 60 – 1 56, p= 90) Between 1st March – 31st July 2020 12 individuals on the SMSR died, 5 of which were linked to COVID-19 (1 PCR confirmed, 4 clinical diagnoses without PCR confirmation) This number of COVID-19-related deaths was higher than expected (observed deaths = 5, expected deaths = 1 2, O/E = 4 03, 95% CI = 1 48 – 8 94, p= 01) All COVID-19-related deaths in the SMSR occurred in individuals with advanced disability (Expanded Disability Status Scale ≥7), and no deaths occurred in patients receiving disease modifying therapy (DMT) therapies Conclusion: In this nationally comprehensive cohort of MS patients diagnosed in Scotland within the past 10 years, we observed similar rates of PCR-confirmed SARS-CoV-2 infection compared to the general Scottish population, but a small number of excess COVID-19 related deaths These deaths occurred in individuals with advanced disability who were not receiving DMTs