News Clinical guidance on risks from coronavirus for people with DMD This is up to date advice specifically from clinicians, received on 24th March 2020. We will continue to update the advice with any further clinical guidance we receive. Clinical guidance for people with muscle-wasting conditions and their families The following guidance is based on advice from a group of neuromuscular clinical experts, working across a wide range of neuromuscular conditions, who lead the adult and children’s NorthStar and SMA REACH clinical networks. Currently there is no specific information on whether people living with a muscle-wasting condition are at increased risk of infection with COVID-19. However, the clinical expert group agree that people with any diagnosed or undiagnosed neuromuscular condition should consider themselves as being at high risk of getting seriously ill from coronavirus and they should practice shielding. All household members are not required to adopt these protective shielding measures for themselves, but they should do what they can to support a person with a neuromuscular condition in shielding and they should stringently follow guidance on social distancing, reducing their contact outside the home to essential shopping. You can also register for support, such as help with deliveries or getting essential supplies, via the Government website. We can also share this advice from the Association of British Neurologists which makes clear that people with a ‘muscle disease’ may be significantly at risk of being severely ill from COVID-19. Shielding is particularly important for people: on oral steroids or other immunosuppressants (such as methotrexate). You should not stop treatment, and if possible ensure that you have a supply at home. If you become unwell, you may need to increase the dose as advised by your specialist service at respiratory risk (ventilated (tracheostomy, BiPAP, CPAP), Forced Vital Capacity less than 60%, weak cough, congenital myasthenic syndrome or myasthenia gravis usually advised to receive the annual influenza vaccine with cardiac complications in their condition who have difficulty swallowing, such as those with myotonic dystrophy and OPMD with risk of decompensation (functional deterioration of a bodily system) during infection such as mitochondrial disease. Shielding There is some updated guidance for those who are at high risk of severe illness from COVID-19, including children, because of their underlying health conditions, and for their family, friends, and carers. It is for those that fall into the category of being “extremely vulnerable”, which includes for example those people on immunosuppression therapy, and people with severe respiratory conditions. Public Health England has more information below about who fits into the category of “extremely vulnerable” https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 What is shielding Shielding is a practice used to protect the “extremely vulnerable” from coming into contact with COVID-19 by minimising all interaction with other people, in case they are carrying COVID-19. This means that those who are extremely vulnerable should not leave their homes. Within their homes they should minimise all non-essential contact with other members of their household. If you have a condition that makes you “extremely vulnerable” then you can register for support, such as help with deliveries or getting essential supplies, via the Government website. You are strongly advised to stay at home at all times, and to avoid any face to face contact for a period of at least 12 weeks – this period of time could change. Letters are being sent out to those who are classed as “extremely vulnerable” – if you do not receive a letter by 29 March and feel you fit into this category please contact your GP or health professional. Please refer to the Public Health England website below if you are visited by people who provide essential support, such as healthcare assistants, personal support with your daily needs or social care. These visits should continue, but carer and care workers must stay away if they are showing symptoms of COVID-19. https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance/covid-19-guidance-on-home-care-provision We are in the process of providing further guidance on this with the support of clinical specialists. Schools and nursery All people in the household of someone with a neuromuscular condition should avoid nursery, school and college, even in cases where they have an Education Health Care Plan (EHCP) in place. Specific information for families with people with Duchenne muscular dystrophy There are no published recommendations, although leading neuromuscular expert clinicians have developed this guidance for people with Duchenne who use steroids. Also: Be sure to have a sufficient dose of steroids available at home. Ensure you have a strategy or at least knowledge of how to deal with the adrenal suppression in case of a severe superimposed infection. See this guidance from the North Star Networks here. The World Duchenne Organisation has regularly updated information about COVID-19 and Duchenne muscular dystrophy. People living with Becker muscular dystrophy may also find this a useful resource. Where possible, make sure you have an alert or symptoms cardto hand which can help in times of an emergency Families, friends, care teams and personal assistants In addition to making sure you have an alert or symptoms card to hand, which can help in times of an emergency, we recommend that you, and any personal assistants or carers who support you, follow the NHS guidelines. We also think this information may help you if you are managing personal assistants. Always carry tissues with you and use them to catch your cough or sneeze. Then bin the tissue, and wash your hands, or use a sanitiser gel. Wash your hands for at least 20 seconds with soap and water, especially before leaving home, after using public transport (although we recommend that you avoid public transport if at all possible), upon arriving somewhere, before and after eating, and after using the bathroom. Use a sanitiser gel if soap and water are not available. Avoid touching your eyes, nose and mouth with unwashed hands. Avoid close contact with people who are unwell.