Coronavirus and Arthritis: What You Need to Know

Last updated: 03-10-2020

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Coronavirus and Arthritis: What You Need to Know

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Coronavirus and Arthritis: What You Need to Know
Please check back regularly. We will stay in touch with the top experts and give you updates on this quick moving story, with a focus on what people with suppressed immune systems need to know.
If you have arthritis, you may have special concerns about the new coronavirus that causes the disease called COVID-19. It doesn’t help that the news changes every day or that misinformation is spreading faster than the virus. The World Health Organization (WHO) calls the flood of false and misleading statements about the coronavirus an “infodemic.”
No one should panic, but protecting yourself or your child is smart if either of you takes immune-suppressing drugs. Public health officials are learning about this virus in real time; there is much they don’t know yet. Our mission is to bring you the facts. We’ve talked to leading experts to find out what they know to date, and we put together some FAQs based on the best evidence we have right now. Be sure to check back with us for updates.
Q: What’s a coronavirus?
A:  Coronaviruses are a big family of viruses that can cause everything from colds to severe pneumonia. Some target your nose, so you get the sniffles and a scratchy throat. Others, like the new coronavirus that causes COVID-19, attach to cells in your lungs.
 
Q: What are the symptoms of COVID-19?
A: Most people – about 80% or more – have mild symptoms similar to a cold or the seasonal flu. Fever, cough, and shortness of breath can show up two to 14 days after infection. (An unpublished study suggests the incubation period may last a week longer). A small number of people develop severe pneumonia, and a few become critically ill. Some people who test positive for COVID-19 never get sick but may still be able to spread the virus.
 
Q: How does the virus spread?
A: Like colds and seasonal flu, the new coronavirus spreads through the droplets expelled when a person coughs or sneezes. People can also pick up the virus when they touch a contaminated surface like a countertop, handrail or doorknob and then touch their eyes, nose or mouth. It’s unlikely this virus can survive on hard surfaces very long, though it’s not clear how long, says Timothy Brewer, MD, a professor of epidemiology at the University of California, Los Angeles.  Isopropyl alcohol, hydrogen peroxide and bleach can all effectively kill surface viruses in about a minute. Soap and water as well as disinfectants like Lysol also do the trick, though not quite as well. 
 
Q: How contagious is it?
A: Maybe not as contagious as was first thought. Scientists calculate transmissibility based on something called the basic reproduction number or R0. This refers to how many people someone with the virus will infect. Seasonal flu’s R0 is about 1.2, meaning you can pass the flu on to a little more than one person. (The math gets complicated). The current estimate for COVID-19 is about 1.4, not that much higher than the flu. This puts COVID-19 in the “moderately contagious” category, according to Michael Minna, MD, an assistant professor of epidemiology, immunology, and infectious diseases at Harvard’s T.H. Chan School of Public Health and a member of the Center for Communicable Disease Dynamics.
 
Q: Am I more likely to catch COVID-19 if I have autoimmune or inflammatory arthritis?
A: Although arthritis specifically hasn’t been studied, Dr. Minna says he has no reason to think having an autoimmune disease makes people more susceptible to the virus. Older adults and those with pre-existing health problems – especially cardiovascular disease, diabetes and high blood pressure – are most at risk of both seasonal flu and COVID-19 infections.
 
Q: Am I at extra risk because I take medicines that suppress my immune system?
A: Most prescription drugs used to treat inflammatory or autoimmune types of arthritis suppress the immune system, including methotrexate, corticosteroids and biologics, such as infliximab (Remicade), adalimumab (Humira), ixekizumab (Taltz) and ustekinumab (Stelara). Dr. Minna says taking them doesn’t increase your risk of infection beyond that of a healthy person, but you could potentially have more severe disease or complications if you do become infected. The concern is that the virus could replicate too quickly for your body to mount an immune response or your immune response might kick in too slowly, leading to possible heart and lung complications. For this reason, it’s critically important if you are taking these medications to contact your doctor right away if you think you’ve been exposed or are experiencing flu-like symptoms. Be sure to state that you are taking immune-suppressing drugs.
 
Q: Can I catch COVID-19 from my pet?
A: The World Health Organization (WHO) says there’s no evidence that cats and dogs can catch or spread the coronavirus to people. There’s a lot of misinformation about how the virus started, with some people suggesting it was made in a lab. That’s not true. Based on past coronavirus outbreaks and the virus’s genome, experts say it appears to have started in a wild animal, probably a bat or pangolin.
 
Q: How deadly is the virus?
A: It’s hard to say. Estimates are likely to change as more mild cases are detected or reported. When people with mild disease are undercounted, the virus can look more lethal than it is. As of March 1, 2020, there were 87,508 confirmed cases worldwide and 2,990 deaths, according to The Center for Systems Science and Engineering at Johns Hopkins University, which is tracking the virus closely. In comparison, the Centers for Disease Control and Prevention (CDC) estimates that in the U.S. alone, 18,000 to 46,000 people have died of seasonal flu since October 2019.
 
Q: What should I do if I think I have this virus?
A: Call your doctor right away and be sure to say that you take immune-suppressing drugs. Your doctor will likely tell you to treat mild symptoms as you would a cold or the flu – rest, drink liquids and stay isolated from others. If you develop pneumonia, you’ll likely be hospitalized and if the effects are severe you may need a mechanical ventilator to help you breathe.
 
Q: If I am infected, is my family at risk?
If infected, you should isolate yourself at home for at least 14 days. If possible, have others use a separate bathroom and not handle or touch objects you’ve touched without gloves. Cough and sneeze into the crook of your elbow, not your hands. Everyone should wash their hands thoroughly and frequently (using separate sinks if possible).
 
Q: How worried should I be?
Don’t worry or panic but do take steps to protect yourself and others. Here’s how:
Wash your hands. We can’t stress this enough. Wet your hands with clean, running water, then lather them with soap. Scrub both sides, between your fingers and under your nails for at least 20 seconds – about as long as it takes to sing the alphabet song twice. Be thorough, and follow the WHO technique .  
Use hand sanitizers on the go. Don’t rely on them, but when soap and water aren’t an option, use a hand sanitizer that contains at least 60% alcohol. Keep a bottle in the car, at your desk and in your purse or pocket.
Disinfect surfaces regularly. Clean high-touch surfaces like countertops, light switches, doorknobs and the inside of your car with disinfectant. Use a mixture of 60% isopropyl alcohol and 40% water to kill germs on high-touch objects and surfaces, like your cell phone, computer keyboard, remote, doorknobs and faucets. Wash eyeglasses with soap and warm water every day.
Cover your mouth and nose when you cough.  Throw away all your used tissues immediately.
Practice your fist bump. Try to forgo handshakes and hugs for the time being.
Skip the mask. Standard surgical face masks won’t screen out viruses in healthy people, but if you’re sick, a mask can help block droplets from sneezing or coughing so you won’t infect others. The U.S. Surgeon General has asked healthy people to not stock up on masks because the priority is that health care providers have them and they may experience a shortage if the general public buys them up.
Call ahead. If you have cold or flu symptoms call your doctor instead of rushing to urgent care or the emergency department. If you don’t have a doctor and are sick enough to need emergency care, call ahead and let the hospital know you’re on the way.
Keep up to date with reliable sources. Check back with us regularly for updates, and follow major news outlets and health authorities, such as the CDC, WHO , and The New York Times .
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