I am very aware that patients on immunosuppressive treatments are feeling particularly vulnerable and anxious due to the novel Coronavirus disease Covid-19 at the moment.
Here’s some information I have been providing to my patients about the virus who are concerned. It broadly reflects the current advice from rheumatology representative groups in Ireland, The US, and Italy.
This advice has been prepared for existing patients of mine who are on immunosuppressive treatments for arthritis or other autoimmune diseases. It is not intended to replace information given to you by your own GP or formal advice given by the HSE. Please check with your own doctor or my office if you are concerned.
This is a changing situation however so please monitor the HSE website and reputable news sources for updates.
What are the symptoms of Novel Corona Virus Infection?
It can take up to 14 days for symptoms of Coronavirus to appear. The most common symptoms of Coronavirus are:
If you have any of these symptoms and have been to a place where there is spread of coronavirus, read this advice.
What we know so far is: The risk in Ireland is currently low to moderate that you will be in contact with someone with Covid-19. This situation is likely to change over the coming days and weeks
Contact is currently defined as closer than 2 metres for 15 minutes, face to face contact or living in the same house as someone who is infected.
Most patients will have a mild illness and recover.
Risk factors for more severe infections that have been identified include age over 60, chronic heart and lung disease and diabetes.
The data from studies of the outbreak we have so far, does not identify immunosuppressive treatments prescribed in rheumatology patients as a risk factor for higher mortality, but it is a reasonable cause for concern. The situation is being monitored.
How should I protect myself?
Is there anything else I do?
Please ensure that you have have received all appropriate vaccinations, including seasonal influenza and pneumonia vaccines if you are on immunosuppressive therapies. These will not prevent COVID-19, but may lessen the chance of a secondary infection and will prevent illnesses that could be confused with COVID-19.
Because many of the treatments (including steroids, biologic therapies and disease modifying drugs) used in arthritis and autoimmune disease suppress the immune system many patients have asked if they should stop their treatment.
My advice (reflected by advice from international rheumatology representative bodies) is that you should remain on treatment (see below). The COVID 19 epidemic may last several months so if you stop your medicine you will be likely to have a flare during this period and restart, or have to take more intensive treatment with steroids. I do not recommend stopping your rheumatology medication with the exceptions detailed below. If you have any further questions about this please contact my office.
What if I develop an infection on treatment?
My current advice is that should you develop an infection that you should postpone your treatment (with the exception of steroids which you should continue). As with all infections I would advise seeking medical attention for any illness you would normally contact your GP about.
Additionally, if you are directly exposed to someone with Novel Corona Virus infection / Covid 19 it makes sense to postpone your treatment (again with the exception of steroids) until you have been assessed to exclude an infection.
Regarding travel, the current WHO recommendations are to avoid all but absolutely necessary travel to the affected areas of Northern Italy, Iran and certain parts of China and South Korea.
The HSE / Department of Foreign affairs / WHO have not yet offered any specific advice regarding air travel to other areas at this time. However it would make sense for the moment, particularly if you are on biologic therapies, steroids or particularly if you have any other risk factors for serious infection (Age > 60, significant chest problems, heart disease, diabetes) that you should avoid any unnecessary air travel. Some common sense and discretion is advised.
Clearly this information may change over time as the infection develops. Please check the HSE website for updates. The WHO website also has excellent advice on global travel.
My clinics are currently running normally as are all infusion services in the Galway Clinic and Bon Secours Hospital. You will be notified if this situation changes.
If you have an infection (any infection), have recently travelled to an affected area, or been exposed to someone with known Novel Corona Virus infection, please do not attend your appointment without speaking to my office.
Please contact my office if you have any pressing queries and please check back here for updates.