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This post was updated 17/3/2020 to include some updated information in the context of the worsening Corona Virus pandemic. I have also removed the videos that I previously posted as the information included in some of the segments is out of date.

Please note: This advice has been prepared by way of information for patients currently under my care and should not be considered medical advice. It is not intended to replace information given to you by your own GP, advice from other doctors or replace information given by the HSE or other health providers. Please check with your own doctor or my office if you are concerned.

I am very aware that patients on immunosuppressive treatments for rheumatological conditions are feeling particularly vulnerable and anxious due to the novel Coronavirus disease Covid-19 at the moment.

Immunosuppressive treatments which include steroid medications, Disease Modifying Anti Rheumatic Drugs (DMARD’S), Biologic Therapies and certain other medications, all act to suppress the immune system. Whereas this is useful in suppressing inflammation, it may also increase the risk of infection in patients who take them. If you are on one of these drugs your risk of developing Corona Virus infection is likely to be increased.

What are the common 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 please follow the following advice.

What we know so far (17/3/2020)

The risk in that you will be exposed to someone with Corona Virus is currently high.

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 cause for some concern.

How should I protect myself?

  • Wash your hands properly and often
  • Cover your mouth and nose with a tissue or your sleeve when you cough and sneeze.
  • Put used tissues into a bin and wash your hands.
  • Clean and disinfect frequently touched objects and surfaces.
  • Practice Social Distancing
  • Avoid unnecessary travel
  • Do not touch your eyes, nose or mouth if your hands are not clean.
  • Do not share objects that touch your mouth – for example, bottles, cups.
  • Stay at home if you are sick to help stop the spread of whatever infection you may have.

Is there anything else I do?

If you are immunosuppressed, you need to take extra care and be even more vigilant where all of the above are concerned.

  1. One way to approach your day is to pretend to yourself that you have the Corona virus infection. If you had an infection (and were fearful of infecting others) you would avoid going out, stay away from crowded areas (restaurants, pubs, coffee shops, churches, gyms and even supermarkets). If you had the infection you might avoid touching surfaces where you might pass on infection etc. If you already had an infection would wash your hands frequently to prevent spreading the virus and so on.
  2. If you are a bit older and immunosuppressed, and have grandchildren, you should avoid them until further notice. If you are asked to babysit say no.
  3. If you are at home with kids off school or college they should not bring other children into the house and encourage your children to avoid contact with other children. No play dates or nights out.
  4. Another  really useful thing you can do is act as an advocate for yourself and other people at risk of infection by getting friends and relatives to adhere to social distancing , coughing and sneezing guidelines and hand hygiene. It is you that they should be trying to protect and you should tell them.
  5. Buy yourself (if you can get them) a portable bottle of hand sanitiser so that if you that you can clean your hands immediately if not close to sink.

Is there a vaccine I can get?

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.

Make sure your blood tests are up to date

One of the reasons I recommend regular blood tests is to ensure that their immunosuppressive treatments do not overly suppress their immune systems. If you haven’t had your blood tests done as per the schedule for your drug recommended by me then I would advise you do.

Should I stop my immunosuppressive treatment?

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.

Please remember that patients who are on steroids / corticosteroids should never stop their treatment without medical advice.

Getting the balance right

The decision to stop immunosuppressive medications needs to be balanced by the risk of developing a flare or recurrence of your underlying disease. It is worth remembering that when the underlying condition flares, doctors often have to escalate therapy (often including the use of steroid medications). Treatment escalation may further increase the risk of infection. Active disease also reduces your ability to fight infection.It is a tricky balance.

Remain on your treatment unless advised to stop.

The current advice from the British Society for Rheumatology and European League Against Rheumatism around the world is to remain on treatment  – unless patients have been advised by their doctor to stop.

Patients should never stop steroids without medical supervision.

What if I develop an infection on treatment?

Most rheumatologists would advise that you should you develop an infection that you should postpone your treatment (with the exception of steroids which you should continue unless told otherwise) until the infection has adequately been dealt with.

As with all infections on immunosuppressive therapy rheumatologists usually advise seeking medical attention a bit earlier the usual of for any infection that  you would normally contact your GP about.

If you have any of the symptoms or Corona Virus then you should phone your GP, or local A+E department, letting them know about your condition and treatment, who will in turn refer you for consideration of testing and or treatment.

If you have suspected Corona Virus infection you should not attend your GP’s or any public or private emergency departments. Please note that The Galway Clinic is not a designated receiving hospital for Corona Virus. infection.

Additionally, if you are directly exposed to someone with Corona Virus, or someone with suspected Corona virus infection you should postpone your treatment (again with the exception of steroids) until you have been assessed to exclude an infection.

Additional information

HSE information for general public

HSE information for Health Care Professionals 

Arthritis Ireland Covid 19 information

Travel Advice from Department of Foreign Affairs

British Society for Rheumatology

American College of Rheumatology

WHO