A Letter to our Immunocompromised Patients
March 16, 2020
A Letter to our Immunocompromised Patients
We understand there is a lot of information and guidance in the news and community these days about Covid-19 (Coronavirus). We are here to help you understand the information and take precautions recommended by the Center for Disease Controls (CDC) and our Physicians.
What is the coronavirus (COVID–19)?
A new coronavirus affecting humans was identified at the end of 2019 (named COVID-19). Reported illnesses have ranged from mild to severe, including death. There have been confirmed cases of COVID-19 in the United States, and that number is growing daily.
The COVID-19 virus is thought to be spread through:
- Contact with an infected person (via respiratory droplets from a cough or sneeze)
- Contact with infected surfaces or objects
What are the symptoms of the coronavirus?
From the cases reported on COVID-19, the symptoms that have been observed may include:
- Fever
- Cough
- Shortness of breath
Many patients have also experienced pneumonia as a complication of the virus.
Can people be tested for the coronavirus?
Yes, there is testing available and the CDC has provided testing guidance for the coronavirus. Contact your healthcare provider as soon as possible if you think you may have the coronavirus. You must contact your primary care physician for testing guidance, as our office does not test for Covid-19.
There is currently no vaccine available to protect against the virus; however investigations are underway.
General Recommendations: Healthy Practices
There are preventive actions you can take to protect yourself from exposure to the virus and prevent the spread of the disease. The CDC recommends the following ways to limit your risk of infection:
- Avoid having close contact with people who are sick.
- Do not touch your nose, eyes, and mouth if you have not washed your hands.
- Wash your hands with soap and water for at least 20 seconds. To ensure you wash for the appropriate amount of time, sing “Mary Had a Little Lamb” or another short song or another short song two to three times to reach 20 full seconds.
- If soap and water are not available to you, use a hand sanitizer that contains at least 60% alcohol. Check the label to confirm the amount of alcohol.
Here are some other actions to take if you are feeling ill or you think you may have been exposed COVID-19:
- Stay home if you are feeling sick
- Contact your doctor
- Cover your cough or sneeze with a tissue, and throw it in the trash
- Clean and disinfect frequently touched objects
- Wear a facemask if you are showing symptoms or have been diagnosed with COVID-19. Wearing a mask will reduce the potential spread of the virus to others.
IBD Patient Guidance
Deciding when to stay home from work, school, and events:
Every IBD patient knows the challenge of making the decision to stay home sick from work or school, and the difficulty of not going to a movie or dinner because of IBD symptoms. With the spread of coronavirus (COVID-19), it has become even more challenging for patients to make decisions about navigating their daily life.
Higher risk groups
The information that is known so far about the 2019 novel coronavirus is based on what has been reported from cases in Wuhan, China, and we are learning more as the virus has spread to other countries. Based on the reported cases, we know that there may be individuals that are at higher risk.
Individuals in high risk groups defined by the CDC are being advised to take extra precautions. In many communities where there are a number of local cases, the health departments are recommending that individuals from high risk groups stay at home and avoid participating in public gatherings. The specific recommendations are listed below:
- Adults over 60, especially men
- Individuals with underlying health conditions like heart disease, lung disease (including asthma), diabetes, chronic kidney disease, chronic liver disease, endocrine and metabolic disorders, neurological, neurologic and neurodevelopment conditions
- Individuals who are pregnant or had a recent pregnancy
- Individuals with weakened immune systems
- Individuals with IBD may have weakened immune systems—see section below.
As of 3/11/2020, the CDC recommends that individuals in high risk groups avoid attending public events with greater than 10 people.
How do you know if you have a weakened immune system?
The terms weakened immune system or immune suppression are general terms that describe the lack of an appropriate response by the body to fighting diseases and producing organisms that may be harmful such as viruses and certain bacteria. Having a weakened immune system can occur for many reasons including medication, recent surgeries, age, genetics, or having a chronic illness. Patients with IBD experience many of these factors, and can have a weakened immune system.
However, not all IBD patients have a weakened immune system. Each IBD patient is different and may be taking different medications. Talk to your GI provider about your medications, your health status, and any precautions you should be taking related to COVID-19.
Updates and recommendations on IBD medications
- Stay on your IBD medications. Inflammation due to IBD can lead to complications and damage to your intestinal tract. Your medications aim to keep this inflammation under control. Always talk to your doctor about your treatment plan if you have concerns or questions.
- If you are taking a mesalamine (Asacol®, Apriso™, Canasa®, Delzicol™, Lialda™, Pentasa®, Rowasa®) or other aminosalicylates, these are all safe and are not immune suppressant medications.
- While taking these medications, you do not need to take extra precautions beyond CDC recommendations regarding proper hygiene
- If you are taking steroids (prednisone/prednisolone) for any reason, be sure to take extra precautions by following the CDC’s recommendations for risk reduction and talk to your healthcare provider, because steroids can suppress your immune system.
- Please discuss with your healthcare provider options to lower your dose or get off steroids (which is always a recommendation in managing IBD).
- Immunomodulators like thiopurines (azathioprine, 6-mercaptopurine, cyclosporine, methotrexate), and the JAK inhibitor tofacitinib (Xeljanz®) tend to inhibit the body’s immune response to viral infections
- Do not stop taking these medications. If you have concerns, talk to your provider.
- Biologics/Biosimilars including certolizumab pegol (Cimzia®), adalimumab (Humira®), infliximab (Remicade®), golimumab (Simponi®), infliximab-abda (Renflexis®), infliximab-dyyb (Inflectra®), infliximab-qbtx (Xifi™), ustekinumab (Stelara®), and vedolizumab (Entyvio®) are immune suppressing drugs (see our biologics factsheet for a full listing of anti-TNFs and other biologic therapies):
- Do not stop taking these medications.
- Talk to your healthcare provider before making any adjustments to these medications.
IBD Medication: Travel and large event recommendations
- Patients on mesalamine should follow the CDC and their public health department’s guidance related to events and travel; use of this medication does not cause immune suppression and does not put patients into a higher risk category.
- Mesalamine medications are in the aminosalicylate category and include: (Asacol®, Apriso™, Canasa®, Delzicol™, Lialda™, Pentasa®, Rowasa®)
- Patients on immunosuppressants and biologics/biosimilars are encouraged not to travel or gather in large numbers. The common immunosuppressing drugs and biologics/biosimilars are listed below:
- Immunomudulators: Azathioprine (Azasan®, Imuran®, cyclosporine (Gengraf®, Neoral®, Sandimmune®), mercaptopurine (Purinethol®), methotrexate (Rheumatrex®), tacrolimus (Prograf®)
- Biologics/biosimilars: Anti-TNF biologics include certolizumab pegol (Cimzia®),adalimumab (Humira®), infliximab (Remicade®), golimumab (Simponi®), infliximab-abda (Renflexis®), infliximab-dyyb (Inflectra®), infliximab-qbtx (Xifi™). Other biologics include integrin receptor antagonists like natalizumab (Tysabri®) and vedolizumab (Entyvio®), and interleukin 12 and 23 antagonists like ustekinumab (Stelara®).
- Steroids: Budesonide (Entocort® EC, UCERIS™), methylprednisolone (A-Methapred®, Depo-Medrol®, Medrol Dosepak®, Solu-Medrol®), prednisolone (Orapred®, Prelone®, Pediapred®), prednisone (Deltasone®).
- JAK inhibitors: Tofacitinib (Xeljanz®)
Medication and supplies
The CDC recommends that people have their medicine cabinets stocked with supplies and essentials during any type of natural disaster or emergency. This includes medicine such as cough syrup, cold and flu medicine, and other items that are typically available to help with the symptoms of a cold or virus. Many IBD patients are concerned about access to medications in the event of a supply shortage. The FDA is closely monitoring the medical supply chain, and there have been no shortages reported to date on medications used to treat IBD.
Patients and caregivers are encouraged to contact their insurance company for specific policies related to testing, prescription refills and other support. For those without insurance or in need of additional insurance-related guidance, the National Association of Insurance Commissioners has compiled a comprehensive list of resources by state. Please visit: https://content.naic.org/naic_coronavirus_info.htm, go to “Resources” and navigate by state.
We encourage all of our patients to reach out to us if you have any concerns about your treatment and/or appointments. Here are a few ways we are encouraging “social-distancing” in our office:
- If you have a fever, cough, shortness of breath, or general malaise, we are asking you to not enter our offices and call to reschedule your appointment.
- No children will be allowed to enter. If needed, we will reschedule your appointment for another date/time.
- Only 1 adult can accompany the patient during their visit while in our office.
- We are offering patients the ability to check-in and sit in their car while they wait for their exam room to become available. We will call when your provider is ready for you.
- We are not using a joint infusion room for treatments. Each person will be given their own exam room.
- We have increased our cleaning and sanitizing protocols to ensure all rooms are clean before patients arrive.
We know you have questions, and we are always here to help! Please call us at 334-836-1212, and we will work with you to discuss the best options for you.
Sources:
Crohn’s Colitis Foundation