After more than two months of major societal changes, including strict stay-at-home orders in most states, the closing of U.S. borders, and shutting down non-essential travel and non-essential businesses, many parts of America are continuing to ease restrictions in phases of opening back up. With so much uncertainty around the coronavirus (including an ongoing lack of testing and a vaccine months or years away) this news continues to worry patients with chronic conditions who may be at a higher risk for coronavirus complications because of their age or co-occurring health conditions.
Managing a chronic disease such as inflammatory arthritis is stressful enough without having to worry about the ongoing spread of COVID-19. CreakyJoints spoke with multiple rheumatologists and infectious disease experts to provide information that is specific to this community. We will update this story as critical information changes.
Coronavirus By the Numbers
Doctors and researchers are continuing to learn more about this novel (new) coronavirus named “coronavirus disease 2019” (“COVID-19”).
Here’s what we do know: The coronavirus outbreak, which originated in Wuhan, China in 2019, has moved its way around the world, with a total of more than 5.9 million detected cases around the world so far and more than 363,000 deaths.
According to the latest data, the U.S. now has more than 1.7 million confirmed cases across all 50 states, Washington, D.C., and Puerto Rico. There have been more than 101,00 deaths linked to coronavirus in the U.S.
While daily cases and deaths have been steadying or declining in many areas of the country, there continue to be spikes and hot spots in others. Public health experts are worried that the loosening of social distancing practices and businesses starting to reopen could lead to another prolonged increase in cases as the summer season begins.
Coronavirus Risks for Inflammatory Arthritis
Are people with inflammatory arthritis more susceptible to the coronavirus or at a higher risk of complications like pneumonia?
Preliminary data on patients with rheumatic conditions is rolling in, but it will take more time before researchers and doctors are able to make any definite conclusions.
In guidance recently issued from the American College of Rheumatology (ACR) and published in the journal Arthritis & Rheumatology, the authors state:
“To our knowledge, there is currently no evidence identifying risk factors of poor outcome with COVID-19 that are specific to rheumatic disease … risk factors of poor outcome with COVID-19 include older age and select comorbidity such as chronic lung disease, hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD), obesity and diabetes mellitus, conditions frequently overrepresented in patients with rheumatic disease.”
A recent case series published in the New England Journal of Medicine found that compared to the general population, people with autoimmune conditions (including psoriasis, rheumatoid arthritis, psoriatic arthritis, and inflammatory bowel disease) had a lower rate of hospitalization. The patients were also more apt to be hospitalized if they had co-occurring high blood pressure, diabetes, or chronic obstructive pulmonary disease (COPD). What’s more, the researchers determined that “baseline use of biologics [in people with autoimmune disease] is not associated with worse COVID-19 findings.” Read more here about the preliminary research.
New research published in the Annals of the Rheumatic Diseases also yielded mostly good news. According to the study, which focused on people in the Boston area (with and without rheumatic diseases) who tested positive for COVID-19 in March and early April, the patients with rheumatic diseases were not any more likely to develop severe symptoms that warranted hospitalization than those without a rheumatic condition. They were not any more likely to die from coronavirus, either. But, if hospitalized, they were far more likely to require major interventions. Read more about the study here.
Still, based on what is known right now, age and comorbidities seem to be bigger influences on poor outcomes from COVID-19 than having an inflammatory condition alone.
How Inflammatory Conditions Affect Your Immune System
It is important to understand how inflammatory conditions like arthritis affect your immune system.
First, when inflammatory arthritis is not well-controlled (not in remission or low disease activity) your immune system tends to focus on attacking your own body rather than outside threats (like the coronavirus).
This can make you “immunocompromised” and might increase your chance of COVID-19 complications, but more data is needed.
Second, some of the medications used to manage arthritis and inflammatory conditions modify the function of the immune system, which can make patients more vulnerable to infection in general, though more research is needed to understand how various medications affect COVID-19 risk specifically.
Third, many rheumatologic patients have other risk factors or underlying health issues linked to coronavirus complications, such as older age, heart disease, lung disease, diabetes, and obesity.
“[The coronavirus pandemic] is certainly concerning for everyone, especially those who are immunocompromised,” says Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Pearland, Texas. “We need to exercise more caution and be more alert with these patients.”
- Read more about rheumatoid arthritis and the coronavirus pandemic
- Read more about axial spondyloarthritis and the coronavirus pandemic
- Read more about psoriasis and psoriatic and the coronavirus pandemic
- Read more about fibromyalgia and the coronavirus pandemic
- Read more about lupus, hydroxychloroquine, and the coronavirus pandemic
- Read more about gout and the coronavirus pandemic
The CDC Definition of High-Risk Patients
The CDC defines the following groups as high-risk for severe illness from COVID-19:
- People aged 65 years and older
- People who live in a nursing home or long-term care facility
- People of all ages with underlying medical conditions, particularly if not well controlled, including chronic lung disease, moderate to severe asthma, serious heart conditions, severe obesity, diabetes, chronic kidney disease, liver disease
- People who are immunocompromised from cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune-weakening medications
If you have risk factors that place you at a possible higher risk for coronavirus complications, it is natural to feel ongoing worry and anxiety as the pandemic ensues. These tips can help.
How to Stay Healthy During the Coronavirus Pandemic
Here is what you should do to stay safe and healthy during the coronavirus pandemic.
1. Know coronavirus symptoms
According to the CDC, symptoms usually appear within two to 14 days of being exposed to the virus. People with COVID-19 can have a wide range of symptoms, ranging from mild to severe, and new symptoms have been added since the beginning of the pandemic:
- Shortness of breath
- Repeated shaking with chills
- Muscle pain
- Sore throat
Keep in mind that because coronavirus symptoms can vary from mild to severe, you shouldn’t necessarily panic if you develop any of them.
Call your rheumatologist or primary care doctor right away to determine next steps. Do not go to see your doctor or an urgent care center in person without calling first so they can advise on precautions, where to go, and how to arrive safely.
Many patients with autoimmune and inflammatory diseases have concerns about coronavirus symptoms possibly overlapping with those of their underlying chronic conditions.
Read more about coronavirus symptoms in autoimmune and chronic illness patients.
2. Understand how coronavirus spreads
“Coronavirus is a respiratory illness and spread very readily through close contact,” says William Schaffner, MD, a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee— for instance, if an infected person coughs or sneezes less than six feet away from you.
Some studies suggest that COVID-19 may be spread by people who are not showing symptoms, which is why the CDC now recommends wearing cloth face masks in public.
Coronavirus may also be spread through an airborne route, which, according to Johns Hopkins, means “that tiny droplets remaining in the air could cause disease in others even after the ill person is no longer near.”
It is also possible, but not likely, that you may also contract coronavirus by touching a surface or object that has the virus on it, and then by touching your mouth, nose, or eyes. According to a study by the National Institutes of Health, CDC, UCLA and Princeton University scientists, published in The New England Journal of Medicine, coronavirus is detectable on the following:
- Aerosols: up to three hours
- Copper: up to four hours
- Cardboard: up to 24 hours
- Plastic and stainless steel: up to two to three days
3. Stop the spread of germs
Washing your hands (for at least 20 seconds with soap and water) is the hands-down (pun intended) winner when it comes to preventing the spread of germs. Here’s a video from the World Health Organization that shows proper hand washing techniques.
The CDC also advises such commonsense measures as:
- Avoiding touching your mouth, nose, and eyes
- Avoiding people who are coughing and sneezing
- Cleaning and disinfecting frequently touched objects and surfaces
- Practicing social distancing, which includes staying at least six feet away from other people and not gathering in large groups
- Wearing cloth face masks in public places
4. Stay home as much as possible
Even as stay-at-home mandates become lifted across the U.S., the CDC continues to urge people at higher risk of COVID-19 complications to stay home as much as possible. If you do need to go out — to go to a doctor appointment or pharmacy — wear a mask and practice social distancing.
Grocery stores are best avoided if you are at higher risk, so utilize online grocery delivery service or curbside pick-up or ask a family member or friend to pick up essentials for you.
Continue to avoid unnecessary errands.
5. Maintain healthy lifestyle habits
The same lifestyle habits that you follow to help your immune system to function optimally are important for staying well during the coronavirus pandemic.
- Practice regular hand washing
- Stay hydrated
- Eat healthy
- Exercise and stay active
- Manage stress (get advice on managing coronavirus anxiety)
- Get adequate sleep
- Stay up to date on your flu and pneumonia vaccines
Another thing to keep in mind is to avoid taking “immune booster” supplements, says rheumatologist Doug Roberts, MD, an assistant clinical professor of medicine at the University of California Davis Medical School. “Some of these may interfere with the immunomodulating effects of your DMARDs [disease-modifying medications].”
It is always a good idea to get your doctor’s approval for any over-the-counter supplements.
6. Maintain your usual medication regimen
The biggest concerns among patients with rheumatologic and inflammatory conditions throughout the coronavirus pandemic have had to do with medications and their potential effects on infection risk.
Medications commonly used to treat inflammatory arthritis and related conditions, including corticosteroids, DMARDs, biologics, and JAK inhibitors do modify the immune system, but many questions remain about their impact on COVID-19 specifically.
There is not yet definitive evidence whether certain medications are causing worse outcomes for patients, or, on the flip side, are even possibly protective against COVID-19 complications.
The most important message is this: You should not stop taking any medications or adjust your dose of any medications without first talking to your doctor.
In general, if you don’t have COVID-19 and are stable on your current regimen, the American College of Rheumatology (ACR) recommends that you stick with the following medications:
- Hydroxychloroquine or chloroquine
- Immunosuppressants (such as tacrolimus and cyclosporine)
- Janus kinase (JAK) inhibitors
- Non-steroidal anti-inflammatory drugs (NSAIDs)
The guidance suggests that patients on corticosteroids should take the lowest possible dose to manage symptoms because they can increase your risk of infection, even more so than other types of disease-modifying medications.
If you are exposed to COVID-19 or have a known coronavirus infection, your doctor might suggest you stop certain medications while you fight the infection and then resume them once you have recovered.
- Read more about the ACR guidance for rheumatology medications
- Read more about biologic infusions
- Read more about “sick-day” planning
- Read more about methotrexate and coronavirus
- Read more about prednisone and coronavirus
Never make any changes to your medication regimen without first discussing them with your doctor.
7. Stay in touch with your doctors and manage your chronic conditions
It is important to make sure your inflammatory conditions are well-controlled. Arthritis that is flaring means that your immune system may be less able to fight off infection.
If you are experiencing pain, fatigue, or other symptoms, contact your doctor. Many doctors are utilizing telemedicine appointments to see patients, so you may not necessarily need to see your doctor in person.
Read more about how practices are implementing telehealth.
If your doctor wants you to come for an in-person visit, know that offices have dramatically changed their environments and systems to ensure safety for patients (as well as for their doctors, nurses, and staff).
You can ask your doctor’s office about their rules. Many changes including taking patients’ temperatures and checking for coronavirus symptoms upon arrival, ensuring social distancing in waiting rooms or eliminating waiting rooms altogether, and limiting the number of patients in the office at one time — not to mention disinfecting measures and personal protective equipment (PPE).
The bottom line for now: The coronavirus has certainly dramatically changed all of our lives and continues to raise concerns for those who may be at a higher risk for infection and complications. For now, keep this advice in mind to stay healthy, safe, and calm:
- Practice social distancing and good handwashing and hygiene habits per public health guidance
- Take care of your mental health and wellness with stress management, healthy eating, and physical activity
- Remain on your current medications and never stop or change a medication without talking to your doctor
- Stay in touch with your doctor and keep your appointments (either in person or telemedicine)
Get Free Coronavirus Support for Chronic Illness Patients
Join the Global Healthy Living Foundation’s free COVID-19 Support Program for chronic illness patients and their families. We will be providing updated information, community support, and other resources tailored specifically to your health and safety. Join now.
Coronavirus Disease 2019 (COVID-19) in the U.S. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/cases-in-us.html.
Coronavirus Disease 2019 vs. the Flu. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu.
D’Silva KM, et al. Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US ‘hot spot.’ Annals of the Rheumatic Diseases. May 26, 2020. doi: https://doi.org/10.1136/annrheumdis-2020-217888.
Haberman R, et al. Covid-19 in Immune-Mediated Inflammatory Diseases — Case Series from New York. New England Journal of Medicine. April 29, 2020. doi: https://doi.org/10.1056/NEJMc2009567.
How to Protect Yourself and Others. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html.
Information for Laboratories COVID-19 Requests for Diagnostic Panels and Virus. U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/lab/tool-virus-requests.html.
Interview with Doug Roberts, MD, rheumatologist and assistant clinical professor of medicine at the University of California Davis Medical School
Interview with Jean Liew, MD, a rheumatologist and senior fellow at the University of Washington in Seattle
Interview with Nilanjana Bose, MD, MBA, a rheumatologist at the Rheumatology Center of Houston in Pearland, Texas
Interview with Vinicius Domingues, MD, a rheumatologist in Daytona Beach, Florida
Interview with William Schaffner, MD, a professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee
Mikuls TR, et al. American College of Rheumatology Guidance for the Management of Adult Patients with Rheumatic Disease During the COVID-19 Pandemic. April 29, 2020. doi: https://doi.org/10.1002/art.41301.
Rabin, Roni C. C.D.C. Confirms First Possible Community Transmission of Coronavirus in U.S. New York Times.February 27, 2020. https://www.nytimes.com/2020/02/26/health/coronavirus-cdc-usa.html.
van Doremalen N, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. The New England Journal of Medicine. April 16, 2020. doi: https://doi.org/10.1056/NEJMc2004973.
What you need to know about coronavirus disease 2019 (COVID-19). U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/downloads/2019-ncov-factsheet.pdf.