As the COVID-19 pandemic continues — with some U.S. states recording record case numbers and others beginning to pause or roll back reopening activities in response to rising cases — people with chronic medical conditions and underlying health issues continue to have concerns that are unique to their health needs.
The Global Healthy Living Foundation recently held a Facebook Live event with the U.S. Centers for Disease Control and Prevention (CDC) and United Rheumatology, a rheumatology care management organization that serves more than 600 independent rheumatologists across the U.S., to address common questions from those in our high-risk patient community.
Of course, we didn’t have time during the event to address everyone’s concerns, so we sent additional questions to the CDC and United Rheumatology for follow-up information.
Below, you’ll find information from:
- Anne Kimball, MD, MPH, of the CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, who is working on the CDC COVID-19 At-Risk Medical Conditions Team and answered these questions on behalf of the CDC’s COVID-19 Response
- Max Hamburger, MD, Founder, Executive Chairman and Chief Medical Officer of United Rheumatology and Managing Partner of Rheumatology Associated of Long Island (RALI).
Note that our experts are answering questions to the best of their current medical knowledge, and information is changing rapidly.
Please keep in mind that we cannot provide individualized medical advice. The information provided in this column is for informational purposes only and is not intended to take the place of consultation with your physician. If you have concerns about your health or treatment, please contact your physician, pharmacist, or other medical professional.
Understanding Underlying Conditions and Increased Risk
A: Based on what we know, the risk of severe illness increases as age increases. In addition, people of any age who have certain underlying medical conditions are at increased risk for severe illness from COVID-19. We are learning new things about COVID-19 every day. So, this list might need to be updated or changed as we get new information and data. But as of right now, the underlying medical conditions that we think put people at higher risk for severe illness include:
- Kidney disease
- Chronic obstructive pulmonary disease (COPD)
- Organ transplant recipients
- Serious heart conditions like heart failure and cardiomyopathy
- Sickle cell disease
- Type 2 diabetes
Other conditions that might increase your risk include:
- Moderate-to-severe asthma
- Cerebrovascular disease
- Cystic fibrosis
- High blood pressure
- Dementia and other neurological conditions
- Liver disease
- Pulmonary fibrosis
- Type 1 diabetes
- Those who are pregnant
- People who are immunocompromised as a result of having a blood or bone marrow transplant, HIV, or use of immune-weakening medications including corticosteroids.
Here is more information from the CDC for people who might be at higher risk for severe illness and information and tips on what you can do to help protect yourself.
You may be wondering what we mean when we say “severe illness from COVID-19.” Some people get the virus that causes COVID-19 and don’t feel very sick at all and some people do feel sick, but their illness can be managed at home. However, some people have significant chest pain and difficulty breathing and need to go to the hospital. People with severe illness may be in the hospital needing oxygen or in the ICU needing help breathing with a ventilator. Unfortunately, some people may die from COVID-19 or complications arising from it.
A: The CDC recommends that all people who are at increased risk for severe illness from COVID-19 should limit interactions with other people as much as possible and to take precautions to prevent getting COVID-19 when you do interact with others. These include:
- Try to stay at least six feet away from others.
- Wash your hands often with soap and water for at least 20 seconds or use a hand sanitizer that contains at least 60 percent alcohol if soap and water are unavailable.
- Avoid touching your face with unwashed hands.
- Wear cloth face coverings in public (because people with COVID-19 can spread the disease even when they don’t have any symptoms).
People at higher risk for severe illness might consider avoiding public places where people are not wearing cloth face coverings.
Additionally, we recommend that everyone — regardless of any underlying medical conditions — clean and disinfect frequently touched surfaces. Finally, we recommend that everyone be in touch with their own health care providers with any concerns or specific questions.
A: There are many precautions to keep in mind when working in close proximity to others. Generally speaking, we should all be practicing social distancing measures wherever possible. This means maintaining a distance of at least six feet between yourself and another person and wearing a face covering.
It is very important to have a conversation with your health care provider about your level of risk. This can inform conversations with your employer about how to put measures in place to promote the safety of employees. Perhaps your employer can make face coverings, face shields, or other protective gear available to all employees. If your job requires you to go into someone’s home then your employer can ask that certain safety measures are followed by others in the house.
If you absolutely have to be in close contact with other people for your job, make sure to wear a face covering, wash or sanitize your hands frequently, avoid touching your face, and use a barrier (like a disinfecting wipe) to touch common surfaces.
But in some situations, safe social distancing and wearing face coverings may not be possible. In these cases, you may have to re-evaluate working at your job in-person. Perhaps you can explore the option of transitioning work to an online format or see if you can reduce the number of in-person visits and complement them with an online visit that can still allow you to continue working in a safe manner.
A: Patients taking therapies like biologics, which can affect immune function, should exercise extra precautions to prevent infection, as noted by the CDC. Here is the latest information about people at high risk for severe illness from COVID-19 and precautions to take to reduce your risk.
In addition, children and others may have COVID-19 but may not show any symptoms. This means they may still be able to transmit the virus to other people even though they don’t appear sick.
You might ask the school you work at for considerations such as teaching using an online format or in open spaces rather than in a classroom. The best advice for this would be to reach out to your doctor and discuss the consequences of going back to work, as each patient will have different considerations based on their health conditions, medical history, where they live, and more. It is also important to discuss your concerns with your employer who might be able to make adjustments to how you can work in an environment that is safe.
Doctor Visits and Health Care
A: Health care providers’ offices are following a rigorous set of measures to keep patients safe during the COVID-19 pandemic. They also want to ensure the safety of their own providers and staff. Some of these may include things like minimizing the number of patients in the office at any given time, checking each patient’s temperature before entering the office, and disinfecting and cleaning exam rooms between patient visits. Wait times have been reduced and this may mean that appointments are spaced out. Your health care provider’s waiting room should have hand sanitizer for you to use. As a patient, you will be required to wear a face covering, but you can also wear gloves, if possible. Once the appointment is complete, be sure to wash your hands thoroughly. All of these precautions will help limit your exposure to COVID-19, but it is recommended to check with your provider before the appointment to ensure the safety and necessity of the procedure.
Also keep in mind that to get to your appointment you may need to take public transport. If this is the case, observe safety measures while on mass transit.
Most importantly, if you are concerned about visiting your health care provider, do not cancel your appointment without speaking to your provider. Together you and your provider can find a way to address your concerns so you can continue to take care of yourself.
The CDC has extensive general infection control guidance for health care professionals as well as additional guidance for specific health care settings, such as dentist’s office, dialysis facilities, pharmacies, and more.
A: Contact your health care provider by phone, email, or online patient portal if you have any concerns about your health. Your health care provider may set up a telemedicine visit with you by phone or video, or they may want to schedule an in-person visit with you. That decision will be made by you and your provider, depending on what your concerns are, whether you should be assessed in-person, and local or community spread of the virus in your area.
It is always best to get in touch with your health care provider and together you can decide the right course of action to keep you as healthy and safe as possible. The CDC has guidance for health care facilities so that they can provide necessary services while minimizing risk to patients and health care personnel. Ask your health care provider’s office what measures they have in place to help protect you when you come into the office.
A: If you have a medical emergency, do not delay calling 911 or having a family member take you to the emergency department. If you start to experience heart attack symptoms such as severe chest pain, or stroke symptoms such as difficulty speaking or arm weakness, or any other concerning symptoms, call 911.
It is very important to seek immediate medical care for emergencies to prevent permanent damage or even death.
Hospitals and emergency departments have prevention measures in place to help protect you from COVID-19 if you need emergency care for any reason.
A: Talk to your health care provider. Communicating via patient portals and telehealth visits can be great alternatives to face-to-face appointments during this time. Many health care providers are increasing use of telehealth, including nurse advice lines and telephone calls, to decrease the number of patients coming into the office for issues that can be managed well from home.
For some medical conditions or evaluations, your health care provider may need to see you in person. This is why health care providers have taken so many measures to make it as safe as possible when you do come in for face-to-face visits.
Read more here about how to have an optimal telehealth visit for a rheumatic condition.
Cleaning & Disinfecting
A: First, it is important to understand the difference between cleaning and disinfecting. Cleaning refers to the removal of germs, dirt, and impurities from surfaces. It does not kill germs, but by removing them, it lowers their numbers and the risk of spreading infection. Disinfecting refers to using chemicals — for example, Environmental Protection Agency-registered disinfectants — to kill germs on surfaces. This process does not necessarily clean dirty surfaces or remove dirt that harbors germs, but by killing germs on a surface after cleaning, it can further lower the risk of spreading infection.
We recommend frequently cleaning and disinfecting surfaces that are touched often such as tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks. You can get general CDC information here on cleaning and disinfecting your household.
Now, to answer your specific question, it may be possible that a person can get COVID-19 by touching a surface or object, like a packaging container, that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads. Currently, there is no evidence of food containers or food packaging being associated with transmission of COVID-19.
The CDC recommends washing your hands after handling food packaging and after removing food from the packaging, before you prepare food for eating, and before you eat. You should follow CDC guidelines on frequent hand washing with soap and water for at least 20 seconds and frequently clean and disinfect surfaces. To avoid ingesting harmful chemicals, disinfectants should not be used directly on food. Packaging can be disposed of through regular recycling or trash. Click here for more information.
A: If you have an underlying condition that increases your risk of severe illness from COVID-19, the CDC recommends that you reduce your risk by staying home as much as possible and taking the steps outlined here. If you do leave your home and decide to use public transportation, we recommend the following:
- Wear a face covering or mask
- Limit touching surfaces that are touched a lot (for example: doorknobs/handles, railings, kiosks, touchscreens, elevator buttons)
- Practice social distancing by using public transit at non-peak hours and trying to stay six feet apart from others
- Practice good hand hygiene, including using hand sanitizer (minimum 60 percent alcohol) after leaving the train station or bus stop
- Wash your hands with soap and water for at least 20 seconds after arriving at your destination
- Avoid touching your eyes, nose, mouth with unwashed hands.
Here are more CDC recommendations on safely using public transportation.
Face Coverings and Masks
A: Face masks such as N95 respirators should be reserved for health care personnel and first responders. You can limit your time in a waiting room by waiting outside or in your vehicle, with considerations for safety and outside temperatures. If you are going to a confined space like a waiting room, the CDC recommends that patients wear cloth face coverings, and health care personnel wear face masks. Wearing a cloth face covering helps protects others in case you’re infected, and others wearing cloth face coverings helps protect you in case they are infected.
The CDC also recommends that all people wear a cloth face covering in public, except for children under 2 years old, people who have trouble breathing, or people who cannot remove the covering without help. You can get more information from the CDC here on wearing cloth face coverings. Additionally, you should limit touching high-touch surfaces (for example: door handles and knobs, railings, elevator buttons), wash your hands or use hand sanitizer frequently, and avoid touching your face with unwashed hands while out in public. Remember to always wash your hands after taking off used face coverings. Follow this CDC advice on how to wash cloth face coverings.
Read more here about what to do if you are having difficulty breathing in a face mask.
A: The CDC has a vaccine planning unit but most of the work to actually make and test the vaccines is being coordinated by the U.S. National Institutes of Health (NIH). The U.S. Food and Drug Administration (FDA), is the group that regulates vaccines in the United States.
Vaccine development always goes through multiple phases. During Phase I, small groups of people receive the trial vaccine to see if it’s safe and seems to work. In Phase II, the clinical study is expanded to several hundred people to learn more about the most common short-term side effects and how volunteers’ immune systems are responding to the vaccine. In Phase III, the vaccine is given to even more people and tested for efficacy, or how well it works, safety, and most common side effects. People with underlying medical conditions are sometimes included in Phase II and III trials, depending on the study design. Unfortunately, we don’t have any more specific information to share about the vaccines against the virus that causes COVID-19 or specifics for people with autoimmune disease.
A: COVID-19 vaccines are being developed and so the answers to these questions are not known at present. We anticipate that guidance will be available as COVID-19 vaccine development progresses. When a vaccine becomes available, it is recommended that you speak with your health care provider to address these questions.
Swimming and Pools
A: There is no evidence that the virus that causes COVID-19 can be spread to people through the water itself in pools, hot tubs, or water playgrounds. Proper operation of aquatic venues and disinfection of the water (with chlorine or bromine) should inactivate SARS-CoV-2, the virus that causes COVID-19. Swimming and other water-related activities are excellent ways to get physical activity. Taking steps to reduce the spread of COVID-19 is one way you can play it safe in and around swimming pools, hot tubs, and water playgrounds.
Don’t visit a swimming pool if you are sick with, tested positive for, or were recently exposed to COVID-19. If you do go to a swimming pool, practice social distancing by staying at least six feet (two meters) from people you don’t live with, and wear a cloth face covering when not in the water. Keep your hands clean by washing hands with soap and water for at least 20 seconds, especially after going to the bathroom, before eating, and after blowing your nose, coughing, or sneezing. For adults and older children who can safely use hand sanitizer, if soap and water are not readily available, use hand sanitizer that contains at least 60 percent alcohol and rub hands together until dry. You can get more information here about visiting parks and recreational facilities, including swimming pools. Additionally, some states and some communities or facilities have adapted CDC’s recommendations with more specific guidelines. Please check the rules specific to your state and your community.
Read more here about staying safe when using pools if you have underlying medical conditions.
A: The CDC and scientists around the world are working hard to answer this question. We still do not know whether having antibodies to the virus that causes COVID-19 actually provides immunity or protection, even for people with normally functioning immune systems. Further, we need to study more in order to understand how long antibody protection might last. This could vary from a few months to a year or even a lifetime as we have seen in most other diseases. How many antibodies are required to offer protection is also another important question.
We do know that certain medical conditions and immunosuppressive drugs can impair someone’s ability to mount an immune response to a virus or to a vaccine. This might be especially true for live-attenuated vaccines. Dead or inattenuated vaccines like the flu vaccine tend to be safe for people with autoimmune conditions.
However, we do not yet know how exactly how all this pertains to COVID-19. If you have an underlying medical condition or take an immunosuppressive medication, we recommend talking with your health care provider about how your condition and treatment might impact your ability to fight off infections like COVID-19. It is very important to try to avoid becoming sick if you are immunosuppressed or have a chronic underlying medical condition linked with severe COVID-19 illness.
A: There is currently no evidence of any specific way to boost your immunity to fight COVID-19. However, we do recommend that you stay as physically healthy as possible by following your health care provider’s instructions and managing your underlying conditions as best you can.
First and foremost, continue taking your medicines as prescribed. This will help you to keep your disease well-controlled and this itself will help reduce your risk of infection and/or complications.
Practicing healthy lifestyle behaviors regarding diet and exercise is very important. Somethings all we can do to maintain good overall health is keep a wholesome diet with plenty of fresh vegetables and fruits. The Mediterranean diet might be a good example to follow for some. Exercising is important for managing chronic conditions as well as mental health and stress management. It’s important to find what works for you during the pandemic, such as doing online videos or streamed classes, or even just taking short walks outside in your neighborhood regularly. In addition, maintain good sleep hygiene, and practice mindfulness and meditation to help manage stress, anxiety, and depression.
Stay in touch with your loved ones and maintain social interaction, both online or in person if you can follow safe social distancing. Taking care of emotional well-being and mental health is important to keep your overall health — including your immune system — strong.
Get more information here on coping with stress during the COVID-19 pandemic.
If you have underlying health issues or are immunosuppressed, the most important thing you can do is avoid being exposed to coronavirus. The best way to do this is to adopt the following behaviors:
- Wash your hands often with soap and water for at least 20 seconds.
- Avoid leaving your home as much as possible and maintain a distance of at least six feet between you and people outside of your household.
- Use a cloth face covering when you are around others.
- Clean and disinfect frequently touched surfaces (i.e. doorknobs, light switches, countertops, etc.).
- Do not make any change to your disease management regimen without consulting your doctor.
Medications for Chronic Illness
A: Many researchers are working to better understand underlying medical conditions and whether medications people are taking may increase their risk for severe illness from COVID-19. Some of the medications that are being studied are blood pressure medications (for example, ACE inhibitors) and medications that suppress the immune system. There are many ways to systematically collect and analyze information about what underlying conditions people have and what medications they are on, such as through surveillance systems and pharmacy claims databases.
One study of 600 COVID-19 cases recently published in the Annals of Rheumatic Diseases found that glucocorticoids were linked with COVID-19 complications, but other medications were not. Read more here about the study’s main findings.
Interested in participating directly in research about how COVID-19 is affecting people with autoimmune and inflammatory conditions? The Autoimmune COVID-19 Project is a patient-centered research study that aims to examine the concerns and behaviors of patients with autoimmune, rheumatic, and related conditions during the COVID-19 pandemic. Learn more and sign up here.
A: Patients who have certain chronic conditions and autoimmune conditions often need to be on immunosuppressive therapies like biologic therapy. The degree to which you may be immunosuppressed depends on the specific biologic you are taking, as well as your underlying medical conditions and other health issues. There is no clear evidence yet indicating that there is a specific time at which you are most immunosuppressed during a biologic treatment cycle. Always remember also that sub-optimal treatment of your autoimmune condition — meaning if your disease is not well-controlled — can increase your risk of getting an infection. It is very important to keep your underlying condition(s) under good control.
At this point, experts think it is safe to continue your biologic treatment as planned as long as you are otherwise healthy and do not have a confirmed or suspected COVID infection or known exposure. The data is not indicating that people on a biologic have an increased risk of getting COVID-19 because of their medication. The best advice is to discuss your dose and other concerns with your doctor. Never stop or change the dose of your medications without consulting with your doctor.
Read more here about the American College of Rheumatology’s clinical guidance on treating rheumatology patients during COVID-19.
A: Numerous studies have found links between taking corticosteroids and an increased risk of COVID-19 complications. In addition to data on rheumatology patients (mentioned above), endocrinologists pointed out that people who regularly take oral steroids are considered higher risk for getting COVID-19 in an article in the Journal of Clinical Endocrinology & Metabolism.
However, if you’re taking corticosteroids to manage a chronic health issue, you should take them exactly as prescribed. It is crucial to never stop taking steroids suddenly, as they must be tapered when reducing the dosage.
You and your doctor should work together to ascertain a safe dosage for you. It may be the case that you can safely lower your dosage, if your underlying health conditions are under good control or improving. But if your condition is not well-managed, you may be better off staying on your corticosteroids.
If you start to notice any additional or worsening of symptoms while taking your medication, contact your doctor immediately.
Read more here about how corticosteroids may affect COVID-19.
Treatment for COVID-19
A: At this time, there are no drugs approved by the U.S. Food and Drug Administration (FDA) to prevent or treat COVID-19. Current treatment for someone who is immunocompromised and gets ill from COVID-19 includes close monitoring and supportive care, including supplemental oxygen and using a ventilator when needed. There are clinical trials underway for several different medications. Remdesivir, an antiviral medication, has not been approved by the FDA as it is an investigational drug, but it does have an Emergency Use Authorization for the treatment of hospitalized patients with severe COVID-19. Hospitals and health care facilities must collaborate with U.S. government agencies to receive remdesivir.
As of right now, there are no specific treatment protocols for people who are immunosuppressed. Treatment depends on how severe the COVID-19 infection is. The National Institutes of Health (NIH) is updating their online treatment guidelines as more evidence becomes available.
A: Published reports do suggest that people who are undergoing cancer therapy, people who have had a solid organ transplant, and people on immunosuppressive medications — in particular corticosteroids — may be more likely to need hospitalization, ICU-level care, or mechanical ventilation, and may be more likely to die. People with other types of immunocompromising conditions may be at higher risk for severe illness, but we are working on getting more information to better understand this. We are learning more about who is at high risk of severe illness every day.
If you are currently taking immunosuppressive medications for your health condition, do not change or stop taking medicines without talking to your doctor. Stopping or changing medicine can cause serious health problems.
A: Many people are feeling more stressed and anxious right now because of the COVID-19 pandemic. You are not alone. Some things you can do to support yourself are: Take breaks from watching, listening to, or reading news stories about the pandemic. Take care of your body by taking deep breaths, stretching, or meditating, eating healthy, well-balanced meals, exercising regularly, and getting plenty of sleep. Make time to unwind and do activities that you enjoy. Stay in touch with friends or family by phone or email or video chats. Talk to people you trust about how you are feeling. If you are a parent, you might also share with your children how you are dealing with stress so they can learn how to cope from you and you can learn together.
If you feel like your stress or anxiety is becoming overwhelming, reach out to your health care provider. If you, or someone you care about, are feeling overwhelmed with sadness or anxiety, or feel like you may harm yourself or others, call 911 or the Disaster Distress Helpline at 1-800-985-5990.
The CDC has more resources here about coping with stress.
You can also check out this library from clinical psychologist Laurie Ferguson, PhD, who specializes in helping people with chronic illness. She has created many resources for mental health support specifically for the Global Healthy Living Foundation and CreakyJoints since the start of the pandemic.
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.
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Interview with Anne Kimball, MD, MPH, of the CDC National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; Division of Sexually Transmitted Disease Prevention
Interview with Max Hamburger, MD, Founder, Executive Chairman and Chief Medical Officer of United Rheumatology and Managing Partner of Rheumatology Associated of Long Island (RALI)
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