03/02/2020
Advice for , 's and other immunosuppressed patients and coronavirus infection (COVID-19 epidemic of 2020):
NOTE: Any comments to my post that are anti-vaccine will be deleted. I usually don't police my posts so strictly, but they have no place here and are based on hysteria and not medical facts.
SHARE with everyone who may have a compromised immune system.
Also, note: There is much more that we do not know about the coronavirus that is currently causing COVID-19. It does appear that elderly patients have higher death rates, while children tend to have milder disease. Therefore, we can assume that this may be related to a poorer immune system in the elderly and that we can assume that patients with compromised immune systems are at higher risk for more severe infection. Therefore, I would make the following recommendations. These are based upon the latest medical literature plus recommendations from the World Health Organization and the Centers for Disease Control.
Part of my recommendations below is also based on our knowledge that coronaviruses cause 10% to 15% of cases of the "common cold." A large number of COVID-19 cases look like "the common cold." Therefore, some of these suggestions come from the prevention and treatment of "the common cold." I will not discuss symptomatic treatment (such as taking cough syrup, Tylenol for fevers, etc); it is best to ask your doctor what is safe for you to take in light of your medications and medical situation for that.
Prevention of getting infected is the most important weapon.
Secondly, it is important to decrease your chances of more severe infection if you were to get COVID-19 (such as lowering your risk for secondary bacterial infection from pneumococcal pneumonia).
Note that none of these are proven to prevent/treat COVID-19, it is just too early and so little is known. However, these are the things that I will practice myself and that I would recommend for my patients.
The most common symptoms of COVID-19 are fever and cough (usually a dry cough); sore throat and muscle achiness in some people. Shortness of breath occurs in severe cases.
Suggestions:
- Get the flu vaccine ASAP if you have not had it. This will not prevent Coronavirus infection, but the last thing you would want to get is coronavirus infection and influenza at the same time.
- Get your pneumonia shots to prevent pneumococcal pneumonia ASAP if you have not had them. It is recommended that all systemic lupus erythematosus (SLE) patients of all ages get both pneumonia shots. (Preventing secondary bacterial pneumonia after getting a viral infection like coronavirus is important). Patients with other autoimmune disorders such as Sjogren's and RA should get both at any age if they are on medicines that suppress the immune system. The two shots are:
Prevnar PCV-13: Get this one first! In those who are not in the above groups, you can get this if you are 50 years old or older. All immunosuppressed patients and SLE patients of all ages should get it (you are automatically 13 times more likely to get severe pneumococcal pneumonia than a healthy person). If you have already received Pneumovax, make sure it has been at least a year later before getting the Prevnar. The Prevnar shot is a life long vaccine, you only need one shot in your lifetime.
Pneumovax 23-valent vaccine: Get this shot 8 weeks after Prevnar-13 if you are on any immunosuppressant medicines. If you are not on immunosuppressant medicines, wait 1 full year after your Prevnar shot. (I know these directions are complicated, but these are the recommendations).
You need 2-3 Pneumovax in your lifetime if you have systemic lupus or if you are on immunosuppressant medicines. The first two should be 5 years apart. If those two were done before you were 65 years old, you need a 3rd one after reaching 65, but make sure it is 5 years since your previous one. For example, if you got your second shot at 64 years old, you should get your third shot at 69 years old.
- Frequent hand washing (at least 20 seconds with soap and water) or use an alcohol-based hand rub (60% alcohol or higher).
- Do not touch eyes, mouth, nose with unwashed hands. Practice not touching your face at all unless you washed your hands first. Have an itchy nose and have that urge to rub it? Getting ready to eat? WASH FIRST
- Avoid close contact with people who are sick
- IF someone sneezes/coughs in your vicinity, stay at least 3 feet away from them.
- Monitor the travel ban recommendations as they unfold
- Should you consider taking zinc (Zicam and ColdEEZE) regularly? This is not known. Two small studies in children showed fewer colds and school absences in those who took zinc supplements daily. I cannot recommend for or against at this time for the prevention of a cold (but I do recommend zinc lozenges for treatment as below).
- DO NOT take Echinacea. It can actually worsen lupus. Other preventatives such as vitamin C, vitamin E, vitamin D have not been proven to be helpful.
What to do if you get cold-like symptoms:
- Stay away from others, isolate yourself as much as is feasible. Stay home as much as possible.
- Consider taking zinc lozenges (ColdEEZE and Zicam) every 2 hours (shown to decrease the severity and duration of the common cold). We have no idea if it works with COVID-19, but coronaviruses cause 10-15% of the common cold. DO NOT use the zinc nasal sprays (Zicam spray), they can cause loss of smell. NOTE: I stock up on ColdEEZE and I keep them on my desk, at home, in office, and I travel with them.
- Consider wearing a mask if around others (though a Japanese study showed that they did not prevent colds; but this was one study).
https://www.ncbi.nlm.nih.gov/pubmed/19216002
- Before a doctor's visit, call to see if you should keep your appointment or stay home.
- Cover your coughs and sneezes. Use tissues and throw them away. If you don't have one, sneeze/cough in the bend of your elbow. Wash hands immediately afterward or use an alcohol wipe.
- Don't share items with other people (glasses, tables, dishes, toothpaste, petting your pets, etc)
- Clean high touch areas (countertops, doorknobs, etc) regularly with household cleaners and wipes.
If someone is in the home that is sick:
- Stay separated
- Follow the above advice.
- Consider having them wear a facemask plus you wear a face mask if near them. HOWEVER, there is no good evidence that face masks help all that much: they do not provide an air-tight seal. A Japanese study showed they made no difference: https://www.ncbi.nlm.nih.gov/pubmed/19216002
- If you are in the same room, try to stay at least 3 feet away
- Keep visitors away
- Keep laundry thoroughly cleaned
- Consider using gloves
Please comment below on any other good recommendations that you have heard/read
by Don Thomas, MD
lupusencyclopedia.com
lupusencyclopedia@gmail.com
facebook.com/LupusEncyclopedia
Image credit: People.com
