People with rheumatic conditions may be at greater risk of getting many infections. While we do not yet have data regarding coronavirus (the virus causing COVID-19), we can assume that the same may be true in the case of that virus. Patients at risk include people with lupus, rheumatoid arthritis, scleroderma, myositis and vasculitis. If they become infected, their symptoms may be more severe. The increased risk may be due to the diseases themselves as well as the medications used to treat them, which suppress the immune system. People over age 65 and those with underlying chronic medical conditions may be at particular risk of developing severe COVID-19 infections. Pregnant women might also be more vulnerable, though there is no specific information on this yet.
Despite the risk, it’s important to know there are many proactive steps you can take to keep yourself healthy:
- Avoid close contact with people who are sick.
- Wash your hands often with soap and water for at least 20 seconds, covering every surface of your hands and under your fingernails.
- Don’t touch your eyes, nose or mouth with unwashed hands.
- Use an alcohol-based hand sanitizer when not near soap and water.
- Practice good respiratory hygiene by coughing or sneezing into the crook of your elbow or into a tissue and then immediately disposing of it. Clean your hands afterward.
- Clean and disinfect areas that you and others touch often.
- There is no need to wear a face mask unless you have developed symptoms of the infection. The US Centers for Disease Control (CDC) does not recommend that healthy people wear face masks for protection.
We also recommend taking further precautions to reduce your risk, including:
- Following guidelines provided by local and state governments regarding social distancing and in some states remaining at home. In fact, during this most active phase of the COVID-19 pandemic, we strongly advise patients with rheumatic disease to remain at home.
- If you must leave home, avoiding public transportation, if possible, including subways, buses, and trains.
- Absolutely avoiding crowded areas and large gatherings, as mandated by the CDC and state governments.
- Working from home to the greatest extent possible. (Your rheumatologist can provide a note to your employer advising that you should work from home, if you need one.)
Many medical practices are temporarily suspending nonessential office visits to further protect patients from unnecessary exposure to the COVID-19 virus. If this happens to you:
- Schedule telehealth appointments if they are offered by your doctor.
- Report any new symptoms related to your rheumatic condition or any new fever, cough or shortness of breath to your doctor.
- Call your doctor or an urgent care center if you develop symptoms of COVID-19.
- Should you experience what you are concerned may be a medical emergency, consult with your physician to determine whether it is best to go to a hospital emergency room or if an alternative site for evaluation might be more appropriate.
- Do not stop taking or lower the dose of your current medication without discussing this with your doctor. Any possible benefits of going off immunosuppressive medications must be balanced by the potential risks of a disease flare. At this time, there is not enough information about how rheumatology medications affect COVID-19 infections to allow for strong recommendations about changes in therapy.
For more detailed and up-to-date information about COVID-19 please visit the CDC website at https://www.cdc.gov/coronavirus/2019-ncov/index.html. Additional guidance for patients with rheumatic conditions concerning COVID-19 can be found at https://www.hss.edu/conditions_rheumatic-disease-and-COVID-19-coronavirus.asp.
*Scanning electron microscope image of coronavirus. Credit: NIAID-RML*
Dr. Mary K. Crow is Physician-in-Chief and Chair of the Department of Medicine at HSS. She is also the Director of the Autoimmunity and Inflammation Research Program and Co-Director of the Mary Kirkland Center for Lupus Research at HSS. Dr. Crow’s academic and research career has focused on unraveling the cellular and molecular mechanisms that underlie the systemic autoimmune diseases, with a particular focus on systemic lupus erythematosus and rheumatoid arthritis.
