2020/04/26
Dear Patient
We have by now all experienced first-hand the inconveniences and economic hardship of Lockdown. Undoubtedly the South African Lockdown was a massive success in ‘flattening the curve’, giving our government and medical services valuable time to prepare for the inevitable surge in COVID-19 cases caused by the novel Corona virus (now called SARS-CoV-2). Our infection rate curve has won international acclaim, with a unique shape due to the rapid response of our government that had acted so quickly and decisively early in the pandemic. However, Lockdown can’t be extended indefinitely and will now be lifted gradually from the end of April to allow Covid-19 infections to run its course in South Africa in controlled and hopefully manageable numbers.
The new Corona virus has been around for a mere four months and knowledge about the virus has exploded. Unfortunately, there is also still a great deal we just simply don’t know.
At this stage I’m glad to report that it doesn’t appear that patients with auto-immune diseases, cancer and HIV seem to be more at risk for contracting the infection. Despite our initial fears that immune-compromised patients such as these will be more prone to complications, the main predictors of complications have turned out to be advancing age, male sex, hypertension, underlying cardiovascular disease and underlying lung disease.
The current recommendation of international societies like the American College of Rheumatology (ACR), European League against Rheumatism (EULAR) and the British Society for Rheumatology (BSR) is that patients with auto-immune disease should carry on with all their medications, including potent immune-suppressants like methotrexate and Biologics during the pandemic. Corticosteroids (cortisone) should be brought down to the lowest possible dose that controls the disease. It will probably be long (many months) before the pandemic is either over or, less likely, we will have a vaccine. If auto-immune diseases are given the chance to flare up, patients will be more prone to Covid-19 infections and complications. Certain exceptions or increases in drug dosing intervals might apply to individual cases and you should please discuss any concerns with your doctor.
We now know that COVID-19 infections have three kinds of presentation. It is a primarily respiratory illness that starts in the upper airways with symptoms like a sore throat and difficulty smelling, often in association with fever. In about 80% of people the infection will end there. In the other 20%, it then moves down into the lungs to cause a form of pneumonia called ARDS, where the tiny air sacs in the lungs become filled with fluid. This stage can cause severe problems with the absorption of oxygen in the lungs and might eventually require breathing assistance with a ventilator. In a third phase in a small minority of patients the virus also moves into the blood stream and sets off a severe and uncontrolled response by the immune system called a cytokine storm. During this over-reaction of the immune system, normal organs can be damaged, and patients can die from multi-organ failure.
The South African National Institute of Communicable Diseases now recommends aggressive COVID-19 testing in ANYONE presenting with ANY respiratory symptoms or fever. The idea is to quickly diagnose any potentially infected persons, so that immediate measures can be taken to limit the infection to just that patient or household. This means that in terms of spread potential this case becomes a ‘dead-end’. So even though you might think that it is only sinus or allergy symptoms, please arrange testing for any new symptoms such as a sore throat, blocked or runny nose, difficulty smelling things, cough, shortness of breath or fever. Please telephonically contact your doctor for advice on how to arrange the testing. DO NOT GO TO THE ROOMS, LAB OR HOSPITAL BEFORE PHONING, as they need to prepare for your arrival to prevent spread of infection to other patients.
Should you fall ill with a COVID-19 infection, the recommendation is to stop all auto-immune medicines, except for Plasmoquine, Salazopyrin and prednisone. Unfortunately, there is no specific antibiotic treatment for COVID-19 and the initial excitement about Plasmoquine as a possible COVID-19 treatment has not been scientifically proven. It is important that you rest, drink plenty of fluids and treat the pain and fever symptomatically. Despite the initial concerns that ibuprofen or non-steroidal anti-inflammatories (Coxflam, Voltaren, Celebrex, Arcoxia, etc) might prolong a COVID-19 infection, it now looks safe to continue them except in extreme cases with seriously ill patients. However, if you can control the COVID-19 fever and pain with just paracetamol (Panado) or combination painkillers like Tramacet and Stilpane, it might be better as anti-inflammatories can also have other side effects like stomach ulcers, kidney and heart problems. It is now also recommended to carry on with all your other medications, including blood pressure medication. It is of great importance that you self-isolate yourself to help prevent the spread of the virus to others in the household and the wider community. If you struggle at all to breathe, you should contact your doctor or ambulance immediately to decide if you need to go to hospital.
If you’ve been exposed to someone with Covid-19, you still need to follow the exact same recommendations as if you were infected with the COVID-19 virus. If you haven’t developed any symptoms after 2 weeks, you can un-isolate yourself and start to take all your medication again.
We expect that the government will try to work towards the ‘Shielding’ of vulnerable people, like the elderly and persons living with auto-immune rheumatic conditions, as the Lockdown eases. This is a special form of self-isolation. It means that the most vulnerable people will need to be ‘protected’ from contact with other people who might bring the infection into their homes for much longer than the general public, probably until about September. Practically speaking, these patients are the ones that should continue to work from home as far as possible, even if the Lockdown for their employment sector lifts.
I would like to thank Charlene for her initiative and enthusiasm in setting up this website in support of South Africans living with auto-immune rheumatic conditions during the Corona virus pandemic. Our epidemic is a few months ‘behind’ China and other developed countries of the world. We can learn a lot from their experience, but it is also easy to become overloaded with the bewildering amount of information and sites out there. Charlene has a great talent to streamline the mass of information out there into digestible chunks of practical information and we hope that you will find the information useful.
Please tell us your story and share your concerns. I can’t answer individual medical questions but will gladly assist with general medical advice and share new information as it becomes available.
Stay safe, stay healthy!
Regards
Dr Christa Visser
