March 2020
On March 11th, the World Health Organization (WHO) declared the coronavirus to be a global pandemic. Understandably, the word “pandemic” has stirred up concern and added fresh fuel to the fear many already feel regarding their susceptibility to the disease. As a follow-up to our article about spondyloarthritis (SpA) and the coronavirus last week, we wanted to share the facts regarding pandemics and answer some of your most urgent questions.
A global pandemic is defined by the wide spread of an illness across the world. The new designation by the WHO acknowledges the rapid and far-reaching expansion of COVID-19, and urges governments and the public to take more aggressive action to help contain the spread, but it does not signal a loss of control over the outbreak. With proper resources and protocols, countries can limit the spread of the disease. The WHO recommends that individuals protect their health by following key safety precautions.
COVID-19 testing is slowly becoming more widely available, and insurance companies in the U.S. have pledged to pay for the tests, without charging co-pays (although you should still check with your insurance company to find out whether they will cover the full cost of treatment). The Federal government has expanded access to paid leave for many U.S. workers, and extended the federal tax filing deadline.
We spoke again to rheumatologist and spondyloarthritis expert Dr. John Reveille, Chief of Rheumatology at The University of Texas Health Science Center in Houston, for his insight on what the pandemic designation means for you.
Dr. Reveille, can you provide some context on the designation of the coronavirus as a pandemic?
The COVID-19 epidemic met pandemic criteria a few days ago, and the WHO just declared it yesterday. Calling a disease a pandemic has nothing to do with lethality or mortality, just how many people are being affected and how widespread and quickly the infection is spreading. As I said last week, the overwhelming majority of those infected with COVID-19 do fine. The majority of the serious and fatal cases occur in the elderly, particularly those with medical complications such as diabetes, severe high blood pressure, and chronic lung disease. That said, the occurrence of serious infection, and even death, in some younger people (though very uncommon, and rarely in children) should underscore the need for everyone to take precaution. The most important thing is frequent hand washing. The CDC also recommends that everyone – even those who appear healthy – wear a face mask when leaving the house. Masks are not guaranteed to shield you from infection, but they help prevent the spread of respiratory droplets from your mouth and nose to reduce the chances of transmitting the illness to others if you are infected but asymptomatic. Masks also protect you by keeping you from putting your hands or fingers in your nose or mouth, which is one way infection is spread.
Does simply having SpA – without being on immunosuppressant medications – put someone at increased risk of being infected, or of having secondary complications from COVID-19?
No, unless other medical complications are present (diabetes, kidney failure, etc.).
The CDC just released new recommendations specifically for “higher risk” patients (the elderly, and those with serious chronic health problems such as heart disease, lung disease, or diabetes), recommending that these people stay home as much as possible and keep a stockpile of medications. Do immune system diseases like SpA, lupus, PsA, and RA also fall into this “higher risk” category?
Not in and of themselves, unless complications associated with other risk factors are present. [Editor’s note: Those taking biologic medications may be at increased risk for certain infections, although there is not enough data yet to say how biologics may interact with a COVID-19 infection.]
In your very informative breakdown of SpA medications last week, methotrexate was not mentioned. How much of an immunosuppressant is it?
Methotrexate taken at anti-inflammatory doses is minimally immunosuppressive. At cancer chemotherapy doses (much higher doses) it likely is more so. Unless the known complications are present, at usual doses (below 25 mg/week) it should not be a worry.
A nurse who is just about to start on Cosentix is not sure if she should begin her biologic now. Should she hold off until there is a clearer picture of how COVID-19 will play out?
This is a good question. We are in a very dynamic situation that should become a lot clearer in the next few weeks, and recommendations may change as new knowledge becomes available. If this epidemic acts like the others since the 1918 flu epidemic, as well as looking at the current situation in China, things may indeed be winding down by May or June. For my patients who lack the risk factors above, I have them continuing their biologics. In this case, waiting a few weeks will likely not hurt.
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