Coronavirus and chronic illness

Which chronic diseases are most at risk?

According to CDC, the risk of developing a severe form of SARS-Cov2 infection is higher if:

• You have a chronic (long-term) heart disease, such as heart failure. 
• You have a chronic respiratory condition like asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis. A viral infection such as COVID-19 may cause the existing respiratory disease to worsen. In fact, both asthma and COPD affect the respiratory tract, which is therefore more vulnerable to a virus causing respiratory complications.
• You have chronic kidney disease. The risk can be explained, as for all chronic pathologies, by the fragility and weakening of your immune system.
• You have chronic liver disease, such as hepatitis.
• You have chronic neurological conditions, such as Parkinson's disease, multiple sclerosis (MS), a learning disability or cerebral palsy.
• You have unstable insulin-dependent diabetes or complications of diabetes. The uncontrolled increase in blood glucose levels due to diabetes can dysregulated the immune system, which will have a harder time defending your body against infectious diseases and their complications. Infections can also cause your blood glucose levels to become unbalanced and/or worsen some of the complications of diabetes you already have.
• You have an autoimmune or auto-inflammatory disease, such as multiple sclerosis, rheumatoid arthritis, lupus, HIV or AIDS, vasculitis or inflammatory myopathies. The main risk of complications comes from the possible impairment of your immune system due to complications of the disease or immunosuppressive and corticosteroid treatments. However, it is very important to follow the recommendations concerning your treatments, not to stop them voluntarily and to talk to your doctor first (see recommendations below).
• You are seriously overweight (Body Mass Index (BMI) > 40). The risk is considered based on analysis of available data for other respiratory infections such as influenza A(H1N1)09.

Who else is vulnerable?

• Patients over the age of 65. As age increases, the immune system becomes weaker and is unable to properly fight off infections such as COVID-19.
• Fragile and immunocompromised patients. Whether it is a primary or secondary immunodeficiency, it is important to be watchful for symptoms.

1. Primary/congenital immunodeficiency (deficit in components of immune system present at birth)
2. Secondary/acquired immunodeficiency, resulting from:
   - Drugs : chemotherapies, immunosuppressant drugs, biotherapies, corticosteroid treatments at immunosuppressive doses 
   - an uncontrolled HIV infection or with a CD4 T count< 200/mm³
   - a solid organ transplant or hematopoietic stem cell transplant 
   - Blood malignancies such as: cancers of the blood or bone marrow like leukemia, Hodgkin lymphoma, and multiple myeloma at any stage of treatment

• Pregnant women. For more information, we invite you to consult the recommendations of the American College of Obstetricians and Gynecologists.

Your doctor has prescribed Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): what should you do?

At this time, the Food & Drug Administration finds that there is no scientific evidence that use of NSAIDs like ibuprofen can worsen the coronavirus (COVID-19). If you wish to use treatment options other than NSAIDs, there are many over-the-counter (OTC) and prescription medications approved for pain relief and fever reduction. If you have been prescribed NSAIDS for your chronic condition, do not stop taking them without consulting your doctor by phone or tele-consultation. 

You are taking immunosuppressant drugs, immunotherapy or corticosteroids: what should you do in case of symptoms?

- If you have an autoimmune or inflammatory disease and are taking immunosuppressant drugs, immunotherapy or corticosteroids, the Cleveland Clinic medical center, the American Autoimmune Related Diseases Association, as well as other health organizations across the United States, recommend certain specific measures in addition to the general recommendations such as:

• Do not stop immunosuppressant treatments or immunotherapy, except in case of signs of infection (fever, cough, breathing difficulties, aches and pains, etc.) and only upon the medical advice of the healthcare provider who is treating you for your condition or of your primary care physician. Just as there is risk associated with being immunocompromised, there is also risk associated with abruptly stopping your medication. If you have questions or concerns, talk to your doctor.
• Do not stop corticosteroids without seeking prior medical advice.

- If you have developed cancer, the American Cancer Society recommends: 

• Not interrupting your treatments without the advice of your doctor, continuing your home care by restricting outings and visits, or to continue treatment at your medical clinic according to the recommendations of your medical team.
• If you are in post-cancer care, strictly adhere to the general guidelines, and contact your doctor if you have any questions about your treatment
• If you are receiving treatments or post-cancer care in a clinic, you may want to consider complete non-urgent follow up visits or talking to your care team virtually and not physically going to the clinic. It is important to maintain contact with your cancer care time to determine the best course of action for you.

My doctor has vaccinated me against flu, pneumococcus, etc. Am I protected?

The flu and pneumococcal vaccines, as well as any other specific vaccine, do not protect against coronavirus infection. There is no vaccine to protect against SARS-Cov2 (coronavirus) at present.

When and how should you contact your doctor?

According to the NFID, the procedure is as follows: 

• If you have symptoms (cough, fever) that make you think of COVID-19: call a healthcare professional. Unless you need immediate medical care, you should stay at home to avoid spreading your illness. Stay in touch with others by phone or email, you may need to ask for help from friends, family, neighbors, or community healthcare workers if you become sick.
• If your symptoms worsen with breathing difficulties and/or signs of choking, call 9-1-1 and get medical attention immediately. Make sure to make the operator aware that you believe you may have COVID-19 or have COVID-19 symptoms.
  In these situations, do not use public transportation, do not go in person to your doctor's, to the ER or to the service that usually monitors your autoimmune or inflammatory disease or your cancer.

How do I refill my prescriptions?

Ask you doctor or local pharmacy if ordering your medications online is an option. Many online pharmacies will fill valid prescriptions and mail them directly to your door, allowing you to avoid taking the risk of going to the pharmacy in person. The Centers for Medicare & Medicaid Services are working with private plans to waive prescription refill limits and to lower restrictions on home or mail delivery of prescription medications.

However, make sure to only order from a reputable online pharmacy. The FDA warns consumers about rogue online pharmacies claiming to sell precription medications at discounted prices. Read the FDA warning and guidelines here. If you have questions or need advice, contact a healthcare professional.

If you need medical help right now, call 9-1-1. 

If you have a medical emergency and need to call 911, notify the operator that you have or think you might have, COVID-19. If possible, put on a facemask before medical help arrives.