Coronavirus Information and Articles

CUH advice for patients on immunosuppressants

Coronavirus COVID 19 risk advice for patients on immunosuppressants_V2_A4_0#LUPUS & #CORONAVIRUS (#COVID_19) GUIDANCE UPDATED: We’ve just published a significant re-write to our info and guidance. Please read the full article carefully.

This update explains how rheumatologists are classifying the risk levels for lupus patients.https://t.co/wh9n7sBwvu pic.twitter.com/uc4uOJjyld

— LUPUSUK (@LUPUSUK) March 25, 2020

 

Coronavirus Information and Articles

This page will hold information from Lupus UK and other articles regarding Coronavirus.

 

20th March 2020

 

Lupus Coronavirus COVID-19    20Mar2020 Briefing.

 

18th March 2020 12:00

Hi everyone,

I hope you are all keeping well and staying as relaxed as possible during this stressful time. I have a few updates for you from National Office.

LUPUS UK Guidance Update
We have a further update for the website guidance ready for publication. I’ve just been informed by our webhosts that our website should be able to handle the increased traffic now and they are on-hand to assist. Expect the update to go live in the next hour. I will email you with the link and a pdf copy of the updated guidance when it goes live.

National Office Staffing
To protect our team, most of our staff will be working from home for the foreseeable future. We’ve got most people set up and we’re working through one or two teething issues. Chris and myself are in the office at the moment taking calls – the phones have been ringing almost constantly with people seeking guidance. Due to the current changes and significant number of enquiries we’re receiving, we may be a bit slower than usual in assisting you and we’re having to prioritise tasks carefully. We’re really grateful for your patience and the whole team is working as hard as it can to help.

Employment Advice
The majority of enquiries we are receiving are from people with lupus who are struggling with unsympathetic employers who are not adequately protecting their health and wellbeing. We are working on additional guidance and information about this. If you are receiving questions about this, here are a couple of helpful pointers;
1. ACAS Guidance
ACAS have an excellent article with guidance for employers and employees which is being updated regularly. A link is included in our website article under ‘further reading’ – https://www.acas.org.uk/coronavirus. One of the most relevant sections at the moment is under ‘Vulnerable People’:
“Vulnerable people
Employers need to be especially careful and take extra steps for anyone in their workforce who is at increased risk from coronavirus.
They include, but are not limited to, those who:
• have a long-term health condition, for example asthma, diabetes or heart disease, or a weakened immune system as the result of medicines such as steroid tablets or chemotherapy
• are pregnant
• are aged 70 or over
• care for someone with a health condition that might put them at a greater risk
2. Government guidance not mentioning ‘lupus or SLE’
Many people have said their employers won’t allow them to take extra precautions because ‘lupus’ is not a listed condition in the guidance at https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults. This is the same list used by the NHS for the annual influenza vaccination campaign, with the exception that it doesn’t state it is not an exhaustive list. Just because lupus and many other conditions are not included on this list does not mean that they are not ‘serious health conditions’. I’m going to be in contact with our friends at RAIRDA to see whether we can produce a joint statement and encourage amendment to this wording. It is currently insufficient and people with rare conditions are falling through the cracks.

Take care,
Paul

 

 

17th March 2020

Lupus & Coronavirus (COVID-19)

Updated (17/03/2020)

The UK has now advised against all “non-essential” travel and contact with others and recommended people with significant health conditions (including lupus) to self-isolate for a period of 12 weeks.

If you are in crisis as a result of these new measures, please contact LUPUS UK by calling 01708 731251 or emailing headoffice@lupusuk.org.uk.

The following article has been updated to reflect the changing guidance. The situation is likely to change further over the coming days and weeks. Please check back here regularly for the latest updates as guidance will change.

What is coronavirus (COVID-19)?
A coronavirus is a type of virus. As a group, coronaviruses are common across the world. Typical symptoms of coronavirus include fever and a cough that may progress to a severe pneumonia causing shortness of breath and breathing difficulties.

Novel coronavirus (COVID-19) is a new strain of coronavirus first identified in Wuhan City, China.

 

How is it spread?
It is a new strain of virus, so it is not yet known exactly how this coronavirus spreads from person to person. Similar viruses are spread in cough droplets. It’s very unlikely it can be spread through things like packages or food. Viruses like coronavirus cannot live outside the body for very long.

 

What is the risk of coronavirus in the UK?


The UK Chief Medical Officers have raised the risk to the UK to high. You can read an up-to-date report of risk HERE.

 

What are the signs and symptoms of coronavirus?
– a cough (in many cases this has been reported as dry and persistent)
– a high temperature
– shortness of breath

But these symptoms do not necessarily mean you have the illness.

The symptoms are similar to other illnesses that are much more common, such as cold and flu.

Generally, coronavirus can cause more severe symptoms, such as pneumonia, in people with weakened immune systems, older people, and those with long-term health conditions.

 

Does my lupus place me in the ‘high-risk’ group for coronavirus?
Data collected so far suggests that people of all ages are at risk of contracting the virus. However, as with most respiratory illnesses, it is likely to be the young, old, and those with chronic health conditions or weakened immune systems who are most at risk once infected.

Lupus is a chronic health condition and many people living with the condition are likely to have a weakened immune system, most commonly as a result of immunosuppressive medication they are required to take. This means that many people with a diagnosis of lupus would be considered as ‘high-risk’ if they contracted the virus.

 

Which lupus treatments are immunosuppressive?

Many medications used in the treatment of lupus help to control lupus activity by dampening down the immune system. The following medications weaken your body’s immune response to infections:

  • High-dose oral steroids (20mg or more daily) [Prednisolone]
  • azathioprine [Imuran]
  • methotrexate
  • mycophenolate mofetil (MMF) [CellCept]
  • cyclophosphamide [Cytoxan]
  • rituximab [Rituxan]
  • belimumab [Benlysta]

 

What about hydroxychloroquine?

Unlike the medications listed above, hydroxychloroquine is known as an immunomodulatory drug and is unlikely to limit your body’s response to infection.

Scientists are currently investigating whether hydroxychloroquine may also offer some protective benefit against the coronavirus (COVID-19). Early studies in China have indicated that chloroquine (a similar anti-malarial historically used to treat lupus) has aided the recovery of patients infected with the virus. It is believed that the activity of hydroxychloroquine on viruses is probably the same as that of chloroquine since the mechanism of action of the two molecules is identical.

 

What precautions can I take to reduce my risk of contracting the virus?
There are some things that you can do to reduce your risk of catching viruses:

– Wash your hands with soap and water for 20 seconds. Use hand sanitiser gel (with at least 60 percent alcohol) if soap and water are not available. It is especially important to wash your hands more often.

1) when you get to work or arrive home
2) after you blow your nose, cough or sneeze
3) before you eat or handle food

– Try to avoid close contact with people who are unwell
– Do not touch your eyes, nose or mouth if your hands are not clean

 

Should I wear a face mask?
The British Lung Foundation says: “We do not recommend using a face mask to protect yourself as there isn’t enough evidence to show how effective they are. Also, for people living with a lung condition wearing a face mask can make breathing more difficult.”

 

Should I stop taking my lupus medication(s)?
It is advised that you DO NOT make any changes to your prescribed lupus medications in an attempt to reduce your risk of contracting the virus. It is important to remember that if your lupus becomes active then this may also increase your risk of picking up infection. If you are concerned that you have developed symptoms of the coronavirus then please take advice from your rheumatologist regarding what medication is safe to continue.

 

Should I still attend medical appointments?

If you have a scheduled medical appointment then it is important that you contact your hospital to check whether you should still attend.

The British Society for Rheumatology has advised clinicians to consider the feasibility of providing remote consultations and implement this where appropriate to reduce the need for patients to attend face-to-face appointments. This includes telephone clinics where your doctor or nurse specialist may call you rather than see you in the hospital clinic. Different hospitals are drawing up separate plans so it is important that you check what your local rheumatology department are doing before travelling to your appointment.

 

Do I need to stay home from work/school and avoid public places?
UK officials have announced that people aged over-70 or with significant health conditions (including lupus) should self-isolate for a period of 12 weeks. It is therefore advised to stay home from work/school and avoid public places. It is not necessary to stay permanently within the home during this period (i.e. you can go for a walk) but it is recommended that you avoid contact with others.

 

Do I need to avoid public places?
Following the emergency Cobra meeting on Friday 12th March 2020 additional measures on delaying the spread of the virus were announced.

It has been recommended that older people and those with pre-existing health conditions (including lupus) should not go on cruises.

UK officials announced that it is currently premature to advise people with underlying health conditions to take further preventative actions such as staying away from work, school and other public places. This guidance may change as the situation develops.

You only need to stay away from public places (self-isolate) if you have symptoms of coronavirus (COVID-19) infection, however mild, or have been advised to by the 111 online coronavirus service or a medical professional.

 

I have a holiday booked, should I still go?

UK officials have announced that people aged over-70 or with significant health conditions (including lupus) should self-isolate for a period of 12 weeks. If you have a holiday booked during this time, it would be recommended not to travel.

If you are planning on travelling overseas, it is important to be aware that some countries are currently a higher risk for the virus than others. You can get the most up-to-date advice for overseas travel HERE.

It is important to bear in mind that the situation is changing rapidly and you could be subject to delays in your return journey. For this reason it is essential that you take additional supplies of your medication away with you. Further advice about taking medication on holiday can be found in our article HERE.

 

What do I do if I suspect I have symptoms of coronavirus?
NHS 111 has an online coronavirus service that can tell you if you need medical help and advise you what to do.

Use this service if:
– You think you might have coronavirus
– You’ve recently been to a country or area with a high risk of coronavirus
– You’ve been in close contact with someone with coronavirus

USE THE 111 ONLINE CORONAVIRUS SERVICE

Getting help in Scotland, Wales or Northern Ireland
– Scotland: call your GP surgery or call 111 if your surgery is not open
– Wales: call 111 (if available in your area) or call 0845 46 47
– Northern Ireland: call 0300 200 7885

DO NOT go to a GP surgery, pharmacy or hospital. Call 111 if you need to speak to someone.

Also DO NOT make any changes to your prescribed lupus medications unless directed to do so by your lupus consultant.

If you have a new continuous cough OR a high temperature (37.8 degrees or higher), you should stay at home and self-isolate (see below) for at least 7 days from when your symptoms started.

If you or someone you live with presents with symptoms of the virus the entire household should self-isolate for at least 14 days.

If you are confirmed to have contracted coronavirus (COVID-19), you may be advised by your consultant to temporarily stop immunosuppressive medications until the infection has cleared. This should only be done in consultation with your rheumatology team.

You may also be advised to withdraw from anti-inflammatory medications (steroids and non-steroidal anti-inflammatories such as ibuprofen and naproxen) if you are confirmed to have contracted coronavirus (COVID-19) as they could increase the risk of complications from the virus. It is very important that you DO NOT stop your steroid dose suddenly. A reduction in oral steroids should always be under your doctor’s supervision.

How to self-isolate if you’re asked to
If there’s a chance you could have coronavirus, you may be asked to stay away from other people (self-isolate).

This means you should:
– Stay at home
– Not go to work, school or public places
– Not use public transport or taxis
– Ask friends, family members or delivery services to do errands for you
– Let your doctor or nurse specialist know if you are worried that you may run out of medication if self-isolating
– Try to avoid visitors to your home – it’s OK for friends, family or delivery drivers to drop off food

You may need to do this for up to 14 days to help reduce the possible spread of infection.

Read more coronavirus self-isolation advice HERE.

Mind have produced some excellent resources to help you look after your mental wellbeing if you do need to self-isolate. You can access this HERE.

 

Treatment for coronavirus
There is currently no specific treatment for coronavirus.

Antibiotics do not help, as they do not work against viruses. However, in some cases people can catch a bacterial chest infection along with the virus. If this is the case your doctor will recommend whether you need antibiotics for this.

Treatment aims to relieve the symptoms while your body fights the illness.

You’ll need to stay in isolation away from other people until you’ve recovered and are no longer a risk of infection.

 

Is there a vaccine for coronavirus?
At present, because this virus is so new and different it does not have a vaccine and needs its own to be developed. Researchers are trying to develop a vaccine and the World Health Organisation is supporting their efforts.

Vaccines against pneumonia do not provide protection against the coronavirus but they are still highly recommended to protect your health from other respiratory illnesses.

 

I need to talk to someone

LUPUS UK has services available for you to speak to someone else for support and non-medical advice;

Telephone Contacts

We have trained volunteers, called Contacts, who either have lupus themselves or have a family member with the disease. You can chat with our Contacts over the telephone. They are not medically trained but are there to offer both emotional and general support and signpost you to someone who can advise you. The telephone service is confidential, and you can disclose as much as you wish. The support service is free apart from the cost of the call.

To request details of your local contact CLICK HERE

HealthUnlocked Online Forum

The community is available for free to anybody affected by lupus to get information, support and advice from other people who are similarly affected. We welcome people with any form of lupus (SLE, discoid lupus, drug-induced lupus, cutaneous lupus etc.) as well as those with associated conditions such as mixed connective tissue disease (MCTD) and undifferentiated connective tissue disease (UCTD).
The community discusses a wide range of topics including; diagnosis, symptoms, medical appointments, medications and support available.
To join the forum CLICK HERE

Crisis Support

If you are in crisis, please call us on 01708 731251 or contact us by email at headoffice@lupusuk.org.uk

Further Reading
If you have more questions about the coronavirus, try reading:
NHS: answers to common questions about coronavirus

ACAS: Coronavirus – advice for employers and employees

BBC: Coronavirus – advice for people with health conditions

BSR: British Society for Rheumatology – COVID-19 coronavirus update for members

We are extremely grateful to Dr Chris Wincup (Senior Clinical Research Fellow at University College London) for his assistance in the production of this article.

 

 

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This article will be updated as new information and guidance becomes available.