Coronavirus and chronic illness
19 Mar 2020 • 13 comments
In view of the current SARS-Cov2 (coronavirus) epidemic, it is important to remember that patients suffering from chronic illnesses or cancers and people over the age of 70 are at greater risk of developing a serious form of the infection. On 16 March 2020, Public Health England (PHE) issued specific recommendations for these patients.
Which chronic diseases are most at risk?
According to PHE, 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 damage 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 problems with your spleen, such as sickle cell disease or you have had your spleen removed.
- 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 70. 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.
- Primary/congenital immunodeficiency (deficit in components of immune system present at birth)
- 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 haematopoietic stem cell transplant
- cancers of the blood or bone marrow such as leukaemia who are at any stage of treatment
- Pregnant women. For more information, we invite you to consult the recommendations of the Royal College of Obstetricians & Gynaecologists.
Your doctor has prescribed Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): what should you do?
At this time, the NHS finds that there is no strong evidence that ibuprofen can worsen coronavirus (COVID-19). However, until there is more information, it is advised to take paracetamol to treat any symptoms, unless otherwise indicated by your doctor. If you have been prescribed NSAIDS for your chronic condition, do not stop taking them without consulting your doctor by phone or tele-consultation first.
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, Crohn's and Colitis UK as well as other health organisations dedicated to immune system and inflammatory diseases 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 team who is treating you for your condition or of your GP. 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, phone your doctor or your medical team.
- Do not stop corticosteroids without seeking prior medical advice.
- If you have developed cancer, the Macmillan Cancer Support advises:
- Your clinician may want to review your treatment plans and evaluate whether the risks involved in any treatment have changed. This may lead to a conversation about a revised or modified treatment plan, as the risks and benefits of certain treatments may be different in light of the COVID-19 risk.
- Hospitals and clinics have started increasing telephone consultations to help people avoid unnecessary contact with others during waits in clinics and for treatment. You may be contacted to arrange your treatments in this way, and previously planned treatments may need to be rearranged to ensure smooth, continued service.
- In any case, your clinical team are the best placed to speak with you about a plan of action in this difficult time. If you have any concerns or questions about your treatment, please speak to your clinical team.
- If you experience COVID-19 symptoms, immediately contact your clinical team, the Acute Oncology Service at your treating hospital, or whatever number you were given by your team in case of emergency. The most crucial thing is to receive urgent medical advice.
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 NHS and PHE, the procedure is as follows:
- If you have symptoms (cough, fever) that make you think of Covid-19: you should stay at home for 7 days from when your symptoms start, avoid contact with others, do not go to a GP surgery, pharmacy, or hospital and instead contact your GP by phone.
- If your symptoms worsen with breathing difficulties and/or signs of choking, use the NHS 111 online coronavirus service. If you do not have internet access, call NHS 111. For a medical emergency dial 999 and inform the call handler or operator that you or your relative have coronavirus symptoms.
In these situations, do not use public transport, do not go in person to your GP, to A&E or to the service that usually monitors your autoimmune or inflammatory disease or your cancer.
How do I refill my prescriptions?
If you are self-isolating and cannot make it to the pharmacy yourself, ask family, friends and neighbours to assist you and use online services. If this is not possible, many members of the public, businesses and charities are preparing to help those who are vulnerable and advised to stay at home. It is important to speak with others and ask for their assistance in making arrangements for delivery of medicines, food and other essentials.
If you receive assistance from health and social care organisations through the local authority or health care system, this will continue as normal.
If you have run out of your prescribed medicines and wish to get an emergency supply: contact your prescriber. If this is not possible, use the NHS 111 online service or contact a pharmacist, he or she may be able to provide an emergency supply of up to 30 days' treatment, with a few exceptions.