– We’re here today totalk about coronavirus,or in this particular case, COVID-19. We’re gonna answer somefrequently asked questionsthat we’ve been getting from our patients. The CDC came out with guidelinesfor people at higher riskof getting very sick from the COVID-19. Should we consider peoplewith rheumatic diseasesto be at high risk?- So, there are several reasonswhy we might consider patientswith rheumatic diseaseto be at higher risk. Probably the most common reasonis that many of our patientstake immune suppressing medications. These medications could bein the form of biologic,injectable, or infusion medications,but also oral medicationsthat people take,that suppress their immune system,such as methotrexate,CellCept, or prednisone,all of these medicines workby suppressing the immune system,so that does place a patientat higher risk potentiallyfrom having complicationsof COVID-19 infection. Another reason that peoplecould be at higher riskis they could havecomplications of their diseasethat might involve their heart or lung,that would also place them at higher risk. So given those concerns,what precautions shouldour patients be taking?- One thing is to stock up on supplies. This would prevent you fromhaving to go out frequentlyinto the public, to get supplies. So if you could stock up on your supplies,and even your medications,to have about a one month extra supplyof medications if possible. You’re going to take youreveryday precautions,which includes good hand hygiene,of course, if you cough or sneeze,to cough into your elbow,to try to avoid touching your face,and some of these otherregular standard precautions. So you don’t wanna go someplacewhere there are going to belarge crowds, you reallywanna limit close contactwith other people, you wannabe cautious with your travel. Please avoid traveling on a cruise,and if you have anynonessential air travel,you may wanna considercanceling that as well. Should I stop my immunosuppressants,to help decrease my risk?- I think at this point,in an asymptomatic patient,we do not want patients as a general rulestopping their immunesuppressing medications. There are several reasonsfor that, the first reason isis that stopping themedications could precipitatea flare up of disease, andfor some of our patientsthese flare ups could be serious. And in some cases, may actually requiregoing on more immune suppressing medicinesthan you were to begin with if there to bea significant flare of the disease. We also know that patients whohave flare of their diseasemight be actually also athigher risk for infectionor infection complicationsif their disease is active. So for those reasons, wereally don’t recommendthat asymptomatic patients stoptheir immune suppressing medications. Symptomatic patientsare a different story,and we would like patientswho develop respiratoryinfection symptoms,particularly if there’sbeen a concern for exposure,to in conjunction with their provider,likely stop their immunesuppressing medications. Another reason patients should not stoptheir immune suppressing medicines,if they don’t have any symptomsof respiratory infection,would be that we don’t reallyknow the timing at this pointin terms of how long thatperiod of time might be,since we don’t know howthis virus is gonna behave. And if patients are off their medicationsfor a period of time,that increases the riskthat they might have a flare,and may reduce the efficacyof their medicationsonce they go back on them. – What should Ido if I develop symptomsof a respiratory illness,and I suspect I may havebeen exposed to COVID-19?- So, if a patient developsrespiratory symptomsthat are severe, meaninga patient has severeshortness of breath, or chest painthat requires emergent evaluation,we still suggest that patients call 911,and get those symptomsimmediately addressed. It is probably helpful thatyou would tell the paramedicsif there has been an exposure,or a concern of exposure to COVID-19,and tell the same thing to a 911 operator. If you have mild symptoms,we ask that you callyour physician, anddiscuss those symptoms,and whether you would stopyour immune suppressing medications,if you can stay at home, whatyou would need to do at hometo take care of yourself,and what symptomsyou should watch out for to seekadditional medical attention.