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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 asthmachronic 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 sclerosisrheumatoid arthritislupusHIV or AIDSvasculitis 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 arrive.

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COVID-19 vaccinations in patients with inflammatory bowel disease

Advances in the treatment of patients with inflammatory bowel disease (IBD) have substantially improved disease activity and quality of life, and reduced hospitalization rates and the need for surgery. However, prolonged immunosuppression in these patients can result in increased susceptibility to opportunistic infections. Many of these infections are preventable through vaccination and immunization strategies that should be undertaken as early as possible after diagnosis because the risk of opportunistic infections increases following the first year of immunosuppressive therapy.

The COVID-19 pandemic has led to substantial concerns for patients with IBD who are on immunosuppressive medications, many of whom are using additional protective measures. Although early COVID-19 studies have suggested that immunosuppressive medications are safe, robust and reproducible data are not available to adequately risk stratify patients with IBD, and current measures are mostly based on observational studies and theoretical risk.

 Large scale, prospective, population-based registry studies, and meta-analyses have identified key risk factors associated with a higher probability of mortality from COVID-19, including age, socioeconomic deprivation, diabetes, respiratory disease, obesity, and being from a Black, Asian, or other minority ethnic group.

One of the best ways to mitigate the risk of COVID-19 is the rapid development of safe and effective vaccines. Although initial phase 1/2 studies are promising,

 patients on immunosuppressant medications have largely been excluded from these studies, creating potential future concerns regarding the safety and generalisability of outcomes for individuals with IBD.

To achieve a sufficient degree of herd immunity, vaccination programs are primarily successful only when there are high rates of coverage and acceptance. The importance of patients with IBD being included in vaccine trials is compounded by the concern that these patients have a lower response to vaccinations and that vaccinations are generally underused in this population. Melmed and colleagues

 showed that in patients with IBD there was an uptake of only 22–46% for the influenza vaccination, and a mere 9% were vaccinated for pneumococcal pneumonia, despite both vaccines being recommended in the British and European IBD guidelines for vaccinating patients.

 A patient survey showed a perceived lack of benefit from a vaccination as the most frequent reason for low vaccine uptake, as well as concerns regarding side-effects, risk of disease flares, needle aversion, and inconvenience.

 However, in the present pandemic, both perception of risk and health awareness might be very different, with implications for vaccine acceptance.

In patients with IBD who were vaccinated against influenza, an immune response was induced, but the use of concomitant infliximab and immunomodulatory therapy were associated with inadequate rates of seroconversion.

 In adult populations vaccinated with the pneumococcal vaccine PSV-23, an impaired immune response was shown in patients with Crohn’s disease taking combination immunosuppressive therapy.

 Other vaccines such as those against hepatitis A and B virus, tetanus, and herpes zoster have also been shown to be potentially less effective in patients with IBD than in control groups.

The extent to which medications might affect vaccine response, independent of underlying disease activity, is unclear. Of note, concurrent anemia, which is a common finding in patients with active IBD, might impair response to vaccinations.

 There is therefore an urgent need for a better understanding of both the effectiveness of potential vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in patients with underlying health conditions, as well as the potential impact of effective disease control on rates of vaccine response.

Currently, the candidate vaccines in phase 3 trials include inactivated, mRNA, or vector-based approaches. The classic inactivated or live-attenuated vaccines raise safety concerns due to possible induction of the disease. However, the ChAdOx1 nCoV-19 trial vaccine uses a replication-deficient chimpanzee adenovirus to deliver a SARS-CoV-2 protein to induce a protective immune response. This vaccine seems to be promising for patients with IBD because adenovirus vectors do not integrate the viral genomic DNA into the host’s genome, are highly immunogenic, and can induce robust innate and adaptive immune responses. The same adenovirus vaccine platform is also being assessed for use against malaria, HIV, influenza, and the Ebola virus.

 Nevertheless, the phase 1/2 trials of the ChAdOx1 nCoV-19 vaccine were done on young, healthy volunteers and as such do not address the potential immunity concerns in patients with chronic diseases or those on immunosuppressants.

 Moreover, we cannot assume that data on one vaccine type in a specific group of people can be extrapolated to other vaccine types.

There needs to be a stronger emphasis on vaccinating patients with IBD within the broader health-care preventative scheme. These factors must be considered when policymakers and national health services start to design and develop future COVID-19 vaccination programs. Equitable access to COVID-19 vaccination programs should be endorsed. If this is not feasible, then we propose that future community vaccination programs support and promote vaccines that can be used by the high-risk cohort of patients with IBD.

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stay safe

Having been under virtual house arrest for some time, it’s easy to get carried away with the excitement of a short break, post Covid-19. You’re taking in new sights, sounds, smells and tastes. It’s an adventure for the soul. But rich foods and drinks, lack of exercise and the stress of travel, particularly with young children, can take a toll on your health. To avoid paying for it later on, take a few steps to remain healthy.

REMEMBER TO GET ENOUGH SLEEP

A holiday after such a stressful period for everyone might be much welcomed, but don’t neglect your sleep patterns. Aim for six to nine hours a night and take a short nap in the afternoon if you need it.

WASH YOUR HANDS OFTEN

Stop germs in their tracks. Remember: wet, lather, scrub, rinse, and dry. This isn’t just good advice in a pandemic, it’s important every single day of your life. Practice it frequently throughout the day to prevent spread of diarrhea and respiratory disease, too. PACK SMART While it’s great to finally be free to enjoy a break, beware of the holiday cheer. Many hotels offer complimentary drinks, snacks or cakes. The result can be hard on your system. Pack Udo’s Choice Ultimate Digestive Enzyme Blend, to aid your digestion. A unique blend of seven plant-based digestive enzymes assist in the breakdown of proteins, fats, carbohydrates and fibre. Udo’s Choice Super 8 Microbiotic is a hi-count microbiotic blend that contains eight strains of lacto and bifido bacteria. Each daily capsule contains 42 billion ‘friendly’ bacteria. Both products can be found in your local health food store or pharmacy.

ALWAYS KEEP HYDRATED

Drink lots of water. Spending hours travelling can dehydrate you. Carry a large bottle of water to have throughout your journey, and pack Manuka Lozenges with vitamin C for an added immune boost and try to choose caffeine free drinks throughout the day.

EAT FISH

If you’re staying by the sea, eat lots of fresh grilled fish. Oily fish –including sardines, fresh tuna, salmon and mackerel – is particularly good as it’s rich in Omega 3, which keeps your skin hydrated and encourages healthy digestion as well as weight loss. Try to eat a variety of different coloured fruits and vegetables – oranges, red peppers, green courgettes, yellow sweet corn – to get a wide range of antioxidants.

PROTECT FROM THE SUN

Lying in the sunshine feels great but you only need 10 minutes of unprotected sun to get your daily dose of vitamin D. After that you should use sunblock. As we get older, the collagen in our skin breaks down more rapidly, leading to lines, wrinkles and discolouring. To prevent the breaking down of collagen, eat lots of purple fruits, such as fresh blackberries, blueberries and black grapes.

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