Coronavirus and Arthritis: What You Need to Know
Please check back regularly. We will stay in touch with the top experts and give you updates on this quick moving story, with a focus on what people with suppressed immune systems need to know.
Updated May 28, 2020
Q: What’s a coronavirus?
Q: How does the virus spread?
A: Like colds and seasonal flu, the new coronavirus spreads through the droplets expelled when an infected person coughs or sneezes. The droplets are loaded with the virus and can land in the eyes or mouth or be inhaled into the lungs of anyone nearby. Droplets can also land on surfaces and live there for several hours or sometimes for days. When people touch a contaminated surface like a doorknob or keypad and then touch their eyes, nose or mouth, they can transfer the virus into their body. Once inside, the virus can replicate and eventually cause symptoms.
People can spread the virus for several days before they develop symptoms, and some people can spread the virus but never develop symptoms. These are the reasons why the essential prevention measures are social distancing, thorough and frequent handwashing and not touching your face.
Q: How contagious is the virus?
But the data that goes into that calculation keeps changing, and there are various ways to do the calculation, which means right now there is not one agreed-upon answer. However, a February 2020 review in the Journal of Travel Medicine found that overall, most scientists’ estimates are around 3 R0, with some being higher and some lower. That means one person can infect three others, a transmission rate far higher than the seasonal flu, with significant consequences. The number of people infected grows exponentially. The 3 R0 will likely change as more reliable data is gathered and lead to greater consensus.
Until then, the best advice is still thorough and frequent handwashing and social distancing. See below for more guidance on infection prevention.
Q: How deadly is the virus?
A: It’s hard to say exactly. Fatality rate relies on comparing the number of people infected to the number of those people who die. When people with mild disease are undercounted, the virus can look more lethal than it is. That’s one reason reported fatality rates vary from place to place and are adjusted, usually lower, over time as more testing is done.
Still, when you look across all the data to date, says Kevin Winthrop, MD, a specialist in infectious disease epidemiology at Oregon Health & Science University, you get a likely estimate that COVID-19 is as much as 10 times more lethal than influenza. And that rate is certainly greater among high-risk groups, such as the elderly, he adds.
Q: Who’s at risk for serious COVID illness or complications?
A: The CDC early on identified older people and those with underlying medical conditions as being at high risk for severe illness. The list was recently updated to reflect the latest information. It specifically notes that people of any age who have a serious medical condition are at risk. New to the list: people who are immunocompromised and taking “immune weakening medications.” Other conditions listed are diabetes, chronic lung disease, moderate to severe asthma, serious heart conditions, being a smoker, severe obesity, chronic kidney disease on dialysis and liver disease.
We asked Michael George, MD, a rheumatologist and epidemiologist at the University of Pennsylvania in Philadelphia who studies infections in patients with autoimmune disease, whether people with inflammatory arthritis are in that high-risk category. He says it likely applies especially to people with more severe inflammatory arthritis, people who have been hospitalized in the past with a respiratory infection, or people with have interstitial lung disease, COPD, asthma, or other medical problems. People treated with medications that suppress the immune system may also be at higher risk, but exactly how much these medications contribute to risk is not known. Patients with milder, well controlled disease who are not on immune-suppressing medications may not be at much greater risk than other people. (See question about risk of taking immunosuppressant drugs.)
All people, including those with osteoarthritis or non-autoimmune types of arthritis, who have risk factors should follow the CDC guidance on infection prevention measures, particularly social distancing, avoiding crowds and staying at home as much as possible. And, Dr. George adds, “everyone should follow the general precautions,” such as handwashing and not touching your face, eyes, nose or mouth.
Infection Risk and Prevention
Q: I am wondering if any of the vaccines in development for COVID-19 are likely to be OK for someone with autoimmune arthritis or on immunosuppressant medications?
The key issue is whether the eventual vaccine will be a live virus vaccine or a killed, or inactivated, vaccine. Live virus vaccines pose a potential risk for immunosuppressed people. It’s possible that a patient would get the very infection, though perhaps a mild version, that the vaccine is intended to prevent. That’s why a killed virus vaccine is almost always preferable.
We will have to know if the eventual vaccine will work in people with disordered immune systems. Whether due to the disease itself or immunosuppressant treatments, vaccines usually work less well in patients with RA, lupus, etc. Methotrexate, glucocorticoids like prednisone, and certain biologics or targeted therapies may -- or may not -- reduce vaccine response and duration of the benefit.
And, of course, a primary concern is making sure that the vaccine is safe. Anything that provokes the immune system -- as a vaccine must, in order for it to work – may cause a disease flare.
Q: Am I more likely to catch COVID-19 if I have autoimmune or inflammatory arthritis?
For COVID-19 and seasonal flu, we do know that older adults and those with pre-existing health problems – especially cardiovascular disease, diabetes and high blood pressure – and those who have been hospitalized before with infections are most at risk.
The experts emphasize that one of the main concerns for people with autoimmune disease who contract seasonal flu or COVID-19 is secondary bacterial infection, or complications, that may follow the original viral infection.
For these reasons, it’s important to call your doctor right away if you think you’ve been exposed or are experiencing flu-like symptoms. Be sure to state that you are taking immune-suppressing drugs. (Read more below on immunosuppressant drugs and risk.)
Q: How can I protect myself?
A: Don’t panic, but do take steps to protect yourself and others. Here’s how:
- Wash your hands often. We can’t stress this enough. Wet your hands with clean, running water, then lather them with soap. Scrub both sides, between your fingers and under your nails for at least 20 seconds – about as long as it takes to sing the alphabet song twice. Be thorough, and follow the WHO technique
- Stay at home (as much as possible) and avoid close contact with others. The CDC recommends that everyone – especially older people over 60 years old and those with severe chronic medical conditions – stay at home if possible, maintain at least 6 feet (two arm lengths) from others and avoid anyone who appears sick. Practicing social distancing means avoiding crowded places. Even though you may encounter less people at grocery stores, pharmacies, and food takeout counters, be extra vigilant. Also, try to telecommute for work.
- Wear a mask when venturing out. New recommendations from the CDC call for all individuals to wear masks that cover both the mouth and nose when in public settings where social distancing (remaining at least 6 feet from people who are not in your household) can prove difficult, like the grocery store. While a mask may not protect an individual from being exposed to COVID-19, it can prevent them from spreading it to others if they are infected – even those who do not have symptoms. There are many ways to make your own mask at home, beyond a simple cotton bandana. The thicker the material, the more effective it will be. Double, even quadruple layers of cloth materials, such as the bottom portion of cotton T-shirts or blue shop towels (available at automotive stores) or use high thread count cotton (quilting fabric). A snug fit around the mouth, nose and sides of the face and straps around the ears are key. When removing the mask, do not grab the front, which is more likely to have been exposed to the virus. Remove the mask from the ears loops. Throw it away if it is disposable or immediately toss it in the washing machine. To learn how to make a homemade mask, visit the CDC’s tutorial page.
- Use hand sanitizers on the go. Do not rely on them, but when soap and water aren’t an option, use a hand sanitizer that contains at least 60% alcohol. Keep a bottle in the car, at your desk and in your purse or pocket. Allow your hands to fully dry after each application.
- Forgo physical contact with anyone outside your home. Skip handshakes, hugs, high-fives and fist, elbow, and foot bumps. Offer a wave or air high-five instead.
- Disinfect surfaces regularly. Clean high-touch surfaces like countertops, light switches, doorknobs, and the inside of your car with disinfectant. Use a mixture of 60% isopropyl alcohol and 40% water to kill germs on high-touch objects and surfaces, like your cell phone, computer keyboard, remote, doorknobs and faucets. Wash eyeglasses with soap and warm water every day.
- Cover your mouth and nose when you cough or sneeze. Throw away all your used tissues immediately.
- Call ahead. If you have cold or flu symptoms call your doctor instead of rushing to urgent care or the emergency department. If you don’t have a doctor and are sick enough to need emergency care, call ahead and let the hospital know you’re on the way.
- Keep up to date with reliable sources. Check back with us regularly for updates, and follow major news outlets and health authorities, such as the Centers for Disease Control (CDC) or World Health Organization (WHO).
Q: Can I catch COVID-19 from my pet?
Q: Are there any vitamins or minerals I can take to protect against COVID-19?
Vitamin D: Vitamin D, commonly known for its role in bone health, also helps make proteins that kill viruses and bacteria, especially in the respiratory tract. Your doctor may recommend specific dosages but, in general, Tod Cooperman, MD, president of the independent supplement testing company, Consumerlab.com, recommends 2,000 IU (50 mcg) of vitamin D a day, preferably in liquid form. Some people with rheumatoid arthritis, lupus and other autoimmune diseases may need higher dosages.
Vitamin C: Research is mixed on Vitamin C for common colds. Some studies suggest that taking 500 mg twice daily can help prevent but not cure colds. Other research has found it may not prevent viral respiratory infections but can speed recovery. Not in dispute: Vitamin C is vital for the function of certain white blood cells that help fight infections – and you need a lot more when you’re sick. (A daily dose of 2,000 mg or more could cause diarrhea.)
Zinc: Decades of research have shown that zinc lozenges can shorten colds by 20% to 40%. And researchers are taking a closer look at zinc for COVID-19, as it may possibly prevent the virus from multiplying in your nose and pharynx. Zinc works best if you start it at the first sign of symptoms. Consumerlab.com recommends taking a lozenge containing 13 mg to 23 mg zinc every two hours throughout the day for no more than a week if you have a cold; those without symptoms may not see any benefit. Your doctor may give different instructions. However, too much zinc can undermine your immune response, and avoid zinc nasal spray, which has been linked to loss of smell.
Polyphenols: Thousands of polyphenols are found naturally in most fruits and vegetables as well as coffee beans, cocoa, nuts, green tea and extra virgin olive oil. In lab (not human) studies, they’ve been found to kill coronaviruses. One polyphenol – quercetin – proved especially effective against infections like COVID-19. In human research, polyphenols from green tea and blueberries helped prevent viral respiratory infections in athletes. You can buy polyphenol supplements or specific types, such as quercetin, but it’s not known what type or dose might be effective against the new coronavirus.
Potassium: This mineral won’t prevent COVID-19 but could play a role in treating it; the new coronavirus causes low potassium levels. If you have mild respiratory symptoms, potassium probably won’t help. Still, only about 2% of American adults get enough. Supplements can be dangerous for certain groups, including those with kidney or heart disease and those who take particular blood pressure medications. Instead, get your potassium from foods, such as potatoes, lentils, beans, squash and dried fruit.
Probiotics: There’s evidence in both animals and humans that probiotics containing Bifidobacterium and Lactobacillus strains can improve your immune response to viruses and reduce the severity and duration of respiratory infections. You can find probiotics in certain fermented foods, but supplements are probably the best way to get the amount needed to fight infections. Many probiotics are heat-sensitive and should be refrigerated, both at home and in the store where you buy them. Look for brands that have been independently tested by a third party for purity and potency.
To read the complete article on using supplements to help support your immune system, click here.
Q: What additional measures can people with autoimmune conditions take to protect themselves during COVD-19 outbreak?
Although investigations are underway in numerous countries to find out whether people who are immunosuppressed as a result of their disease or medications to treat it are at higher risk, not enough information is available yet to say for sure. People with autoimmune conditions – as well as others in their households – should be especially compliant with CDC recommendations: frequent hand washing, wearing masks in public and social distancing. People who have lung disease (such as those with RA-related lung disease) are thought to be more vulnerable. It isn’t clear whether immunosuppressant medications also raise the risk; some (such as hydroxychloroquine, anakinra and tocilizumab) might even be protective.
Most people should continue their immunosuppressant medications if their disease is well controlled and they do not have any symptoms of COVID-19 or other respiratory illness. Depending on a patient’s other medical conditions, medications and exposure risk, their doctor may suggest delaying their infusions or lab tests.
If you do have symptoms of COVID-19, such as a dry cough or difficulty breathing, call your doctor right away – he may want you to stop certain medications. “This will vary by the autoimmune condition, your symptom severity, and the specific medications you take,” advises Timothy Niewold, MD, Judith and Stewart Colton Professor of Medicine, professor of pathology, and director of the Colton Center for Autoimmunity at NYU Langone Health in New York City.
It's also important that patients with autoimmune conditions maintain their overall health, which includes staying physically active, eating and sleeping well, and managing stress. Online classes, workshops and apps may help. “There are so many opportunities for patients to engage with yoga or tai chi lessons online, and this has been recommended to help with pain and stiffness,” says John Miller, MD, Division of Rheumatology, Johns Hopkins University School of Medicine in Baltimore. “Mindfulness is also so important in a time of so much stress and uncertainty.” Practice healthy habits daily to help maintain your health and control arthritis symptoms.
Q: What are the best ways to clean or disinfect a cloth/fabric face mask?
According to CDC guidelines, cloth and fabric face masks:
- Should be removed at the ear loops, without touching your face, mouth or eyes. Hands should be washed immediately after removing the mask.
- Should be washed regularly depending on how often they are used.
- Can be washed in the washing machine.
- Wash all face masks with hot water in the washing machine and tumble dry on high heat.
- Handsewn masks made of more delicate material may need to be handwashed by lathering with soap and scrubbing for at least 20 seconds with warm to hot water before putting in the dryer.
Q: In case I get sick with COVID-19, can I be treated with remdesivir?
Studies on its effectiveness have been mixed. It may shorten the course of COVID-19, but at this point very little is known about the potential benefits or risks, when to use or in which patients. There is no guidance about use in patients with autoimmune disease.
Any patient who has impaired liver or kidney function is not considered a good candidate for the treatment unless the potential benefit outweighs the potential risk.
The decision of whether to treat COVID-19 with remdesivir depends on the judgment of the physician and treatment team and is based on individual situations. When possible, the decision should be made in consultation with the patient or caregiver.
Q: Am I at extra risk because I take immune suppressing medications?
The concern with immune suppression is that the virus could replicate more freely and cause more severe or extensive disease, says Dr. Winthrop. For this reason, it’s important if you are taking these medications to contact your doctor right away if you think you’ve been exposed or are experiencing flu-like symptoms. (See question addressing symptoms.) Be sure to state that you are taking immune-suppressing drugs.
Experts warn patients not to stop or change dosage of medication without calling their doctors.
Q: I take hydroxychloroquine (Plaquenil) and heard about a shortage. What should I do if I can’t get a refill?
A: Because there is keen interest in hydroxychloroquine as a COVID-19 treatment, it is suddenly in high demand, which has created a widespread shortage. This has left many people with arthritis unable to refill their prescription. If this happens to you, here’s what you can do:
- If you are due for a refill, don’t wait until the last minute.
- If your refill is for 30 days, ask your doctor for a 90-day supply to give you a cushion in case it’s difficult to find later.
- If your pharmacy can’t fill a full 90-day prescription due to short supply, see if you can take what’s available now and be contacted as soon as new stock comes in.
- Be sure to tell your pharmacist the reason you are taking the medication. Some states give pharmacists the discretion to decide which prescriptions to prioritize, if, for example, stock is low.
See what the Arthritis Foundation is doing to ensure that there is enough hydroxychloroquine available for the people who depend on this drug. Outreach to congressional leader and a joint letter to the coronavirus task force leadership and a broad range of stakeholders nationwide
Q: Should I continue to get my arthritis treatment at an infusion center?
A: The goal is to continue to get your biologic infusion on schedule, as long as you don’t have a concurrent infection. You don’t want a disease flare, says Andrew J. Laster, MD, a rheumatologist in Charlotte, North Carolina. Call ahead to ask about new processes that enhance safety. At his clinic, staff screens patients with a questionnaire and take their temperature before they enter. Patients are asked about recent travel to China, Italy, Iran or other countries with high infection rates and if they currently have fever and symptoms of a respiratory infection such as cough and/or shortness of breath or if they have experienced these symptoms within the last 14 days. Dr. Laster says that an extra safety feature at his clinic is the distance between infusion chairs. It’s best for patients to be seated at least 6 feet apart. Staff should sanitize chairs between patients. Consider, too, other safety issues related to getting your infusion. For example, how do you get to the clinic? Are you taking public transportation? If it’s crowded, can you find an alternative? But bottom line is that you want to find a way to continue your medication.
See Safety Tips for an Upcoming Infusion Appointment.
Q: I heard NSAIDs can worsen the coronavirus? Should I stop taking my NSAID now, just in case I get sick?
A: News outlets in the U.S. have reported that France’s health minister recommended against using NSAIDs (such as ibuprofen or naproxen) in those who have coronavirus. A leading U.S. expert in NSAIDs and cardiovascular risk, Daniel Solomon, MD, says there is no clear evidence of adverse effects related to NSAIDs and the coronavirus.
Nor do NSAIDs appear to increase your risk of catching COVID-19. “Some health authorities have suggested that NSAIDs (such as ibuprofen or naproxen) might make people more susceptible to COVID. There [is] no direct evidence supporting this suggestion,” says Dr. Solomon, a rheumatologist at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School.
Because of that, “I recommend that my patients who need these drugs for analgesia [pain relief] continue NSAIDs,” he says.
Michael George, MD, a rheumatologist and assistant professor of medicine and epidemiology at the University of Pennsylvania, in Philadelphia, agrees it’s OK to stay on NSAIDs if you’re not feeling sick. In a coronavirus discussion with patients in on the Arthritis Foundation’s LiveYes! Online Community, he writes, “This has received a lot of attention. I haven’t seen any evidence. This is all based on hypothetical concerns…. I do not think that NSAIDs need to be stopped in people who are feeling well.”
But Dr. George adds, “It is controversial on what to do if you develop COVID-19. I would start off by taking Tylenol [acetaminophen] to treat a fever. If you take NSAIDs for your arthritis, though, and you develop COVID-19, you should ask your doctor about their opinion.”
Daniel Solomon, MD, is a member of the Arthritis Foundation’s Medical and Scientific Advisory Committee.
Listen to conversation with Michael George, MD, on our Live Yes! With Arthritis podcast.
Read more about NSAIDs and the coronavirus from the FDA.
Q: Is it possible that there will be a shortage of DMARDs or biologics used for arthritis?
Here are summary statements regarding medication supply from the following manufacturers:
Abbvie: (Humira), (RINVOQ)
We are continuing to closely monitor manufacturing and supply chain resources around the world to help ensure our patients continue to receive their medicines. We do not anticipate any disruption to our medicine supply for patients as a result of COVID-19. For more information: https://www.abbvie.com/coronavirus.html
Amgen: (Enbrel)(Evenity) (Prolia)
Amgen continues to provide an uninterrupted supply of medicines for patients around the world and we do not currently anticipate a shortage of our medicines due to COVID-19. For more information: https://www.amgen.com/covid-19/
Bristol Myers Squibb: (Orencia)
At this time, we do not anticipate disruptions to the supply of our medicines for patients due to COVID-19. All of our manufacturing sites worldwide are continuing to manufacture medicines for our patients. We continue to diligently monitor our manufacturing and supply facilities across the globe, including in areas that have seen a greater impact. For more information:https://www.bms.com/about-us/responsibility/coronavirus-updates.html
Genentech: (Actemra), (Rituxan)
Though we are not currently experiencing supply issues for our portfolio of medicines related to the global COVID-19 pandemic, we are closely monitoring and responding to the evolving situation. We have robust business continuity and mitigation strategies in place and we're working closely with health authorities; federal, state and local governments; and distribution partners to manage inventory levels equitably and best meet the needs of patients. For more information:
We have taken a number of measures to support supply of our products, including: prioritizing medically critical products; building capacity to respond faster to unpredictable demand in some of our key consumer healthcare products; and working with logistics service providers to find alternative distribution routes. We are experiencing some delays with distribution and delivery of our products to customers as countries around the world introduce different virus containment measures, such as border closures and flight suspensions. Our focus is to avoid or minimize any potential delivery delays or disruptions, closely monitor what is happening and keep our customers informed. For more information: https://www.gsk.com/en-gb/media/resource-centre/our-contribution-to-the-fight-against-2019-ncov/
Janssen/Johnson and Johnson: (Remicade), (Simponi) (Stelara)
Johnson & Johnson has robust business continuity plans in place across its global supply chain network to prepare for unforeseen events like the coronavirus outbreak. These steps include maintaining critical inventory at major distribution centers away from high-risk areas and working with external suppliers to support our preparedness plans. We are closely monitoring product demand and supply levels across our global network to ensure adequate and effective distribution, and working diligently to meet patient, customer and consumer need. For more information:
Eli Lilly: (Taltz)
Lilly does not currently anticipate shortages for any of our medicines, Globally, our manufacturing network is operational and taking steps to prevent impact. We're also in close communication with key suppliers regarding supplies of raw materials. As the global situation evolves, we will continue to take the steps necessary to safeguard the reliable supply of our medicines. Lilly has a global monitoring system that allows us to be in the best position to determine the necessary supply of medicines to meet our obligation to patients and health care providers in each country For more information:
While supply and demand vary by product, there are not any current impacts from COVID-19 on the production and supply of our medicines and vaccines for the U.S. However, we are working to assess an increase in demand for our pneumococcal vaccine. As communities around our manufacturing facilities are impacted by various social distancing measures implemented by authorities, we will assess the impact of reduced staffing levels on our supply chains. For more information:
Novartis: (Cosentyx) (Ilaris)
Currently, all Novartis manufacturing sites as well as our major suppliers are operational. At this time, we are confident that our stock is sufficient to cover production/ distribution needs. Furthermore, we do not currently anticipate any major supply chain disruption due to the coronavirus outbreak. For more information: https://www.novartis.com/news/coronavirus-disease-covid-19-update
Pfizer: (Celebrex), (Inflectra), (Lyrica), (Xeljanz)
Our manufacturing and supply chain professionals have been working non-stop to ensure that the global supply of Pfizer medicines continue to be available to patients. As of now, we have not seen a disruption in our supply chain, and all of our plants in impacted areas around the world are operational. We have implemented an unprecedented and comprehensive preparedness plan to control our site operations and will continue to provide timely updates if there is any new information to be shared.
For more: https://www.pfizer.com/health/coronavirus
As of today, we are working to maintain the supply of all our medicines and vaccines, critical for patients with other illnesses and to maintain public health, through close collaboration with our suppliers throughout the world. Our global industrial network is operational, including France, China and Italy, and the diversity of our sourcing allows for business continuity across all our medicines for the time being.For latest update from Sanofi on coronavirus:
NOTE: Sobi does not have an official statement about potential shortage of Kineret. If you have a question about your medication: Call: 781.786.7370
Despite the rapid emergence of the novel coronavirus and the challenge presented to healthcare systems around the globe, UCB has not experienced shortages for any of our products due to this epidemic. Our global manufacturing and distribution network continues to be fully operational and UCB remains in constant contact with our global network of key suppliers, manufacturing partners, and distributors to identify potential risks and take appropriate measures to avoid any disruption. At this time, we do not anticipate any supply disruption of our products. For more information: https://www.ucb.com
Q: Should I stop or reduce my arthritis medicine? I’m still healthy, not infected, or at least I don’t have any symptoms.
A: The short answer is “no,” says Daniel Solomon, MD, a rheumatologist at Brigham and Women’s Hospital in Boston and professor of medicine at Harvard Medical School. Immunosuppressive medication is used to keep patients’ immune systems in check, allowing them to function while minimizing pain and disability. "Stopping immunosuppressive medications puts patients at risks for a disease flare, with worsening symptoms and potential for joint damage," he says.
If patients get sick with COVID-19 (or any infectious illness), your doctor may limit or stop your immunosuppressive therapy. However, glucocorticoid dosages should not be suddenly stopped without a gradual taper. “Stopping those drugs during the acute illness makes sense,” he says, but not stopping when you are healthy, “just in case” you get sick.
Some reports have suggested that NSAIDs (such as ibuprofen or naproxen) might make people more susceptible to COVID-19. He says there is no direct evidence supporting this suggestion. I recommend that my patients who need these drugs for analgesia continue NSAIDs, he says. If they develop a flu-like illness, acetaminophen is good to reduce fevers.
Daniel Solomon, MD, is a member of the Arthritis Foundation’s Medical and Scientific Advisory Committee.
Q: Is hydroxychloroquine approved to treat COVID-19?
A: Hydroxychloroquine or chloroquine are not FDA-approved to treat COVID-19.
These medications are FDA-approved to prevent or treat malaria and some autoimmune conditions such as rheumatoid arthritis and two types of lupus: chronic discoid lupus erythematosus and systemic lupus erythematosus (in adults only).
The FDA has issued a warning against the use of hydroxycholoroquine or chloroquine for COVID-19 unless they are used within a hospital setting or a clinical trial due to the risk of heart rhythm problems.
Symptoms and Exposure
Q: What are the symptoms of COVID-19?
A: The CDC continues to provide updates on new COVID-19 symptoms. They have added the following to the list: chills, repeated shaking with chills and new loss of taste.
COVID-10 symptoms tend to show up from two to 14 days after infection. Most people – about 80% or more – have mild symptoms; some of the others can develop severe pneumonia and become critically ill.
Knowing that the disease can show up in many ways helps you know when to contact your doctor. The following symptoms have been reported previously:
- No symptoms: The first thing to know is that people who are infected can feel fine. They aren’t sick (at least, not yet), but they can still spread the virus to others – some of whom will get sick, maybe very sick. Very rough estimates are that up to 25% and possibly as many as 50% of individuals who are infected with COVID-19 will have no symptoms. That’s why the CDC recommends that everyone wear a face covering (mask, bandana, etc.) when going out in public so that people who are infected but have no symptoms are less likely to unknowingly infect others.
- Fever: Fewer than half of people have fever at onset, but almost everyone who was hospitalized in China early in the outbreak had fever at some time over the course of the disease. The fever may be low, just over 100 degrees in many cases, or spike to over 102 degrees.
- Dry or non-productive cough: Usually followed by shortness of breath.
- Shortness of breath: May be severe in some and mild in others.
- Loss of smell: Reports are that this occurs in about 60% of people.This is specific to COVID-19; it doesn’t happen commonly with influenza or other viruses.
- Fatigue: Varies in intensity and may come and go.
- Headache: Some describe the pain as the worst headache ever, while others have mild pain.
- Muscle pain: There may be an overall deep achiness that is uncomfortable.
- Nausea and vomiting
- Sore throat
- Conjunctivitis (“pink eye”)
- Nasal stuffiness or runny nose
- Skin rashes
- Swollen glands
If you are feeling sick, be sure to tell your doctor about all of your symptoms. If your symptoms are mild and manageable, you will probably be told to isolate yourself at home, stay hydrated and take care of yourself. If your symptoms become severe, your doctor may advise urgent care.
If you are interested in tracking your symptoms to help researchers understand how this new coronavirus is affecting people, you can download the Covid-19 Symptom Tracker app for iPhone.
Q: What should I do if I think I have this new coronavirus?
Your doctor can also help you decide how to manage your illness. If you have a mild illness your doctor will likely recommend that you rest, drink liquids, take acetaminophen (Tylenol) for fever, and stay isolated from others in your household. If you have a more severe illness you might be sent to the hospital to be monitored for complications such as pneumonia.
Q: If I am infected, is my family at risk?
Q: If I have already been infected with COVID-19 virus and recovered, can I get re-infected?
A: Someone who has been infected with a virus will have antibodies to that virus. Sometimes those antibodies provide an ongoing immunity so that re-infection does not occur. Sometimes that immunity lasts only for a period of time before re-infection can occur. According to the CDC, there’s not enough information to determine yet if having antibodies to SARS-CoV-2 is fully protective or makes someone less likely to get infected with the virus again. Over time and with ongoing testing, researchers will know more. The World Health Organization reports that “we expect that most people who are infected with COVID-10 will develop an antibody response that will provide some level of protection.”
Q: Should I take an antibody test so I’ll know if I’m immune to COVID-19?
Antibody tests are different than diagnostic, or viral, tests. A diagnostic test, usually done by nasal swab, identifies the presence of live virus, which indicates an active COVID-19 infection, whereas an antibody test confirms the presence of antibodies to the virus, indicating a past infection, at least one to three weeks ago.
Antibodies are proteins that result from the immune system’s fight against a virus. Those antibodies are what protect people from future infection with that virus. With this new coronavirus no one knows yet how long immunity might last. The CDC says the presence of antibodies cannot be used to assess immunity.
While the FDA has begun requiring companies that market antibody tests to demonstrate reliability of results, studies report that up to half of available tests may not provide valid results.
If you are interested in taking an antibody test, talk to your doctor first to assess the potential value in your situation.
Q: What’s the difference between testing for a COVID-19 infection vs antibodies?
A: To test for a COVID-19 infection, a sample is taken from the inside of the nose or mouth using a swab. The sample is sent to a testing site or lab to determine if you are infected with SARS-CoV-2, the virus that causes COVID-19.
The antibody test is a blood test. Also called a serological test, it checks the blood for antibodies that show up if you have had a previous infection. The body releases antibodies (blood proteins) to help fight off germs. If you have a current infection, it may take 1 to 3 weeks before your body makes antibodies. Talk to your doctor before getting an antibody test to ensure that it’s provided by a reputable company. There are reports that many tests currently available provide inaccurate results.
Q: Who can get tested for coronavirus?
Until testing is more widely available and the shortage of protective gear and supplies eases up, authorities are asking that only high-risk people and the sickest patients get tested.
Generally, to qualify for testing, you will have to have symptoms compatible with COVID-19: a fever, cough, shortness of breath and possibly gastrointestinal issues. (The CDC has a Coronavirus Self-Checker. If you have symptoms of COVID-19, contact your doctor or your local public health department to find out if you qualify for testing, what type of facility is available near you, and what steps you should take to prevent infecting others when going to get tested. Some cities/counties have already set up drive through options.
Q: What should I expect during the test?
Q: What should I do if I test positive for COVID-19?
Be sure your rheumatologist is aware, too. If you take immunosuppressant drugs, your doctor may recommend you stop or change dose, depending on the medicine(s) you take. Limited data has shown that some medications used to treat autoimmune types of arthritis may increase your risk for a more severe disease course. Do not stop or change your medication dose without your doctor’s guidance, especially if you take a corticosteroid, such as prednisolone.
Older adults and those with severe underlying chronic medical conditions (see the list in question about risk, above) appear to be at higher risk for developing more serious complications. If that’s you, don’t wait to contact your doctor even if your illness is mild.
If you have severe symptoms, such as trouble breathing or persistent pain/pressure in the chest, you may need emergency care. Call ahead to alert your doctor or the hospital. If you need urgent care or do not have transportation, call 911.
Juvenile Arthritis FAQs
Q: Can my child take remdesivir in case of COVID-19 illness?
Children who are hospitalized with severe illness due to COVID-19 may be considered for treatment with the antiviral drug remdesivir within a clinical trial or on a case-by-case basis. The drug is not
FDA-approved but has been granted emergency use authorization by the FDA.
Little is known about the drug’s potential benefits and potential risks, so it would be used in children only after careful consideration by the treatment team and discussion with caregivers. There is no guidance about use specifically in children with rheumatic disease.
Q: Should I have my child, who has JIA, take an antibody test to check for immunity to COVID-19?
There is another catch to antibody tests. Even tests that are FDA-approved may not produce reliable results. At this point, a lot more research is needed before these tests will be useful to individual patients. Over time, knowledge will increase, and tests improve. Your son’s doctor will be the best source of advice on the value of testing.
Q: There is a new childhood illness related to COVID-19 that looks like Kawasaki disease. What do experts know?
Q: Is my child considered "high-risk" for COVID-19 infection or complications?
A: We don't know yet. At this point we know very little about patients with rheumatic diseases who develop COVID-19. Past experience with flu and other infections would suggest that children and adults on immunosuppressive medications are at higher risk for infection and complications but that may not be the case with this virus.
The good news is there are case reports suggesting that these patients do not appear to have more severe disease compared to the general population. Early reports from Italy note that post-transplant patients on immunosuppressive medications did not appear to have worse COVID-related symptoms or disease, which is somewhat reassuring.
Pediatric rheumatologists would say that each child with rheumatic disease is unique. Factors such as disease type, disease activity, degree of immunosuppression and organ involvement, will affect the amount of risk from a coronavirus infection. In addition, it is likely that genetic makeup and degree of exposure to the coronavirus also contribute to the risk of infection, as well as the severity of the COVID-19 illness.
The Childhood Arthritis and Rheumatology Research Alliance (CARRA) has developed a registry of COVID-19 infections in pediatric rheumatic diseases, where health care providers can report cases of COVID-19 so that we can learn as much as we can about what happens to children and teens with rheumatic diseases during this pandemic. Information about this special registry can be found here https://carragroup.org/research-registry/projects/covid-19-global-pediatric-rheumatology-database. The Arthritis Foundation provides funding to CARRA in order to advance research focusing on pediatric rheumatic disease.
Q: What are the symptoms of COVID-19 in children?
In contrast, signs of severe COVID-19 infection include symptoms of lung problems, such as rapid and labored breathing and/or a bluish discoloration of the lips. If you see any of these severe symptoms, get your child to an emergency room as soon as possible.
Q: How can I protect my child?
A: The most important thing you can do is to follow general prevention advice that applies to everyone. This includes advice from the Centers for Disease Control and Prevention (CDC) website, cdc.gov, which has general and specific advice on how to prevent infection. Some of this advice includes, but is not limited to, common-sense measures such as washing hands often for at least 20 seconds, avoiding touching the face and avoiding close contact with those who are sick. It is updated frequently, so check back regularly.Other tips for your child include:
- Teach proper handwashing methods. We can’t stress this one enough. Frequent handwashing is arguably one of the more important measures your child can take to keep safe. This video can help teach your child proper handwashing measures.
- Limit outside exposure. The less contact your child and entire family has with the outside world right now, the better. Even as stay-at-home orders are being lifted in some states, it’s important to remember that many people are asymptomatic (that means they have the virus but don’t show any signs) and testing is not readily available for people without symptoms. Being away from friends may be distressing for your child, but express that it’s only temporary and come up with alternatives in the meantime. This may include setting up virtual play dates or “game nights” with friends. Older children, with the supervision of a parent, can participate in online hangouts or Facetime chats. This also means putting a pause on time spent with extended family members and if possible, avoiding the use of child-care services. If you have a job that still requires you to return to work and need to help of a daycare, make sure that the staff adheres to these CDC guidelines. If your child needs a babysitter, be sure that they are practicing strict social distancing and prevention measures, and ask them to wear a mask.
- Be prepared. If your child does contract the virus, have a plan ready. Contact your child’s doctor and ask them what to do if you suspect your child has the virus, and when to see a doctor.
- Protect yourself. Take measures to prevent infection and limit your exposure to protect your child. You can find a comprehensive list of measures to prevent infection for you and your family here.
Q: Should my child stay on immunosuppressive medication?
A: Medications should be continued as prescribed. Stopping or changing the dose without consulting your doctor can put your child at risk of a flare and other health problems. This applies to all medications, including nonsteroidal anti-inflammatories, or NSAIDs, such as ibuprofen and naproxen (Aleve), and immune-suppressing drugs, including the following:
Disease-modifying antirheumatic drugs, or DMARDs, such as methotrexate, hydroxychloroquine and sulfasalazine.
Biologics, such as abatacept (Orencia), adalimumab (Humira), canakinumab (Ilaris), etanercept (Enbrel) or tocilizumab (Actemra).
Corticosteroids, such as prednisone.
Stopping or changing medication dose is not recommended because we know that uncontrolled rheumatic disease puts patients at increased risk of infections, in general.
Q: If I am or another person in my family is infected, how can I reduce my child’s infection risk?
A: Even if you’re diligent with safety and prevention measures, there’s still a risk of contracting the virus. Designate a “sick room” and keep it stocked in case of infection – enough toilet paper, towels, sheets, clean clothes, etc. – to limit the times you or a loved one need to leave the room or need to wash contaminated items. If infected, isolate yourself for at least 14 days and if possible, use a separate bathroom and avoid sharing items like dishes, towels and bedding. If you must handle or touch objects shared objects, wear gloves.
Cough and sneeze into the crook of your elbow, not your hands. Buy masks for the whole family and wear them when you must leave the room. Everyone should wash their hands thoroughly and frequently (using separate sinks if possible). Have your loved ones leave food and beverages outside your room during mealtime. If you require care, select one person to help you. You should both wear masks when in the same room. For more tips on what to do if you or a family member gets sick, click here.
Q: I'm worried about catching the virus at work and exposing my child, who has JA. Should I request a medical leave of absence from work?
You may be eligible for benefits under the Families First Coronavirus Response Act (FFCRA) or the Coronavirus Aid, Relief and Economic Security Act (CARES), federal relief packages that extend and broaden family medical leave and unemployment benefits. The FFCRA provides relief for employees who are under a quarantine or isolation order by a local government or under the advice of your health care provider; those who care for someone in quarantine; those who have COVID-19 symptoms; and those who must care for a child as a result of school closings, shelter-in-place mandates or other COVID-19 repercussions.
Q: Will my insurer cover all expenses for testing and treatment related to COVID-19 (coronavirus)?
Q: Is there a special open enrollment period for Affordable Care Act?
If you lose job-based coverage, you could also qualify for COBRA coverage. Talk to your employer about your COBRA options.
California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont and Washington state have announced that people without insurance can sign up for a plan — even without a life-changing event.
Q: Where can I get help paying for my biologic?
Drug manufacturers may have financial assistance programs. Visit the links below to find out more about them.
Abbvie: (Humira), (RINVOQ)
Humira and RINVOQ Patient Assistance - https://www.abbvie.com/patients/patient-assistance/patient-assistance-and-covid19.html
Amgen: (Enbrel)(Evenity) (Prolia)
Enbrel Patient Assistance - https://www.enbrel.com/support/financial-support
Evenity Patient Assistance - https://www.evenity.com/evenity-support/evenity-cost
Prolia Patient Assistance - https://www.prolia.com/paying-for-prolia
Bristol Myers Squibb (Orencia)
Orencia Patient Assistance - https://www.orencia.com/registration1?siteid=902&type=requestcopay&formtype=reqcopay
Genentech: (Actemra), (Rituxan)
Actemra and Rituxan Patient Assistance https://www.gene.com/patients/financial-support
Benlysta Patient Assistance https://www.benlystacopayprogram.com/#/app/layout/home
Janssen (Remicade), (Simponi) (Stelara)
Remicade Patient Assistance - https://www.remicade.com/cost-support.html
Simponi Patient Assistance - http://www.janssenprescriptionassistance.com/simponi-cost-assistance
Stelara Patient Assistance - https://www.stelarainfo.com/crohns-disease/stelara-prescription
Eli Lilly (Taltz)
Talz Patient Assistance - https://www.taltz.com/patient-support/insurance-support
Renflexis Patient Assistance https://www.merckaccessprogram-renflexis.com/
Novartis: (Cosentyx) (Ilaris)
Cosentyx Patient Assistance - https://www.cosentyx.com/treatment-cost
Ilaris Patient Assistance - https://www.ilaris.com/info/sjia/ilaris-copay-assistance.jsp
Pfizer: (Celebrex), (Inflectra), (Lyrica), (Xeljanz)
Celebrex Patient Assistance - https://www.celebrex.com/savings
Inflectra Patient Assistance https://www.pfizerrxpathways.com/
Lyrica Patient Assistance - https://www.lyrica.com/co-pay-savings-card
Xeljanz Patient Assistance - https://www.pfizerrxpathways.com/
Kevzarra Patient Assistance - https://www.kevzara.com/starting-kevzara/kevzaraconnect-copay-card
Kineret Patient Assistance https://www.kineretrx.com/ra/kineret-on-track
Cimzia Patient Assistance https://www.cimzia.com/cimplicity-program
Get more information about other patient assistance programs and ways to manage the cost of your arthritis care.
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Learn who can get tested, how it works and what you should do if you test positive.
The COVID-19 Global Rheumatology Alliance is a registry for health care providers to enter data about rheumatology patients infected by the coronavirus. Talk to your doctor about supporting this effort to help clinicians evaluate risks, assess and treat patients.
Read about the emergency plans that health insurance providers are activating to ensure that Americans have access to the prevention, testing and treatment needed to handle the current coronavirus situation. Compiled by America’s Health Insurance Plans (AHIP).
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