Blog

Updated March 17, 2020

If you are a member of a vulnerable population, what you need to do and what you need to worry about in relation coronavirus and COVID-19 (the illness you get from coronavirus) may be entirely different than what’s general available. Finding the answers isn’t always easy. I asked my readers to send me their questions so I could put as much information as possible in one place.

Before you start: this is long. By all means, read all of it, but if you feel overwhelmed already, I have divided it into sections (each indicated by an image), as well as specific questions, so it’s easy to skim until you see what you need to know. And a disclaimer: I am not a doctor. Make sure you contact your own medical team for recommendations that are specific to your case.

Also: wash your hands well and often (at least once per hour). Don’t touch your face. And try to stay calm. We’ll get through this together.

If you’d rather watch than read, here’s my Facebook live broadcast on COVID-19, coronavirus and chronic illness.

Facts about coronavirus and COVID-19 for vulnerable populations

Why are we more worried about coronavirus than the flu?

Three aspects about coronavirus make it scarier. It is much more contagious than the flu, it is contagious before you get it (and if you have it, but don’t have symptoms), and the mortality rate is much higher than the flu.

How many people actually have coronavirus?

Aside from ‘a lot,’ it’s difficult to estimate how many people have COVID-19. Since most people have mild symptoms, the rates of infection are likely much higher than the official numbers indicate that. As well, countries vary on how quickly they took this seriously and how prepared they were. Without getting political at all, this unfortunately means the US is likely to be hit quite severely.

Will this go away when the weather gets warmer?

We have flu season for a reason: influenza virus does poorly in the heat of summer. Although it was initially hoped that coronavirus would start to dissipate as the weather warmed, early data seems to indicate that this may not be the case.

How long will COVID-19 last?

The short answer is likely quite a long time. It depends on how successful countries are in slowing it down (see below for more on flattening the curve). Contagious illnesses follow a pattern — infection rates rise to a peak, then gradually decrease. Dr. Anthony Fauci of the US Federal coronavirus task force has estimated that a best case scenario is a couple of months until the peak in the US. If it takes the same amount of time to return to relative normal, we are looking at early Fall. To keep from getting completely overwhelmed, start by planning for the next month or so, with an eye towards the long-term.

How bad does COVID-19 get?

You know this by now: most people are fine. Data from a Chinese study on over 50,000 people with COVID-19 showed that 80% had a mild case — that is, symptoms much like a cold or mild flu — 14% had a severe case, and only about 5% became critically ill. As well, some people seem to be completely asymptomatic. But remember, they may still be able to pass the virus on to others.

How long is the coronavirus incubation period?

At this time, the incubation period — the time it takes from coronavirus being passed to you until you develop COVID-19 — ranges from 2-14 days. However, one case in China appeared to have a period of 27 days.

Who is extra vulnerable to coronavirus?

Being ‘vulnerable’ isn’t just the obvious, but includes people who have a chronic medical conditions,, autoimmune diseases, other types of pre-existing medical condition (asthma, hypertension, cardiovascular disease), immunosuppressed, or elderly. There is some indication that if your blood pressure/asthma/diabetes is controlled, your risk may not be as high.

What if I have a pre-existing condition?

This is what we all want to know. Common sense says that if you’re at increased risk in general due to an existing medical condition, you’ll be more likely to catch infectious illness going around in your community. As well, you may be more likely to have a severe case, and you are more likely to have complications, and even die. I know this first hand from my 2016 ICU trip with complications from the flu.

That means you will also be more at risk of becoming severely ill with COVID-19. There is some data about mortality rates in people with pre-existing conditions. For instance, if you have cardiovascular disease, the mortality rate is about 10%, if you have asthma or other types of respiratory illnesses, the mortality rate is between 6-8%, and so on.

Before you hyperventilate about that, remember that a lot of people also recover and may even be completely okay, even with these types of conditions. More on that in a minute.

What is my risk for COVID-19 if I take a biologic that suppresses my immune system?

If you take immunosuppressant medication for an autoimmune condition, such as rheumatoid arthritis, you do have an increased risk. Think about how you have reacted to other types of illnesses, be they colds or the flu. Most likely, you’re a bit of an infection magnet, illnesses hit you harder than your healthy peers, and it takes longer for you to recover. That can likely also been the case with COVID-19. But it doesn’t mean you are guaranteed to catch it, to have a severe case, or to have complications, or to die. At the time of writing this, over 70,000 people have survived getting COVID-19, including 90% of those over 80 years old.

So breathe.

As mentioned above, I was hospitalized with severe complications from the flu in the past. But before that — and even after that — I have had multiple instances of being sick whenever something infectious was trotting around. And so have you. I think it’s really important to remember to flip the risk numbers. For instance, if 10 in 100 immunosuppressed die from COVID-19 — and please remember I invented that number, it is not based in anything scientific — then 90 people didn’t. Yes, there absolutely is a higher risk, but we are not doomed.

Each of us is an individual with different risk factors. Your medical team is the best people to help you assess your particular risk and how to deal with it.

One note of caution: you may be tempted to take Echinecea, Elderberry, and other supplements that boost immune system. However, if you have an autoimmune disease, be aware that this may cause it to flare, which can have its own set of complications.

Should I take my immunosuppressant medication?

This is another one of those questions that is best answered by your doctor. Do remember that the medication that suppresses your immune system is also helping you to be as healthy as possible. After my experience with severe complications from the flu, my doctors told me that the only reason I survived was because I was very healthy. That good state of health was directly attributed to taking Biologics.

Also, if you are taking prednisone, remember that you should not stop this cold turkey, as that can cause serious adrenal gland issues.

If I take immunosuppressant medication and get COVID-19, can I wash out the medication to reduce the impact of the illness?

It’s intuitively reasonable to expect that getting rid of the drug that suppresses your immune system might make you more able to fight COVID-19 or avoid serious complications. It is possible to wash it out other RA meds (Arava, methotrexate) if you have severe side effects or want to have children, but I was unable to find anything about washing out Biologics. The recommendation seems to be that if you have been exposed to someone with COVID-19 or develop symptoms, it may be best to pause your medication (not prednisone/steroids, obviously). Don’t do this on your own — make sure you contact your rheumatologist for advice.

Protecting each other during coronavirus

Reducing the risk of COVID-19 for people with existing medical conditions and immunosuppression

High risk isn’t just about autoimmune conditions, but can also be something as simple as high blood pressure. Many people who don’t consider themselves vulnerable are in fact high risk. And there are a lot of us. Which is why countries all over the world are taking drastic action to limit social interaction, to prevent and reduce contact with others who may be infected, or reducing your own risk of being a vector (a person who spreads the infection) to someone high-risk.

Why is everything closing down?

It’s really important to remind ourselves why this is happening. Italy is the cautionary tale in this. COVID-19 has exploded there, to the point that the health care system cannot cope. There simply isn’t enough doctors, nurses, respirators, or hospital beds for everyone who needs it. This means that people who have a severe case of COVID-19 may not receive medical treatment, thereby increasing the mortality rate.

You have no doubt heard the phrase flattening the curve. It does not refer to reducing the number of cases, but rather spreading them out over a much longer time. Slowing down the rate of COVID-19 by various techniques, such as closures, distance learning, and social distancing (more below), means that the load on the health care system remains much lower, enabling it to cope with the number of cases. This means that those with more severe cases will get the medical treatment they need, thereby increasing the survival rate.

Does that mean I’ll get coronavirus for sure?

Again, hard to say — so much is still not known about this virus. However, it is likely that most of us will catch it at some point. But the more successful we are at slowing it down, spreading it out over a long time, the more time we give that researchers to develop a vaccine and effective treatment.

Weapon #1 against coronavirus: social distancing

Social distancing is not isolation. It is not never going outside, and it is not keeping a 6 foot perimeter personal space around you at all times, and it is not never touching someone else.

This concept has more to do with crowds and gatherings and it can be enforced by health authorities and governments. This is why there is no more travel, sports, concerts, conventions, church services, and more. Think places and events attended by a lot of people crammed closely together. Schools and universities are going online, meetings and conferences are also going virtual, and so on. Countries that have done this effectively are indeed slowing down coronavirus.

On an individual level, social distancing includes grocery shopping at non-peak times (although ironically, these may now have become the peak times) and working from home (if possible).

What can I do to protect myself if I’m high risk?

This cannot be said enough: wash your hands often and don’t touch your face. Of course, that goes for everyone, but even more so for us. Clean down surfaces and counters in your home daily, as well as door handles (so rarely cleaned), your phone, debit and credit cards, and so on. If anything, this has taught us all just how many things we touch without paying attention to it and it’s easy to get a little freaked out.

The CDC has released guidelines for people in high-risk populations. Everything we’ve already discussed is on the list, but also staying at home as much as possible, avoiding travel, groups, not sharing glasses or bottles. And those of us who have chronic illness are experts in keeping ourselves entertained at home. So there’s that.

What if I can’t work from home?

There’s a lot of emphasis on working from home, but a lot of people have to go to work. Use common sense precautions when going to work, including washing your hands frequently, use hand sanitizer (if you can find any), wiping down your work area, wearing gloves. Your employer will have developed their own protocol specific to that workplace. If you are a member of the vulnerable population, talk to your boss about this. Most will be very supportive, either because they are human beings, or because the government tells them to be.

Should I isolate myself if I haven’t been exposed?

Much depends on your individual level of comfort, state of health, and COVID-19 rates in your immediate community. Again, you should contact your medical team for guidance specific to your case.

Some are staying at home for the duration, but it may not be practical for all (and not just because this thing will not be over quickly). There’s work, there’s groceries, there’s cabin fever… Use common sense. You may want to delay family gatherings for while, shop online if you can, and take a walk outside where is easier to not get too close to others.

Preparing for quarantine and/or isolation

It’s important to prepare for possible two week quarantine, should you develop symptoms or be exposed to someone who has the illness. Make sure you have enough food and medications for your family and pets to get through two weeks. You might even want to make it three, just have a buffer zone. Stock up on things you already eat, instead of buying something you don’t know if you like or can prepare. It’s really important that you don’t hoard beyond that. If everyone just bought enough to make it through three weeks, we wouldn’t have a toilet paper shortage.

Stocking up can be a real challenge if you don’t have a lot of money. Use credit if you can, go hunting for that gift card you got for Christmas, or perhaps even talk to family and friends about a loan so you can stock up. If you have restrictions on how often you can renew prescriptions due to insurance or social assistance rules, talk to your medical team and pharmacist about solutions. They may agree to give you a larger prescription due to these extenuating circumstances and connect you with a mail order pharmacy. You should also make sure to have a few extra boxes of vinyl gloves (remember latex can cause allergies), masks, and cold/sinus medication. Remember that coronavirus is more likely to give you a runny nose than a runny bottom (see above point re: toilet paper).

Coping with coronavirus

I have symptoms. Should I get tested?

There is significant overlap between symptoms from cold, regular flu, and COVID-19. Given the current state of affairs, if you have symptoms that fall into this category, self-quarantine immediately and call your doctor or public health department. Most are told to stay home for a period of two weeks (that includes anyone living with you) and to not go to to your doctor, urgent care, or emergency department.

Make sure you know what to do case you or someone in your home develops severe symptoms that may need medical intervention, most notably difficulty in breathing. Your local government will provide you with the number to call — post it on your fridge, add it to your phone.

I am really freaking out about coronavirus — what can I do to stay calm?

When I started losing my grip on calmness, my first step was to minimize my exposure to the news. The more I read, the more I talk about it, the more freaked out I get. Yes, the situation is serious, and new things happen all the time. But also keep in mind that we have a 24-hours new cycle and that any media outlet is in sharp competition.  Check a reputable and fairly objective news media once or twice a day, maximum. If something big happens, it’ll still be available to read later, or your friends or family will text or call to tell you.

Take your cue from medical professionals

Your doctor’s office is the best place to get first-hand knowledge about how to act by now, they are sure to strongly encourage social distancing. My provincial government has enabled doctors to bill for consultations by phone or virtual (e.g., Skype). Your government and insurance companies may be doing the same. Call your doctor’s office for information.

Please also remember that if you are sick with anything other than COVID-19, it may be important to still keep your appointments. Continuing your treatments is part of what keeps you healthy and able to get through a possible infection. Again, contact your medical team to ask how to proceed

My family and friends are not taking coronavirus seriously. How can I convince them to protect me?

Share my story on surviving my trip to the ICU with complications from the flu. Have a conversation with them about just how many people are high risk. Yes, those of us who have chronic illness, who may be immune compromised, but also people who simply have high blood pressure or are taking blood thinners. Being over 50 years old means you are at a higher risk. Encourage them to pay attention to what governments are saying, not just in your own country, but all over the world. When the entire world shuts down, it is not a hoax, it is not “just the flu,” it is very serious.

I could keep writing about aspects of this situation, but I’m going to end this post here. If you have questions that didn’t get covered, please feel free to contact me directly by email. I’ll continue to post on social media on a number of topics — because chronic illness haven’t stopped being relevant to us — and also hopefully bring a bit of lightness to your day. Getting through this won’t be easy, but we can do it together.

Let’s take care of each other.

REFERENCES:

Patty Winsa, “What a Massive Study of COBIT-19 Cases in China tell Canada About What’s to Come.” Toronto Star.

“Age, Sex, Existing Conditions of COVID-19 Cases and Deaths.” Worldometer.

Jenna Moon. “I Tracked Everything I Touched on My Morning Commute. Here’s What Public Health Experts Have To Say about It.”  Toronto Star.

“Coronavirus (COVID-19): vulnerable populations in COVID-19.” Government of Canada.

“Coronavirus Incubation Period.” Worldometer.

Katie Daubs. “Lessons in Social Distancing from the 1918 Spanish Flu Pandemic: St. Louis shutdown public gatherings quickly. Philadelphia held a parade and saw death rates spike.” Toronto Star

Kate Allen: “’Social distancing’ could go a long way toward slowing down COVID-19, researchers say.” Toronto Star.

Lauren Gelman. “’Stay at Home As Much As Possible’: The New CDC Advice for Those at High Risk for Coronavirus Complications.” CreakyJoints.

Bruce Arthur. “The suspension of sports for coronavirus is bigger, much bigger, then a pause.” Toronto Star.

Jason Herring. “Province says schools wouldn’t reopen until at least September if closed.” Calgary Herald.

Leah Piepzna-Samarasinha. “Half Assed Disabled Prepper Tips for Preparing for a Coronavirus Quarantine.”

“Roche wins approval for Actemra for coronavirus complications.” Pharmaceutical Technology.

Rosie DiManno. “I’m locked down and watching the world do the same.” Toronto Star.

Ronan Kavanagh. “Information for rheumatology patients about corona virus.” Ronan Kavanagh, MD, MRCP Rheumatologist.