Practical Tips for Patients with AIRD in the COVID-19 Pandemic

Vaccination

• Vaccination is the best way to protect yourself, and others around you, from COVID-19.
• All patients with AIIRD should complete the recommended course of COVID-19 vaccinations. 
• Many patients with AIIRD are recommended to have a 3rd primary vaccine dose.
• All patients with AIIRD should have a booster dose 3 months after the 2nd or 3rd primary dose, a second booster dose is recommended 3 months after the 1st booster or COVID-19 infection.
• The 2023 winter booster dose is now recommended for some people 6 months after their previous booster dose or most recent COVID-19 infection whichever was most recent. 
• This will mean that some people with rheumatic diseases will be up to their 6th COVID-19 vaccine dose i.e. a primary course of 3 doses, original booster, the 2022 winter booster and the 2023 winter booster dose. 
• For more information on the COVID-19 vaccine and the 2023 winter booster dose and who should have it please refer to the ARA COVID-19 vaccination information sheet here 
• It is reassuring to note that evidence has shown that patients with rheumatic disease are likely to experience mild, flu-like symptoms from COVID-19, when vaccinations are up to date. Patients being treated with rituximab and cyclophosphamide may be an exception to this and should discuss their individual circumstances with their rheumatologist.

Other things you can do to reduce your risk

• Wear a mask, (preferably N95), correctly and in appropriate situations, even if not mandated. 
• Eye protection (glasses) can reduce the risk of contracting COVID by 15%.
• Regular hand washing and good personal hygiene practices continue to be vital.
• Maintain social distancing especially indoors and avoid crowded or indoor venues.
• Consider shopping online.
• If you cannot work from home optimise physical distancing and hygiene measures in the workplace.
• If you are on rituximab or cyclophosphamide contact your rheumatologist to see if you are eligible for treatment that may improve your immunity to COVID-19.

• Make sure you have rapid antigen tests (RAT) at home and know how to use them. 
• Have a plan to ensure dependents and pets will be cared for if you became unwell.
• Think about who could take you to have a PCR test/medical appointment if you needed one if you were unwell.
• Ensure you have medicines, a thermometer, masks, hand sanitiser, simple pain relief, throat lozenges, tissues and sufficient food.
   

• If you have a fever, (≥37.5°C) OR acute respiratory infection (e.g. cough, shortness of breath, sore throat) OR loss of taste or smell or any other symptoms of COVID-19 perform a RAT or have a PCR test. 

• CONTACT YOUR RHEUMATOLOGY TEAM.
• Specific advice such as decisions to pause or continue treatment should be made on a case-by-case basis.
• If you are on glucocorticoids/steroids (e.g. prednisolone), do not stop them suddenly; seek advice from your treating team. 
• There are currently 2 types of antiviral tablets available in Australia via the Pharmaceutical Benefits Scheme (PBS) for the treatment of adults with COVID-19, who are at increased risk of severe disease: 
  • Molnupiravir (brand name Lagevrio)
  • Nirmatrelvir + ritonavir (brand name Paxlovid) - preferred treatment unless contraindicated or not suitable.
• These are most effective if taken as soon as possible after a diagnosis of COVID-19.
• People with AIIRD may be eligible to receive other treatments when the above are not suitable or available; seek advice from your rheumatology team if you have any questions. 
• Isolate according to your state government rules and tell your contacts.
• If you are very unwell, call an ambulance as you would do normally in an emergency.

• You may be able to get prescriptions electronically via a text or e-mail. This is not available for all medicines. 
• Some phone or video appointments are funded by Medicare. 
• Some blood tests may be collected at  home.
• If you are on a biological or a targeted synthetic DMARD, please keep in touch with your rheumatologist to ensure there is no interruption of your treatment supply. 

• Eat a wholesome diet that includes plenty of fruit and vegetables.
• Ensure you exercise each day for general physical and psychological health.
• Get plenty of sleep—aim for eight hours every night.
• Take steps to relieve stress—try yoga, meditation, or light exercise you can do at home.
• The Australian Government website Head to Health is also a good resource for tips on maintaining good mental health and reducing stress.

• For the latest advice, information and resources, please refer to Department of Health at COVID-19 resources.  There are resources available in a number of languages.
• The National Coronavirus Health Information Line, 1800 020 080, operates 24 hours, 7 days a week. If translation or interpreting services are needed, call 131 450. The phone number of your state or territory public health agency is available at State and Territory Health Departments. 
• The RACGP has produced a useful resource for all patients that you may find helpful.