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 AIRD should have the COVID-19 vaccine. 
• Many patients with AIRD are recommended to have a 3rd primary vaccine dose.
• All patients with AIRD should have a booster dose after the 3rd primary dose OR, if not eligible for the 3rd primary dose, after the 2nd primary dose. All booster doses can currently be administered 3 months after the previous dose.
• Many patients with AIRD should receive an additional winter booster dose from 4 months after their first booster. This is to increase vaccine protection before winter for those with a weakened immune system who are at greater risk of severe illness with COVID-19.
• The ARA have produced an information sheet on the COVID-19 vaccine specifically for patients. It includes information about the difference between third primary doses and booster doses. This sheet can be found here.

Other things you can do to reduce your risk

• Wear a mask (preferably N95), ensure it is worn correctly and in appropriate or mandated situations. 
• Wearing eye protection (glasses) has been shown to reduce the risk of contracting COVID-19 by 15%.
• Regular hand washing and good personal hygiene practices continue to be vital.
• Observe all current restrictions. Check your state or territory Department of Health for updates.
• Maintain social distancing especially indoors and avoid crowded or indoor venues.
• Shop online if possible.
• Work from home where you can. If you cannot work from home, ensure physical distancing and hygiene measures are adhered to in the workplace.
• The Australian Government has developed a COVID-19 action plan; if your doctor has assessed you as being at high risk of severe illness if you contract COVID-19, this action plan will help you manage risks.  

• Have rapid antigen tests (RAT) at home. Most importantly know how to use them. 
• Think about who would be able to look after your kids, pets and other dependents 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 enough prescriptions and medicines for 2 weeks in case you have to isolate.
• Ensure you have access to a thermometer, masks, hand sanitizer, simple pain relief, throat lozenges, tissues and sufficient food if you are unable to have it delivered.

• If you have a fever, (≥37.5°C) or history of fever (e.g. night sweats, chills) 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 rapid antigen test (RAT) if you have one. If you do not have a RAT you will need to have a PCR test. 
• Guidelines state that if the RAT is positive you do not need to have a PCR test. 
• More information on testing can be found here.
   

• EVEN IF YOU DO NOT HAVE SYMPTOMS, IF YOU TEST POSITIVE FOR COVID-19, CONTACT YOUR RHEUMATOLOGY TEAM.
• Contact your rheumatology team for specific advice about treatment, as decisions to pause or continue treatment should be made on a case-by-case basis.
• If you are on glucocorticoids/steroids (for e.g., prednisolone), do not stop them suddenly; seek advice from your treating team. 

• There are currently 2 oral antiviral medicines available in Australia available on 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) can interact with many other medicines so speak to your doctor or rheumatology team if you have any questions.

• These medicines are most effective if taken as soon as possible after a diagnosis of COVID-19. If you have been treated with these medicines, you should delay vaccination until you have fully recovered (approximately 4-6 weeks).

• Sotrovimab is a medicine available for the treatment of people >12 years with mild COVID-19 that is likely to progress to severe disease. People with AIRD may be eligible to receive sotrovimab.  Please seek advice from your rheumatology team as to whether you are eligible. 
• Isolate according to your state government rules and tell your contacts.
• You can call the National Coronavirus Health Information Line 1800 020 080 or your state or territory public health agency for advice.
• If you are acutely unwell, please call an ambulance as you would do normally in an emergency situation.
• Do not have visitors to your house whilst you are isolating.
• You can get food and other things delivered.

• If you are on a medicine for AIRD you may be able to get this prescription from your doctor electronically via your phone or e-mail. This is not available for all medicines. 
• Call your pharmacy to ask about home delivery of medicines.
• There has been a global shortage of tocilizumab. As a result, the supply of IV tocilizumab products in Australia is currently limited, but is anticipated to improve by later in 2022. The SC tocilizumab shortage has resolved. More information on the tocilizumab shortage can be found on Arthritis Australia's website here and the Therapeutic Goods Administration website here.

• Some telehealth (phone or video) appointments are funded by Medicare. The reimbursements for telehealth appointments will chang on the 1st July 2022. Contact your rheumatologist about this option.
• Make sure you keep in touch with your treating team so there is no interruption in prescriptions.
• If you need blood tests, Medicare rebates may allow you to have these collected at  home.
• If you are on a biological or a targeted synthetic DMARD, due to the exceptional circumstances, you do not have to see your rheumatologist face to face for a repeat prescription at the moment; the review can be conducted by telehealth at the discretion of your rheumatologist. This option may be removed on 30th June 2022. Please keep in touch with your rheumatologist to ensure there is no interruption of your treatment supply.

• It is important to maintain healthy habits to keep your immune system as strong as possible.
• Emotional stress, lack of sleep and physical exhaustion can impact your immune system further, making you more susceptible to illness.
• Eat a healthy diet that includes plenty of fruit and vegetables.
• Ensure you exercise each day.
  • This is helpful for general physical and psychological health, but especially while physically and socially isolated.
• 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.
• For more suggestions on how to stay healthy at home, take a look at the Healthier. Happier. website.
• 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.