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 complete the recommended course of COVID-19 vaccinations. 
• Many patients with AIRD are recommended to have a 3rd primary vaccine dose.
• All patients with AIRD 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.
• 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.
• The ARA has produced an information sheet on the COVID-19 vaccine specifically for patients. 

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 AIRD 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.