Coronavirus COVID-19 Asheville Arthritis Statement

Asheville Arthritis & Osteoporosis Center is monitoring the evolving outbreak of coronavirus COVID-19 carefully.

Update July 28, 2021 – The Delta Variant of COVID in unvaccinated persons is driving another wave of cases and hospitalizations in western North Carolina. We strongly recommend that all our patients get vaccinated if they have not already. And we recommend all our patients wear a face mask while indoors in public and when they are with unvaccinated persons, even if they have been vaccinated. We do not recommend eating indoors in restaurants or other public places at this time.

Appointments at our office during the coronavirus (COVID-19) outbreak:

If you have a fever, respiratory symptoms, close contact to a person with fever or respiratory symptoms, any contact with a person with coronavirus COVID-19, or history of travel to an area with significant coronavirus COVID-19 infection, please contact us before coming to your appointment. Unless absolutely necessary for patient care, patients coming to Asheville Arthritis should not bring family members or friends to their appointment. We continue to provide infusions and obtain labs and radiology studies, though we are taking extra precautions to insure patient safety.

We are still using telehealth virtual visits for some recheck patient visits if patients have good internet access on their smartphone or other electronic device that has a camera, so contact our office to schedule a telehealth visit in place of an in-person recheck visit if you prefer this. You do need to be located in North Carolina to have a telehealth visit. Medicare and most private insurances are now covering this option during the coronavirus epidemic.

Recommendations:

We recommend that our patients wear a face mask while indoors in public during the coronavirus COVID-19 outbreak at this time, even if they have been vaccinated. Avoiding unnecessary travel and public exposures is recommended for everyone including patients with autoimmune disease at this time. It is also recommended to avoid close contact with people who are sick. Most of our patients can continue working at this time, though working from home is advisable if this is an option. Some selected patients with severe disease may need to stay home from work altogether.

Hand washing after exposure to public spaces and before eating or touching face, mouth or eyes is an important preventive measure. The CDC recommends frequent hand washing with soap and water for at least 20 seconds and after going to the bathroom, before eating, and after blowing your nose, coughing or sneezing. Alcohol based hand cleaners with >60% alcohol are also effective, though soap and water are recommended if hands are visibly dirty. Cleaning and disinfecting frequently touched objects and surfaces using a regular household cleaning spray or wipe can slow spread of infection.

Patients with autoimmune diseases and/or taking immune modulating treatments including DMARDs and steroids are at some increased risk of infection and risk of complications should they contract a coronavirus COVID-19 infection. Because autoimmune diseases themselves also carry significant risk to your health, and because untreated autoimmune disease may also put patients at increased risk of complications of coronavirus COVID-19 infection, we do not recommend that patients on immune modulating treatment stop any of their treatments unless this is done in consultation with rheumatology.

If you develop a fever and/or respiratory illness, and you feel that you might have coronavirus COVID-19, we recommend you contact your primary care physician by phone or portal to determine further care, or call your local health department if you do not have a primary care physician (Buncombe County: 828-250-5109). If you develop a respiratory illness, and you feel that you might have coronavirus COVID-19, before you visit a health care facility including any doctor’s office, an urgent care, or emergency room (by appointment or by ambulance) you should notify that facility of your concern so that protective measures can be put in place. If you develop a respiratory illness, after you discuss management with your primary care physician or other physician, you should contact your rheumatologist to determine whether you should change your rheumatology treatments during the illness. If you contract coronavirus COVID-19, you may be eligible for an antibody infusion treatment for this, and please discuss this with your diagnosing physician or your rheumatologist.

Asheville Arthritis & Osteoporosis Center will continue to monitor the coronavirus outbreak and provide updates at www.ashevillearthritis.com. The CDC is a reliable source of information: https://www.cdc.gov/coronavirus/2019-nCoV/index.html. The American College of Rheumatology is also monitoring this outbreak: https://www.rheumatology.org/Announcements.

COVID-19 Vaccination 

Asheville Arthritis continues to monitor the coronavirus COVID-19 outbreak. Unfortunately, case counts, hospitalizations, intensive care admissions, and deaths have begun climbing again during the summer of 2021. We continue to emphasize the importance of wearing a mask indoors in public settings, social distancing, and careful hand washing.

The physicians of Asheville Arthritis have reviewed safety and effectiveness data on the available coronavirus COVID-19 vaccinations. At this time we recommend that all our patients and our staff proceed with COVID vaccination with any of these vaccines as soon as one is available to them if they are not pregnant and if they are 12 years of age or older. There is not enough information available at this time to comment on the effectiveness or safety in pregnant patients or patients under these ages, though consideration should be given for vaccination in these populations depending upon their risk of COVID-19 infection and complications.

The Pfizer/BioNTech and Moderna COVID-19 vaccinations each require two shots 3-4 weeks apart, and are about 95% effective at reducing symptomatic COVID-19 infection, and also greatly reduce the risk of severe COVID-19 infection requiring hospitalization or intensive care unit care. The Pfizer/BioNTech vaccine has been testing in non-pregnant persons 12 years of age and older, and Moderna has been tested in non-pregnant persons 18 year of age and older.

The Johnson and Johnson COVID-19 vaccine only requires one shot. It is about 72% effective at reducing symptomatic COVID-19 infection, and reduces the risk of severe COVID-19 infection requiring hospitalization or intensive care unit care by 85%. The Johnson and Johnson vaccine has been tested in non-pregnant persons 18 year of age and older.

Our office will not have a COVID-19 vaccine to administer, so please contact your local primary care office, hospital, pharmacy, or health department to obtain. We recognize that there is limited data on the use of these vaccines in patients with autoimmune disease, and/or patients taking immune modulating treatments, and we recognize that the vaccine may not be as effective in these patients, but nevertheless we feel the risk of COVID-19 infection is much greater than the risk of the vaccines. At this time we are not routinely asking our patients to alter their DMARD rheumatic disease treatments around the time of the vaccine except that we prefer patients not take a vaccine on the day of an injection or infusion. If you have further questions on this topic you may contact your Asheville Arthritis team to discuss.

Our physicians will continue to monitor safety, effectiveness, and other information from the Centers for Disease Control (CDC), the Food and Drug Administration (FDA), the American College of Rheumatology, state and local health departments, and other sources, and we will stay in communication with our patients with any changes to our recommendations.

Several vaccines are being developed, and they will become available as they are adequately tested and then manufactured. The vaccines available to date are not live vaccines, and we believe they are safe for patients who are immunocompromised, take immune modulating medications, and/or have autoimmune disease. These vaccines may not be as effective in persons with autoimmune disease and/or taking immune modulating treatment, but we believe they remain beneficial at reducing the risk of COVID infection and reducing the risk of serious illness and death if COVID is contracted. Adverse reactions to vaccines are always possible, but the rate in large scale studies of these vaccines is low at this time, and we believe the risk of COVID-19 is much higher. In studies to date, about 10% of persons receiving the vaccines have low grade fever, headache or muscle aches. These symptoms are normal and are a sign that the body is building immunity.

Below is a list of frequently asked questions about the vaccines:

When and where do I get the vaccine?
The federal government, your state government, and local hospitals, health departments, doctor’s offices and pharmacies are working together to provide the vaccine as quickly as possible to our nation. The vaccines are readily available at this time.

Will I have to continue to wear a mask?
Yes- the risk of silent infections among vaccinated volunteers continues to be studied and there will not be enough data collected for some time. The thinking is that it may be possible for some people who are vaccinated to still spread the virus through silent infections. It takes several weeks for the vaccine protections to begin, so it is particularly important to remain very cautious the first month after vaccination is started. We recommend our vaccinated patients continue to wear a mask in public and practice protective measures.

Do you know if they are preservative free like our preservative free flu vaccines?
The Pfizer and Moderna vaccines are preservative free, and free from egg protein. These are mRNA vaccines. This technology is new, but not unknown. They have been studied for more than a decade. mRNA vaccines do not contain a live virus and do not carry a risk of causing disease. Many vaccines use a weakened or inactivated germ in our bodies to trigger an immune response. mRNA teaches our cells how to make a protein or just a piece of protein that triggers an immune response inside our bodies. That immune response, which produces antibodies to the virus, is what protects us from getting infected if the real virus enters our bodies.

The Johnson & Johnson vaccine is also preservative free and free from egg protein. It uses a benign adenovirus vector that does not cause any symptoms and can not replicate in the body and that delivers a piece of DNA that is used to make the spike protein of COVID-19. This allows your body to temporarily make the spike protein, which does not cause disease, but teaches the immune system to defend against COVID-19 infection. This is an older technology than the mRNA vaccines, and has been used in other vaccines.

These vaccines were developed quickly, are they really safe?
The US vaccine safety system ensures that all vaccines are as safe as possible. Safety is the top priority while federal partners work to make the COVID-19 vaccines. Operation Warp Speed does not mean that manufacturers were able to “skip steps” in the vaccine process; instead after development of the vaccine, manufacturers took a secured risk and overlapped the Study, Manufacturing and Distribution phases. The FDA has committed to giving these vaccinations priority (not rushed) review at all phases of the studies.

Is this a live virus vaccine- will it give me COVID?
None of the COVID-19 vaccines currently in development in the United States use the live virus that causes COVID-19. There are several different types of vaccines in development. However, the goal for each of them is to teach our immune systems how to recognize and fight the virus that causes COVID-19. Sometimes this process can cause symptoms, such as low grade fever, headache or muscle aches. These symptoms occurred in about 10% of people in the trials. These symptoms are normal and are a sign that the body is building immunity.

How long will immunity last after receiving the vaccine?
Long term immunity from COVID-19 vaccination remains to be seen based on long term follow-up data. Trials will continue to follow participants to determine the answer to this question. However, fairly lengthy immunity looks promising

If I have already tested positive COVID- do I still need to get the vaccine?
Due to the severe health risks as well as long term unknown risks (neurological and respiratory side effects have been seen months post infections) associated with COVID-19 and the fact that re-infection with COVID-19 is possible, people are advised to get a COVID-19 vaccine even if they have been sick with COVID-19 before. At this time, experts do not know how long someone is protected from getting sick again after recovering from COVID-19. The immunity someone gains from having an infection, called natural immunity, varies from person to person.

Should I wait to see if others have adverse effects before I get the vaccine?
The best vaccine to get is the first one available to you as soon as you can get it. In order to get life back to normal and to decrease the risk of COVID for you, your family, and loved ones, it is necessary to vaccinate as many people as possible as soon as possible. Hundreds of thousands of people have received COVID-19 vaccines in trials, and side effects are generally mild and manageable.

Do I need to get an antibody test after my vaccine to determine if I am protected?
Our practice, the American College of Rheumatology, the FDA, and the CDC do not presently recommend antibody testing after COVID vaccination in order to determine your protection after COVID vaccination because the antibody tests do not accurately determine whether you are or are not protected. This issue is being actively studied, and we may change our recommendations in coming months. We also do not know whether patients will need COVID vaccination booster shots, and hope to learn more about this in coming months. https://www.pbs.org/newshour/health/covid-antibody-test-after-vaccine

References:
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html
https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html
https://www.gbs-cidp.org/covid-19-vaccines-and-the-gbscidp-community/

More information:
North Carolina Department of health and Human Resources COVID-19 Vaccination information: https://covid19.ncdhhs.gov/vaccines
CDC COVID-19 Vaccination Information: https://www.cdc.gov/vaccines/covid-19/index.html