Coronavirus COVID-19 Asheville Arthritis Statement

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

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. It is also recommended to avoid close contact with people who are sick.

Patients with autoimmune diseases and/or taking immune modulating treatments including disease modifying antirheumatic drugs (DMARDs) and steroids are at some increased risk of infection and risk of complications should they contract a coronavirus COVID-19 infection. You should contact your rheumatologist if you contract COVID-19 so your medications can be temporarily adjusted if needed. If you contract coronavirus COVID-19, you may be eligible for a monoclonal antibody infusion or antiviral medication treatment, and please discuss this with your diagnosing physician or your rheumatologist. If you are exposed to someone with COVID-19, you should also contact your primary care doctor or rheumatologist to consider prophylactic monoclonal antibody infusion treatment.

Asheville Arthritis & Osteoporosis Center will continue to monitor the coronavirus outbreak and provide updates at https://www.ashevillearthritis.com/coronavirus-covid-19/. 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/COVID-19.

COVID-19 Vaccination 

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 proceed with COVID vaccination if they are 5 years of age or older.

We recommend that our patients follow the COVID-19 vaccination schedules recommended by the CDC, available at:  https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html.

Extra vaccine doses for immunocompromised persons –The CDC recommends special vaccination schedules for patients who are immunocompromised. Asheville Arthritis recommends that our patients with a systemic rheumatic disease and taking disease modifying medications (DMARDs) including methotrexate, sulfasalazine, leflunomide, azathioprine, mycophenolate, cyclophosphamide, cyclosporin, tacrolimus, biologic medications (including antiTNF agents; IL1, IL6, IL17, and IL23 inhibitors; abatacept; and rituximab), and targeted small molecule agents (including tofacitinib, baricitinimb, upadacitinib, and apremilast), as well as patients on chronic high dose steroids (Prednisone 20mg daily or higher or equivalent) follow these schedules: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html

Pre-exposure prophylaxis with monoclonal antibodies – The FDA issued emergency use authorization on December 8, 2021 for AstraZeneca’s Evusheld (Tixagevimab + Cilgavimab) for pre-exposure prophylaxis in moderately to severely immune compromised adults and children 12 years of age and older. Asheville Arthritis & Osteoporosis Center may be starting this for our severely immunocompromised patients, such as those taking Cyclophosphamide, Rituximab, chemotherapy for cancer, or persons with an immunodeficiency condition, though this treatment is in short supply at this time.

Frequently asked questions about the vaccines:

The delta variant on average spreads to six persons every time any one person is infected, and omicron variant is even more contagious, so vaccination and mask wearing is not only important to you, but also important to the health of your family, friends and community, and reduces the risk of other variant development. We also recommend that our patients proceed with influenza vaccination this year, as there are concerns that influenza may worsen in the winter of 2021/2022.

Scientific data to date on the use of these vaccines in patients with autoimmune disease is reassuring, with a small risk of usually self-limited disease flare after vaccination. If you plan COVID vaccination, please contact your rheumatologist to discuss whether any DMARD rheumatic disease treatments should be adjusted around the time of vaccination.

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, and state and local health departments.

What about appointments at Asheville Arthritis during the coronavirus (COVID-19) outbreak: If you have a fever, respiratory symptoms, close contact to a person with fever or respiratory symptoms, or any contact with a person with coronavirus COVID-19, contact us before coming to your appointment. We continue to provide infusions and obtain labs and radiology studies, though we are taking extra precautions to ensure 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 and if their insurance allows it, 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.

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 in most all pharmacies. Our office will not have a COVID-19 vaccine to administer.

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 available. 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.

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 but does wane with time.

Should I wait to see if others have adverse effects before I get the vaccine?
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. Our doctors now have extensive experience with vaccination in our patients, and continue to recommend COVID vaccination.

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 the future.

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

North Carolina Department of health and Human Resources COVID-19 Vaccination information: https://covid19.ncdhhs.gov/vaccines