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. Most of our patients can continue working at this time, though working from home is advisable if this is an option.

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. You should contact your rheumatologist if you contract COVID-19 so your medications can be adjusted if needed. If you contract coronavirus COVID-19, you may be eligible for a monoclonal antibody infusion treatment, and please discuss this with your diagnosing physician or your rheumatologist.

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 during the pandemic 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, 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.

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.

The Pfizer/BioNTech and Moderna COVID-19 vaccinations each require two initial shots 3-4 weeks apart, and are about 90% effective at reducing symptomatic COVID-19 infection, and perhaps more importantly reduce the risk of severe COVID-19 infection requiring hospitalization or intensive care unit care and reduce the risk of death from COVID-19. The Pfizer/BioNTech vaccine is recommended in persons 5 years of age and older, and the Moderna in persons 18 year of age and older.

Johnson and Johnson’s Janssen COVID-19 vaccine 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%, and significantly reduces the risk of death from COVID-19. The Johnson and Johnson vaccine is recommended in persons 18 year of age and older.

Extra vaccine dose for immunocompromised persons – As per FDA and CDC recommendations (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html), Asheville Arthritis recommends that all patients previously vaccinated with the Pfizer or Moderna vaccine, and who have autoimmune disease and were taking immune modulating treatment at the time of vaccination, obtain an extra full vaccine dose with the Pfizer or Moderna vaccine if it has been at least 28 days after completing the initial vaccination series. These recommendations apply to 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). Any of the available COVID-19 vaccines (Pfizer, Moderna, and Johnson & Johnson) are recommended as the extra vaccine dose.

Booster shots for some vaccinated persons – As per recent FDA and CDC recommendations (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html) Asheville Arthritis recommends that patients 18 years of age and older previously vaccinated against COVID-19 obtain a booster shot.

This booster shot should be obtained 6 months after your last vaccination if you received the Pfizer or Moderna vaccines, and 2 months after your vaccination if you received the Johnson & Johnson’s Janssen vaccine.

Any of the available COVID-19 vaccines (Pfizer, Moderna, and Johnson & Johnson) are recommended as the booster vaccine.

Potential 4th COVID vaccination dose – Asheville Arthritis & Osteoporosis Center concurs with recommendations by the CDC (https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#considerations-covid19-vax-booster) that some of our patients may eventually be eligible for a 4th COVID vaccination dose.

Recommendations for this next dose:

  • Patients who completed an mRNA (Pfizer or Moderna) COVID-19 vaccine primary series of two doses, and received an additional mRNA vaccine, may receive a single COVID-19 booster dose with Pfizer, Moderna (half dose 50µg) or Johnson & Johnson’s Janssen 6 months after their third vaccination.

Frequently asked questions about the vaccines:

The present delta variant on average spreads to six persons every time any one person is infected, 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 should proceed with influenza vaccination at this time, 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, state and local health departments, and other sources, and we will stay in communication with our patients with any changes to our recommendations.

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. Unless necessary for patient care, patients coming to Asheville Arthritis are discouraged from bringing 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 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, 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 still covering this option at this time.

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.

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, and has 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.

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. Patients should wait 90 days after a monoclonal antibody COVID treatment before receiving the vaccine.

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. 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
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