COVID-19 Information Print Page

Need some tips to prepare for your Virtual Visit – Click here.

If you have travelled outside of Canada in the last 14 days, please check with your rheumatologist’s office to determine if the visit can be in person or needs to be scheduled as a virtual visit. Do NOT attend your appointment in person if you have any symptoms suggestive of COVID-19, or recent exposure to a confirmed case of COVID-19.

Should I get the COVID-19 vaccine?

Yes! Please click here to see our updated information webpage about COVID-19 vaccines. This information is based on knowledge available at this moment in time; data about the effectiveness and safety of available vaccines will continuously be updated. Check back here for updated information as it becomes available.

What about other treatments for COVID-19?

Paxlovid (nirmatrelevir/ritonavir)

Paxlovid® contains 2 medications: nirmatrelevir, which stops the virus from multiplying, while ritonavir serves to increase the nirmatrelevir drug level in the body.
It is the second treatment available to patients with mild to moderate COVID-19 in the community who are at high risk of hospitalization.
- It has been shown to be approximately 88% effective to reduce hospitalization or death from COVID-19. Patients enrolled in the clinical trial had not been previously vaccinated and had at least 1 risk factor for severe disease, including the use of medications that affect the immune system.
This treatment may be offered to patients with rheumatic diseases who are taking immunomodulating or immunosuppressive medications with confirmed diagnosis of COVID-19 and symptoms for less than 5 days.
The recommended dosage is 3 tablets (2 nirmatrelevir and 1 ritonavir) by mouth twice daily for 5 days. Even if you feel better, you should continue this medication.
- This dosage is reduced in patients with reduced kidney function (GFR 30-60 mL/min) (1 nirmatrelevir and 1 ritonavir twice daily). Paxlovid® is not recommended for patients with severely reduced kidney function (GFR <30 mL/min).
- Of note, Paxlovid® has several drug interactions (CYP3A substrates including tofacitinib, baricitinib, upadacitinib, apremilast, cyclosporine and colchicine for rheumatic conditions), so be sure to inform your care provider of all of your prescription and non-prescription drug therapies. These medications can be stopped to safely receive Paxlovid.
Common side effects include a change in taste, diarrhea, muscle aches, headache, and an increase in blood pressure.

Remdesivir

Remdesivir is an antiviral medication that prevents the replication of the COVID-19 virus.
It is given as a one-time intravenous dose over 30 minutes at an AHS clinic or another clinic site.
It is approved for patients 12 years and older who have mild to moderate COVID-19 symptoms in the community and are at high risk of hospitalization. It may also be used for patients who are hospitalized.
This treatment may be offered to patients with rheumatic diseases who are taking immunomodulating or immunosuppressive medications with confirmed diagnosis of COVID-19 and symptoms for less than 7 days.
It is the preferred treatment for patients on JAK inhibitors (tofacitinib, baricitinib, upadacitinib), apremilast, or cyclosporine, as these drugs interact with Paxlovid®.

What should you do if you have COVID19 and may be eligible for these treatments?

If you have had symptoms for 4 days or less and think you may be eligible for this treatment, call HealthLink directly (811 or 1-844-343-0971)
- Check with your rheumatologist as some medications for your rheumatic condition should be held during active COVID infection
- Remdesivir and Paxlovid are available in Alberta. Those with rheumatic conditions may be eligible to receive either of these medications.
Remember that getting vaccinated is still your best way to avoid COVID-19 infection and hospitalization. If you have not yet been vaccinated or have received your primary series (3 doses) but not boosters, it is recommended that you be vaccinated 3 months after your COVID-19 infection to help prevent further infections.
More information on COVID19 outpatient treatment is available on the Alberta Health Services website here.

FAQs

As your rheumatologists, we can appreciate that there is concern among our patients surrounding the novel coronavirus COVID-19 worldwide pandemic.

Below are some of our answers to your frequently asked questions.

Who is at risk of contracting the coronavirus?
This virus is unknown to all our immune systems and therefore has the potential to make anyone sick. We know those who are of older age, have suppressed immune systems, or underlying lung disease may be at increased risk of significant illness. If you think you may have symptoms, use this online screening tool provided by Alberta Health Services to complete an assessment.

Should I change or stop my medications?
If you are feeling well we would NOT recommend changing or stopping your medications. This can lead to worsening of your rheumatologic disease and symptoms.

What should I do if I am feeling unwell?

If you are unwell with a fever or other significant infectious illness we would recommend holding your rheumatology medications until your symptoms improve. In particular, hold any biologic therapy (Abatacept, TNF antagonist, IL-6 antagonist, IL-17 antagonist, Rituximab, Ustekinumab, or JAK Kinase inhibitor). Typically holding 1 or 2 weeks of medications is unlikely to have a significant effect on your rheumatologic disease, and will aid in the recovery from the infection.
Those patients on hydroxychloroquine (plaquenil) may continue this medication. Continuing hydroxychloroquine is recommended because it is safe; there is not data to suggest it will help treat COVID-19.

***DO NOT STOP prednisone or other steroid treatment without speaking to your rheumatologist or other healthcare professional.

What do I do if I think I may have coronavirus?
DO NOT go to the doctor’s office or hospital. Only go to the hospital if you need care.

If you are living in Alberta, call HealthLink at 811 or book an appointment to be tested by clicking here. They will advise you on next steps for local testing procedure. Please be patient, as there are likely many people like you calling this line. Refer to the Alberta Health Services website for further information.

Those with rheumatic diseases are still recommended to have a PCR test (not only the at home Rapid Antigen Test) to diagnose COVID19, particularly as you may be eligible for at home IV or oral treatment. (see below for more information). Please contact your rheumatologist’s office, or your family physician, to receive a prescription for a PCR test.

Advise any healthcare worker if you are on medication that suppresses the immune system.

How can I protect myself from the risk of coronavirus?
We think that the coronavirus spreads through droplets in the air and may live on surfaces. Therefore to reduce your risk of contracting coronavirus you should reduce your chance of exposure to anyone who might be unwell. We would suggest avoiding interactions in large crowds and public spaces (social distancing). Keep at least 2 metres distance (6 feet) between yourself and others. Avoid contact with anyone who is unwell. Wash your hands frequently and avoid touching your eyes, nose or mouth. Wearing a mask will help protect others.

Should I come to my upcoming rheumatology appointment?

If you are feeling unwell, or have had contact with anyone with coronavirus, do not come to the clinic. If you feel your rheumatologic disease is stable, you may ask for a virtual visit. Please call your rheumatologist’s office to cancel and reschedule if this is appropriate. If you have travelled outside of Canada in the last 14 days, please check with your rheumatologist’s office to determine if the visit can be in person or needs to be scheduled as a virtual visit.

What about doing my lab tests or x-rays?

It may be reasonable to avoid having your regular blood tests done so as to avoid a busy laboratory facility, assuming your lab tests have been normal recently. Please speak to your rheumatologist if you are not sure if this is safe for you to do.

What should I do if I am planning on travel ?
Health officials are advising that patients at high risk avoid any unnecessary travel, especially outside Canada. We agree with this advice. If you do need to travel, make sure you take extra medication with you. If you require a doctor’s note to cancel travel arrangements we would be happy to provide this.