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        In the last few months, the pandemic of COVID-19 has been looming over the world ominously with 1M+ active cases and numerous deaths. Primarily characterized by a fever, dry cough, and shortness of breath, COVID-19 is highly contagious and significantly affects the respiratory system. However, when institutions and people discuss about who are at high risk for COVID-19, they generally mention the ones above the age of 60, and those with long-term medical conditions such as cardiovascular illnesses, cancer, diabetes, lung disease and high blood pressure, largely driven by mortality data. But a significant portion of the community that is often forgotten are the ones that look perfectly normal and healthy from the outside, but have an autoimmune condition wherein their immune system has gone berserk. We have not seen as many deaths from this community because these people have been already practicing “social distancing” since many years due to lowered immunity. Not just the illness, but also various medications and treatments taken by these patients to slow-down the overactivity of the immune response, makes them more susceptible to infections.

 

          On March 14th, the hashtag #HighRiskCOVID19, started by Molly Schreiber, Charis Hill, Dawn Gibson, Jed Finley, Jennifer Walker, and Ray Bouchard, took the Twitter by storm. This was a collaborative effort to spread awareness that lives of immuno-compromised patients also count. It was also a strong message to all the general public to act as one community and take all the precautions for the sake of other people who are vulnerable and may experience much more severe symptoms. Thankfully, with the recent lock-down measures in multiple countries, and stringent social distancing guidelines, more people are staying indoors, and hence, reducing exposure to the autoimmune community.

 

          In such trying times, many autoimmune patients are wondering what additional precautions they should take to combat this deadly crisis. Here are some thoughts:

 

• Social isolation: This one is quite obvious. Isolate yourself physically, stay connected virtually. Most of the chronic patients are already quite used to spending time indoors because they have been doing it for many years whenever they are sick or have an active flare. Given our high risk of catching a flu or an infection from the other person, we know what social distancing really means. If your country lockdown policies do not involve compulsory work-from-home, try to speak to your employer and explain him why you are at higher risk compared to others and need to work remotely till the situation improves.

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• Stay away from crowded venues for essential supplies: If you are living with somebody who is healthier and at comparatively lower risk, request that person to step out for buying groceries, medicines and other essential supplies. However, if you are living alone, avoid going to stores during peak hours. Try to avoid large supermarkets that are crowded with too many people.

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• Keep washing/ sanitizing hands: Goes without saying, wash your hands often for 20 seconds, especially after returning from the stores. Do not touch your face. Do not use the same mask for multiple weeks in a row. Ask anybody who enters your house to first wash their hands.

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• Avoid touching surfaces: Try as much as possible to avoid touching surfaces directly with your fingers – use elbows or disposable tissues. If any external person visited your house, sanitize the surfaces that person may have touched.

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• Connect digitally with your physician & avoid non-essential hospital visits: If you can use telemedicine to consult your physician, then do that. Ask your physician if there are any additional preventive measures that you should take for your condition. While many immuno-suppressant medicines lower body’s ability to fight the virus, do not stop taking any medications without your physician’s advice. Stopping one’s medicines could cause flare, aggravated pain, and might result in a hospital visit – something you want to avoid during this time unless absolutely critical. On the other hand, do not self-medicate yourself either. Postpone all non-essential diagnostic testing and procedures.

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• Store adequate medicine supply: Ask your physician if he could write you a prescription for a longer duration so you do not need to step out frequently for buying your medicines. If you are on Hydroxychloroquine (Plaquenil), and unable to get your medicine supplies since the drug is also used to potentially treat COVID-19 patients, please reach out to your physician. Ask your physician about how you should deal with such situation and if there are any alternate drugs that you could take in the meantime. If you can order medicines online, do that.

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• Buy enough grocery supply: When I say this, I do not mean hoarding groceries. But since most of us are advised to reduce public interaction as much as possible due to high risk, and if you are living alone, you should try avoid stepping out often and buy enough groceries that last you for atleast 2 weeks. Order grocery online if possible.

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• Create boundaries: It is okay to create boundaries. If your close friend or family member has recently travelled or exposed to COVID-19 patients, it is okay to ask them not to visit you for a while. Many people are asymptomatic and may be carriers of virus.

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• Reliable medical information: We know it best that Google is not reliable for researching on medical conditions. Follow that approach for COVID-19 as well. Do not believe every article or WhatsApp message that you read. Only trust verified sources like WHO website, Country-specific government websites, certain patient associations such as CreakyJoints, IFAA, Lupus Foundation of America, NRAS, and others, that are actively researching on how it impacts patients with specific ailments.

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• Preserve mental health: All the information can be quite overwhelming. Most of the autoimmune patients are scared and anxious on how will they cope if they get infected. But remember your mental health plays a very big role in keeping your physical health in check. Do not trigger the vicious cycle: Anxiety > Lack of sleep > Bad immunity > Flare > Loss of movement > Anxiety. Follow relaxation methods such as deep breathing, music, meditation, art, reading novels or anything that freshens your mood.

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• Identify caretaker: Lastly, be prepared for the worse situation as well. Identify your caretaker – could be your partner, friend, neighbor, family member. In case you fall sick, that person can help you with chores, take care of your children and pets (if any), get you all the essential supplies, and be your support system while you recover.

 

           We are in this together. It is perfectly normal to feel apprehensive, but don’t let those feelings engulf your overall sense of being. The chronic patient community has seen more adversities in life than many others, and always emerged out stronger. We will emerge stronger from this crisis as well! Take care and stay safe.