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COVID-19 Rheumatology News

Mar 19, 2020 3:37 pm

With the COVID-19 pandemic dynamically changing, we have provided several news items germane to the Rheumatologist.

ACR Website

The ACR website has a COVID press statement and info on Telemedicine: "We know you’ve been following the news about coronavirus disease 2019 (COVID-19) closely, and have many questions and concerns about what this outbreak will mean for you, your family, and your patients.   We call your attention to a number of regularly updated sources of information from the Centers for Disease Control and Prevention and the American Medical Association, specifically recent CDC travel warnings and updated clinical criteria. As you are no doubt aware and as we mentioned in a letter to members who travel on behalf of the ACR, travel advisories have been issued for numerous countries around the world.   Citation source: http://bit.ly/2J0XKW8

TELEHEALTH RESOURCES - With the outbreak of COVID-19, it is imperative to ensure rheumatology health services are available to respond and telemedicine is a viable option to treat patients. The ACR will continue to provide telehealth resources for the rheumatology community and will advocate to commercial payers that they follow the lead of the federal government in easing telehealth restrictions.

CMS Relaxed Telehealth Restrictions; CMS Press Release

Fact Sheet

FAQs

HHS Relaxed HIPAA Reinforcement

HHS Press Release

UnitedHealthcare Expanded Provider Telehealth Policies

UnitedHealthcare Press Release

Medicaid Telehealth Guidance

Medicaid Guidance Document

Medicaid Telemedicine Information

American Medical Association Quick Guide to Telemedicine in Practice

American College of Physicians COVID-19 Toolkit

British Society of Rheumatology

The BSR has cancelled its 20-22 April scheduled meeting in Glasgow due to the current coronavirus situation.  The BSR has also issued guidance stating, "The recommendations state that some rheumatology patients should be considered “high-risk” for coronavirus infection due to immunosuppressive medication, and provide direction on treatment decisions and precautions that should be taken.  As with other medical appointments, the BSR recommends that rheumatologists should try to “remove the need for patients to attend face-to-face appointments wherever possible,” and suggests that telephone or video consultations may be appropriate alternatives." 

French Study of HCQ + Azithromycin in COVID

This study was done because chloroquine and hydroxychloroquine have been found to be efficient on SARS-CoV-2, and reported to be effective in Chinese COV-19 patients. This study evaluates the role of hydroxychloroquine combined with azithromycin on respiratory viral loads. The study showed that 6 days of treatment a combination of hydroxychloroquine and azithromycin significantly reduced SARS-CoV-2 viral loads. 

A total of 36 of 42 patients met inclusion criteria and were enrolled and randomized to receive 600mg of hydroxychloroquine daily and azithromycin was added depending on their clinical presentation. 26 patients received hydroxychloroquine and 16 were control patients. Six hydroxychloroquine-treated patients were lost in follow-up during the survey because of early cessation of treatment. Six patients were asymptomatic, 22 had upper respiratory tract infection symptoms and eight had lower respiratory tract infection symptoms. The 20 HCQ treated patients in this study and showed a significant reduction of the viral carriage at D6-post inclusion compared to controls, and much lower average carrying duration than reported of untreated patients in the literature. Adding azithromycin to hydroxychloroquine significantly improved virus elimination.

Pregnancy and COVID

There is little information thus far, but there are reports of success.  One study reports 9 pregnant women admitted with COVID19 in Wuhan, with successful pregnancy outcomes.  Lancet has a paper presenting guidelines and an approach to such patients. Thanks to Nigil Haroon (@NigilHaroon) for tweeting this citation.

Hydroxychloroquine Approved for COVID?

Today, President Donald Trump announced that the Food and Drug Administration (FDA) has approved hydroxychloroquine—a drug used to treat malaria, rheumatic diseases and other conditions—for COVID-19. (Its unclear that the FDA has approved HCQ for use in COVID. I believe President Trump was indicating that HCQ is a FDA approved drug that will be used in treating COVID-19. The FDA.gov website, currently states "There are no FDA-approved therapeutics (drugs) to treat COVID-19 or other coronaviruses.")

Disclosures
The author has no conflicts of interest to disclose related to this subject

Rheumatologists’ Comments

Atul Khasnis

| Mar 19, 2020 11:08 pm

Any role for HCQ at a lower dose in prevention against COVID-19?

Farid Taymouri

| Mar 20, 2020 4:20 am

There is a study aims to evaluate the efficacy and safety of hydroxychloroquine in the treatment of pneumonia caused by the COVID-19. Primary purpose of this study is treatment. Subjects take hydroxychloroquine 400mg per day for 5 days and measurement of the virological clearance rate of throat swabs, sputum, or lower respiratory tract secretions at day 3, day 5 and day 7.

Deaver Collins

| Mar 20, 2020 1:39 pm

The announcement about HCQ by President Trump yesterday was followed, in my area, by an abrupt run on pharmacies. Non-rheumatologists are writing RX for HCQ. Today 3 (and counting) of my patients who are legitimately taking Plaquenil have been told that the pharmacies have no more. Any suggestions (other than chloroquine) ? Thank you.

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