The following are considered high-risk environments - environments in which people may be at high-risk for infection with the novel coronavirus and the resultant COVID-19 disease.
- People who have travelled to affected areas in last 14 days (for a current list, visit the Centers for Disease Control (CDC).
- People who have had close contact with a confirmed COVID-19 case in last 14 days;
- People who have spent time in skilled nursing facilities in last 14 days;
- Special populations:
- Age ≥ 65;
- Immunocompromised adult (including those with cancer, solid organ transplants and those on immunosuppressive therapy, people with chronic lung diseases, those on hemodialysis, those with advanced HIV);
- Pregnant women;
- People living in congregant facilities (e.g., hospital, daycare, college dorms, skilled nursing facilities, adult family homes, shelters, jail, prison).
Because of the lack of data on the influence of these medications on COVID-19, it is generally recommended that patients continue their medications as prescribed unless there is concern for active infection or exposure to the novel coronavirus.
According to Public Health officials, patients at high risk for COVID-19, including those taking immunosuppressive medicines, should:
- Avoid large gatherings or gatherings in which close contact with others is difficult to avoid. This includes restaurants, conferences, conventions, sporting events, concerts and crowded social gatherings.
- Wash your hands frequently with soap and water and for at least 20 seconds. If soap and water are not readily available, use an alcohol-based sanitizer with at least 60% alcohol.
- Avoid touching your face. Special attention should be made to hand washing before eating and after coughing, sneezing or blowing one’s nose.
- Avoid close contact with people who are sick.
- Clean frequently touched surfaces and objects daily using a regular household detergent and water. Frequently touched surfaces may include tables, countertops, cellular phones, switches, doorknobs, and cabinet handles. A list of recommended cleaning supplies has been provided by the American Chemistry Council.
- Delay any non-essential travel.
- Get vaccinated against influenza if you have not already done so this season.
 Immunosuppressive Medications: Azathioprine, Cyclosporine, Methotrexate, Mycophenolate Mofetil, Prednisone, IL-1 inhibitors (Anakinra), IL-17 inhibitors (Brodalumab, Ixekizumab, Secukinumab), IL-12/23 inhibitors (ustekinumab), IL-23 inhibitors (Guselkumab, Risankizumab, Tildrakizumab), IL-4/13 inhibitor (Dupilumab), anti-TNF medications (Adalimumab, Certolizumab pegol, Etanercept, Golimumab, Infliximab), Megomalizumab, Omalizumab, Rituximab, Apremilast, JAK inhibitors (Tofacitinib), Interferon (alpha, beta or gamma), chemokine inhibitors for CTCL.
If you think that you have COVID-19, the best things to do are (1) contact your health care provider and (2) stay home and isolate yourself. Always call your health care provider before going to the office. Your health care provider will help determine if you need to be tested. Avoid going to the emergency room unless you have symptoms like: shortness of breath, dizziness, confusion, persistent high fevers, or worsening of symptoms after you initially started feeling better. Whenever possible, avoid bringing family members with you to your local healthcare facility to decrease their risk for exposure.
Emory will continue to work with state and local officials to stay up-to-date on the latest developments. Check with your local health department for testing criteria and testing options for your patients as they become available. For up-to-date COVID-19 testing criteria, visit Emory Healthcare.
Patients are encouraged to “contact your primary care doctor, an urgent care clinic, or your local federally qualified healthcare center. Please do not show up unannounced at an emergency room or health care facility.”
Most dermatologists would advise a patient to withhold immunosuppressive medicines (except for steroids) until the patient is afebrile for 24 - 48 hours and is clinically improving. If a patient is taking more than 10 mg per day of prednisone, a temporary dose reduction may be considered.
You may want to discuss with your provider if laboratory monitoring can be delayed. For example, if you have been on a stable dose of your medication for at least 3-6 months with no laboratory abnormalities, we recommend delaying lab monitoring whenever possible to avoid any exposure to infection with the novel coronavirus. Again, patients are strongly encouraged to reach their providers if they have any questions about laboratory monitoring.
Patients at high risk for COVID-19 and likely to be exposed to crowded conditions like a busy office should ask their employer for special accommodations, including the option of remote work. A letter faxed to your employer may be all that’s required. Ask your healthcare provider’s office if you think you’ll need a letter of medical necessity for remote work.
Patients at high risk for COVID-19 should consider delaying all non-essential travel. This includes avoiding all modes of public transportation. Ask your provider to write a letter of medical necessity if you face financial penalties for cancelling or rescheduling your travel.
Patients should contact their dermatologist to discuss specific scenarios. In most situations, medications should be held until 2 weeks after exposure in the absence of symptoms.
I have heard that biologic medications are being used to treat COVID-19 infections. Are my medications going to protect me?
Some biologic medications have been used experimentally in the setting of severe COVID-19 infection in an attempt to reduce the inflammatory response. However, there is no evidence to suggest that these medications provide protection from infection with COVID-19.
Patients can play an important role in limiting the spread of COVID-19. Make every effort to remain healthy (e.g., by getting plenty of sleep, eating well, and getting outdoor exercise whenever possible) and follow guidelines on social distancing and handwashing. In the coming weeks, hospitals and public health authorities will need to devote as many resources as possible to management of COVID-19 outbreaks. Patients can also educate friends, families, and loved ones about ways to reduce transmission and protect vulnerable populations. At this time, wearing of masks by uninfected individuals is not encouraged because it may provide a false sense of security. However, those suspected of having COVID-19 should wear masks to help prevent transmission. Washing potentially infected surfaces with specific anti-viral hospital-grade disinfectants may help limit spread of the virus. If you have not received the flu vaccine, consider doing so now.
For additional information, please visit the Centers for Disease Control.