Doc issues warning to people with underlying conditions

Doc issues warning to people with underlying conditions

Senior staff reporter

Thursday, March 26, 2020

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AS the country braces for the impact of COVID-19, consultant pulmonologist Dr Althea Aquart-Stewart is urging individuals who have serious underlying medical conditions to self-isolate, as they may be at higher risk for more serious complications from the infectious disease.

This group includes people with autoimmune disease, such as systemic lupus and rheumatoid arthritis, individuals with chronic diseases like asthma, diabetes, kidney disease, cancer patients on treatment, and those with sickle cell disease.

“People who are on medication to suppress their immune system [to control their underlying disease] are particularly vulnerable. That population would include a large cohort of young people and older adults with rheumatoid arthritis, systemic lupus, and certain gastrointestinal disorders... They are particularly vulnerable so they must observe all precautions,” Aquart-Stewart told the Jamaica Observer in a telephone interview on Tuesday.

Her counsel came a day after Prime Minister Andrew Holness put the country on high alert, announcing a slew of forceful measures expected to reduce the impact of COVID-19 on the population, with predictions of a surge in community transmission during the coming weeks.

Holness said that the country was “rapidly approaching” the fourth phase of the COVID-19 pandemic, in which the virus spreads but the source of infection is unknown or cannot be directly traced to a known exposure.

Social distancing, Aquart-Stewart stressed, is an obligation for people with the aforementioned conditions, some of whom take drugs called immune modulators.

“They must heed all precaution. Social distancing, careful hand washing, for them is compulsory because when exposed to anyone with the virus who sheds it, either in droplets or aerosol while in their presence, these persons are at higher risk of developing an infection,” the physician warned.

“The truth is, about 80 per cent of people will be exposed to COVID-19 virus and be asymptomatic — they have a mild case of the disease, and will not require hospitalisation. The problem is with the elderly patients who have chronic non-communicable diseases, those immuno-suppressed persons who are on drugs for autoimmune [diseases], and the patients who are on cancer therapy. So these patients now, once they are exposed, they'll pick up the virus very quickly,” she cautioned.

The consultant pulmonologist also put sickle cell patients on alert, explaining that these patients do not have a robust immune system and can develop pneumonia.

“So what they do, they observe the precautions. They stay home and they avoid public spaces, social gatherings; they observe all the hand hygiene and everything. They can't overdo it. What the sicklers should do, in addition, is stay hydrated and make sure they are on their medications. They should be vigilant with their self-care,” the senior doctor said.

For asthmatic individuals, Aquart-Stewart is urging them to “stay on their puffers”. Asthmatics and patients with chronic obstructive pulmonary disease (lung disease), she explained, if afflicted with the virus, will experience a flare in their disease and experience worsening cough and chest tightness.

“They need to be vigilant with their pumps. They use their controllers regularly to make sure the airways do not become inflamed from any virus exposure, to avoid an asthma flare,” she said, adding that, in addition to COVID-19, the risk of co-infection with the regular influenza virus remains.

“So my patients with asthma and my patients with chronic obstructive pulmonary disease at this time [must be] vigilant with their use of puffers, vigilant with hand hygiene, and stay home,” she added.

Diabetic and hypertensive patients who may be older, she explained, are also at higher risk.

According to the physician, diabetics, in particular, do not have a robust immune system and should avoid unnecessary contact with others as much as possible.

“The most common manifestation of COVID-19 is pneumonia. When we speak about pneumonia we are always thinking about bacterial pneumonia, but a viral pneumonia can be even more deadly; and in somebody whose immune system is not as robust as it ought to be, a viral pneumonia can escalate and run into serious life-threatening complications. So, diabetics, stay at home. Keep your sugar well controlled. Limit your exposures,” she stated.

At the same time, Aquart-Stewart said that there are lessons to be learnt from the COVID-19 pandemic. As she puts it, every cloud has a silver lining.

“The silver lining in this nightmare is for us to learn the importance of adult immunisation. Our older people, our senior citizens, are not conscious about the immunisations that they ought to have. While we do not yet have a vaccine for COVID-19, what this pandemic has done is brought out, forcefully, the need for adult immunisation. As a society, we are reminded to be proactive with our health,” she said.

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