We have all had to change the way we work as a result of the Covid19 pandemic and this includes rheumatologists.
If the service you require can be delivered via telehealth (i.e. phone or video consultation) this option is available to you.
When being seen in person, you will need to confirm you are well from an infection perspective. All patients will have to have their hands sanitized and will need to wear a surgical mask on entry into our waiting room.
Dr Suppiah and all his staff are fully vaccinated. Appropriate PPE is used by all. The room and equipment is sanitised between patients.
If we are in Covid Alert level 3 or 4, you will also not be able to bring family or a support person into the clinic rooms (including waiting room) unless there is a specific reason that this is required and will need to be prearranged with the admin staff. You may need to wait in your car until we call you in for your consultation (this depends on whether there is space in our waiting room or not - as we will need to limit numbers to ensure appropriate physical distancing measures are followed).
Most insurance companies now cover telehealth consultations under their policies.
Corona Virus Disease 19 is a new coronavirus that causes lung and airway infections. It is sometimes called SARS-CoV-2.
Typical symptoms include fever, sore throat, cough, tightness of the chest and shortness of breath. The current evidence is that most cases appear to be mild. The symptoms are similar to other viral illnesses such as the common cold and flu.
New variants of the disorder are more likely to have less respiratory symptoms, and cause more muscle pain and non specific flu like symptoms
Yes. All patients with rheumatic conditions are encouraged to get any of the Covid-19 vaccines that are (or will be) available in New Zealand.
The American College of Rheumatology recommends that methotrexate should be withheld for one week after each vaccine dose, for those with well controlled disease. This recommendation is to increase the effectiveness of the vaccine rather than due to concerns about safety.
For patients on rituximab, the optimal timing of vaccination should be discussed with Dr Suppiah. No modification to vaccination timing is required for other medications.
It is not clear if the risks of COVID-19 are increased for patients with immune-mediated rheumatic diseases or the medications they are on.
Data from the Global Covid19 Rheumatology Alliance suggested that people with moderate or high disease activity of their underlying rheumatic disorder were more likely to die from Covid-19 than those with low disease activity or people who were in remission. Most medications used by people with rheumatic diseases (including most DMARDs) were not associated with higher risk of death.
People over the age of 70 and with chronic health conditions such as diabetes, heart conditions and respiratory illness are at higher risk of complications such as intensive care admission and death.
This following list of medications that you may be on can suppress the immune system. If you are just on one medication from this list, then your risk of Covid-19 infection risk or complication risk is not thought to be increased. However if you are on 2 or more of these medications then we worry that your risk may be increased - but so far there is no evidence to support that. The British Society of Rheumatology have pragmatically recommended extra precautions if you are on 2 or more of the following medications :
- Adalimumab (Humira)
- Etanercept (Enbrel)
- Prednisone >7.5mg/day
- Secukinumab (Cosentyx)
The level of precaution needed is dependent on the current risk of Covid-19 spread in the community. If at any point there is a surge of new cases in New Zealand, you should take extra isolation measures such as not leaving your home and minimize all non-essential contact with other members of your household if any of the following apply to you:
- Are greater than 70 years old
- You have diabetes
- You have hypertension
- Known to have heart disease
- Known to have lung disease
If you do happen to contract Covid19 infection, then please contact Dr Suppiah as to whether you need to temporarily stop any of your medications. The evidence on what we should do is constantly evolving as we learn more about Covid19 infection. Prednisone should NOT be stopped suddenly.