The COVID-19 pandemic has created new questions and challenges for individuals with compromised immune systems or those with chronic conditions. Should you still visit your rheumatologist? What about infusions? Is telehealth an option?
To help patients answer these questions and more, the American College of Rheumatology has issued two new guidance documents:
Developed by a team of rheumatologists, the information is designed to help patients navigate the new and unexpected healthcare challenges created by COVID-19.
Below are some of the common questions addressed in these resources:
When and How to Seek Care
Should I go in for my routine rheumatology visit?
If you are taking medicine prescribed by your rheumatologist or rheumatology health professional, you’ll need to continue to have at least some monitoring and follow-up even during COVID-19. Depending on local conditions and regulations, many rheumatology clinics are delaying routine visits or conducting them remotely by video or telephone. If you have not heard from your provider’s office, you should check before you go in.
Should I go in for my infusion? Injection?
For many patients with inflammatory diseases, continuing infusion and injection treatments is necessary to prevent a flare. For some patients, flares are treated with prednisone which may confer additional risk during the COVID-19 pandemic. For still other patients, such as those with well controlled disease or very high risk of complications should they develop COVID-19, a delay in therapy may be safest. Therefore, it’s advisable to have a conversation with your rheumatologist or rheumatology health professional before going in for an infusion or injection.
What if I think I have COVID-19?
Your primary care provider is probably the best and first place to call for guidance. The CDC recommends self-quarantine in your home if your symptoms are mild. If you think you need to be seen, contact your primary care or urgent care or emergency department by phone BEFORE you go in. They will have instructions for how to proceed with testing and access care while minimizing exposure to others.
You should also contact your rheumatologist or rheumatology health professional if you think you have COVID-19 or if you have a confirmed case of COVID-19. Some medicines routinely prescribed to rheumatology patients should be discontinued in the setting of infection with SARS-CoV-2 (the virus that causes COVID-19). Other medicines can be continued. Your rheumatologist or rheumatology health professional will assess the particulars of your situation and provide specific advice.
How to Navigate Telehealth
What is the best way to connect with my provider during the COVID-19 pandemic?
Many clinics are calling scheduled patients in advance, sometimes screening for symptoms of infection, and offering telehealth visits as an alternative to in-person visits. Clinic staff will provide information about preferred telehealth platform(s) at that time (see below). While remote visits are imperfect, and sometimes a face-to-face evaluation may be necessary, in many cases your provider may be able to address your immediate concerns and delay a face-to-face visit until the COVID-19 risk has sufficiently decreased. Local conditions and/or regulations will influence your provider’s approach, so please call ahead before walking into the clinic. Patients are encouraged to call their providers with questions, especially medical problems, between visits. Alternatively, many patients can send electronic messages through a patient portal. These portals are often preferred for non-urgent requests as their use can help prevent overloading the phone systems. Depending on how complex your questions or problems are, your provider may ask you to schedule a formal visit (through telehealth or in-person) to discuss.
Can I talk to my provider on the phone?
Some providers may offer phone-only evaluations, especially if your internet connection doesn’t allow for a video chat. Some insurers do not reimburse for phone visits, but this is changing as payors respond to the COVID-19 crisis. The lack of video further reduces your provider’s ability to perform an exam, which remains a cornerstone of medical care, so this is typically the least preferred method of communication, but it may be better than nothing in some circumstances.