Coronavirus (COVID-19) practice advisory and information for patients taking immunosuppressive medications

At Bulimba Dermatology we continue to monitor the situation regarding Coronavirus. The health and well-being of our patients and staff remains our priority. Our Dermatologists and nursing staff remain in full operation to provide care for you and your skin. However, to reassure our patients, we have provided an overview of our ongoing procedures and additional precautions we have put in place to minimise the risk of Coronavirus exposure at our practice to protect our staff so that we can stay open to provide continued services for our patients during this time:

  • restricted entry of persons who are unwell or displaying signs of acute respiratory infection; persons returning from international travel within 14 days and persons who have had exposure to a known Coronavirus patient and/or are caring for people who are sick within their household
  • restricted entry to reception and waiting room areas, with only the patient who has the appointment to enter these areas - to better observe social distancing guidelines, accompanying persons are kindly requested to wait outside or on seats provided in the foyer area. If the patient has a carer that needs to accompany them, this will of course be accommodated
  • removal of non-essential, higher risk materials from our patient waiting areas and at the reception desk. This includes: magazines, product samples, fresh mints (sorry!)
  • provision of tissues and alcohol based hand sanitiser stations throughout the practice for use by patients, including at our entry/exit and on reception counters
  • as per standard practice, strict cleaning procedures (using anti-viral hospital grade products) of patient contact areas such as examination and procedural beds, medical work surfaces and other equipment and surfaces contacted by patients such as our phototherapy machine
  • use of personal protective equipment including gloves and face masks by staff as needed to minimise risk of exposure
  • strict handwashing procedures and good personal hygiene by all staff
  • increased cleaning of access points within the practice (such as door handles, lift control panels, waiting room areas); and at patient/staff interaction points at reception (such as the eftpos machines, pens, clipboards)
  • *couriers and visitors (excluding non-essential medical services such as pathology collections) are asked to wait in the foyer area and call 3399 1100 for a staff member to collect any parcels/deliveries

What patients can do to help the situation:

  • reschedule your appointment if it occurs during any self-isolation period that the Government requires you to undertake
  • if you begin to display symptoms of the virus or if you have had contact with a confirmed or suspected case of the coronavirus, reschedule your appointment until after you have sought medical attention
  • ONLY patients who have an appointment are to enter our reception and waiting room areas - to better observe social distancing guidelines, accompanying persons are kindly asked to wait outside or on the seats provided in the foyer area. If the patient has a carer that needs to accompany them, this will of course be accommodated
  • whilst at the practice and in your daily life, follow guidelines from the World Health Organisation on infection control. This includes: cleaning your hands using the hand sanitiser available on entry and throughout the practice and/or using the soap and water available in the bathrooms; when coughing and sneezing, covering your mouth and nose with flexed elbow or tissue, throwing this tissue away immediately and washing your hands; and avoiding close contact with others in the practice waiting room or lift etc.

Staff at Bulimba Dermatology remain available to offer advice to patients via our usual communication channels. We would like to reassure patients that we will continue to do everything possible to protect our staff and patients.

Extra information for people taking immunosuppressive medications

This information is relevant to patients who take medication that suppresses their immune system.

As you are aware, there is concern about the spreading infection of the novel Coronavirus (COVID-19) becoming widespread and the impact it will have on the community.

Information about COVID-19

This virus causes an illness similar to influenza in that most will have a fever, runny nose and cough. For some, the infection is more severe and progresses to a pneumonia which in a small percentage can be fatal.

Most of the limited information we have about the virus comes from China1 and around 14% of cases have been classified as severe and the death rate is around 2%.

Currently in Australia the disease has been contained, limited to isolated cases and the chances of catching it therefore are low. This situation could change in the next weeks to months.

Who is at most risk?

It would appear that older age is the biggest risk factor with the death rate being 15% for those above 80, 8% for those in 70s and much less for the rest of the population. Children appear to be less likely to catch the virus and so far there have been no fatalities.

Other risk factors identified have been the health issues of cardiovascular disease, diabetes, chronic lung disease, hypertension and cancer.

Immunosuppressive medication

The ‘immune system’ is the term used to describe the part of our bodies that helps us fight infection. There are a variety of different medications that, in their attempt to control disease, also suppress the body’s immune system. They all differ with how powerfully they suppress the immune system and which part of the immune system they affect.

For most medications, common and mild infections such as the ‘common cold’ do not seem to occur more often or last longer than expected. More serious infections can be more common or worse on certain immunosuppressive medications.

At this point in time, we do not have any information as to how your medication may affect your disease of you were to contract COVID-19.

However, it would be reasonable to assume that if you are taking an immunosuppressive medication that you are at greater risk to catch the virus and have more severe disease. It is impossible to determine though if this is a small or large extra risk.

Recommendation

For all medications, there is benefit as well as potential for side effect.

There is now a new risk that was not present when you commenced your medication and this may lead to the consideration of stopping your medication.

If you choose to cease your medication, within 1-2 weeks your immune system would be functioning normally and you would not be considered to be at higher risk for COVID-19. However, your disease could flare.

If you choose to stay on your medication, your disease will remain controlled but you would have to take on the extra risk with COVID-19.

This then becomes a very individual decision as it depends upon the severity of your underlying disease, your level of disease control as well as any other risk factors you have for COVID-19 infection.

If you have any questions about this matter, please contact our reception on 07 3399 1100.

Reference: https://jamanetwork.com/journals/jama/fullarticle/2762130?resultClick=24