Show Notes: Episode 20 - "COVID-19 & AiArthritis: Special Series Episode 2"

00:52 - Tiffany welcomes listeners and co-host, Matt Iseman, host of American Ninja Warrior

01:37 - Tiffany and Matt welcome special guest, Dr. Alfred Kim, a rheumatologist with Washington University

03:08 - Dr. Kim is fielding many questions from patients and other physicians about COVID-19

05:05 - Viral infections tend to wreak more havoc on patients who are immunosuppressed (either by disease or medications)

05:34 - Anecdotal evidence suggests there is a subset of patients with COVID-19 who have too much inflammation and may be helped by immunosuppressive therapies

05:48 - Other patients may be harmed by these same medications

06:55 - At this time there are no recommendations regarding discontinuing immunosuppressive therapies during the COVID-19 outbreak

07:44 - Dr. Kim has been recommending continuity of immunosuppressive therapies to his patients while we await more data

07:54 - Taking higher doses of prednisone is the worst thing you can do for your immune system and could increase morbidity and mortality

08:30 - Dr. Kim recommends not using any prednisone (or the lowest dose possible if it is absolutely necessary) 

09:03 - Patients who have a lower baseline immune fitness may have an easier time with COVID-19 than a patient who has a higher baseline immune fitness

10:20 - Dr. Kim doesn’t want to discourage patients from pursuing vitamins or homeopathic prophylactics because he has no data to suggest they are harmful, and if nothing else, the placebo effect from them could be helpful 

11:16 - There is some preliminary data to suggest that there may be some harm from NSAIDs and some benefit from anti-malarials (including Plaquenil) 

12:40 - The data suggesting Plaquenil was beneficial is problematic because it excluded all patients who were unable to complete the course of medication for any reason - including those who became more sick or died

14:18 - Dr. Kim is very uncomfortable with the government suggestion that patients with COVID-19 should be treated with Plaquenil because the data to support that conclusion is not sufficient 

16:13 - Dr. Kim recommends patients follow the general guidelines available to the public, but he also tells his patients to follow him on Twitter @alhkim so that they can have ready access to new information as it comes out

20:20 - As soon as the President of the US announced that Plaquenil could be used to treat COVID-19, patients would had already been taking Hydroxychloroquine immediately became afraid that they would not be able to access their medications

21:26 - None of the US distributors of hydroxychloroquine have any remaining stock, so the pills available at local pharmacies are all that there is

22:00 - The hope is that more manufacturers will begin producing hydroxychloroquine 

22:36 - The VA system has restricted the use of hydroxychloroquine to COVID-19 patients ONLY, so AiArthritis patients who were taking it can no longer get it through the VA 

22:44 - Hydroxychloroquine has a very long half-life and takes 30-40 days for your serum blood level to reduce by half and will take 6 months for it to be completely gone

 23:08 - AiArthritis patients would probably be OK for a month or two in the event of a shortage, but after that they would really need access restored or a different medication if possible

24:04 - Patients may want to consider refilling all available medications in case of a hard quarantine 

25:50 - Telemedicine appointments (to avoid in person visits) are more difficult for the physician because they cannot examine the patient and require the patient to be able to communicate problems and concerns verbally and accurately

30:00 - An increase in the accessibility of Telehealth appointments may allow patients to access clinics or hospitals or specialists they want to see regardless of their physical location 

33:37 - Dr. Kim describes the American situation with testing for COVID-19 as frustrating and too late

34:18 - Dr. Kim estimates that the number of cases in the US is underreported by 5-10 times as a result of the lack of access to testing

35:04 - A private company is offering at-home COVID-19 testing for patients who qualify and can pay $130 for it

37:54 - Dr. Kim recommends self-quarantining if you have any symptoms of illness if you have no access to testing

38:10 - Immunosuppressed patients may shed more viral particles than patients in the general population, so AiArthritis patients may be more likely to spread the virus to others if they contract it and do not self-quarantine

38:22 - One study found that aerosolized COVID-19 may be able to last several days in the air after being expelled by a sick individual and up to 3 days on non-porous surfaces

43:12 - Allergies often have itchiness associated with them, so itching is pro

43:28 - A common cold is over quickly

43:39 - Flu and other respiratory viruses are difficult to distinguish from COVID-19

44:29 - Influenza tends to cause body aches

44:38 - A primary symptom of COVID-19 appears to be diarrhea, not necessarily fever

47:34 - Patients should seek medical care if they have respiratory distress when at rest or a fever that is unresponsive to medicine 

51:14 - To avoid misinformation, follow Dr. Kim, the CDC, and other reputable sources for scientific information on social media

51:25 - Some stand-up comedians are hosting shows from their living rooms on social media, which may be a nice relief from social isolation

51:50 - Try to connect with other people over text, Facetime, Zoom, or social media so that you are isolated physically, but not emotionally

52:49 - Outlets for recreation and connection will be key for mental health during social isolation

53:02 - Prioritize outdoor activity as much as possible for wellness and to minimize joint pain and stiffness

55:50 - We hope after society returns to “normal” that people will understand that immunocompromised people are not only elderly

59:00 - You can find Matt Iseman on Twitter and Instagram @MattIseman

59:25 - For more information on COVID-19, you can join our organization’s COVID-19 group on Facebook by connecting to our page @IFAiArthritis

1:00:03 - If you would like to take a seat at the table, visit us on the web at aiarthritis.org/podcast, on social medias @IfAiArthritis on all platforms, or email us @ podcast@aiarthritis.org

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