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primary care provider on Humira

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Nope. Not at work. All the British guidance suggests this person work from home or stay home and to stay home in general. Immunosuppressed with underlying autoimmune disease process.......

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Tough question. I would say depends on their age and setting. I’m around providers on biologics that are still working, however they’re taking extra precautions when doing procedures or in the hospital. I’ve had pts come in on azathioprine and long term pred, which is more concerning to me. 

Edited by ANESMCR

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jus a thought..... stop the humira, extra ppe, and work

just skip 1-2 injections.... every option sucks, but getting dead is the worst option....

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I work critical care and I'm on remicade infusions.  No option to stay home.  I wear a PAPR if SARS-CoV-19 is suspected and when intubating go straight to glidescope.  I would say if this person is primary care and there is no PPE available, should any of you be there?  How critical is this practice?

I would contact your prescriber before stopping.  Keep in mind if you take a break from a biologic, it might not work as well, or at all, when you start again.  And the risk of a relapse or flare may be just as serious depending on what autoimmune disease you have.  

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apparently some biologics are higher risk than others. I have a friend on xolair so did a bit of research. Apparently that particular agent does not confer additional risk, according to pulmonologists, allergists, and immunologists. 

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I was on Humira for 3 years then about a year ago I came down with something that knocked me out for weeks. I had high fevers for two weeks, fatigue, aches. After a couple of UC/ER visits I was admitted for FUO. They did every test under the book. Chest/ABD/pelvis CT, HIDA, LP, MRI, etc. I was on IV ABX for a week. To this day don't know what it was. Took weeks for my energy to fully recover.

After a year hiatus, I'm now on Entyvio which is supposed to be gut specific. I hope. But I'm not taking any chances, I'm in outpt ortho so I took the next couple of weeks off. I definitely wouldn't be anywhere near a COVID patient without PPE on Humira. Sounds like a bad time.

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My thoughts are turning toward WHICH PROVIDERS should be seeing patients with potential COVID and is that actually everyone until proven otherwise??

Very conflicted right now. 

All non urgent stuff needs to go back burner and video (gawd, help me, I said that) or phone visits need to be for everything - diabetes, blood pressure, etc.

Folks will still cut themselves in the garage, break bones and do bizarre stuff - but we should reserve PPE for first response folks 100% and inpatient folks. 

Those of us in Primary Care and Internal Medicine should not be having much if any patient face to face contact. Chest pain notwithstanding. Holy Hell, the ART of medicine is taking a hit right now. 

We still don't know enough about the disease - reinfection, relapse, carrier status, continued exposure, mutations, etc. Do we ever get immunity? 

When will we be able to test folks en mass and find some sort of function?

Also, how long does it take a biologic agent to get out of your system and does the underlying disease not make one just as susceptible to infection and intolerant of excess stressors?

So, I guess I go back to minimize, minimize and a heaping dose of common sense.

Bless our colleagues who are on the front line of this mess. 

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I'm on Humira - when I had my cancer scare, I was taken off it, and within a few months I had one of my severe flares, the kind I've had just a few times in the 30-ish years since I was diagnosed, and in the 18 or so years I've been on biologics. So stopping is arguably my least favorite option.

But my health system has done some re-organizing and planning, and I feel pretty well protected. Patients are assessed on the phone first, and in the past week or so we have done everything possible to move scheduled office visits over to phone visits. Visitors and patients entering the building are asked all the screening questions first. People with respiratory symptoms are directed to a specific subset of our Urgent Cares, for either scheduled or walk-in visits. People with no respiratory symptoms can use the rest of the UC locations. 

Last week on Monday, I saw 8 patients in the office plus 12 on the phone. Yesterday it was just one pre-op, for a surgery that can't be postponed, and the rest were phone. We still have the option of asking a patient to come in if there's something we need to assess in person, and if they have no respiratory symptoms, but even those are being treated as high-risk.

I know there's debate and sometimes strong opinions about telemedicine, but right now is a good time to lean on your history-taking skills and clinical judgment. As a good Oslerian, I consider the physical exam a way to confirm what I think I know, or find out what I know I definitely don't know yet, based on the history. If something needs to be done in person, I have a process for getting it done. 

But yeah, in a situation where I was seeing undifferentiated patients, some of whom had obvious COVID-19 symptoms, hell no I wouldn't accept that without a lot of discussion and planning. 

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