Coronavirus Response and Updates

COVID-19 Vaccination Facts

SOCIAL DISTANCING

Why do we take social distancing so seriously?  The attached 3-D demonstration from the New York Times helps to demonstrate why.  Click here to check it out. 

Recently the Governor announced a relaxation of the  stay at home order.  This does NOT mean that we are ready to open our office to in-person appointments.  Please do not arrive to the office.  For the safety of our patients, staff and physicians, we will continue to offer our clinical visits only through telehealth.  RAB is continuously monitoring the COVID situation and is actively engaging in discussion about how to safely open the office for in-office patient visits.  By keeping everyone's exposure to a minimum, we are contributing to the reduction of the spread of the virus, which is still active in the State.

Coronavirus Response and Updates

COVID-19 Vaccination Facts

The approval of Covid-19 vaccines is very good news. We understand, however, that you may have questions or concerns about the vaccine, its safety, and its eventual availability. While we wait for additional information, the RAB clinicians have put together these COVID-19 Vaccination facts.

UPDATE  8/23/2021:   On Monday, August 23, 2021, the FDA granted full approval of the Pfizer-BioNTech vaccine for all individuals older than 16 years old.  The formal name of the vaccine is Comirnaty.  It is expected that the Moderna and Johnson and Johnson vaccines will get similar FDA approvals, along with the 12 years and older Pfizer indication.

 

As of August 23, approximately 50% of the eligible U.S. population has been vaccinated and 73% of the adult population has received at least one shot.  More than 80% of adult Marylanders have been vaccinated  and greater than 90% of adults 65 and older.  

 

Booster vaccinations are expected in about a month for those previously vaccinated at least 8 months ago (from the second vaccine) of Pfizer and Moderna.  Recommendations concerning the J&J booser will be forthcoming.  We will continue to update you as more information becomes available.

UPDATE 8/16/2021: Recently there have been a number of questions surrounding the Covid-19 infectious risks in patients with chronic rheumatic diseases, especially vaccination recommendations.  On August 13, 2021 the CDC made further recommendations.  The important points include the following:

 

  • Patients on chronic Biologic* medications or on the following non-Biologic DMARDS:  Methotrexate, leflunomide, Jak inhibitors (Xeljanz, Rinvoq, Olumiant), prednisone above 20mg daily, should receive a third vaccine dose if they initially received either the Moderna or Pfizer vaccine.  Additionally, patients on Azathrioprine, Cellcept and cyclosporine should also receive a third vaccine.

 

  • The third vaccine should be the same brand as the first two

 

  • No recommendations have been made concerning the Johnson & Johnson vaccine as of yet

 

  • There are no specific recommendations concerning using the result of testing of the Covid spike protein antibody to alter any treatment recommendations at this time

 

  • Patients should remain careful in situations where they would be exposed to non-vaccinated people, such as crowds, etc.  When in doubt, continue to use the same rules of masking and social distancing

 

  • Data has shown that a third vaccine has increased the antibodies in patients who are immunocompromised and that the vaccine has been well tolerated including a relatively low risk of causing flares of the underlying chronic disease

 

  • RAB does not have vaccine and is not administering any Covid vaccines.  Please contact your local pharmacy or the County health department for vaccine administration locations.

 

 

*Biologic medications include:  Enbrel, Humira, Remicade, Simponi, Cimzia, Orencia, Actemra, Kevzara, Rituxan, Cosentyx, Taltz and Stelara as well as biosimilar biologics for Remicade and Rituxan.  

UPDATE 4/19/2021: The American College of Rheumatology has recently come out with some new guidelines regarding medications and receiving the COVID19 vaccine. Please understand that these are Guidelines and RECOMMENDATIONS and may not apply to every patient. You will likely want to discuss with your provider caring for you if you have questions or concerns. 

 

The following guidelines were given: 

 

  1. Do not take methotrexate for one week following each COVID19 vaccination (for those with well controlled disease) 

  2. Do not take JAK-inhibitors such as Xeljanz (tofacitinib), Olumiant (baricitinib), or Rinvoq (upadacitinib) for one week following each COVID19 vaccination 

  3. No changes need to be made in terms of medications for: hydroxychloroquine, IVIG, or prednisone dose of less than 20 mg 

  4. Orencia (abatacept) Subcutaneous - hold for one week before and one week after the FIRST COVID19 vaccination injection ONLY. No change around second dose 

  5. Orencia (abatacept) IV - Time vaccine administration so that the first vaccination will occur four weeks after Orencia infusion (i.e., the entire dosing interval), and postpone the subsequent Orencia infusion by one week (i.e., a 5-week gap in total); no medication adjustment for the second vaccine dose

  6. Rituxan (Rituximab) -  schedule vaccination so that the vaccine series is initiated approximately 4 weeks prior to ext scheduled rituximab cycle; after vaccination, delay rituximab 2-4 weeks after the 2nd vaccine dose, if disease activity allows. 

  7. Cytoxan (Cyclophosphamide) - time for one week after each COVID19 dose if possible 

  8. No recommended modifications for: Sulfasalazine, leflunomide, azathioprine, cellcept, Actemra, Benlysta, tacrolimus, and TNF inhibitors such as Remicade (infliximab), Humira, (adalimumab), Enbrel (etanercept), Cimzia (certolizumab), Simponi (Golimumab), nor biologics used for psoriatic arthritis such as Cosentyx (secukinumab), Stelara (ustekinumab), Taltz (ixekizumab), Tremfya (Guselkumab). Biosimilars fall into this same category. No recommended modifications for Otezla (apremilast)

 

The ACR has voiced that recommendations in the guidance should not replace clinical judgement, and decisions about individual patients should be made as part of shared decision-making with patients that considers their underlying health condition(s), disease activity level, current treatments, risk of exposure to SARS-CoV-2 and geography. (In short, your provider will be the best person to help in making these decisions with you). Patients are also encouraged to continue following all public health guidelines regarding mask wearing, physical distancing and other preventive measures even after vaccination. Remember: Continue masking and social distancing......GET YOUR VACCINE!  

 

We would also like to use this space to say: As we learn more through studies in the coming months to years, we will do our best to share that information with you. These are merely eminence based recommendations/guidelines and not set in stone. If you have already had your vaccine and not made such changes, then we must remember this fact.  Again, the most important thing is to get vaccinated.

UPDATE 3/3/2021: We are receiving many questions surrounding when patients can start getting the COVID-19 vaccine through their medical providers. We do not have vaccines,  however our practice has registered with the State's Covid-19 Vaccination Program indicating our strong interest and ability to be a vaccine distribution site for our patient population.  Our office has been approved and we are now simply waiting on vaccine availability.

 

When we get notified of vaccine availability and receive the doses, we will send out mass notices to patients via our Phreesia registration system, the patient portal, our Facebook page, and our website.  Please pay close attention to communications from our office.

 

Rest assured we are committed to sending updates and appointment instructions as we we prepare our vaccination plans.  In the meantime, we are continuously monitoring the CDC's guidance for changes and updates so we can provide you with the most current and valid information. 

 

Please continue to practice social distancing, masking, and hand sanitizing as the first line of defense against the virus.  

  • As of March 1, 2021, three vaccinations have been approved (Pfizer, Moderna, Johnson and Johnson). Several other vaccines are currently completing trials and hopefully the data will support their approval in upcoming weeks. There will be several platforms for these vaccines but the first two use mRNA technology, J&J uses anadenovirus vector. All of the vaccines generate an immune response to enable resistance when exposed to the actual Covid virus. No studies have or are using live virus.The first two require two injections while the J&J is a single injection. There have been over 1.2 Marylanders who have received a vaccine as of February 28, 2021.
     

  • All of the vaccine trials enrolled more than 30,000 participants with an efficacy rate around 95% in the Moderna and Pfizer trials and slightly lower in the J&J trial. However, all three prevented severe cases. Participants included all adult age groups and included people with chronic diseases. Further plans include additional studies on people who are chronically immunosuppressed and with chronic autoimmune diseases.

 

  • Some vaccine recipients have experienced side effects following the injections, but these tend to be mild including soreness in the injection site, low grade fevers, fatigue, and muscle or joint pain. However, the benefit of preventing Covid-19 infections far outweighs the risk of side effects of the vaccine. Acetaminophen or ibuprofen generally lessen these side effects

 

  • People who have already had a Covid-19 infection should also receive one of the vaccines since they most likely will only have protective antibodies for about three months. If someone has had a recent infection, the vaccination may be delayed to allow others to get the vaccine if the infection is within the previous 3 months.

 

  • At this point, there are no specific reasons that patients with rheumatic illnesses should not receive vaccination against Covid-19. The vaccines have proven to be safe and extremely effective at preventing severe infections to a virus that has proven to be deadly

 

  • What is Herd Immunity with these vaccines? When about 70% of the population receives a vaccine, it becomes much more difficult for the virus to spread. The hope is that this figure will be reached for Covid-19 for additional significant protection as the vaccine becomes more widely available.
     

  • Masking and social distancing remain prominent in preventing spread of Covid 19. Recent research has shown that double masking is much more effective than single cloth masks. Options include a standard medical procedure mask (surgical mask) under a cloth mask (95% effective), KN95 mask (95% effective). N95 masks remain in short supply and should be saved for healthcare workers.

 

  For additional up to date information, we recommend using the following sources:

SOCIAL DISTANCING

Why do we take social distancing so seriously?  The attached 3-D demonstration from the New York Times helps to demonstrate why.  Click here to check it out. 

Recently the Governor announced a relaxation of the  stay at home order.  This does NOT mean that we are ready to open our office to in-person appointments.  Please do not arrive to the office.  For the safety of our patients, staff and physicians, we will continue to offer our clinical visits only through telehealth.  RAB is continuously monitoring the COVID situation and is actively engaging in discussion about how to safely open the office for in-office patient visits.  By keeping everyone's exposure to a minimum, we are contributing to the reduction of the spread of the virus, which is still active in the State.

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Please register for our new portal. If you're a patient that has been seen in the past 2 years, you should've gotten an email with a link to register. If not, contact our office and we can send you an invite.

New Portal!

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