CHRISTIAN MEDICAL COLLEGE VELLORE
Not to be ministered unto but to minister

High-risk groups

Resources sourced for this compilation
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html
https://www.health.harvard.edu/blog/covid-19-if-youre-older-and-have-chronic-health-problems-read-this-2020040119396
https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-hiv-and-antiretrovirals
https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html
https://www.theunion.org/news-centre/covid-19/covid-tb-faqs


1) Can people who recover from COVID-19 be infected again?

Adequate evidence is still lacking regarding the possibility of re-infection. However it is better to be cautious and avoid any chance of getting re-infected. Patients who have recovered should wear face mask and should follow social distancing and proper hand wash. Patients with MERS-CoV are unlikely to be re-infected shortly after they recover, but it is not yet known whether similar immune protection is present for those infected with COVID-19.

2) Are patients after transplantations, on immunosuppressants or where immune status is challenged at a higher risk of developing COVID-19?

Patients in an immune compromised state are at a higher risk of developing severe disease.  When the immune system is weakened by age or illness, they are unable to fight off the virus and can develop a more severe infection. In some patients, an exaggerated immune response happens which itself can lead to more inflammation and tissue damage.


It is recommended not to make anticipatory adjustments to current immuno-suppressive drugs or dosages.

3) Should an HIV patient take more precautions to prevent getting COVID 19?

People diagnosed with advanced symptoms of HIV, those with low CD4, high viral load and those who are not taking antiretroviral treatment have an increased risk of infections in general.  However it is unknown if these patients are at a higher risk for developing COVID-19. HIV patients are advised to take the same precautions as the general population. People living with HIV who are taking antiretroviral drugs should ensure that they have at least 30 days and up to 6-month supply of medicines.

4) Are patients diagnosed with cancer at a higher risk for COVID-19?  

So far, no systematic reports are available about a higher incidence of COVID-19 infections in patients with cancer. But those at risk includes,
Patients having chemotherapy, or who have received chemotherapy in the last 3 months
Patients receiving extensive radiotherapy
People who have had bone marrow or stem cell transplants in the last 6 months, or who are taking immunosuppressive drugs
People with some types of blood or lymphatic system cancer which damage the immune system, even when not being treated.
Specific risk groups for cancer patients are those with an impaired immune system      
such as with leukocytopenia and those with low immunoglobulin levels


5) Should Chemotherapy be continued in cancer patients?

Delaying surgery in cancer patients may lead to disease progressions and result in tumors which may not be resectable, and can lead to worse survival outcomes. The same goes for neoadjuvant or adjuvant chemotherapy regimens administered with suboptimal timing. Therefore, any delay of these fundamental procedures, either intentional or due to shortage of personnel, should be avoided. Patients with advanced disease, and no suggestive symptoms of COVID-19, should keep receiving planned chemotherapy or radiotherapy treatment, without unnecessary delays.                                                                           
Resource: https://www.annalsofoncology.org/article/S0923-7534(20)36373-0/fulltext


6) What are the co-morbidities which makes patients at a higher risk of severe disease?

Patients with underlying chronic conditions like diabetes mellitus, chronic lung disease, and moderate to severe asthma, cardiac disease with complications, immunocompromised states or old age are at very high risk. 

7) Will a patient who is on treatment for Tuberculosis get COVID-19?

Patients who are diagnosed of TB are at higher risk of getting severe COVID-19 disease and their treatment outcome will be poor if either anti-tubercular drugs intake is interrupted, or if they develop post TB lung disease.

8) If a patient on treatment for tuberculosis shows symptoms of cough, breathlessness or fever what should he do?

Since the symptoms of both TB and COVID-19 are very much similar, if the TB patient has history of contact with a COVID patient, or travel history and if the symptoms worsens he/she should contact the healthcare workers and get tested for COVID-19
 
9) Do I need to stock up my TB drugs for future use? 

National quarantine may affect your mobility to reach your care provider. It will be worthwhile to discuss with your doctor about stockpiling and make a decision based on the current situation in your locality.

10) I am on treatment for TB. If I get diagnosed with COVID-19, what should I do?

Continue taking the TB drugs, follow strict safety measures like wearing face mask at all times, wash your hands with alcohol based sanitiser or soap. Isolate yourself from other family members.  Inform your doctor about your TB treatment, so that they can make sure there will be no drug interaction.