Question: Is there anything we should know in regards to immunocompromised patients since they are in a high-risk category when it comes to COVID-19?
Answer: The published data from China has very few immunodeficient patients included in their cohorts, for example, out of 1,066 hospitalized there were two, and they had non-severe disease (NEJM 2020. DOI: 10.1056/NEJMoa2002032). Nonetheless, it makes sense that patients who have compromised immune systems will be at risk of a more severe infection, if they get COVID-19. The importance here is to prevent infection in the first place. As has been said numerous times, the best approach at this time is for these patients to: (1) practice social distancing (avoid crowds and travel, keep at least six feet away from anyone who appears ill), (2) frequently wash their hands with soap and water for 20 seconds, and don’t touch your face, (3) continue any medications for their underlying health conditions, and (4) call before going to any healthcare provider (including emergency department and urgent care). The last issue is important because providers need to make sure that when an immunocompromised patient comes to their office they are not exposed to potential COVID-19 patients. Providers should keep a close eye on their own health and take appropriate precautions to not become infected with SARS-CoV-2, and to stay at home should they exhibit signs of COVID-19.
Question: I have a patient recently diagnosed with CVID. She has no ability to make antibodies at all, and is now receiving IVIG. For COVID-19, even if a vaccine becomes available in the fall, are there any antiviral medication regimens you would recommend at this juncture to utilize prophylactically or maintain on standby if required?
Answer: At this point there is no proven effective therapy for COVID-19. There are a number of clinical trials ongoing. Social isolation is key in this setting. Anti-COVID 19 IgG will eventually make its way into IVIg materials, but this will take several years at a minimum. This is a very difficult problem. You will also find information on this topic in the Special Article: COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic
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