Managing SARDs: The Importance of COVID-19 Vaccination

EP: 1.What Characterizes SARDs or Connective Tissue Diseases?

EP: 2.An Overview of Systemic Lupus Erythematous

EP: 3.Idiopathic Inflammatory Myopathies

EP: 4.Treatment Options for Systemic Lupus Erythematous

EP: 5.Treatment Options for Idiopathic Inflammatory Myopathies

EP: 6.Improving Rheumatology: Telemedicine and Patient Evaluation

EP: 7.Improving Rheumatology: Patient Education and Advocacy

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EP: 8.Managing SARDs: The Importance of COVID-19 Vaccination

EP: 9.Practical Advice for Managing SARDs in the Current Treatment Landscape

Transcript:

W. Hayes Wilson, MD: Since we’re in the middle of COVID-19, and patients come in and they say, “What do you think, should I get the vaccine, or not get the vaccine?” How do you couch your answers to them? I’ll just toss this out here and see if you’ve run into this. I had a patient yesterday who said that she got COVID-19. She got ivermectin off the internet. And she thinks that helped her a lot. How do you answer?

Kostas N. Botsoglou, MD: I was hoping when this pandemic started that we had the solution all these years in hydroxychloroquine, and we see in the trials, it really didn’t make a difference. But I advise all my patients that the benefits outweigh the risk. Although this is a new virus, and we’re still understanding it, getting vaccinated is in their best interest. And for many of our patients who are on DMARDs [disease-modifying antirheumatic drugs] and biologics, they qualify for a booster, if available. It’s a conversation we’re having every day. I think you’ll agree, COVID-19isn’t going anywhere. And this may eventually be COVID-19, 20, 21, and so forth. We’re going to have our annual booster, an annual vaccine, similar to what we’ve done with influenza.

W. Hayes Wilson, MD: I’m hoping that this may run the course in 3 or 4 years. But I don’t think it’s going to be over by Christmas. And the fact of the matter is, I point out to my patients that there’s a hospital south of us called [Piedmont] Newnan Hospital, and it’s at 128% of capacity. They’re stuffing people in places that aren’t supposed to have people, and they’ve got the National Guard there. And I said that more than 90% of the patients are unvaccinated people. That the problem that we have now is not from the vaccine, the problem is we have is from the unvaccinated. And the people on ventilators and the people who are seriously ill are certainly the people who are unvaccinated. As a matter of fact, we have a report. There are some people who get COVID-19 even though they have been vaccinated. However, one of the comments I saw was, well, if you get vaccinated, you can still get COVID-19. All it does is, you don’t die. And the comment after that was, well not dying sounds pretty good.

Most of my patients who got COVID-19 after they got vaccinated had it for 3 to 5 days, and it was a very limited course. I have some patients who, they’ll say, “I’m waiting to see.” And I point out to them, that’s like you’re not sure about seatbelts. You’re waiting to see about seatbelts. That’s great, as long as you don’t have a wreck. But if you have a wreck, it’s not going to work out very well for you. And the same thing with COVID-19. If you’re just waiting to see about the vaccine and you get COVID-19, you may wind up dying. I guess they’ve estimated now that 675,000 people have died from COVID-19, and that’s as many as died from the Spanish flu. Of course, we have 6 times as many people, but we also have a vaccine. It just seems sort of obscene that that would happen. I read the other day that for the first time in history, more people have died in Alabama than were born in Alabama. That’s a sobering characteristic too.

When we think about rare autoimmune diseases, we have to consider that that puts you at risk for other things. And who would have thought when we were in fellowship, that we’d be treating people during the middle of a pandemic? I never would’ve thought that, but it’s a “yes, and.” So, what we have to do is say, yes, it’s a pandemic and what are we going to do? We’re going to do the best we can, which is to vaccinate the people. And that’s a lot of the same thing that we do with our patients with lupus. I have patients come in all the time, and they say, “Well, I really don’t want to take any medicine.” And I say, “Well, you’ve got a serious disease that can affect different organs of your body. You need to strongly consider taking medicine.” And it can be hard when somebody says, “Well, I’m going to eat whatever vegetables and it’s going to make me better.” And I’ll say, “Not with an autoimmune disease, it isn’t.”

Sometimes like you said, and I like the way you brought it up, is we get the family to help us out. We get them to be advocates with us and say, “There are other people who care about you and who think that you should address your problems.” I completely agree with everything that you said because it is a team approach. Patients with systemic autoimmune disease tend to be women of childbearing years, which means they tend to have families. And the whole family gets involved. Kids get involved, the husband gets involved, and sometimes grandparents get involved, because they have to help with taking care of the kids. The opposite is true as well, that sometimes some of our patients who are a little bit older wind up having to take care of grandkids because the parents are going off to work. And because they have an autoimmune disease, and kids are like little Petri dishes and carry infectious diseases, we have to be cautious. That’s another reason why you may want to have them vaccinated as well. Any comments you have on that?

Kostas N. Botsoglou, MD: Well to add to that, that’s why, for example, we offer the flu vaccine at the office for all our patients because we want to minimize these risk factors. I use the same example as you mentioned with the seatbelt. A seatbelt may not prevent you from dying, but it’s going to protect you from having a serious injury, and you may still have a car accident, but you might survive it because of the seatbelt. There’s going to be a lot of education going on about maintaining these vaccinations and preventing deaths and hospitalizations because that’s what the vaccine is intended to do.

W. Hayes Wilson, MD: I agree. I’ve seen cartoons from the Spanish flu at the turn of the last century, when people didn’t want to take vaccines. And I remember when I was a kid, you’re too young to remember this, but they made cars that wouldn’t start if you didn’t put your seatbelt on. And a guy 2 doors down from us said, “Nobody’s going to make me put a seatbelt on.” And so he would buckle the seatbelt behind him because, by God, nobody was going to tell him he was going to wear a seatbelt. Also, my first job at Grady [Memorial] Hospital was washing dishes. And I washed dishes with a guy who said, “I’m not going to wear a seatbelt because if I get in a wreck, I’m going to jump free.” I just point those 2 things out to my patients. I say, “You wouldn’t do either one of those, would you?” My patients say, “No, that sounds absurd.” And I say, “Yes, maybe you ought to go ahead and get a vaccine.”

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Transcript edited for clarity.