Caring for Immunocompromised Patients in the COVID-19 Context
Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.
This tool has has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’, with considerations and recommendations on what’s ‘new’ and what’s ‘changed’ in the delivery of care for immunocompromised patients. While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.
Key takeaway
Immunocompromised patients are at higher risk of getting severely sick from COVID-19 (CDC, December 16, 2020), and should take precautions to protect against acquisition of the virus. Immunocompromised patients include (CDC, December 29, 2020):
- Individuals using immunosuppressant medications.
- Bone marrow or solid organ transplant recipients.
- Individuals with inherited immunodeficiency.
- Individuals living with poorly controlled human immunodeficiency virus (HIV) infection.
- Patients receiving chemotherapy.
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What's new, what's changed
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Management
Immunocompromised patients should self-isolate for their own protection (PHO, October 28, 2020), keep physically active, and continue practicing condition-specific preventative measures (ECDC, September 24, 2020).
Immunocompromised healthcare providers must make decisions that reflect their own unique situations, while also considering public health advice and the best available evidence (CPSO, January 15, 2021).
Putting it into practice
- Encourage patient to take their medications, follow the advice of their healthcare providers, and call their healthcare provider if they have concerns about their condition or feel sick (CDC, December 29, 2020).
- Make sure that they have at least a 30 day supply of medications if possible (CDC, December 29, 2020).
- Do not delay life-saving treatment or emergency care (CDC, December 29, 2020).
- Leverage virtual platforms to engage with a patient’s multidisciplinary management team (specialist, nurse case manager, dietitian, social worker, pharmacist, etc.).
- Consider risk mitigation options in consultation with the patient’s specialist (NICE April 3, 2020; NICE, April 23, 2020; NICE, April 9, 2020):
- Enable virtual or in-home monitoring (see local community services and resources for Homecare in your area).
- Enable in-home laboratory sample collection (see local community services and resources for Diagnostic centres and laboratories in your area).
- Reduce the frequency of in-person appointments.
- Increase the time interval between blood tests in patients who are stable on treatment (taking age and comorbidities into account).
- Modify dose, treatment schedule, and/or administration protocol to reduce the need for hospital attendance (including use of community outreach teams if available) and/or reduce the likelihood of subsequent hospital admission.
Supporting evidence
According to a study in the BMJ, inflammatory bowel disease (IBD) medication has been shown to be associated with significant increased risk of severe COVID-19 (October 20, 2020).
- Specifically, thiopurine monotherapy and the combination thiopurines with TNF antagonists are associated with significantly increased risk of severe COVID-19.
- Mesalamine/sulfasalazine may be associated with an increased the risk of severe COVID-19, particularly when compared with TNF antagonists.
Resources
For patients
In-home nursing
- North: North West, North East
- West: Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant
- Central: Central West, Central, Mississauga Halton, North Simcoe Muskoka
- East: Central East, South East, Champlain
- Toronto: Toronto Central
In-home personal support
- North: North West, North East
- West: Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant
- Central: Central West, Central, Mississauga Halton, North Simcoe Muskoka
- East: Central East, South East, Champlain
- Toronto: Toronto Central
For patients
Other local services
- Assistance for isolated people
- Financial services
- Food
- Home equipment services
- Mental health services
- Pharmacies
Resources
These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.
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Acknowledgement and legal
The COVID-19 Resource Centre was developed by the Centre for Effective Practice (CEP) in collaboration with the Department of Family Medicine at McMaster University, the Ontario College of Family Physicians and the Nurse Practitioners’ Association of Ontario using a rapidly modified version of the CEP’s integrated knowledge translation approach.
They are some of several clinical resources developed as part of the Knowledge Translation in Primary Care Initiative. Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.
Clinical Working Group
A clinical working group was established and provides significant input and oversight into the development of this resource. Members include:
• Claudia Mariano, MSc, NP-PHC
• Darren Larsen, MD, CCFP, MPLc
• Derelie Mangin, MBChB (Otago), DPH (Otago), FRNZCGP (NZ)
• Dominik Nowak, MD MHSc, CCFP, CH
• Jennifer P. Young, MD, FCFP-EM
• Lee Donohue MD, CCFP, MHSc, MPLc
• Mira Backo-Shannon, MD, BSc, MHSc
• Paul Preston, MD, CCFP, CCPE, CHE
• Rob Annis, MD, CCFP
• Soreya Dhanji, MD, CCFP
In addition to our clinical working group the CEP also obtained feedback from others, including:
• Arun Radhakrishnan, MSC, MD, CM, CCFP
• David Price, BSC, MD, CCFP, FCFP
• Jose Silveira, BSC, MD, FRCPC, DIP, ABAM
• Michael Chang MD, FRCP(C)
• Payal Agarwal, MD, CCFP
• Robert Sauls MD, CCFP(PC), FCFP
• Tara Walton, MPH
Thank you to everyone who supported the development of this resource.
Conflict of interest
• Clinical Leads receive compensation for their role
• Clinical Working Group receive an honorarium for their participation
• Focus group and usability participants receive a small token of appreciation (e.g. gift certificate)
The Caring for Immunocompromised Patients in the COVID-19 Context resource is a product of the Centre for Effective Practice. Permission to use, copy, and distribute this material for all non-commercial and research purposes is granted, provided the above disclaimer, this paragraph and the following paragraphs, and appropriate citations appear in all copies, modifications, and distributions. Use of the Caring for Immunocompromised Patients in the COVID-19 Context resource for commercial purposes or any modifications of the Tool are subject to charge and use must be negotiated with the Centre for Effective Practice (Email: info@cep.health).
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