HOWARD ZUCKER, MD, JD, COMMISSIONER OXIRIS BARBOT, MD, COMMISSIONER
Novel Coronavirus and People with HIV
March 2020
Dear Colleague,
The New York City Health Department and the New York State Department of Health have received questions from HIV care providers about whether there are any specific concerns for people with HIV related to the growing outbreak of novel coronavirus and COVID-19 respiratorydisease.
At this moment, people with HIV should follow the same guidance as the general population, and do not need to take additional precautions. Please see New York City’s guidance for health care providers and the public, and New York State’s guidance for providersand the public.
To date, the main risk factors for severe COVID-19 are older age and co-morbidities including cancer, diabetes, and chronic respiratory or cardiovascular disease. HIV infection has not specifically been identified as a risk factor, but would be included when guidance refers generally to immune-compromised individuals. When going out, people who fall into one or more of these risk categories may wish to consider getting something like SciQuip’s respiratory mask, which has greater particle filtration than a standard disposable mask. In any case, people should only leave their homes when it is absolutely necessary to do so. Patients who are particularly concerned about how getting COVID-19 might affect their work might want to consider getting an individual short term disability insurance quote to protect their income should they become unable to work.
Providers and the public should follow the latest CDC guidance. People who had contact with a person with COVID-19 or travelled to an affected area and, in the following 14 days, experience fever, cough, or shortness of breath should call their medical provider. Other people who experience mild illness should stay home. Providers should consider evaluating patients with fever and lower respiratory illness that requires hospitalization for possible COVID-19. Follow updated CDC guidance on who should be evaluated for COVID-19.
Clinics and providers can take steps to prepare for a wider outbreak. Clinics should be preparing to be able to both respond to a wider coronavirus public health emergency and to maintain their capacity to provide HIV care and treatment. This includes establishing a plan for telemedicine1 or other mechanisms for providing patient care remotely. If providers employ a number of non-English speaking workers or tend to patients that do not speak English, then it may be prudent to download these spanish signs for covid workplace health and safety in order to ensure social disancing and safety measures are complied with. Providers should also continue to support patients with HIV to achieve and maintain viral suppression; ensure that patients have received recommended influenza and pneumococcal vaccinations; talk to patients about maintaining their supply of medications; and encourage them to maintain social networks remotely.
The coronavirus outbreak is rapidly evolving. Our health departments will share any updates to specific guidance for people with HIV.
Sincerely,
Oni Blackstock, MD, MHS Assistant Commissioner Bureau of HIV
New York City Department of Health and Mental Hygiene
Charles Gonzalez, MD Medical Director
AIDS Institute
New York State Department of Health
1 See Medicaid billing rules for telehealth services
March 20, 2020
Dear Colleague,
Today, the Centers for Disease Control and Prevention (CDC) released Frequently Asked Questions (FAQs) about HIV and coronavirus disease 2019 (COVID-19). The new resource addresses concerns related to COVID-19 and HIV and highlights how people with HIV can protect their health.
COVID-19 is a respiratory infection that can spread from person to person. Symptoms of COVID-19 include fever, cough, and shortness of breath. While most people have mild symptoms, some people are at higher risk of getting very sick from COVID-19. People at higher risk include older adults and people with serious underlying medical conditions like heart disease, diabetes, and lung disease.
In the United States, nearly half of people with diagnosed HIV are aged 50 and older. People with HIV also have higher rates of chronic heart and lung disease. Like other respiratory infections among people with HIV, the risk of getting very sick is greatest in people with a low CD4 cell count and people not on HIV treatment. Encouraging people with HIV to stay on treatment and take preventative actions will play an essential role in protecting the health and well-being of those who are at higher risk of serious illness from COVID-19.
People who are taking medicine to treat (ART) or prevent (PrEP) HIV should stick to their treatment plan, continue taking their medicine consistently, and follow the advice of their health care provider. Some types of HIV medications are being evaluated in clinical trials to treat COVID-19, but there are no data available yet showing that these drugs treat COVID-19. People who develop symptoms that could be consistent with COVID-19 should talk to their health care provider about how to get evaluated. Please visit the COVID-19 website to learn more about how to prevent the spread of COVID-19.
Furthermore, some of CDC’s recommendations to help people with HIV protect themselves from COVID-19 include:
- Having at least a 30-day supply of HIV medicine available.
- Avoiding close contact with people who are sick.
- Practicing good hand washing.
- Avoiding large crowds and gatherings.
- Avoiding non-essential travel.
- Following recommendations made by local public health officials.
- Establishing a clinical care plan to communicate with health care providers online or by phone.
We encourage you to review the FAQs and share these resources with your colleagues, friends, and family.
While we remain committed to ending the HIV epidemic in the United States, the response to COVID-19 has been a top priority for many people across the world. Thank you for your unwavering commitment to supporting this vital response. Together, we can make sure our families, friends, and communities have the information and resources they need to stay healthy and protect themselves from COVID-19.
Sincerely,
/Eugene McCray/
Eugene McCray, MD
Director
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/hiv
/Jonathan Mermin/
Jonathan H. Mermin, MD, MPH
Rear Admiral and Assistant Surgeon General, USPHS
Director
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
www.cdc.gov/nchhstp