Novel Coronavirus (COVID-19) - 24/06/2020 Updated 24/06/2020. Healthcare professionals managing a patient with COVID-19 and Adrenal Insufficiency - please view the latest guidance from the European Society of Endocrinology. This page is currently up-to-date, based on the most recent guidance available and is the best advice we have for people with Addison's and Adrenal Insufficiency at this time. This advice is for people living in the UK and ROI. Our trustee medics and Clinical Advisory Panel alongside Society for Endocrinology, have been keeping an eye on the emerging situation and the current view is as follows. We hope you find it useful and it answers some of your questions. Here are our six COVID-19 (coronavirus) precautions for people who have Addison's Disease or Adrenal Insufficiency. 1. Protecting Yourself 2. Preparing for Emergencies 3. Managing Your Medication 4. Keeping Informed 5. Managing Employment and Finances 6. Getting About Safely 7. Recovering from COVID-19 1. Protecting Yourself In the UK and ROI guidance is in place to keep the general public safe during the time of COVID-19 UK Coronavirus Guidance ROI Coronavirus Guidance However if you have Addison's disease or adrenal insufficiency you are considered to be within the group of vulnerable individuals, "who are at an increased risk of COVID-19 infection, which may be complicated by developing an adrenal crisis." "There is currently no evidence that people with adrenal insufficiency are more likely to develop a severe course of disease." According to guidance published EJE journal in April. According to current government guidance and the Summary Advice Statement released by Society for Endocrinology, you should be particularly stringent in following social distancing measures. Please see section 6. Getting About Safely below for more information. Shielding advice From 6 July, the rules will allow people to meet in a group of up to six outdoors and single adult households will be able to form a ‘support bubble’ with another. It’s also been confirmed that shielding will pause in England after the end of July. The guidance will then be to adopt strict social distancing – the advice the ‘clinically vulnerable’ group currently follow - rather than full shielding measures. If this applies to you (those on the shielded patient list) you will be sent information about these next steps. We know some of you may welcome the news that the guidance is being relaxed, as current measures have taken a huge toll on both your physical and mental health. But there are also those who will feel understandably anxious. It’s important to remember that shielding is dependant on your personal health and multiple health conditions you may have so we encourage anyone with concerns to speak to their GP, Endocrine nurse or hospital consultant to know what is right for you. Currently people with Addison's or adrenal insufficiency are classified as "‘clinically vulnerable" individuals, together with those over 70 years of age and those with diabetes. The most up-to-date government guidance is available at @DHSCgovuk and www.gov.uk/coronavirus Who is at a very high risk and what does that mean? Most people with Addison's or adrenal insufficiency – but do not fall into any other categories defined as extremely vulnerable – are not considered at very high risk as confirmed by the Society of Endocrinology and so are not part of the government's shielding programme. The rules for stringent social distancing should be followed however, as those with Addison's are considered to be at an increased risk/ vulnerable - similar to those in the over 70's category. There may be some people with Addison's or adrenal insufficiency who are part pf the shielding programme based on other conditions, for example those who have had organ transplants, have certain types of cancers, or have significant respiratory conditions. The full list of people who should be part of the shielding programme can be found on the gov.uk website. You may hear from the government or NHS directly with updates on pausing or resuming shielding as appropriate. If you think you or a loved one are in this highest risk category and have not received a letter from the NHS, the government or your GP, get in touch with your GP or hospital doctor by phone or online to find out what's right for you. Other ways to protect yourself If you're in the UK, follow the advice from the NHS on avoiding catching or spreading coronavirus. You may be caring for a person in an at-risk group. If you are, take extra care to protect yourself and the person you care for from coronavirus. Make sure your vaccinations are up to date. Note that our medics have confirmed that the pneumonia vaccine protects against pneumococcal bacterium and would not protect against the type of Pneumonia caused by COVID-19. This is confirmed on the WHO website on their coronavirus myth-busters page. Managing your mental wellbeing Think about ways to keep your stress levels down. Being prepared can be a great help. Talk to someone if you are feeling stressed or anxious. Read our advice on coping with psychological stress or our blog post Easing lockdown - How are you feeling?. If you are an ADSHG member, go into our online forum and talk about how you feel. Others can then support you. The World Health Organisation has published advice here about managing your mental wellbeing during the coronavirus outbreak. 2. Preparing for Emergencies Get your Emergency kit and Emergency Letter ready: Make sure you have an Emergency Injection Kit containing hydrocortisone vials available from your GP or Endocrinologist, syringes, injection instructions, and plastic vial snaps. Make sure it is up to date, that you have the instructions and practice a self-injection using our videos. Make sure you have a completed Emergency Letter and it is up to date. Keep your NHS Steroid Card handy: Keep a copy of both the NHS Steroid Emergency Card and ADSHG charity Adrenal Crisis Emergency wallet card, filled in with your details, in your wallet or purse. Prepare in case you need to be admitted to hospital: Read our four tips for preparing for hospital admission If living in the UK, register with your local ambulance trust. Make sure you can stay hydrated: Make sure you have plenty of non-alcoholic drinks, salty snacks and rehydration fluids (available in most chemists) or salts available in your home. Learn about Self Isolation in case you are asked to isolate: Familiarise yourself with the NHS advice on self-isolation or the HSE self-isolation and limited social interaction so that you are prepared in case you are told to self-isolate. Get familiar with how to get medical help in an emergency: If you need to use the NHS 111 service please use the NHS 111 website in the first instance so that the service can handle more urgent cases over the phone. If you need to contact NHS 111 or call 999 in an emergency, be sure to mention 'steroid-dependent' and 'adrenal insufficiency' when explaining your health status. Or in ROI: the HSE contact details are: Callsave: 1850 24 1850, Phone: 041 6850300 or Tweet: @HSELive 3. Managing your medication Keep taking your tablets as normally prescribed unless you are ill! Steroids taken for adrenal insufficiency are replacement doses and increasing the dose during illness is to try and mimic your body's natural physiological response. In the correctly tailored dosages, they should not suppress your immune system. Make sure you have a good supply of medication that cover you, in the event, you have to self isolate and fall ill enough to increase your dosing as per our Sick Day Rules. Please read our Sick Day Rules before increasing your dosing and make sure you have an extra month's worth of medication. In our latest video, ADSHG Trustee and Professor or Endocrinology explains how to manage your medication should you get ill in the coming weeks. If your UK or ROI based GP or Endocrinologist does not wish to provide additional prescriptions to provide the above cover, please print and provide them with the below documents as a guide and politely ask again: EJE Clinical Guidance: Managing Adrenal Insufficiency in the time of COVID-19 The advice from the Society for Endocrinologists for people with adrenal insufficiency. The ADSHG Caring For the Addison's Patient leaflet The Pituitary Foundations's Letter to GPs - Digital Template Please note: The ADSHG cannot become involved in individual disputes, but our resources can be downloaded to raise awareness amongst medics. 4. Keeping Informed Make sure you have useful ADSHG publications printed, filled in and stored in an easy to find location. Talk to your family about the support and/or treatment you need - make a plan. You could use our Personal Emergency Plan to think everything through together. Our Sick Day Rules are an excellent set of principles to follow if you become ill. Print them and share them with those who are likely to be looking after you if you become ill. The Government and NHS are providing regular updates so follow them online or keep an eye on the media for their latest updates. UK Department of Health and Social Care On Facebook On Twitter UK NHS On Facebook On Twitter ROI HSEOn Facebook On Twitter Tailored information for people living in Wales, Scotland and Northern Ireland can also be found at: • Public Health Wales • Health Protection Scotland • Public Health Agency (NI) Tailored information for British Sign Language users Read the advice from the Society for Endocrinologists for people with adrenal insufficiency. Read the advice from the Society for Endocrinologists regarding adrenal crisis. Please familiarise yourself with the NHS advice on self-isolation in case you are asked to self-isolate. Follow the ADSHG on Twitter, Facebook or if you are a member all our updates will also feature on our forum. We'll also include advice on our ADSHG website. Misinformation can be troubling and misleading. Please review the WHO's Mythbusters to verify the things you are hearing, reading or sharing. 5. Managing employment and finances If you are employed, talk to your employer about their plans and your needs. Ask if it's possible for you to work from home or make other arrangements. Read the UK Government's Health and Safety Executive latest advice for employees. You can now receive an isolation note to give to your employer. Click here to visit the NHS website to find out more. If you find that your employer insists that you go into work and you have concerns about this, please print out our advice, ask them to do a risk assessment, consider other ways of working or other roles that will help keep you safe. Discuss these reasonable adjustments with with your employer and if needed your HR department. Find the latest advice from the Citizens Advice bureau here, if you are concerned about going to work, sick pay or any benefits you receive. 6. Getting out and about safely The Society for Endocrinology have confirmed it is considered that patients with adrenal insufficiency are part of the group of vulnerable individuals who should be particularly stringent in following social distancing measures during the COVID-19 (Coronavirus) crisis. In line with their latest guidance - the following updated advice is recommended: "Patients with adrenal insufficiency are at increased risk from COVID-19, albeit not as high as in patients undergoing cancer treatment or taking high doses of potent immunosuppressive drugs. All patients with adrenal insufficiency should observe stringent social distancing. If they are working, they should either work from home or work under conditions that allow very stringent socialdistancing at all times. This means that adrenal insufficiency patients should not work in situations that do now allow them to keep their safe distance, as is the case e.g. for healthcare workers, carers, and supermarket cashier staff." If you are planning to travel, please check the travel advice from the UK Government about the countries you'll be travelling to and from. We have advice on our website about managing your Addison's when travelling. If you have a medical appointment, check the current advice at the medical centre in question and discuss any concerns with them when considering if you will attend or not. It is important to contact the NHS if you have any healthcare concerns. It's important not to put off talking to your GP or endocrinologist. If you have been travelling abroad, and you think you may have been exposed to Coronavirus, the most up-to-date advice on what to do can be found on the NHS, HSE or UK Government websites. 7. Recovering from COVID-19 If you have experienced COVID-19 yourself. make an appointment with your GP to discuss how you are recovering since your were ill. It seems to be that recovery from COVID-19 can be a long haul, you might benefit from being referred to a COVID-19 follow up clinic if you are having persistent problems. It might well be worth your seeing your endocrinologist for an up to date assessment. As it is still very early days for the medics generally to know how people are going to recover, there will be no 'one size fits all' approach, so contact your healthcare team, who know your circumstances, and find out the best strategy for you.