The scientific research on SARS-CoV2 and its possible therapies are based on the knowledge of previous coronaviruses and on data recently made available by the Chinese scientific society. Likewise, social and health policy, information and containment measures are based on what has been learned from previous epidemics, in order to optimize the current measures. From the epidemiology of SARS-CoV and SARS-CoV2 in China we have learned how fundamental are measures such as early recognition of the problem, strict infection control and identification of infected patients, isolation measures, inclusion and formation of new medical and sanitary staff in the health system, designation of new hospital wards with appropriate equipment and information through the mass and social media [14]. As part of these measures, recently, the Italian Society of Rheumatology has proposed a set of practical recommendations to improve the management of CoViD-19 patients and to decrease the risk of acquiring this infection in particular in rheumatic patients undergoing immunosuppressive therapies (Table 1). In general, the interruption of therapies used in rheumatic patients is not advised, as it may be responsible for the onset of clinical flares of the rheumatic disease with subsequent use of other immunosuppressants such as oral glucocorticoids that may be equally unsafe for patients in case of acquired CoViD-19. Although the data are at present unavailable, it appears important to maintain chronic therapies and to have a strict control of each patient in order to evaluate specific clinical needs. In fact, the infection risk in rheumatic diseases such as rheumatoid arthritis is also related to disease activity and a flare due to therapy discontinuation would confer a higher risk of infection [23].
Table 1 Recommendations proposed for rheumatic diseases during CoViD-19 pandemic.
1- Do not discontinue immunosuppressive treatment
2- Follow the recommendations for infection prevention suggested by the Italian Ministry of Health, in particular avoid contact with crowded places. Smart working is encouraged.
3- Chloroquine and hydroxychloroquine seem to have some efficacy on SARS-CoV2 infection.
4- Chronic immunomodulatory therapies, including biologic drugs, must be guaranteed for rheumatic patients. This includes tocilizumab and baricitinib availability for patients chronically taking these compounds, as they may start to be used to treat CoViD-19 severe pneumonia cases.
5- Outpatients clinics, albeit with limited activity, should be guaranteed for biologic therapies, as the National Health System has authorized people to move for very specific reasons such as health issues. For all patients, consulting should be made available using media that exclude a person-to-person relationship.