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Please note that, to date, two coronavirus vaccines have been approved for use in Canada — the Pfizer-BioNTech vaccine, and the Moderna vaccine. The only way to access these COVID-19 vaccines is through clinics organized or endorsed by local public health authority in collaboration with Canada's federal, provincial and territorial governments.
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Anticipating your questions re the much-anticipated Covid-19 vaccine, we asked our Medical Advisor, Dr. Van Uum, for his advice on what if any precautions we should take before receiving the Covid-19 vaccine.
Here are his thoughts on the subject. If still uncertain, we are encouraged to check with our own Doctor.
“The discussion goes between two issues:
i. Is getting a vaccination (flu shot or the COVID shot) a stressful event that requires stress dosing?
ii. Is there a potential negative effect of steroids on the effectiveness of the COVID vaccine?
Starting with the second question, theoretically high dose steroids could change the response of the immune system, and possibly reduce effectiveness of the COVID vaccine. However, there is no published data on the effect of steroids on COVID.
There is some data regarding flu shots in children who are on prednisone, and there is no clear effect of the prednisone on the effectiveness of the vaccination.
However, as these are different types of vaccinations, these results cannot simply be extrapolated from the flu shot to the COVID vaccine.
Therefore, I would suggest that an up dose (single extra dose up to doubling), would be OK. I would recommend not to use a higher dose unless there are specific reasons to do so.”
Editor’s Note: The terms 'up dose' and 'stress dose' are synonymous as used above.
We have received a lot of questions regarding returning to school. These questions are very pertinent for patients with adrenal insufficiency, whether they are a teacher, a parent, or a student. There is limited evidence to guide us.
Here are a couple of considerations:
As a person with adrenal insufficiency, you are considered to have moderately increased risk for infections. While adrenal crisis may occur, there is no clear evidence that there is an increased risk to develop a severe course of COVID-19 disease. Your focus should be on mitigation of the risk to be infected (which cannot be reduced to zero, given that the COVID-19 virus is present in the population in general). The risk will be dependent on what measures the school has put in place, e.g., Is there physical distancing? (which I agree may be hard for young children); is there a mask policy? Is there a school bus or transportation policy? Are there sufficient hand hygiene supplies? Will there be the implementation of hand hygiene measures? What is the cleaning protocol? Importantly, is there screening for symptoms of COVID-19 (e.g., standard symptom checklist to use every day), and what happens with those who screen positive? Of note, some data suggest that children under 10 years of age are probably less likely to transmit the COVID-19 virus than older children or adults. Further, in case there is a case of COVID-19 in the school, is there a robust tracing system in place?
Safety with respect to physical distancing is important. If your work/school environment cannot provide that, e.g., when teaching young children, then alternative ways of work, e.g., from home, or change to an office, may need to be considered - perhaps you could switch to a role for online learning support. I suspect that the school board may not have a fully developed plan to address this for the teachers or for students. You may need to ask your doctor for a support letter. For students, alternative ways of studying, e.g., from home, may need to be considered.
All risk assessments are very much dependent on the epidemiology of the COVID-19 virus. How many people in the community you live in are affected (case burden), and how many cases are diagnosed (community transmission)? This may change depending on the area or province/territory where you live. Moreover, this local epidemiology may change over time. Therefore, even if you decide to return to your work/school now, you should always be prepared to changing circumstances, and have the ability to switch to an alternate plan, e.g., if a second wave of infections were to develop. I would suggest developing an individualized plan now with your healthcare team, rather than wait until the wave is there.
In addition to the following, you may also want to consult the Canadian Pediatric Society for updated links and resources:
Please find the links below to various sites regarding the Coronavirus.
As per our medical director with the Canadian Addison Society, those with adrenal insufficiencies are not more likely to get the virus but if you do get sick, you should follow the guidelines for the management of stress while seeking medical attention.
We encourage those with Adrenal Insufficiency to have extra medications on hand. It is suggested you have a 90 day supply at hand, along with emergency solu-cortef vials.
Do consider working from home if possible should your workplace pose a health risk during this pandemic.
The video you are about to see is titled “ICE COLD MOM” and was originally a segment on the popular TV series UNTOLD STORIES OF THE ER. We are grateful to the Executive Producers, Bob Niemack and Allan Harmon, for use of this segment highlighting the life or death nature of an adrenal / Addisonian crisis. The video also outlines the challenges emergency doctors face in diagnosing Addison’s disease and/or Adrenal Insufficiency and treating an adrenal crisis.
The woman brought into the ER and played by an actress is depicting the experience of Shannon Meister, a longtime member of our South/Central Ontario Support Group.
The emergency events that unfold are not necessarily unique. Many ER Physicians may have never faced what is eventually diagnosed as Addison’s disease/Adrenal Insufficiency. All of the symptoms exhibited in this scenario are not necessarily typical of an Addisonian or adrenal crisis.
Enjoy the Video!
The following information will divulge the outcome but the video is certainly still worth watching to see the process that was followed and how diagnosis was eventually made.
In an ideal world, CBC (Blood tests) and Electrolytes would initially be tested. The testing of electrolytes is often overlooked and may dramatically reduce the time to diagnosis and prevent unnecessary tests not relevant to treatment.
Shannon’s treatment path included: IV fluids, raising her body temperature, giving antibiotics. Electrolyte tests revealed low sodium and high potassium results. It was at this point that Dr. Kapoor suspected Addison’s disease. Her sodium levels were raised slowly to avoid complications. His decision to give hydrocortisone before getting confirmatory lab results (hormone testing) may have saved Shannon’s life. Injectable hydrocortisone was immediately given with this suspected diagnosis.
Various shock states: hypoglycemic (glucose gel given), hypovolemic (fluids), hypothermic (“Ice cold mom”), septic/infectious (antibiotics given), drug overdose (confusion / "incoherent") were considered by Dr. Kapoor up to that point. This video depicts a chain of events whereby the suspicion and/or confirmation of an Addisonian or adrenal crisis resulted in immediate administration of hydrocortisone (glucocorticoid of choice) with saline support. Dr. Kapoor states it well: “As an emergency physician I wanted to ‘get it right’”! The THREE rights for an adrenal crisis: right medication (hydrocortisone) at the right time (immediately) at the right dose (adult dose – 100 mg). Hydrocortisone is the treatment that saved Shannon's life.
This video also aligns with our EMS initiative whereby any individual with Addison's Disease / adrenal insufficiency carrying injectable hydrocortisone will require a pre-hospital injection if an adrenal crisis is suspected (before transport to hospital).
This is the positive outcome in this video: "Thank you for saving my life". Unfortunately, many die because of delayed hydrocortisone treatment for confirmed or suspected conditions of adrenal insufficiency.
The Society also has a description of symptoms posted here.
Thank you for watching!
The Canadian Addison Society
We are extremely pleased to share the latest EMS news from Newfoundland & Labrador as of Sept 25, 2018. Following are the intros and links to media reports both print and video, all of which announce and/or discuss the implementation of the new potentially lifesaving EMS protocol for suspected adrenal crisis. We are very grateful to all that helped to make this new protocol a reality.
LIFE-SAVING MEDICATION TO BE ADMINISTERED BY PARAMEDICS: Paramedics in the province that now able to administer a shot that could save lives.
["Dr. Brian Metcalfe"]
THE CARTER FILE: A milestone in our health care system today; paramedics will
now be able to administer a life-saving drug.
["Dr. Brian Metcalfe"; "Dr. Carole Joyce"; "Paula Courage"]
We are pleased to participate in the global introduction of a short film “The Last Remaining Light”. A link to the film is located at the bottom of this article. The film was produced and directed by Martin Wallgren and co-produced by Addisonian and Team Addison bicyclist Martin Norrman (Martin Norrman also founded the non-profit Swedish Addison’s Association https://www.addisongruppen.se).
Following is a short intro to the film:
This is the most brilliant, touching and phenomenal movie for Addison's ever, letting the world know more about primary Addison's (it applies greatly to all forms of AI) along with breathtaking cinematography and narration. It is the story of the illness, fight and triumphs of co-producer and actor Martin Norrman, in coordination with producer and director Martin Wallgren. This movie was made with the goal of raising awareness of AI diseases, and we can't thank Martin and his team enough for their years of hard work and dedication to this important project, and for this awesome film.
While some people diagnosed with primary Addison's might not feel they can resume the level of activity Martin does in this amazing film, they will definitely see their own story in his.
PLEASE SHARE THIS MOVIE LINK WITH EVERYONE YOU KNOW:
The more we can raise awareness of Addison's and other forms of AI, the more we will increase our diseases' funding, research, treatment options and maybe one day find a cure. This will be the best 15 minutes you will ever have with Addison’s. You can view this film in many languages by clicking the “CC” button at the top.
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