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COVID-19 and sickle cell disease: Our expert answers your questions

Dr. Wally Smith addresses the impact of COVID-19 on sickle cell patients and whether the vaccine is right for you.

Wally Smith Dr. Wally Smith, the Florence Neal Cooper Smith Professor of Sickle Cell Disease at VCU and medical director of the adult sickle cell program at VCU Health. (Photo: Kevin Morley, University Marketing)

Sickle cell disease is a chronic blood disorder that in the United States mainly affects the Black community. If you have sickle cell disease, your immune system is weaker than those of other people. Does this mean it’s easier for you to get COVID-19? Will your symptoms will be worse?

Dr. Wally R. Smith is the Florence Neal Cooper Smith Professor of Sickle Cell Disease at VCU and medical director of the adult sickle cell program at VCU Health. Here he addresses concerns you may have about COVID-19 if you or your child has sickle cell disease.

How dangerous is COVID-19 for people with sickle cell disease?

Because people with sickle cell disease have an increased risk of developing certain infections, we thought at first that it would be very dangerous. We have been pleasantly surprised. COVID-19 may be one of those infections people with sickle cell disease are not more susceptible to. The only places where COVID-19 has been mortally dangerous for sickle cell patients have been in the Northeast and the crowded urban centers. In Richmond to date, maybe one patient with sickle cell disease has died from COVID-19.

I'm also seeing patients come out in good numbers to get the vaccine. There isn’t the hesitancy among sickle cell patients for COVID vaccination the way there is in other parts of the population. Once again, maybe they think that their immune system can't take COVID-19, so they're more likely to come and get vaccinated and protect themselves. We were very pleasantly surprised.

Is it harder to treat people with sickle cell disease if they get COVID-19?

There's a new database that's been gathering every case that people are willing to report called the secure SCD database. What we have seen is that people with sickle cell who get COVID-19 have a tendency to present with pneumonia, which is a common complication of sickle cell disease. We’ve also seen instances of blood clotting and other bleeding complications, but more than likely, it's going to be in the form of pneumonia. Fortunately, we can treat pneumonia. It may complicate the treatment, but you can recover.

Do all people with sickle cell disease who get COVID-19 require hospitalization?

Not everyone. If you have only a fever and mild symptoms, you may be able to manage your condition at home. If you have severe pain or respiratory distress, you may need to be hospitalized.

When should I call my doctor?

If you think you have a fever, use a thermometer to be sure. If you do have a fever, don’t panic. Lots of different infections can cause a fever. This doesn’t mean you have COVID-19.

If you’re sure you have a fever, call your doctor right away. Don’t rush to the emergency room (ER), though. Your weakened immune system puts you at greater risk of catching COVID-19 or any other disease someone there may have.

When should I call 9-1-1?

Call 9-1-1 or come to the Emergency Department if you have:

  • A lot of difficulty breathing
  • Unusual persistent pain or pressure in your chest
  • New confusion or inability to wake up easily
  • Darkening of your lips or face (a sign of insufficient oxygen in the blood)

Is it safe for people with sickle cell disease to come to VCU Health for a routine appointment or treatment? What precautions are you taking to keep patients safe?

Yes, it’s very safe. We have increased our cleaning and disinfecting measures to make sure our hospitals and clinics are a safe environment for your care. We screen people entering our facilities for symptoms of COVID-19, and we have fewer people in our waiting rooms. Please visit our COVID-19 news center for more information on the measures we’re taking to keep patients, staff and visitors safe.

As a sickle cell patient, is there anything special I need to do before I come in for my appointment?

We ask that you follow standard COVID-19 safety procedures. When you enter the building, be sure to wear your mask, stop at the door for your temperature check, look for the signage in the elevator as to how many people can enter, and wash your hands when you enter the doctor’s office.

 

Is the COVID-19 vaccine safe and effective for people with sickle cell disease?

Yes. All COVID-19 vaccines available in the U.S. are safe for people with sickle cell disease. The U.S. Food and Drug Administration approved the vaccines under an emergency use authorization. To be approved, the vaccines must go through a careful trial process with several phases to address safety and effectives. The COVID-19 vaccine trials did just that, and they included thousands of participants.

The COVID-19 vaccines were produced so rapidly not because they were rushed by cutting corners but because scientists have significant prior experience working with other coronaviruses such as SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Research on a COVID-19 vaccine did not start from scratch.

In addition, the U.S. government made vaccine development a priority once the COVID-19 coronavirus took off in the U.S.

Every patient who calls the sickle cell unit is nervous. And I say to them OK, I understand you're nervous. But which would you rather have— COVID or the vaccine? And that sort of does it for them. Most of them get past their nerves and decide to come and get the vaccine. We're past the stage where they're saying, ‘I'm gonna wait about a week.’

But isn’t there a chance I could get COVID-19 from the vaccine? Is it worth the risk?

You can’t get COVID-19 from any of the vaccines. None of the vaccines authorized by the FDA in this country contain the live coronavirus, nor do they contain a weakened or dead version of the coronavirus. The vaccines have no coronavirus to pass on to you.

It’s definitely worth getting vaccinated. All of the currently authorized vaccines available in the United States have been highly effective at preventing COVID-19.

What about children with sickle cell disease. Should they get the vaccine?

Right now, only kids 12 and over have been approved to get the vaccine. But one day we'll be able to say, yes, all kids need to get the vaccine.

If you are the parent of a child with sickle cell, I can imagine you being nervous — especially about your child going back to school amongst the herd and more exposure to COVID.  My guess is that  your child will be no more likely to have a problem than the other children returning.

Will the vaccine interact with our meds, posing a health hazard? Should I stop taking my meds before getting the vaccine?

Whether or not you’re scheduled for the vaccine, continue taking your prescribed medications (Hydroxyurea, glutamine, penicillin, folic acid, Voxelotor, Crizanlizumab, Deferasirox, and any others). These will help keep your body in the best possible condition to fight off infection, should you be exposed to someone with COVID-19. Continue all of your treatments unless your doctor says otherwise.

This includes your transfusions. There is no evidence that COVID-19 is transmitted through blood. If you’re worried about going in for your transfusions, ask your doctor about the risks of missing them and ask about alternatives.

Should I get the one-dose vaccine because of my sickle cell disease, rather than the two-dose vaccine?

You won't have a choice as to which vaccine you receive. Each of the vaccines is highly effective at preventing severe illness. The sooner you get the vaccine, the sooner you will be protected. We recommend getting whichever vaccine is offered to you.


What if I’ve already had COVID-19? Do I still need to get the vaccine?

We recommend you still get the vaccine. Although rare, reinfection is possible. If you've had symptoms of COVID-19 but were never diagnosed, don't assume you had the disease and are immune. Get the vaccine.


How do I get the vaccine?

You can register for the COVID-19 vaccine through the Virginia Department of Health (VDH). VDH is working with a number of institutions to provide the vaccine. You will learn where you will get the vaccine when your appointment is scheduled.

If you are a patient at VCU Health, please visit our COVID-19 vaccine page for our vaccination plans.

Are the side effects of the vaccine any different for people with sickle cell disease? Is there anything specific to sickle cell disease I should look out for?

What people are observing mostly is a good effect. Your body is supposed to react when you introduce a foreign body into it. You're supposed to get a little fever. You're supposed to have a little immune response. That's what people call side effects. My observation is that patients with sickle cell disease have side effects just like everybody else. That's a good thing.

Turning the tide — Sickle cell disease finally gets its due

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