Many Alphas who were receiving augmentation therapy infusion at a hospital or infusion center prior to the COVID-19 epidemic have continued to receive their infusions as usual.  Much depends on the steps that your local facility has taken to maintain the safety of individuals coming in for infusion.  Our guidance to Alphas receiving augmentation on the Alpha-1 Foundation website addresses this question.

See answer to the first question above.

As far as we know, no Alpha has been infected with the COVID-19 virus from receiving an infusion of augmentation therapy.  The Plasma Protein Therapeutics Association (PPTA) released several statements outlining the expectation that the viral elimination and viral inactivation steps that all plasma products go through during manufacture would be expected to eliminate the risk of transmitting infection through augmentation therapy infusions.

In consultation with your physician, it may be reasonable to temporarily change to biweekly in infusions of double the usual dose of augmentation therapy in order to reduce exposure to healthcare workers who might be also working to treat COVID-19 patients.  Biweekly infusions are not thought to be as effective as weekly infusions but are better than missing an infusion.

Answered above.

We don’t believe that Alphas are at greater risk of being infected with COVID-19 than the general population.  The risk of infection is most closely related to the number of people you associate with who might be infected and the steps you take, such as mask wearing and social distancing, to protect yourself.  Augmentation therapy is not expected to change these risks.

With both of you wearing masks, the protection provided is likely very good, especially if combined with social distancing (as much as possible) and wiping of surfaces with disinfectant before and after the infusion.

We recommend that any Alpha who has been receiving augmentation therapy prior to COVID-19 infection should make every effort to maintain weekly augmentation therapy infusions if they become infected.  There is reason to believe that COVID-19 lung injury will be reduced in Alphas who continue their infusions. One issue is whether you should put an infusion nurse at risk of infection by continuing your infusions.  It might be best to check with your local hospital or infusion facility to see if they have a mechanism to do outpatient treatment of COVID-19 patients. In terms of other treatments specific to Alphas with COVID-19, there are no other specific recommendations.

We recommend that any Alpha who has been receiving augmentation therapy prior to COVID-19 infection should make every effort to maintain weekly augmentation therapy infusions if they become infected.  There is reason to believe that COVID-19 lung injury will be reduced in Alphas who continue their infusions. One issue is whether you should put an infusion nurse at risk of infection by continuing your infusions.  It might be best to check with your local hospital or infusion facility to see if they have a mechanism to do outpatient treatment of COVID-19 patients. In terms of other treatments specific to Alphas with COVID-19, there are no other specific recommendations.

Antibody testing performed by commercial labs tests for the appearance of a specific antibody against a protein in the virus and provides a positive or negative answer.  It is not yet known whether the antibody being looked for and the quantity of antibody that leads to a positive result are the most accurate way to tell whether someone has developed immunity to the SARS-CoV-2 virus that causes COVIC-19.  While a positive antibody test may let you know that your body has been infected with COVID-19, a negative test may not mean you are not immune.

Generally, testing for the virus is most accurate 24-48 hours after exposure and during an infection.

See above.

This is a difficult question to answer.  Any mask is better than none. The effectiveness of cloth masks and paper-like surgical masks is dependent on the number of layers of material used and the number of different types of material in each layer.  More is better for both.  N95 masks are the most effective but their effectiveness is based on having a proper fit (there are different sizes and shapes of N95 masks).  In addition, N95 masks are in short supply and often cause a sense of difficulty breathing in people with lung disease.

Thinner cloth masks cause less shortness of breath and easier breathing but may be less effective than other types of clinical masks.  Individuals on supplemental oxygen should continue to use their oxygen under their masks but also understand that this could lead to the spread of infection to those around you if you happen to have a COVID-19 infection.

Generally, using a face shield alone is not effective at protecting the wearer from COVID-19 or protecting from spreading infection if you are the one infected.  A face shield should not be used in place of an effective mask.  Using a face shield in addition to a mask can provide some additional protection to the wearer.

The filter on an oxygen concentrator should be quite effective at stopping infected particles from reaching the oxygen user.

There are risks and benefits to attending in-person religious services.  Certainly, social distancing needs to be a given but, as we recommend for all Alphas, mask wearing for both you and the other attendees should be considered.

This is an area of some controversy at the present time.  There is some evidence that children younger than 10 may not transmit the virus to others as much as older children and adults. On the other hand, a severe neurological disease has been described in younger children with COVID-19.

This is a very difficult decision that must be made on an individual basis.  Children can transmit disease to adults even if they have no symptoms. It is certainly worth considering taking such an FMLA until we know more about the risk to teachers who do not have an underlying medical problem like Alpha-1.

Although difficult, if an Alpha must go to work with others, it is reasonable to ask your employer to make accommodations to protect your health, including requiring masks of all who work with you or providing a space to work separated from employees not wearing masks or able to social distance.  Some of these considerations depend on the local prevalence of COVID-19 infection in your town or city.

In consultation with your child’s physician it is important to consider special steps to protect such a child.  It may be wise to continue at-home distance education or special precautions at school.

A person with a documented SARS-CoV-2 infection who is asymptomatic can can still be contagious to others.  This appears to be less so in children under 10 years old who have the infection.

There is no direct evidence regarding people with abnormal Alpha-1 genes and liver disease.  However, since the liver is one of the organs that can be affected by a severe COVID-19 infection, it is reasonable to assume that underlying liver disease is a risk factor for a more severe course.

It is certainly true that most hospital based pulmonary function labs require a viral test for COVID-19 prior to undergoing such a procedures. Individual physician offices may not be set up to perform such COVID-19 testing.

There is still much that is unknown about whether and how long protection is provided by recovering from a COVID-19 infection.  There are some viral infections and vaccines that give people lifetime immunity to that virus.  There are other viruses that change enough that yearly immunizations are required, like the flu.  We don’t yet know enough about the immunity caused by the corona virus that causes COVID-19.  It appears that for many people who recover from COVID-19 they have some degree of immunity and the duration of that immunity is not known.

It is probably reasonable to consider being tested for antibodies to SARS-CoV-2 (the virus that causes COVID-19) under these circumstances but unless you’ve had symptoms that are truly consistent with COVID-19, it is unlikely that the test will be positive.

We do not have enough information to know whether Alpha-1 patients present symptoms faster than the general population who get infected.  Generally, symptoms start 2-7 days after infection.

The severity of disease in COVID-19 is quite variable and not everyone develops persistent worsening of lung function.  However, Alphas who get COVID-19 are likely to note a decline in lung function but the amount and whether the change will be permanent is quite variable.

There are therapies that appear to have some effect decreasing the duration of symptoms or reducing mortality of hospitalized or requiring ICU/ventilator therapy.   Dexamethasone (a steroid) and plasma from people who have recovered from the virus seem to have beneficial effects in some with COVID-19 as does the antiviral drug remdesivir.  Many other interventions are currently in clinical trials.

We currently don’t know whether healthy Alphas are at greater risk of complication and long-term health issues if they have COVID-19.  There is reason to believe that lung damage, if it occurs in an individual with Alpha-1 will likely be worse, but this has not been studied.

It is reasonable to assume that kids with COVID-19 might be more susceptible to lung injury if infected.  There is no data to support this assumption at the present time.

Gym workouts usually involve fast, heavy breathing and work out on equipment that has been used by other people.  Social distancing in gyms and locker rooms is difficult and use of masks is quite uncomfortable.  Decisions to go to a gym should take this into account especially if you are an Alpha.

This is best answered by your physician and dentist.  If they are experienced protecting their patients from risks of COVID-19 in their offices, you should consider going, especially if you require follow-up or evaluation for a medical condition. Don’t hesitate to ask your healthcare provider what steps they are taking to ensure your protection.