Incidence of COVID-19 in patients with rheumatic disease: is prior health education more important than shielding advice during the pandemic?

Abstract

The COVID-19 pandemic has led to major changes in clinical practice on a global scale in order to protect patients. This includes the identification of vulnerable patients who should “shield” in order to reduce the likelihood of contracting SARS-CoV2. We used national specialty guidance and an adapted screening tool to risk stratify patients identified from our prescribing and monitoring databases, and identify those needing to shield (score ≥ 3) using information from departmental letters, online general practice records and recent laboratory investigations. We collated underlying rheumatological conditions and risk factors. Two months into the shielding process, we examined the COVID-19 status of these patients using hospital laboratory records and compared to population level data. Of 887 patients assessed, 248 (28%) scored ≥ 3 and were sent a standard shielding letter. The most common risk factor in the shielding letter group was age ≥ 70 years and/or presence of a listed co-morbidity (199 patients). The most common rheumatology conditions were rheumatoid arthritis (69.4%), polymyalgia rheumatica (8.5%) and giant cell arteritis (8.5%). Coronavirus incidence rates were similar in the shielding letter group (0.403%) and in the UK population (0.397%). However, we found a trend towards lower incidence (0.113%) in our whole cohort (RR 0.28, 95%CI 0.04–2.01 for the whole cohort compared to UK population). The trend towards lower incidence in this cohort could be because of prior education regarding general infection risk and response to public health messages. While risk stratification and shielding could be effective, prior education regarding general infection risk and public health messages to enhance health protection behaviours during a pandemic may have equal or more important roles. Key Points• Patients on treatment for rheumatic disorders showed a trend for lower incidence of COVID-19 transmission irrespective of shielding letter status• This could potentially be because of prior education regarding infection risk received when starting on disease-modifying medication• Health education influencing health protection behaviours may be of equal or more importance than shielding information in reducing transmission of SARS-CoV-2

Updated APLAR consensus statements on care for patients with rheumatic diseases during the COVID‐19 pandemic

“…Initially, shielding, or strict quarantine and minimizing non‐essential contact even with other household members, was recommended for certain high‐risk RMD patients 13 . However, shielding may even be less important than self‐education and adherence to general preventive measures 14 . RMD patients should thus be advised to follow locally stipulated guidance for transmission prevention as advised for the general population.…”

SARS-CoV-2 vaccines and autoimmune diseases amidst the COVID-19 crisis

“…On the other hand, they have led to some changes in an "unfavorable" direction, generally increasing the risk of infections. Nevertheless, numerous high-quality studies have already found that the risk of contracting SARS-CoV-2 and poor COVID-19 outcomes of patients with the most common AIID is similar to the general population [15,16]. In the case of immunosuppression, the response to some vaccines and the efficacy resulting in immunogenicity, however, has become unpredictable, especially in the case of B cell depleting therapies [17].…”

“…Although preliminary data showed that AIIDs themselves did not pose an increased risk of SARS-CoV-2 infection and severe disease [15,16], there is a complexity of disease-disease and drug-disease interactions characteristic of AIIDs that need special consideration. AIID-induced organ damage, coexisting chronic cardiovascular, metabolic, and respiratory comorbidities, predisposition to bacterial infections, B cell depletion therapies, and the use of high-dose glucocorticoids could increase the risk of poor outcome [19].…”

COVID-19 vaccine hesitancy in patients with systemic autoimmune rheumatic disease: an interview-based survey

“…Patients with systemic autoimmune rheumatic disease (AIRD) are a vulnerable group for SARS Cov-2 infection [3][4][5]. The heterogeneous nature of AIRD and treatment with various immunomodulators can lead to an immunocompromised state.…”