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Shrestha GS, Lamsal R, Tiwari P, Acharya SP. Anesthesiology and Critical Care Response to COVID-19 in Resource-Limited Settings: Experiences from Nepal. Anesthesiol Clin 2021; 39:285-292. [PMID: 34024431 PMCID: PMC7879105 DOI: 10.1016/j.anclin.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
It is difficult to predict the future course and length of the ongoing COVID-19 pandemic, which has devastated health care systems in low- and middle-income countries. Anesthesiology and critical care services are hard hit because many hospitals have stopped performing elective surgeries, staff and scarce hospital resources have been diverted to manage COVID-19 patients, and several makeshift COVID-19 units had to be set up. Intensive care units are overwhelmed with critically ill patients. In these difficult times, low- and middle-income countries need to improvise, perform indigenous research, adapt international guidelines to suit local needs, and target attainable clinical goals.
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Affiliation(s)
- Gentle S Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj Road, PO Box: 1524, Maharajgunj, Kathmandu 44600, Nepal.
| | - Ritesh Lamsal
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj Road, PO Box: 1524, Maharajgunj, Kathmandu 44600, Nepal
| | - Pradip Tiwari
- Department of Critical Care, Norvic International Hospital, PO Box: 14126, Thapathali, Kathmandu 44617, Nepal
| | - Subhash P Acharya
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj Road, PO Box: 1524, Maharajgunj, Kathmandu 44600, Nepal
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102
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Effects of non-invasive respiratory support on gas exchange and outcomes in COVID-19 outside the ICU. Respir Med 2021; 185:106481. [PMID: 34077874 PMCID: PMC8143910 DOI: 10.1016/j.rmed.2021.106481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022]
Abstract
Non-invasive respiratory support (NRS) outside of the ICU has played an important role in the management of COVID-19 pneumonia. There is little data to guide selection of NRS modality. We present outcomes of NRS outside the ICU and discuss the effects of NRS on gas exchange with implications for management.
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103
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Abstract
PURPOSE OF REVIEW The Coronavirus Disease 2019 (COVID-19) pandemic has exposed preexisting racial disparities in the healthcare system. This review discusses racial-ethnic differences in COVID-19 related outcomes with an emphasis on the social determinants of health that are responsible for these disparities. RECENT FINDINGS Higher hospitalizations and deaths have been reported amongst minority individuals after a COVID-19 infection. Cardiovascular disease and its risk factors are also more common in minority populations and negatively impact clinical outcomes after a COVID-19 illness. The racial disparities seen after COVID-19 infections appear to be driven by multiple preexisting comorbidities, adverse socioeconomic conditions, and lack of access to healthcare. These disadvantages were present before the COVID-19 pandemic. To effectively reduce disparities in outcomes of COVID-19 and the impact of the virus on minority communities, a multifaceted approach will be needed. SUMMARY Government-backed policies that foster health equity and promote easily accessible testing and fair distribution of COVID-19 therapies and vaccines are necessary to successfully combat racial disparities in COVID-19 outcomes.
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Affiliation(s)
| | - Duke Appiah
- CA Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Imo A Ebong
- Division of Cardiology, University of California Davis, Sacramento, California, USA
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104
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Machado-Alba JE, Usma-Valencia AF, Sánchez-Ramírez N, Valladales-Restrepo LF, Machado-Duque M, Gaviria-Mendoza A. Factors Associated with Survival in Patients Undergoing Invasive Mechanical Ventilation in an Intensive Care Unit in Colombia, 2017-2018: A Retrospective Cohort Study. Drugs Real World Outcomes 2021; 8:417-425. [PMID: 33829374 PMCID: PMC8026090 DOI: 10.1007/s40801-021-00241-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Critically ill patients are admitted to intensive care units so they can be comprehensively managed and provided with services not covered in general hospital wards, with the aim to increase their chances of survival. These procedures include invasive mechanical ventilation. OBJECTIVE The aim of this study was to identify the factors associated with survival in critically ill patients who required invasive mechanical ventilation in an intensive care unit of a tertiary-level hospital in Colombia. METHODS This was a retrospective follow-up study of a cohort of adult patients who required invasive mechanical ventilation in an intensive care unit in San José de Buga Hospital, between 2017 and 2018. Sociodemographic, clinical, and pharmacological variables were identified. Using Cox regression, variables associated with survival and complications were identified. RESULTS A total of 357 patients were analyzed. The average age was 64.8 ± 18.9 years, and 52.9% were male. The most frequent diagnoses were sepsis/septic shock (38.4%) and trauma (17.4%). The main factors associated with shorter survival were advanced age (HR 0.97; 95% CI 0.96-0.99), a diagnosis of septic shock (HR 0.29; 95% CI 0.18-0.48) or diabetes mellitus at admission (HR 0.57; 95% CI 0.33-0.98), a healthcare-associated infection (HR 0.51; 95% CI 0.33-0.80), and the need for vasopressors (HR 0.36; 95% CI 0.22-0.59). The administration of systemic corticosteroids was associated with a higher probability of survival (HR 1.93; 95% CI 1.15-3.25). CONCLUSIONS The use of systemic corticosteroids was associated with a greater probability of survival in critically ill patients who required invasive mechanical ventilation in an intensive care unit. The identification of the variables associated with a higher risk of dying should allow care protocols to be improved, thereby extending the life expectancy of these patients.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia.
| | - Andrés Felipe Usma-Valencia
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia
| | - Nicolás Sánchez-Ramírez
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia
| | - Luis Fernando Valladales-Restrepo
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia.,Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Manuel Machado-Duque
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia.,Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
| | - Andrés Gaviria-Mendoza
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A, Calle 105 No. 14-140, 660003, Pereira, Risaralda, Colombia.,Grupo de Investigación Biomedicina, Facultad de Medicina, Fundación Universitaria Autónoma de las Américas, Pereira, Colombia
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105
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Zhou J, Lee S, Wang X, Li Y, Wu WKK, Liu T, Cao Z, Zeng DD, Leung KSK, Wai AKC, Wong ICK, Cheung BMY, Zhang Q, Tse G. Development of a multivariable prediction model for severe COVID-19 disease: a population-based study from Hong Kong. NPJ Digit Med 2021; 4:66. [PMID: 33833388 PMCID: PMC8032826 DOI: 10.1038/s41746-021-00433-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Recent studies have reported numerous predictors for adverse outcomes in COVID-19 disease. However, there have been few simple clinical risk scores available for prompt risk stratification. The objective is to develop a simple risk score for predicting severe COVID-19 disease using territory-wide data based on simple clinical and laboratory variables. Consecutive patients admitted to Hong Kong’s public hospitals between 1 January and 22 August 2020 and diagnosed with COVID-19, as confirmed by RT-PCR, were included. The primary outcome was composite intensive care unit admission, need for intubation or death with follow-up until 8 September 2020. An external independent cohort from Wuhan was used for model validation. COVID-19 testing was performed in 237,493 patients and 4442 patients (median age 44.8 years old, 95% confidence interval (CI): [28.9, 60.8]); 50% males) were tested positive. Of these, 209 patients (4.8%) met the primary outcome. A risk score including the following components was derived from Cox regression: gender, age, diabetes mellitus, hypertension, atrial fibrillation, heart failure, ischemic heart disease, peripheral vascular disease, stroke, dementia, liver diseases, gastrointestinal bleeding, cancer, increases in neutrophil count, potassium, urea, creatinine, aspartate transaminase, alanine transaminase, bilirubin, D-dimer, high sensitive troponin-I, lactate dehydrogenase, activated partial thromboplastin time, prothrombin time, and C-reactive protein, as well as decreases in lymphocyte count, platelet, hematocrit, albumin, sodium, low-density lipoprotein, high-density lipoprotein, cholesterol, glucose, and base excess. The model based on test results taken on the day of admission demonstrated an excellent predictive value. Incorporation of test results on successive time points did not further improve risk prediction. The derived score system was evaluated with out-of-sample five-cross-validation (AUC: 0.86, 95% CI: 0.82–0.91) and external validation (N = 202, AUC: 0.89, 95% CI: 0.85–0.93). A simple clinical score accurately predicted severe COVID-19 disease, even without including symptoms, blood pressure or oxygen status on presentation, or chest radiograph results.
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Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Cardiovascular Analytics Group, Laboratory of Cardiovascular Physiology, Hong Kong, China
| | - Xiansong Wang
- Li Ka Shing Institute of Health Sciences, Hong Kong, China
| | - Yi Li
- Department of Cardiothoracic Surgery, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Hubei, Wuhan, China
| | | | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhidong Cao
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Daniel Dajun Zeng
- Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Keith Sai Kit Leung
- Emergency Medicine Unit, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Abraham Ka Chung Wai
- Emergency Medicine Unit, LKS Faculty of Medicine, University of Hong Kong, Pokfulam, Hong Kong, China
| | - Ian Chi Kei Wong
- Department of Pharmacology and Pharmacy, University of Hong Kong, Pokfulam, Hong Kong, China.,Medicines Optimisation Research and Education (CMORE), UCL School of Pharmacy, London, United Kingdom
| | | | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China.
| | - Gary Tse
- Department of Cardiothoracic Surgery, Wuhan Asia Heart Hospital Affiliated to Wuhan University of Science and Technology, Hubei, Wuhan, China.
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Richmond P, Hatchuel L, Dong M, Ma B, Hu B, Smolenov I, Li P, Liang P, Han HH, Liang J, Clemens R. Safety and immunogenicity of S-Trimer (SCB-2019), a protein subunit vaccine candidate for COVID-19 in healthy adults: a phase 1, randomised, double-blind, placebo-controlled trial. Lancet 2021; 397:682-694. [PMID: 33524311 PMCID: PMC7906655 DOI: 10.1016/s0140-6736(21)00241-5] [Citation(s) in RCA: 201] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/12/2021] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND As part of the accelerated development of vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we report a dose-finding and adjuvant justification study of SCB-2019, a protein subunit vaccine candidate containing a stabilised trimeric form of the spike (S)-protein (S-Trimer) combined with two different adjuvants. METHODS Our study is a phase 1, randomised, double-blind placebo-controlled trial at a specialised clinical trials centre in Australia. We enrolled healthy adult volunteers in two age groups: younger adults (aged 18-54 years) and older adults (aged 55-75 years). Participants were randomly allocated either vaccine or placebo using a list prepared by the study funder. Participants were to receive two doses of SCB-2019 (either 3 μg, 9 μg, or 30 μg) or a placebo (0·9% NaCl) 21 days apart. SCB-2019 either had no adjuvant (S-Trimer protein alone) or was adjuvanted with AS03 or CpG/Alum. The assigned treatment was administered in opaque syringes to maintain masking of assignments. Reactogenicity was assessed for 7 days after each vaccination. Humoral responses were measured as SCB-2019 binding IgG antibodies and ACE2-competitive blocking IgG antibodies by ELISA and as neutralising antibodies by wild-type SARS-CoV-2 microneutralisation assay. Cellular responses to pooled S-protein peptides were measured by flow-cytometric intracellular cytokine staining. This trial is registered with ClinicalTrials.gov, NCT04405908; this is an interim analysis and the study is continuing. FINDINGS Between June 19 and Sept 23, 2020, 151 volunteers were enrolled; three people withdrew, two for personal reasons and one with an unrelated serious adverse event (pituitary adenoma). 148 participants had at least 4 weeks of follow-up after dose two and were included in this analysis (database lock, Oct 23, 2020). Vaccination was well tolerated, with two grade 3 solicited adverse events (pain in 9 μg AS03-adjuvanted and 9 μg CpG/Alum-adjuvanted groups). Most local adverse events were mild injection-site pain, and local events were more frequent with SCB-2019 formulations containing AS03 adjuvant (44-69%) than with those containing CpG/Alum adjuvant (6-44%) or no adjuvant (3-13%). Systemic adverse events were more frequent in younger adults (38%) than in older adults (17%) after the first dose but increased to similar levels in both age groups after the second dose (30% in older and 34% in younger adults). SCB-2019 with no adjuvant elicited minimal immune responses (three seroconversions by day 50), but SCB-2019 with fixed doses of either AS03 or CpG/Alum adjuvants induced high titres and seroconversion rates of binding and neutralising antibodies in both younger and older adults (anti-SCB-2019 IgG antibody geometric mean titres at day 36 were 1567-4452 with AS03 and 174-2440 with CpG/Alum). Titres in all AS03 dose groups and the CpG/Alum 30 μg group were higher than were those recorded in a panel of convalescent serum samples from patients with COVID-19. Both adjuvanted SCB-2019 formulations elicited T-helper-1-biased CD4+ T-cell responses. INTERPRETATION The SCB-2019 vaccine, comprising S-Trimer protein formulated with either AS03 or CpG/Alum adjuvants, elicited robust humoral and cellular immune responses against SARS-CoV-2, with high viral neutralising activity. Both adjuvanted vaccine formulations were well tolerated and are suitable for further clinical development. FUNDING Clover Biopharmaceuticals and the Coalition for Epidemic Preparedness Innovations.
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Affiliation(s)
- Peter Richmond
- Division of Paediatrics, University of Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Perth Children's Hospital, Perth, WA, Australia
| | | | - Min Dong
- Clover Biopharmaceuticals, Chengdu, China
| | - Brenda Ma
- Clover Biopharmaceuticals, Chengdu, China
| | - Branda Hu
- Clover Biopharmaceuticals, Chengdu, China
| | | | - Ping Li
- Clover Biopharmaceuticals, Chengdu, China
| | - Peng Liang
- Clover Biopharmaceuticals, Chengdu, China
| | | | | | - Ralf Clemens
- Global Research in Infectious Diseases, Rio de Janeiro, Brazil.
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107
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Naeini MB, Sahebi M, Nikbakht F, Jamshidi Z, Ahmadimanesh M, Hashemi M, Ramezani J, Miri HH, Yazdian-Robati R. A meta-meta-analysis: Evaluation of meta-analyses published in the effectiveness of cardiovascular comorbidities on the severity of COVID-19. ACTA ACUST UNITED AC 2021; 22:100323. [PMID: 33521379 PMCID: PMC7826091 DOI: 10.1016/j.obmed.2021.100323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023]
Abstract
On January 2020, WHO confirmed the epidemic outbreak of SARS-CoV-2 as a Health Emergency of International Concern. The aim of this meta-meta-analysis is quantifying meta-analytic findings on the association of cardiovascular disease (CVD) comorbidities and COVID-19 severity. Findings suggest that chances of getting severe COVID-19 disease in patients with CVD is greater than those without CVD. Also, prevalence of CVD in patents with COVID-19 is 0.08 (95% CI = 0.07–0.08). The OR as 3.44 indicates that the odds of getting severe COVID-19 is more than 3 times higher in those with CVD. Also, prevalence of hypertension in patient with COVID-19 is 0.27 (95%CI = 0.27–0.28) and the OR as 2.68 indicates that the odds of getting severe COVID-19 in cases with high blood pressure is more than 2.5 times higher than those without hypertension. It is rational to suppose that persons with coronary artery disease are prone to severe viral infection thereby, guideline-directed diagnosis and medical therapy is vital in CVD patients.
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Affiliation(s)
- Mehri Bemani Naeini
- Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdieh Sahebi
- Social Determinants of Health Research Center, Department of Epidemiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fateme Nikbakht
- Social Determinants of Health Research Center, Department of Epidemiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Jamshidi
- Department of Medicinal Chemistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahnaz Ahmadimanesh
- Food and Drug Vice Presidency, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Hashemi
- Nanotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Ramezani
- Department of Cardiology, Atherosclerosis Prevention Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Heidarian Miri
- Social Determinants of Health Research Center, Department of Epidemiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rezvan Yazdian-Robati
- Molecular and Cell Biology Research Center, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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108
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Glintborg B, Jensen DV, Engel S, Terslev L, Pfeiffer Jensen M, Hendricks O, Ostergaard M, Horskjær Rasmussen S, Adelsten T, Colic A, Danebod K, Kildemand M, Loft AG, Munk HL, Pedersen JK, Østgård RD, Møller Sørensen C, Krogh NS, Agerbo J, Ziegler C, Hetland M. Self-protection strategies and health behaviour in patients with inflammatory rheumatic diseases during the COVID-19 pandemic: results and predictors in more than 12 000 patients with inflammatory rheumatic diseases followed in the Danish DANBIO registry. RMD Open 2021; 7:e001505. [PMID: 33402443 PMCID: PMC7786545 DOI: 10.1136/rmdopen-2020-001505] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022] Open
Abstract
AIMS In Danish patients with inflammatory rheumatic diseases to explore self-protection strategies and health behaviour including adherence to disease-modifying antirheumatic treatment (DMARD) during the initial phase of the COVID-19 pandemic and again after the reopening of the society started. Furthermore, to identify characteristics of patients with high levels of anxiety and self-isolation. METHODS Patients in routine care followed prospectively in the nationwide DANBIO registry were invited to answer an online questionnaire regarding disease activity and COVID-19 infection, behaviour in March and June 2020. Responses were linked to patient data in DANBIO. Characteristics potentially associated with anxiety, self-isolation and medication adherence (gender/age/diagnosis/education/work status/comorbidity/DMARD/smoking/EQ-5D/disease activity) were explored with multivariable logistic regression analyses. RESULTS We included 12 789 patients (8168 rheumatoid arthritis/2068 psoriatic arthritis/1758 axial spondyloarthritis/795 other) of whom 65% were women and 36% treated with biological DMARD. Self-reported COVID-19 prevalence was 0.3%. Patients reported that they were worried to get COVID-19 infection (March/June: 70%/45%) and self-isolated more than others of the same age (48%/38%). The fraction of patients who changed medication due to fear of COVID-19 were 4.1%/0.6%. Female gender, comorbidities, not working, lower education, biological treatment and poor European Quality of life, 5 dimensions were associated with both anxiety and self-isolation. CONCLUSION In >12 000 patients with inflammatory arthritis, we found widespread anxiety and self-isolation, but high medication adherence, in the initial phase of the COVID-19 pandemic. This persisted during the gradual opening of society during the following months. Attention to patients' anxiety and self-isolation is important during this and potential future epidemics.
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Affiliation(s)
- Bente Glintborg
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Dorte Vendelbo Jensen
- DANBIO, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Gentofte University Hospital, Hellerup, Hovedstaden, Denmark
| | - Sara Engel
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Lene Terslev
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Mogens Pfeiffer Jensen
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University of Southern Denmark, Sønderborg, Syddanmark, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Mikkel Ostergaard
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Simon Horskjær Rasmussen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Thomas Adelsten
- Department of Rheumatology, Sjællands Universitetshospital Køge, Koge, Sjælland, Denmark
| | - Ada Colic
- Department of Rheumatology, Sjællands Universitetshospital Køge, Koge, Sjælland, Denmark
| | - Kamilla Danebod
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Malene Kildemand
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Anne Gitte Loft
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Heidi Lausten Munk
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | | | - René Drage Østgård
- Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Midtjylland, Denmark
| | | | | | - Jette Agerbo
- Danish Rheumatism Association/Gigtforeningen, Copenhagen, Denmark
| | - Connie Ziegler
- Danish Rheumatism Association/Gigtforeningen, Copenhagen, Denmark
| | - Merete Hetland
- DANBIO and Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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