The Psychological Impacts of COVID-19 Pandemics on Pregnant Women in Hong Kong-Results of a Web-Based Cross-Sectional Survey

Background: We sought to assess the anxiety and depression scores of pregnant women in Hong Kong during the COVID-19 pandemic and to evaluate the impact of demographic, economic and social factors on these scores. Method(s): This was part of an ongoing worldwide cross-sectional study conducted from 22 May 2020 to 28 February 2021. Data were collected through an anonymous web-based survey. The severity of depression and anxiety was assessed using the Patient Health Questionnaire-9 (PHQ-9) score and the General Anxiety Disorder-7 (GAD-7) score, respectively. Result(s): A total of 361 participants completed both the GAD-7 and PHQ-9 questionnaires. Participants with psychiatric illness reported a significant higher median GAD-7 score (6.00, interquartile range [IQR] 3.00-7.75 vs. 2.00, IQR 0.00-6.00, p = 0.001), while the median PHQ-9 score was also higher but was not statistically significant (6.50, IQR 3.00-11.00 vs. 5.00, IQR 3.00-8.00, p = 0.066). A higher proportion of participants with psychiatric illness reported moderate-severe depression and anxiety (35.7% vs. 16.5%, p = 0.002, 17.8% vs. 3.6%, p < 0.001 respectively). Multivariate regression analysis demonstrated that financial difficulty, in education and pregnancy by in-vitro fertilization were associated with a higher PHQ-9 score in pregnant women during the COVID-19 pandemic, while underlying psychiatric illness was associated with a higher GAD-7 score. Support from a partner was demonstrated to be associated with a reduced level of depression and anxiety in pregnancy. Conclusion(s): Pregnant women with underlying psychiatric illness were more vulnerable during the COVID-19 pandemics than the non-psychiatric counterparts. Partner support is important for alleviating depression and anxiety in pregnancy during the COVID-19 pandemic. Clinical Trial Registration: The study was registered at http://www.clinicaltrials.gov, registration number NCT04377412.Copyright © 2023 The Author(s).

The Efficacy, Safety, And Cost Savings Of High Dose IV Diuretics For Heart Failure Patients In An Outpatient Setting With Limited Hospital Bed Space Due To Covid-19

Introduction: Hospitalization is the greatest expenditure for heart failure treatment, estimated to be 8-15 billion dollars annually with the most common cost due to acute decompensation. An approach to manage this is an infusion clinic for outpatient diuresis and observation is an effective way to reduce the admission rate and improve patient outcomes. There are limited studies about high dose IV diuretics for outpatient treatment and outcomes. Bed availability during 2021 was severely limited due to COVID, and sicker patients were cared for outside of conventional hospital treatment. Hypothesis: High dose IV diuretics for heart failure patients in an infusion clinic can reduce admission rate effectively and safely. Method(s): Patient medical records were retrospectively reviewed. 83 patients with symptomatic decompensation underwent 117 treatments in 2021. They received an individualized, protocol driven bolus and infusion of IV diuretics at the clinic calculated on their baseline diuretic dosing. All but one patient was seen in follow up in 2 business days. Outcomes measured included hospital admission within 30 days, hospital days avoided, and costs saved. Adverse outcomes monitored included acute kidney injury, hypokalemia, symptomatic hypotension, and arrhythmia. Result(s): The patients had an average age of 73.6+/-12.9 years old, 64% male and 36% female. There were 80% of patients with HFpEF. The average weight gain above dry weight was 14.6 pounds. The patients had multiple comorbidities and all have chronic kidney disease stage 3 or higher. They were all on high dose diuretics. The results showed that following treatment the admission rate was 47% with 78% of those diagnosed with heart failure exacerbation. Only 1 patient was hospitalized for AKI and hypokalemia. Two patients had transient AKI at follow-up which resolved with diuretic adjustment. Estimated hospital days avoided was 372 days with a savings of 413,168 dollars based on FY21 direct cost/case. Conclusion(s): COVID-19 significantly limited the ability to provide care for patients with chronic issues in the hospital due to bed availability. Avoiding inpatient admissions on a medically complex, congested group of patients results in a significant cost saving while providing safe and effective care.Copyright © 2022

Hemolytic anemia following intravenous immunoglobulins in children with PIMS-TS: Two case reports.

This is the first case report on two children presenting with immediate and severe hemolytic anemia following the administration of high-dose intravenous immunoglobulins (IVIGs) in the context of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Hemolytic anemia was described as a significant decrease in hemoglobin and an increase in lactate dehydrogenase after the second administration of high-dose IVIGs was performed. Both patients were found to have AB blood group. One of our patients showed massive pallor, weakness, and inability to walk in association with hemolysis. However, in both cases, the anemia was self-limiting and transfusion of red blood cells was not required: both patients recovered without persistent impact. Nonetheless, we aim to draw attention to this widely unknown adverse effect of IVIG, especially in the context of PIMS-TS. We suggest determining the patient's blood group prior to high-dose IVIG infusion and replacing the second IVIG through high-dose steroids or anticytokine therapy. Using IVIGs containing lower titers of specifically anti-A or anti-B antibodies to avoid isoagglutinin-caused hemolytic anemia is desirable; however, the information is not routinely available.

Increased Age Heaping in Mobile Phone Surveys Conducted in Low-Income and Middle-Income Countries

Since the beginning of the coronavirus disease 2019 pandemic, the number of surveys conducted remotely by mobile phone in low-income and middle-income countries has increased rapidly. This shift has helped sustain data collection despite restrictions on mobility and interactions. It might also allow collecting data more frequently on important demographic and socioeconomic topics. However, conducting interviews by mobile phone might affect the accuracy of reported data, for example, if respondents have difficulties understanding questions asked remotely, or data collectors have less time to probe and cross-check answers. In this visualization, the authors explore time trends in age heaping, a strong signal of reporting errors, in six African countries. They show that mobile phone surveys have generated noisier data on age than recent household surveys and censuses, thus possibly affecting researchers' understanding of demographic processes and confounding multivariate analyses of socioeconomic outcomes. © The Author(s) 2023.

Inpatient forensic psychiatry in the time of COVID-19: a survey study of perceived mental health implications on people with schizophrenia spectrum disorder

Background: The aim of our study was to assess the perceived mental health impact of the COVID-19 pandemic on people with schizophrenia spectrum disorder (SSD) in an inpatient forensic psychiatric institution and to identify personal networks most crucial for the patient during the pandemic. Method(s): In this cross-sectional survey study, 44 patients with SSD took part in a COVID-19-specific interview. The data was correlated with the Positive and Negative Syndrome Scale (PANSS) to evaluate the patients' psychopathology. In addition, we investigated subgroups of vaccinated and unvaccinated patients to analyze possible differences in psychopathology. Result(s): Less contact with family members was associated with significantly higher PANSS scores (p < 0.05). Patients who reported to feel less relaxed and more stressed during the pandemic than they had been before the outbreak of the virus showed significantly higher PANSS scores (p < 0.05). Unvaccinated patients demonstrated significantly higher PANSS scores than their vaccinated controls (p < 0.05). Conclusion(s): Social support from family members played an important role for people with SSD in inpatient forensic psychiatric institutions during the pandemic. Moreover, individuals with SSD seemed to be more emotionally vulnerable during the pandemic. A more pronounced symptomatology in patients with SSD might be a potential barrier to immunization against COVID-19.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

A practice brief: Virtual supports in ACE-IT's inclusive higher education program

BACKGROUND: During the onset of COVID-19, universities across the country shifted to virtual modalities. For inclusive postsecondary education programs, this shift required developing new strategies to continue highly individualized supports for students with ID/DD. Navigating this shift demanded collaboration and communication between program staff and students. OBJECTIVE(S): The purpose of this practice brief is to share strategies used in the 2020-2021 academic school year for VCU ACE-IT in College. In this practice brief, ACE-IT staff reflect on practices to support virtual work and school so other inclusive postsecondary education programs can replicate innovative supports. METHOD(S): To prepare this practice brief, program staff reviewed program materials and identified programmatic changes that occurred during the 2020-2021 academic year. Program materials included student academic and career case notes, employment shift notes, staff meeting agendas, communications between staff and college instructors, and program training materials. RESULT(S): Program staff implemented a variety of strategies to improve organization and communication between students, program staff, college faculty, and employers. Many of these systems have been retained since the height of the COVID-19 pandemic. CONCLUSION(S): Alternative formats for work and school continue to evolve. It is critical for inclusive postsecondary education programs to integrate virtual supports into their practices so students can prepare to enter the pandemic and post-pandemic workforce. Copyright © 2022 - IOS Press. All rights reserved.

Evaluation of a Rapid Immunochromatographic Middle East Respiratory Syndrome Coronavirus Antigen Detection Assay

Middle East respiratory syndrome coronavirus (MERS-CoV) infection in humans has a high mortality of >30%. Dromedaries are the reservoir of MERS-CoV and the main source of human infections. However, MERS-CoV infections in dromedaries are usually subclinical. Rapid diagnosis of MERS-CoV infection in these animals is important in preventing camel-to-human transmission of the virus. The possible cross-reactivity of a previously reported rapid nucleocapsid protein-based antigen detection assay for MERS-CoV was examined with different CoVs, including Tylonycteris bat CoV HKU4, dromedary camel CoV UAE-HKU23, human CoV-229E, human CoV-OC43, severe acute respiratory syndrome CoV-2 and rabbit CoV HKU14, where none of them showed false-positive results. The assay was further validated using quantitative real-time reverse transcription-polymerase chain reaction-confirmed MERS-CoV-positive and MERS-CoV-negative dromedary nasal samples collected in Dubai, the United Arab Emirates, which showed that the rapid antigen detection assay has a specificity of 100% and sensitivity of 91.7%.

Co-Archiving a Ballet Repertory Course during the COVID-19 Pandemic

Archiving is a process of organizing and creating content for sustainable, long-term access. However, the “archivists” actively shape the content in the realm of the performing arts, which often involves adding a new layer of knowledge to the original artform. This article explores the archiving of a ballet repertory course conducted in a higher education institution in Hong Kong during the pandemic, including the archival product and the collaborative process between a multidisciplinary team of people from dance, education, and library science. While teaching repertory online has its challenges, being “online” also offered unique learning experiences. Aiming to illustrate the topics related to hybrid pedagogy and individual creativity in use during the pandemic, the team conducted interviews with some participants for the purpose of creating a series of short educational films. These materials were collected and stored in the institution’s digital repository as the first archive for a specific course. © 2022 National Dance Education Organization.

USE of TELEMEDICINE for FOLLOW-UP of LUPUS NEPHRITIS in the COVID-19 OUTBREAK: ONE-YEAR, PRAGMATIC RANDOMISED CONTROLLED TRIAL

Background: Patients with systemic lupus erythematosus (SLE) are at increased risk of severe COVID-19 due to the underlying disease, comorbidities and use of immuno-suppressants (IS). An alternative option would be to adopt telemedicine (TM) to maintain medical care while minimizing exposure. Despite being widely adopted during the pandemic, the evidence supporting the use of TM in rheumatology has been limited. Objectives: We primarily aimed to evaluate the effectiveness to maintain disease activity control using TM delivered care compared to conventional in-person follow-up in patients with lupus nephritis (LN). The secondary objectives were to compare the patient reported outcomes, safety and cost-of-illness from the patient's perspective between the 2 modes of health care delivery. Methods: This was a 1-year, single-center, RCT conducted at a regional hospital in Hong Kong. From May 2020, consecutive adult patients with a SLE according to the 2019 EULAR/ACR classifcation criteria followed up at the LN clinic were invited to participate in the study. Participants were randomized 1:1 to either TM (TM group) or standard FU (SF group). Patients randomized to receive TM FU were scheduled for a video consultation via a commerical software ZOOM. Patients in the SF group received standard in-person outpatient care. SLE disease activity at each consultation was assessed by SLEDAI-2k and physician global assessment (PGA). Results: A total of 144 patients with LN were randomized and 3 patients self-withdrew from the study. The mean age was 44.5±11.4 years and the median time from diagnosis to randomization was 168 months (range: 1-528). Most of the patients had class III, IV or V LN (87.2%) and were on prednisolone (89.4%, median dose 5mg daily). Many of them (68.1%) were on IS. While 66.0% of the patients were in lupus low disease activity state (LLDAS), none had disease remission. There were no baseline differences, including demographics, SLEDAI-2k (TM: 3.8±2.3, SF: 3.2±2.2, p=0.13, PGA (TM: 6.2±6.5, SF: 4.6±5.9, p=0.13) and SLE damage index (TM: 1.1±1.3, SF: 0.8±1.1, p=0.10), between the 2 groups. At one year, 80.0% and 80.2% of the patients in the TM group and SF group were in LLDAS or remission respectively. SLE disease activity indices including SLEDAI-2k, PGA, proteinuria amount and serum anti-ds-DNA level remained similar between the 2 groups. Within the study period, 28 (40%) patients in the TM group and 21 (29.6%) patients in the SF group had disease fare (p=0.20). There were no differences in the SF-36, lupusQoL and HADS scores between the 2 groups at the end of the study. The overall patient satisfaction score was higher in the TM group with a signifcantly shorter waiting time before seeing doctors. At the end of the study, 67.9% of the overall participants agreed to (versus 15.0% who did not agree to) use TM as a mode of future FU. The mean indirect costs of illness (HKD26,681 vs HKD12,016, p=0.20) and the out-of-pocket costs for health care services were similar between the 2 groups (TM: HKD13,547 vs SF: HKD12,297, p=0.83) in one year. The total number of FU was similar (TM: 6.0±2.0, SF: 5.7±1.7, p=0.40). However, signifcantly more patients in the TM group (29/70, 41.4% vs 4/71, 5.6%;p<0.01) requested change mode of FU. The proportion of patients requiring hospitalization during the study period was also higher in the TM group (TM: 23/70, 32.9% vs 11/71, 15.5%;p=0.02). After adjusting for age and pred-nisolone dosage, not being in LLDAS at baseline was the predictor of hospitalization (OR 3.4, 95%CI 1.20-9.65). None of the participants was tested positive for COVID-19. Conclusion: TM FU resulted in similar 1-year disease activity control and better satisfaction in patients with LN compared to standard care. However, a signifcant proportion of patients cared by TM required in-person visits or were hospitalized. The results of the study suggest that TM delivered care could help minimizing exposure to COVID-19, but it needs to be complemented by physical visits, particularly in those with unstable d sease.

COVID-19 in patients with gynecologic cancer: A preliminary report from the COVID-19 and Cancer Consortium (CCC19)

Background: Limited information exists regarding the severity of short-term outcomes among patients with gynecologic cancer who are infected with SARS-CoV-2. Methods: Patients with gynecologic cancer and laboratory confirmed SARS-CoV-2 infection were identified from the international CCC19 registry. We estimated odds ratios (OR) from ordinal logistic regression for associations with severity of COVID-19 outcomes, defined from least to most severe as hospitalization, intensive care unit (ICU) admittance, mechanical ventilation, and 30-day mortality. Results: Of 842 patients identified, 48% had endometrial cancer, 24% had ovarian cancer, 22% had cervical cancer, and 6% had dual primary/other gynecologic cancers. The majority were from the United States (86%), most were non-Hispanic White (46%), and the median age was 62 years (IQR 52-72). The majority were diagnosed with localized disease (68%);only 18 (2%) and 15 (2%) were fully or partially vaccinated, respectively. In the 3 months prior to COVID-19, 36% had any cancer treatment, with chemotherapy the most common (23%). When diagnosed with COVID-19, most patients were in remission (50%), while 37% had active disease, including 22% with metastatic disease. Most patients presented with typical COVID-19 symptoms (76%);few had a poor ECOG performance status (PS ≥2, 14%). Outcomes included hospitalization (50%), ICU admittance (12%), mechanical ventilation (8%), and death within 30 days of testing positive for SARS-CoV-2 (10%). In unadjusted models, increasing age (OR: 1.03 1.02-1.04) and Black race (OR 1.91, 1.31-2.77) were associated with increased severity of COVID-19 outcomes. Compared to patients in remission for ≥5 years, those with progressive disease had increased severity (OR 1.88, 1.25-2.82), while those in remission for < 5 years or with stable disease had decreased severity of COVID-19 outcomes (OR 0.55, 0.39-0.76). In multivariable models that included adjustment for age, race, and cancer status, additional factors associated with increased COVID-19 outcome severity included cardiac (OR 1.57, 1.13-2.19) and renal (OR 2.00, 1.33-3.00) comorbidities, an ECOG PS ≥2 (OR 5.15, 3.21-8.27), having pneumonia or pneumonitis (OR 4.08, 2.94-5.66), venous thromboembolism (OR 4.67, 2.49-8.75), sepsis (OR 14.2, 9.05-22.1), or a co-infection within ±2 weeks of SARS-CoV-2 (OR: 4.40, 2.91-6.65);asymptomatic SARS-CoV-2 infection was associated with decreased severity of outcomes (OR: 0.25, 0.16-0.38). The overall case fatality rate was 15.7%. Conclusions: Patients with gynecologic cancer experience significant morbidity and mortality related to infection with SARS-CoV-2. Age, race, cancer status, co-morbidities, and COVID-19 complications were associated with more severe COVID-19 outcomes, along the continuum from least to most, of hospitalization, ICU admittance, mechanical ventilation, and 30-day mortality.

Potential Antiviral Target for SARS-CoV-2: A Key Early Responsive Kinase during Viral Entry

Currently, there is no effective antiviral medication for coronavirus disease 2019 (COVID-19) and the knowledge on the potential therapeutic target is in great need. Guided by a time-course transmission electron microscope (TEM) imaging, we analyzed early phosphorylation dynamics within the first 15 min during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral entry. Based on alterations in the phosphorylation events, we found that kinase activities such as protein kinase C (PKC), interleukin-1 receptor-associated kinase 4 (IRAK4), MAP/microtubule affinity-regulating kinase 3 (MARK3), and TANK-binding kinase 1 (TBK1) were affected within 15 min of infection. Application of the corresponding kinase inhibitors of PKC, IRAK4, and p38 showed significant inhibition of SARS-CoV-2 replication. Additionally, proinflammatory cytokine production was reduced by applying PKC and p38 inhibitors. By an acquisition of a combined image data using positiveand negative-sense RNA probes, as well as pseudovirus entry assay, we demonstrated that PKC contributed to viral entry into the host cell, and therefore, could be a potential COVID-19 therapeutic target. © 2022 Chinese Chemical Society. All right reserved.

USE OF TELEMEDICINE FOR FOLLOW-UP OF SLE PATIENTS WITH NEPHRITIS IN THE COVID-19 OUTBREAK (“TeleSLE”): THE 6-MONTH RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Background:Patients with lupus nephritis (LN) might be more susceptible to COVID-19 due to the underlying disease, co-morbidities and use of immunosuppressants. We hypothesized that telemedicine (TM) could be a well-accepted mode of health-care delivery minimizing the risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while maintaining disease control in these patients.Objectives:To evaluate the short-term patient satisfaction, compliance, disease control and infection risk of TM compared with standard in-person follow-up (FU) for patients with LN during COVID-19.Methods:This was a single-center randomized-controlled study. Consecutive patients followed at the LN clinic were randomized to either TM (TM group) or standard FU (SF group) in a 1:1 ratio. Patients in the TM group received scheduled follow-ups via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared.Results:From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had attended at least 2 FU visits. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the 2 groups except a higher physician global assessment score (PGA) in the TM group (mean 0.67±0.69 vs 0.45±0.60, p=0.003) (Table 1). The mean FU duration was 19.8±4.5 weeks. When comparing the most recent visit, the mean waiting time between entering the clinic waiting room (virtual or real) and seeing a rheumatologist (virtual or in-person) was significantly shorter in the TM group (22.5±28.6 vs 68.9±40.7 minutes, p< 0.001) (Figure 1A). The mean overall patient satisfaction score was higher in the TM group (mean 2.19±0.61 vs 1.89±0.78, p=0.042). The results of the post-consultation satisfaction questionnaire are shown in Figure 1B. The number of visits was similar in the two groups (TM: 3.1±1.3 vs SF: 3.0±1.2, p=0.981). However, there was a trend suggesting that alternative mode of FU was requested more frequently in the TM group than the SF group (TM: 12/60, 20.0% and SF: 5/62, 8.1%;p=0.057). More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%;p=0.049) within the FU period, which was no longer statistically significant after adjusting for the baseline PGA. The proportions of patients remained in LLDAS were similar in the 2 groups (TM: 75.0% vs SF: 74.2%, p=0.919). None of the patients had COVID-19.Conclusion:TM resulted in better patient satisfaction and could achieve similar disease control in patients with LN in the short-term when compared to standard care.Table 1.Baseline clinical data of the recruited patients and comparison between the telemedicine/standard follow-up groupsOverall (n=122)Telemedicine group (n=60)Standard follow-up group (n=62)P-valueAge in years44.4±11.544.1±11.744.7±11.50.779Gender: Female111 (91.0)55 (91.7)56 (90.3)0.796Disease duration in years15.1±9.016.2±8.714.0±9.10.115Nephritis class III, IV or V108 (88.5)54 (90.0)54 (87.1)0.42724 hour urine proteinuria in gram0.51±0.630.53±0.600.50±0.650.712Current use of prednisolone112 (91.8)57 (95.0)55 (88.7)0.323Daily prednisolone dose in mg5.51±4.215.69±4.175.34±4.290.570Use of immunosuppressant90 (73.8)46 (76.7)44 (71.0)0.474SLEDAI-2K3.65±2.334.00±2.343.30±2.290.097PGA0.56±0.650.67±0.690.45±0.600.003LLDAS78 (63.9)36 (60.0)42(67.7)0.251Remission0 (0)0 (0)0 (0)n/aPresence of comorbidity87 (71.3)40 (66.7)47 (75.8)0.264SDI0.93±1.151.08±1.280.78±0.980.243HAQ-DI0.23±0.460.25±0.470.21±0.440.571HADS: Anxiety scale Depression scale6.07±4.12 5.72±4.316.20±4.19 5.73±3.935.93±4.09 5.70±4.680.720 0.724Data are reported as mean ± SD or number (%). LLDAS: lupus low disease activity state;SDI: Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index;HAQ-DI: Health Assessment Questionnaire Disability Index;and HADS: Hospital Anxiety and Depression Scale.Disclosure of Interests:Ho SO: None declared, Evelyn Chow: None declared, Tena K. Li: None declared, Sze-Lok Lau: None declared, Isaac T. Cheng: None declared, Cheuk-Chun Szeto: None declared, Lai-Shan Tam Grant/research support from: Grants from Novartis and Pfizer.

Factors associated with use of telemedicine for follow-up of lupus nephritis in the COVID-19 outbreak

Background: It is important to weigh the potential risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a doctor visits against the risk of missing disease controls in patients with lupus nephritis during the COVID-19. Telemedicine (TM) follow-up is a reasonable option. Despite the recent exponential increase in application worldwide, there is no study examining the clinical factors associated with the patients' choice of TM use in lupus nephritis. Objectives: In this study, we aimed to examine the clinical variables associated with a higher preference for TM follow-up in patients with lupus nephritis. Methods: Consecutive patients followed at the lupus nephritis clinic were contacted for their preferred mode of follow-up. The demographic, socioeconomic and clinical data of the first 140 patients opted for TM and 140 patients preferred to continue standard in-person follow-up were collected and compared. Results: The mean age of the 280 recruited patients was 45.6 ± 11.8 years. The mean disease duration was 15.0 ± 9.2 years. The majority of them had lupus nephritis class III, IV or V (88.2%) and were on prednisolone (90%). Three quarters of the patients (67.1%) were on immunosuppressants. The mean SLEDAI-2k was 4.06 ± 2.54, physician global assessment (PGA) 0.46 ± 0.62 and SLICC/ ACR damage index 1.11 ± 1.36. A significant proportion of the patients (72.1%) had one or more comorbidities. It was found that patients with higher PGA and family monthly income (≥ USD3,800) preferred TM, while fulltime employees preferred in-person follow-up (Table 1). These predictors remained significant after controlling for age in the multivariate analysis with odd ratios for PGA 1.05 (95% CI 1.01-1.09), family income ≥USD3,800 1.90 (95% CI 1.24-3.79) and fulltime employment 0.53 (95% CI 0.32-0.88). PGA was noted to be positively correlated with the perceptions that TM reduces (r=0.13, p=0.036) and routine visit increases (r=0.12, p=0.04) the risk of COVID-19 during the outbreak. Conclusion: When choosing the mode of care delivery between TM and clinic visit, the patient's disease activity as well as employment and economic status appeared to be important.