ABSTRACT
Background: The coronavirus pandemic, is an ongoing global pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2.1 The pandemic has posed major challenges to the National Health Service, with implications for patients with rheumatological diseases. 2 In order to try and prevent transmission of the virus, the delivery of patient care has adapted, involving more telephone and virtual review of patients. The British Society of Rheumatology (BSR) has highlighted the importance of adopting a 'treat-to-target' 3 approach in managing these patients to facilitate early treatment escalation in the presence of active disease. Close monitoring of disease is an integral approach to managing these patients. Disruption to previous patterns of care and disease monitoring of biologic patients theoretically may increase the risk of disease fare and adverse clinical outcomes. 4 Objectives: The BSR recommends all patients receiving biologic therapy should be reviewed for drug safety every 6 months. It recommends that patients prescribed a biologic should have monitoring blood tests every 3-6 months.3, 5 The BSR has published mitigating guidance outlined within the COVID-19 rapid guide-line.5 This suggests it's safe to increase time intervals between blood tests for drug monitoring, particularly if 3-monthly blood tests have been stable for over 2 years. Our aims are to evaluate whether altering our delivery of care has impacted on the 'treat-to-target' approach and the frequency of blood monitoring in those on biologic therapy, despite the challenges of an ongoing global pandemic. Methods: Over a period of 1 month a total of 51 patients receiving biologic therapy case notes were reviewed. Data was collected relating to underlying diagnosis, choice of biologic, whether a disease activity score was performed, method of consult and compliance with drug monitoring. Results: Of the 51 patients 24 patients were receiving adalimumab, 20 baric-itinib, 2 flgotinib, 2 upadacitinib and 3 on entarcept. Diagnoses ranged from 33 patients with rheumatoid arthritis, 7 psoriatic arthritis, 5 ankylosing spondylitis, 5 spondyloarthropathy and 1 enteropathic arthritis. Disease activity scores were documented in the majority of patients (75%). In those where disease activity scores were not documented, 11 had rheumatoid arthritis and the remaining 2 psoriatic arthritis. The majority of the patients who didn't have disease activity scores documented were reviewed via telephone consult (84%). All patients had undergone adequate blood monitoring with 100% compliance with blood tests performed within 6 months. Conclusion: The COVID-19 pandemic has presented an extraordinary necessity for change in how we manage patients suffering from rheumatic disease. The impact of this global pandemic will be long-lasting and thorough analysis of patient outcomes is needed. However, this period presents an exciting opportunity to embrace new ways of working, which may improve efficiency and efficacy of patient care.
ABSTRACT
SARS-CoV-2 is a novel coronavirus which has caused the COVID-19 pandemic. Other known coronaviruses show a strong pattern of seasonality, with the infection cases in humans being more prominent in winter. Although several plausible origins of such seasonal variability have been proposed, its mechanism is unclear. SARS-CoV-2 is transmitted via airborne droplets ejected from the upper respiratory tract of the infected individuals. It has been reported that SARS-CoV-2 can remain infectious for hours on surfaces. As such, the stability of viral particles both in liquid droplets as well as dried on surfaces is essential for infectivity. Here we have used atomic force microscopy to examine the structural stability of individual SARS-CoV-2 virus like particles at different temperatures. We demonstrate that even a mild temperature increase, commensurate with what is common for summer warming, leads to dramatic disruption of viral structural stability, especially when the heat is applied in the dry state. This is consistent with other existing non-mechanistic studies of viral infectivity, provides a single particle perspective on viral seasonality, and strengthens the case for a resurgence of COVID-19 in winter.