ABSTRACT
Background: In our experience during the first year of development of ACHOC-C19 study, we observed 26% mortality in patients with cancer and COVID 19 infection. The impact of vaccination was not evaluated prior to the implementation of this strategy worldwide in this kind of population. It was proposed to evaluate the effectiveness of immunization during the second phase of our investigation. Methods: Cohort study derived from the National Registry of Patients with Cancer and COVID-19 (ACHOCC-19). Data were collected from June 2021 since vaccine was available. Patients were: older than 18 years, diagnosed with cancer (solid tumors), treated and/or under follow-up, and with COVID-19 infection. The comparative analysis of the vaccinated and non-vaccinated cohort is presented. Outcomes included: all-cause mortality within 30 days of infection diagnosis, hospitalization, and mechanical ventilation. Effect estimation was performed through relative risk (RR) and multivariate analysis for each event, using generalized linear models of the binomial family. Results: 896 patients were included, 470 were older than 60 years (52.4%) and 59% women (n = 530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of hospitalization among the unvaccinated was 42.4% (n = 307), and among the vaccinated, 29% (n = 50);invasive mechanical ventilation requirement was 8.4% (n = 61) in unvaccinated, and 4.6% (n = 8) in vaccinated. The cumulative incidence of mortality from all causes in the unvaccinated was 17% (n = 123) and in the vaccinated 4.65% (n = 8). Table summarizes the multivariate analysis. The adjusted RR for mortality for the unvaccinated is 3.4 (95% CI: 1.7-6.8), for hospitalization 1.36 (95% CI: 1.08-1.72), and for mechanical ventilation 2.1 (95% CI: 1.02-4.2). Conclusions: The incidence of complications and death in patients with cancer and COVID-19 infection is significantly higher in those who have not received a vaccination schedule compared to those who have been vaccinated. Immunization should be promoted and intensified in this population group.
ABSTRACT
Objectives: The new coronavirus disease became a public health emergency that has not been seen for generations. The COVID-19 disease leads to an excessive immune activation and cytokine response and constitutes a considerable risk and a challenge for patients with inflammatory conditions such as rheumatic diseases. Patients with rheumatoid arthritis (RA) due to their age and comorbidities were the first to be in continuous lockdown due to their risk and current circumstances. This new normality has caused barriers to accessmedical care and a radical change in their daily life, especially during the beginning of the pandemic. The aim of this study is to describe the practices and behaviors of patients with rheumatoid arthritis during the first lockdown due to the COVID-19 pandemic in Bogotá, Colombia. Methods: In this study, we conducted a telephone survey.We included respondents who participated in an educational program for patients with rheumatoid arthritis. We asked about their behaviors around COVID-19 during the first lockdown established in Colombia, adherence to pharmacological treatment and compliance to a newly implemented telemedicine model. We also asked about COVID-19 related symptoms two weeks before the survey. Results: We included 296 participants. The mean age of the respondents was 60 years IQR (54-66), 95% were female. 86% of patients were receiving more than one conventional DMARD. See Table 1. Although the telemedicine model was entirely new to them, 75% participated in a tele rheumatology consultation. In general, at the beginning of the pandemic, patients were compliant with the COVID-19 prevention measurements. However, we found that 3.5% of patients reported having been less adherent to pharmacological therapy due to information received through media or social networks. Only one patient tested positive for having SARS-COV-2 and reported only flu symptoms without any complications. Patients reported the need to have information and education about the relationship between rheumatoid arthritis and COVID-19. Conclusion: Patients with rheumatoid arthritis have experienced drastic changes in their lives and adapted to new ways to receive medical care. Patients with RA need support and education. As other forms of education, for example, for college students new teaching methods have been implemented, programs for patients should follow the same model.