ABSTRACT
Background and aim: During coronavirus disease 2019 (COVID-19) pandemic, immumodulatory therapies as well as the access to high-risk places (i.e. hospitals, infusion centers) were associated to an increased risk of infection. Nevertheless, patients with inflammatory bowel diseases (IBD) treated with intravenous (i.v.) biologics had to move to hospital for drug infusion, in contrast to patients treated with subcutaneous (s.c.) therapies who could remain at home, monitored through telemedicine. We investigated whether patients hospitalized or treated at home showed similar COVID-19 risk, as well as the levels of anxiety in both groups Materials and methods: We conducted a survey including consecutive IBD patients in clinical and biochemical remission treated with biologics referring to the lockdown period. Patients underwent the normally scheduled clinical visits, performed at home by means of telemedicine for patients treated with s.c. drugs and only in specific cases for patients treated with i.v. therapies. We administered to all patients the Hospital Anxiety and Depression Scale (HADS) questionnaire and other 12 questions, specifically related to COVID and its implications. Group differences in continuous and nominal variables were tested by Kruskal–Wallis test and Fisher exact test, respectively Results: A total of 189 IBD patients were recruited, 112 (59.3%) treated with i.v. drugs and 77 (40.7%) with s.c. ones. No augmented risk of COVID infection were recorded in both groups (hospitalized vs. non-hospitalized, p=ns). The two groups of patients had similar scores in the 14 single items of the HADS questionnaire (p>0.10 for all). The total HADS score obtained by the sum of all items was also almost identical between groups (37.1±2.8 vs 37.2±2.8;p=0.98). In patients treated with i.v. drugs receiving a televisit (n=17), the rates of satisfaction about telemedicine (58.8%) and the lack of in-person care (33.3%) were significantly lower compared with those treated with s.c. drugs (94.8% and 92.2%, respectively;both p<0.0005). Conclusions: Our results suggest that there is no need to convert patients from i.v. to s.c. therapy during COVID-19 outbreaks, since the risk of infection and its transmission is not increased. Moreover, anxiety levels are similar in both groups, emphasizing that hospitalization seems not affecting the psychological status of the patients and therefore not increasing the relapse rate.
ABSTRACT
Aims This is a prospective observational web-based survey aimed to assess the impact of SARS-CoV-2 pandemic onGastroenterology Units in Italy. Methods All members of the Italian Society of Gastroenterology (SIGE) were invited to answer a 39-point multiple-choiceweb-based survey between March 30 thand April 7 th2020. Results Data of 121 hospitals from all 20 Italian regions were analyzed. Overall, 10.7 % of Gastroenterology divisions havebeen converted to COVID Units. Outpatients consultations, endoscopic and ultrasound procedures were limited to urgenciesand oncology indications in 85.1 %, 96.2 % and 72.2 % of Units, respectively, and 46.7 % of Units suspended the screeningfor colorectal cancer.In order to guarantee the ordinary follow-up of outpatients, 83/121 (68.6 %) divisions activated aremote consultancy service (63.9 % by phone, 31.3 % by email, 4.8 % by video). Overall, 112/121 (92.6 %) GI Units issued and followed a specific protocol for the management of patients with suspectedor confirmed SARS-CoV-2 infection. The 72.2 % of the staff received proper training for the use of personal protective equipment, although 45.5 % did not havesufficient devices for an adequate replacement. With regard to PPE availability, N95/FFP2-3 masks were available in 91/121 (75.2 %), surgical masks in 115/121 (95.0 %),gloves in 117/121 (96.7 %), disposable gown in 100/121 (82.6 %), hairnet in 104/121 (85.9 %), goggles in 78/121 (64.5 %)and boots in 57/121 (47.1 %) of divisions. Finally, in 41/121 GI divisions (33.9 %) there was at least one healthcare professional who got infected, in a total of 132subjects, of which 121/132 from divisions not-converted to COVID Units and 75/132 from high-prevalence areas. Conclusions Substantial changes of practice and reduction of procedures have been recorded in the entire country duringthe first wave of the pandemic. The long-term impact of such modifications is difficult to estimate but potentially very riskyfor many digestive diseases.