Adherence to COVID-19 risk stratificationduring the peak of pandemic: A District GeneralHospital experience

ABSTRACT

Background/AimsDuring the peak of COVID-19 pandemic, there were growingconcerns that rheumatology patients could have an increased risk ofcontracting coronavirus due to the immunosuppressive drugs that theywere taking. British Society for Rheumatology (BSR) recommended inits risk stratification guide in March 2020 that vulnerable patientsshould be either shielded or isolated according to their level of risk.The purpose of this survey is to evaluate the compliance to the riskstratification advice among rheumatology patients in a single centre.MethodsRisk stratification guidance was sent out to 401 patients recommending either to shield or to isolate. Patients were contacted over thetelephone between 14 September and 18 October 2020 to ensure theyhad received a postal letter with risk stratification advice. If received, itwas checked whether they had followed the guidance. Responsesreceived from all participants were analysed.Results93% (373) of patients confirmed that they had received the guidance;however, 8 patients suggested they hadn't received and we wereunable to contact 16 patients, despite trying multiple times. Fourpatients died but they did not have confirmed coronavirus. 267confirmed they were shielding and 83 were isolating, but 21 patientsdecided not to follow the guidance despite the recommendation andtwo patients stopped taking the drugs due to fear of contracting thecoronavirus. Total 258 females and 143 males with the mean age 59.Most common diagnoses were rheumatoid arthritis (227), psoriaticarthritis (97) and axial spondyloarthritis (59). It was noted that out of 7patients who had symptoms suggestive of COVID-19, only threepatients were confirmed to have COVID-19 positive PCR test. Threemost commonly used drugs were Benepali (128) followed by Amjevita(100), then Rituximab (56).ConclusionAlthough uptake of postal communication was high in this study, it wasdifficult to establish how rapidly the guidance was delivered. Werealise the need to employ better ways of communicating with thepatients. Innovative ways such as text messaging and social mediahave an important role in the delivery of a rapid mass communicationduring the pandemic. It was reassuring to note that only a very smallnumber of patients had COVID-19 among the patients who followedthe government advice to either shield or isolate. But, it would beinteresting to see whether the incidence of COVID-19 cases rise sincerheumatology patients are no longer shielding.