Awareness and Concerns Among Adult Liver Transplant Recipients in the Current Pandemic Caused by Novel Coronavirus (COVID-19): Strategies to Safeguard a High-risk Population

Abstract

Background: The coronavirus disease 2019 (COVID-19) virus is spreading rapidly, and there are obvious concerns for the immunocompromised patient population including transplant recipients. Creating awareness and understanding patient concerns will play an important role in protecting this vulnerable group in developing timely and appropriate healthcare interventions. Methods: A cross-sectional online survey was conducted between 23rd March 2020 and 1st April 2020 among 154 liver transplant recipients, transplanted between October 2018 and February 2020. An 18-point questionnaire explored their knowledge of COVID-19, awareness of recipient's high-risk status, interventions to minimize cross-infections, and concerns of this patient group regarding the pandemic. Results: There were 112 (73%) respondents, with median age of 53 years (81% males). There was no difference in demographics between those who responded (n = 112) and those who did not respond to the survey (n = 42). Most of the recipients were aware of the main symptoms of COVID-19, such as fever (92%), breathlessness (86%), and dry cough (87%), but less than half were aware of diarrhea (39%) as a symptom. Awareness about spread from asymptomatic individuals was limited (26%). Majority (95%) understood their high-risk status, but worryingly, 23% of the respondents felt that there was no risk in visiting the hospital for routine clinic visit and blood tests. Concerns were raised by the recipients mostly regarding the uncertainties of COVID-19 infection and its treatment options, the quality of information on social messaging platforms, and lack of access to routine tests/immunosuppression levels because of lockdown/social distancing. Conclusions: Our liver transplant recipients have a reasonable awareness regarding COVID-19. Problems in accessing the healthcare system during prolonged periods of lockdown was a major concern. It is important for each transplant unit to educate, support, and remain accessible to this vulnerable patient cohort as the pandemic continues to progress worldwide.

Risk Perceptions, Knowledge and Behaviors of General and High-Risk Adult Populations towards COVID-19: A Systematic Scoping Review

“…We did not notice significant differences in RPs between the general and the high-risk adult populations. Nevertheless, two studies, one with pregnant women in Turkey (35) and the other with poor households in Kenya (36) reported low-risk perception levels, in contrast to six other studies conducted among high-risk adults (31-34, 40, 41). Interestingly, overall, the perceived severity of the disease was slightly higher than the perceived susceptibility of getting COVID-19 during the first months of the pandemic.…”

“…Nevertheless, only 40% of the adults with Parkinson’s disease reported washing their hands more frequently (40). Staying at home or leaving home less frequently were also reported by a majority of respondents (60-79%) from poor households (36), liver transplant recipients, candidates for transplants (34, 41), and people with Parkinson’s disease (40). Most of the respondents (63%-94%) from poor households (32, 36) and sexual minorities (33) avoided crowded places or stopped attending social gatherings.…”

“…Most of the respondents (63%-94%) from poor households (32, 36) and sexual minorities (33) avoided crowded places or stopped attending social gatherings. In three studies involving liver transplantation recipients and candidates for transplants in India (41), poor households (32) and adults with Parkinson’s disease (40) few participants reported wearing a mask (6%-40%). Nevertheless, in Germany, 78% of the liver transplantation recipients and candidates reported wearing a mask when leaving home (34).…”

“…Nevertheless, staying at home, reducing social contacts, and avoiding public transport were less widespread in general populations. Alternatively, the high-risk adults reported being much more compliant with staying at home or leaving home less frequently (34,36,41).…”

“…Studies focusing on high-risk adults also found that most respondents were very knowledgeable about COVID-19, including common symptoms, routes of transmission, and behaviors to avoid an infection (proportions of respondents were between 77% and 94%) (32-34, 36, 41). As for adults in general populations, one study found that only 26% of liver recipients and candidates for transplants thought that COVID-19 can be spread by asymptomatic patients (41). The two studies conducted with poor households also showed a lack of knowledge about difficulty in breathing being a common symptom of COVID-19 (36) and some preventive behaviors such as social distancing, wearing a mask, and avoiding crowded places (32).…”