Survey on the continued impact of COVID‐19 on immunocompromised patients in rheumatology

Abstract

The COVID-19 pandemic rapidly transitioned from strict to relaxed policies that resembled pre-COVID-19 conditions. This shift may be harmful to the physical and mental health of immunocompromised patients as they navigate returning to in-person work and social activities.Patients with autoimmune and inflammatory rheumatic diseases are immunocompromised, most commonly due to immunosuppressive medications, but also due to their disease and end organ damage.Immunocompromised patients have significantly lower seroconversion rates after COVID-19 vaccination, putting them at an increased risk of COVID-19 infection (Lee et al., 2022;Tang et al., 2021). Patients with rheumatic disease also have lower vaccine responses, particularly if taking immunosuppressive medications (Furer et al., 2021). Overall, patients with rheumatic disease have higher rates of infection and increased mortality from COVID-19 compared to the general population (Conway et al., 2022;D'Silva & Wallace, 2021).Patients with rheumatic disease may have significant concerns about their ongoing risk (Yong, 2022) since the rollback of policies and mandates that had previously provided protection against COVID-19 transmission. Furthermore, they may be experiencing more difficulty engaging in various activities of daily living. Some patients may have self-modified their immunosuppressive treatment, which may predispose them to an increased risk of disease flare.The purpose of this study was to describe the impact of relaxed COVID-19 policies on the mental health and social behaviours of adult patients in our rheumatology clinic. We also explored the association between anxiety and depression and social, travel, and work activities. | METHODSThis was a survey conducted at the University of Vermont Medical Center (UVMMC) Rheumatology clinic. UVMMC is a 620-bed academic medical centre located in Burlington, Vermont, USA, which serves approximately 1 million people in Vermont and northern New York. The Rheumatology clinic includes 8 physicians, 2 fellowship trainees, and 1 nurse practitioner with approximately 13,000 patient visits annually.Eligible patients were adults aged 18 years and older who had an immunocompromising condition defined as such by the treating clinician at the time of a clinic visit (e.g. ankylosing spondylitis, inflammatory arthritis, systemic lupus erythematosus, psoriatic arthritis, rheumatoid arthritis, vasculitis), who were on immunosuppressive medications. Patients completed the survey alone in a clinicThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.