P021 Rheumatology shielded patients, hospitalised COVID-19 and outcomes in Essex: an audit across Mid and South Essex and Barking, Havering and Redbridge Hospitals NHS Trusts
Authors: Ranasinghe Chavini , Nandagudi Anupama , Balogh Emese , Sekaran Emerald , Doherty Teresa , Ali Akmol , Koduri Gouri , Dasgupta Bhaskar 
Published: April 2021

Background/Aims 

Shielding measures were implemented within the United Kingdom in an attempt to slow the rate of COVID-19 infections, with shielding letters being sent to extremely vulnerable patients. This included rheumatology patients on immunosuppressive therapies sufficient to increase their risk of infection.

Methods 

This was a retrospective audit assessing the number of rheumatology patients within the Mid and South Essex NHS Foundation Trust (MSE Trust) and Barking, Havering and Redbridge University Trust (BHR Trust) who were sent shielding letters. We audited how effective these measures were in preventing COVID-19 infection during the shielding period (up to 1st July 2020). Risk criteria from NHS Digital and the British Society for Rheumatology (BSR) were used by individual departments within these Trusts to identify the relevant patients. We audited from case records demographic details, rheumatological diagnoses, therapies and associated co-morbidities in these patients.

Results 

A total of 5,876 high risk patients within these Trusts were identified and sent shielding letters: 4,914 within the MSE Trust and 962 patients within the BHR Trust. As seen in Table 1, of these 5,876 patients, 28 (0.48%) were hospitalised with positive tests for COVID-19: 23 of the 4,914 (0.47%) in MSE Trust and 5 of the 962 (0.52%) in BHR Trust. Of the 28 COVID-19 admissions, 10 died (36%). The number of rheumatology patients that developed COVID-19 as a proportion of all patients admitted across these two Trusts was 0.76% (28 out of 3,695). P021 Table 1:COVID-19 Rheumatology admissions in MSE and BHR TrustsBasi ldonSouth endMid- EssexBHRTotalNumber of Rheumatology shielding letters sent1000274011749625876Total number of COVID-19 admissions76950173716883695Shielded Rheumatology patients admitted with COVID-19995528Deaths331310Mean age67.375.673.469.071.3GenderMale352111Female643417Rheumatological diagnosisRheumatoid arthritis354214Sjogren’s10001Vasculitis13004PMR01012Reactive arthritis00011Psoriatic arthritis20103SLE00011Systemic sclerosis10001Dermatomyositis10001Co-morbiditiesHypertension01012Atrial fibrillation01012Stroke/TIA01001Ischaemic heart disease21003Interstitial lung disease40004Diabetes02103Dementia01001CKD21115COPD22004Cancer12003Osteoarthritis20013Ulcerative colitis01001HIV00011TreatmentPrednisolone33039Methotrexate535215Hydroxychloroquine30025Adalimumab10102Rituximab00123Sulfasalazine30115Leflunomide10012Azathioprine01001Baricitinib00101Table shows number of shielding letters and total COVID-19 admissions within the 2 Trusts, as well as the demographics, rheumatological diagnoses, co-morbidities and treatment of the shielded Rheumatology patients who were admitted with COVID-19.

Conclusion 

This audit supports the idea that shielding is an effective tool in protecting these vulnerable patients. Most of our patients admitted were elderly, had multiple co-morbidities and generally conformed with the known risk factors for severe COVID-19 illness. This supports Government guidelines and BSR risk scoring and is particularly important as it is becoming increasingly apparent that COVID-19 will be prevalent for a long time to come. In line with the recent EULAR COVID-19 registry report, only one of the hospitalised patients from these Trusts was on anti-TNF therapy, suggesting that these therapies were in fact protective. It raises the open question: whether immunosuppression may have a protective effect in some Rheumatology patients.

Disclosure 

C. Ranasinghe: None. A. Nandagudi: None. E. Balogh: None. E. Sekaran: None. T. Doherty: None. A. Ali: None. G. Koduri: None. B. Dasgupta: None.