ABSTRACT
Background/Aims Over the last 12 months (September 2020-21), we have been conducting a clinical trial with two biologic agents comparing pain outcomes in rheumatoid arthritis (RA) (n=26). Within the trial, we investigated how participants with RA taking immunosuppressive medication felt about their care and responded to the COVID-19 pandemic. Such information is important to guide healthcare providers. Methods Semi-structured interviews were conducted either face-to-face or virtually with participants who had recently been recruited to the Biologics for Rheumatoid Arthritis Pain (BIORA-PAIN) study and attended a South West London hospital. Participants had a DAS-28- CRP score of above 5.1 and were just starting on biological treatment. Seven interviews were conducted between April-September 2021, lasting between 23-60 minutes during which participants were asked how they managed their RA during the pandemic. All the responding participants were female, aged between 27-74 (mean 50.3 years), with a mixture of employment status and some living alone or with others. Interviews were recorded then transcribed verbatim and an interim thematic analysis was conducted. Results Four main themes were identified: the effect of lockdown;care of self;medical care;and support. Participants reported weight gain during lockdown due to being more sedentary and feeling less able to exercise, which increased stiffness. Despite reporting no official advice from doctors regarding shielding, most participants felt more vulnerable due to awareness of immunosuppression, but protective measures and vaccine uptake alleviated fears. Many sought advice from online resources, such as Versus Arthritis, and support groups which, as well as comfort, provided information enabling some participants to ask doctors specific questions about their care and medications. Most participants were wary of misinformation and chose to use trusted websites such as NHS and gov.uk or sources advised by doctors. There were varied reports of participants' experiences of their care: most participants felt that their care was largely unaffected by the pandemic, with all participants feeling able to obtain current medication. However, some felt the COVID-19 restrictions slowed the progress of their care and felt unsupported whilst suffering worsening symptoms. Face-to-face appointments were preferred over telephone appointments, as participants felt doctors were unable to assess their pain and joints via phone call. Participants who lived alone suffered more mentally. Conclusion Participants in this study were wary of coronavirus in relation to their disease and many chose to shield whilst reporting no shielding guidance. Many participants looked for reliable sources to research their care and treatment, which have been increased by feeling less able to contact clinicians during the pandemic. Participants felt that routine treatment was possible via telephone but changes in their condition required face-to-face appointments.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic has led to reconfiguration of healthcare resources to manage increased demand for acute hospital beds and intensive care places. Concerns were raised regarding continuing provision of critical care for non-COVID patients during the pandemic. The aim of this study was to assess the impact of the COVID-19 pandemic on patients admitted with major trauma (Injury Severity Score >15) across the four Level 1 trauma centres in London. METHODS: Data were collected from all four major trauma centres (MTCs) in London using the Trauma Audit and Research Network database and from local databases at each centre. A 2-month period from 5 March to 5 May 2020 was selected and the same period during 2019 was used to compare changes due to the pandemic. RESULTS: There was a 31% decrease in overall number of patients presenting to the four MTCs during the COVID-19 period compared with 2019. There was no difference in patient demographics or mechanism of injury between the two periods. Sports-related injuries and proportion of self-presentation to hospital were reduced slightly during the pandemic, although the differences were not statistically significant. The mortality rate and association between mortality and injury severity were similar. Proportion of patients requiring intensive care unit facilities also did not change. CONCLUSION: Despite diversion of critical care resources to deal with COVID-related admissions, we did not observe a change in mortality rate or proportion of severely injured patients requiring critical care. Our results suggest London MTCs were able to provide their usual standard of care for critically injured major trauma (Injury Severity Score >15) patients during the pandemic.