Challenges of Egyptian patients with systemic lupus erythematosus during COVID-19 pandemic

Tharwat, S.; Zohdy, S.

Background: Coronavirus disease 2019 (COVID-19) pandemic in Egypt is part of worldwide COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)[1]. The current COVID-19 pandemic has contributed to substantial deterioration to healthcare systems worldwide [2].Systemic lupus erythematosus (SLE) patients may have several barriers as medications access during the pandemic. Objectives: The aim of this study was to assess the tremendous challenges faced by the Egyptian SLE patients during COVID-19 pandemic either in the drug shortage, hospitalization or COVID-19 infection through a questionnaire-based study. Methods: This questionnaire-based study was carried out on 200 patients with SLE from Egypt. The questionnaire provided covered socioeconomic status, lupus disease data, knowledge about COVID-19 infection and medical and family history of COVID-19 infection. Results: The mean age of the participants was 30.1 years (with SD 8.4). Among the participants,180 (90 %) were females and 172 (86%) were from urban areas. Corticosteroids and mycophenolate mofetil and antimalarials were the most used medications (87%,87% and 70 % respectively). 140/200 (70 %) of the participants reported difficulty in obtaining medications during COVID-19 pandemic particularly antimalarials (60%). Lupus disease activity was affected by the drug shortage in half of the participants. Twenty-eight (14%) patients lost their jobs while 26 patients (13%) reported that their work was severely impacted by the crisis. Among the precautions taken for prophylaxis against infection wearing protective masks (74%) and using disinfectants of the hands several times per day (67%) were the most reported measures. Forty patients (20%) had to stop or reduce taking NSAIDs to guard against COVID-19 infection while 10 patients (5%) had to start taking antimalarials as a prophylaxis. Among 34 patients (17%) who needed hospitalization,26 (76%) were mainly due to lupus activity and 24 (71%) of them found difficulty on hospital admission because of COVID-19 pandemics. About 40 % of the participants reported that they had at least one close relative had confirmed COVID-19 infection. In addition, thirty-two patients (16%) had confirmed COVID-19 infection. Most of them became clinically free after treatment. However, about half of them had lupus flare and had to change the medications used for treatment of lupus. Figure 1 shows the differences between males and females in response to the questionnaire. 58.6% of females versus 20 % of males would use telemedicine for remote contact with the rheumatologist. Most of females were more keen than males to wear the masks (76.7% versus 50 % respectively). Conclusion: The current COVID-19 pandemic has negative impact on the healthcare provided to SLE patients in Egypt. Patients with SLE faced shortage their medications especially antimalarials.