The proportion of people with a rheumatic disease getting severe COVID has diminished since early in the pandemic
INTRODUCTION
COVID-19 (often referred to as COVID) is the disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It was declared a pandemic by the World Health Organization in March 2020. The infections caused by the initial wave of the Omicron variant have been reported to cause less severe outcomes in the general population compared with prior waves of different variants. However, whether such better outcomes have also been observed in people with systemic autoimmune rheumatic diseases (sometimes shortened to SARD) remains unclear.
Rheumatic diseases can make people more susceptible to infections. This is partly due to the underlying disease, which can be driven by inflammation and immune imbalance. Some anti-rheumatic drugs might also put people at higher risk for more severe COVID infection because of the way they interact with the immune system.
WHAT DID THE AUTHORS HOPE TO FIND?
The authors hoped to see if there has been an improvement in severe COVID outcomes such as hospitalisations and deaths over time among people with rheumatic diseases.
WHO WAS STUDIED?
The study looked at 1,449 people with rheumatic diseases who had COVID during the pandemic. Everyone was seen at one healthcare system in the United States.
HOW WAS THE STUDY CONDUCTED?
This was a retrospective observational study, which means that the authors used an existing database of patient records to look back through. There was no interventional treatment given.
The authors searched for people with a rheumatic disease who had logged a positive COVID test between March 2020 and January 2022. The records were used to determine how many people ended up having severe COVID, and to evaluate whether the risk for severe outcomes decreased over time.
They compared the results for the early part of the pandemic where the most common form of COVID was the Delta variant (Delta wave; 1 March 2020 to 30 June 2020) with those seen in the first outbreak of the Omicron variant (Omicron wave; 17 December 2021 to 31 January 2022), as well as some other periods between these dates.
WHAT WAS THE MAIN FINDING?
People with rheumatic diseases who got COVID in more recent periods had a much lower risk of hospitalisation or death compared to those who had COVID earlier in the pandemic.
Overall, there were 399 cases of severe COVID, which accounted for 28% of people in the study. But the proportion of severe COVID outcomes declined over time, with 46% of cases classed as severe in the early pandemic (2020 Delta wave) versus only 15% in the initial 2021 Omicron wave. Advances in prevention, diagnosis, and treatment of COVID may have improved outcomes among patients with SARD. The authors also found that there was a higher proportion of unvaccinated people in the severe cases: 78% compared to 60% in those who had been vaccinated against COVID.
ARE THESE FINDINGS NEW?
Yes, these findings are new. Some previous studies have been done in the general population, but not much was known about people with rheumatic disease who are at higher risk for severe COVID.
WHAT ARE THE LIMITATIONS OF THIS STUDY?
One limitation is that this study was done in a single healthcare system. Also, the severe COVID outcomes at the beginning of the pandemic may have been influenced by undertesting and problems with hospital capacity, so the initial numbers could look worse due to these factors. It is also possible that the study missed some people who had COVID testing outside of the hospital system and did not report this to their doctor
WHAT DO THE AUTHORS PLAN TO DO WITH THIS INFORMATION?
These findings may help reassure people with rheumatic diseases that the proportion of patients who have severe COVID seems to be declining, even among those with underlying autoimmune conditions or taking immunosuppressing medications. There are more treatment options available now than before, and this is another area that the authors are investigating. However, the large number of infections in the initial Omicron wave means there were still many severe COVID cases. The authors recommend investigating outpatient treatment and prevention strategies that include monoclonal antibodies and additional vaccine doses.
WHAT DOES THIS MEAN FOR ME?
If you have a rheumatic disease, the best protection against COVID is getting vaccinated. You should continue to be careful and let your doctor know if you feel ill or test positive for COVID. However, these findings may provide some reassurance that people with rheumatic diseases are not experiencing as much severe COVID now as was seen earlier on in the pandemic.
Protect yourself from COVID by following the advice of the government in your country. Where recommended, follow social distancing rules, and use protective masks. Wash your hands regularly, and avoid touching your face. Maintaining good ventilation may also help stop the virus spreading.
Date prepared: November 2022
Summary based on research article published on: 9 August 2022
From: Kawano Y, et al. Temporal trends in COVID-19 outcomes among patients with systemic autoimmune rheumatic diseases: from the first wave through the initial Omicron wave. Ann Rheum Dis 2022;81(12):1742–9. doi:10.1136/ard-2022-222954
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