Abstract
The coronavirus disease 2019 (COVID-19) pandemic is having a major clinical as well as organisational impact on the national health-care system in Italy, particularly in high-volume hospitals which are usually active for many essential clinical needs, including inflammatory bowel disease (IBD). Here, we report major clinical and organisational challenges at a high-volume Italian IBD centre one month after the start of the Italian government’s restrictions due to the COVID-19 pandemic. All routine follow-up IBD visits of patients in remission were cancelled or rescheduled for 8–12 weeks’ time. However, access to the hospital for therapy or for unstable/relapsing patients was not considered postponable. Everyone attending the centre (e.g. physicians, nurses, administrative personnel and patients) were advised to respect the general recommended rules for hand hygiene and social distancing, to disclose if they had a fever or cough or flu-like symptoms and to wear a surgical mask and gloves. At the entrance of the therapy area, a control station was set up in order to double-check all patients with a clinical interview and conduct thermal scanning. A total of 1451 IBD patients under biotechnological or experimental therapy actively followed in the CEMAD IBD centre were included in the study. About 65% of patients maintained their appointment schedules without major problems, while in 20% of cases planned infusions were delayed because of the patient’s decision or practical issues. About 10% of patients receiving subcutaneous therapy were allowed to collect their medicine without a follow-up visit. Finally, 10% of patients living outside the Lazio region requested access to their therapy at a local centre closer to their home. At present, five patients have been found to be positive for SARS-CoV-2 infection but with minimal symptoms, 22 are in ‘quarantine’ for contact considered to be ‘at risk’ for the infection. Up to now, none of them has experienced significant symptoms. This study represents the first observational detailed report about short-term impact of the COVID-19 pandemic on patient organisation and management in a high-volume IBD centre.
Highlights
Since January 2020 (December 2019 in China), coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection has represented a dramatic publichealth emergency both in Italy and worldwide.[1,2]The high rate of transmission, frequent need for hospitalisation among symptomatic cases ($10%), high requirement for intensive-care management and prominent mortality[1,2] have led to a rapid change in the organisation of the health system at local as well as national and international levels
A total of 1451 inflammatory bowel disease (IBD) patients on biological drugs or enrolled in clinical trials were included in the study
At one-month follow-up, we experienced a significant increase in email and phone contacts for both physicians and administrative personnel
Summary
Since January 2020 (December 2019 in China), coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) infection has represented a dramatic publichealth emergency both in Italy and worldwide.[1,2]The high rate of transmission, frequent need for hospitalisation among symptomatic cases ($10%), high requirement for intensive-care management and prominent mortality[1,2] have led to a rapid change in the organisation of the health system at local as well as national and international levels. To reduce the risk of spreading SARSCoV-2 infection, access to hospitals has been strictly limited to urgent cases. In this context, the management of chronic diseases, including inflammatory bowel disease (IBD), has been critically impacted, with a significant reduction in visits, endoscopic and radiological procedures and multidisciplinary evaluations, modifying the current standard of care for IBD.[4,5] There are currently only a few reports on IBD patients,[6,7,8,9,10] but no specific recommendations can be given to IBD patients based on direct evidence
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