Introduction
The coronavirus 2019 (COVID19) pandemic has become a significant world health problem. Clinical manifestations of COVID19 are widely variable from asymptomatic to severe illness with progression to acute respiratory distress and respiratory failure. Age, male sex and comorbidities, have been associated with worse outcomes in the general population with COVID-19, but less is known about its effects specific to cystic fibrosis (CF)1,2.
Viral infections cause about 60% of the acute pulmonary exacerbations in CF, leading to more severe infections than in the general population with an increased risk of complications. The H1N1 pandemic in 2009 was associated with respiratory deterioration, mechanical ventilation and caused significant morbidity in patients with CF3,4. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic emerged as a major world health problem at the beginning of 2020, causing two million deaths, so far, worldwide5,6. Many countries have recommended quarantine to decrease person to person transmission of COVID-195,7. All US states and most European CF centers have advised their cystic fibrosis (CF) populations to isolate socially, as they were identified as being particularly vulnerable to COVID -19 disease.7.
Cystic fibrosis is a genetic disease in which consistent follow-up care with frequent hospital visits is required to avoid a decline in pulmonary and nutritional health8Infants are seen every few weeks; older children and adults are recommended to have routine check-ups every few months. It is believed that if a CF patient ceases treatment for two days, this can result in an exacerbation8.
The COVID19 pandemic overwhelmed many countries’ healthcare systems and intensive-care facilities. Many hospitals shifted their workforces to the rapidly escalating numbers of COVID-19 admissions and, for a time, closed routine clinical work, including outpatient services, to limit contamination and infection risks9. Thus emerged the paramount need to monitor chronic patients at home10. In the USA, health care payers such as Medicare and most private insurance companies have agreed to reimburse health care providers for telemedicine and telephone visits7.
In Greece, where there are limited financial resources, telemedicine procedures were not feasible to be applied during the first wave of the pandemic. To comply with the social distancing policy and follow up with our patients regularly, our CF center contacted all its patients via phone to monitor their clinical condition and health care needs during the first quarantine period. Another measure available by the NHS applied in our center to restrict hospital visits was e-prescription via email or SMS.
The aim of this study was to assess the impact of the lockdown during the first wave of the COVID-19 pandemic and remote monitoring on patient’s health status and daily maintenance therapy in a middle-income resource setting.