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.