COVID-19 trajectory similar across countries despite disparate containment plans
The infection and mortality rates of COVID-19 seem to be comparable across international borders despite different countries employing widely different containment strategies, according to findings presented during a webinar hosted by United Rheumatology.
“It is very difficult to influence the outcome of this disease,” Paul Emery, MD, director of The Leeds Institute of Rheumatic and Musculoskeletal Medicine, said during the “On Survival and Resilience: Managing A Rheumatology Practice Through the COVID-19 Pandemic” webinar. “For example, the sobering fact is that we in the U.K. started 3 weeks later than Italy and yet our trajectory looks largely the same. It is a worldwide phenomenon.”
Emery suggested that despite a growing body of data on topics ranging from epidemiology to pathogenesis, attempting to make sense of how COVID-19 is spreading from country to country remains a challenge. He made sure to note that not all the news is bad.
“For example, the U.S. is following the European curve in the number of cases but doing rather better in terms of the number of deaths [compared with the EU],” Emery said. However, like many of the emerging trends, it remains largely unexplained.
Another important epidemiological trend pertains to race. “The only doctors who have died from COVID in the U.K. are Asian, from India,” he said. “For patients who get respiratory support, the black and Indian patients end up with worse mortality.”
Early ICU data are showing that, compared with white patients, there is a fourfold increase in mortality among black patients and a twofold increase among Indian patients. “This may have to do with genetics, but that is just a supposition,” Emery said.
As more such data emerge, and if these trends continue, Emery suggested that this knowledge may help countries divert resources to areas with higher concentrations of black or Indian individuals.
Turning his attention to more rheumatology-specific information, Emery urged clinicians to focus on known factors in treating patients with rheumatic diseases, regardless of race or national origin. “We already know that viral illnesses can cause non-specific flares in the rheumatic diseases,” he said. “If you do flare, you will require steroids, and we know that steroids can increase viral infections. So, the message here is to keep on therapy to reduce the risk of flare.”
Emery noted that while official guidance in the E.U. suggests avoiding steroids, Italian doctors were administering them in severe or potentially fatal situations, with some success. This information may aid other nations in managing these patients.
Other anecdotal data from Italy showed that in one district, zero of 700 patients with COVID-19 had rheumatic diseases.
“In the U.K., we saw just two patients with scleroderma,” he said. “One survived after treatment with tocilizumab and one died after intubation.”
Looking more broadly at international data, Emery said that the Global Rheumatology Alliance has accrued the first 110 patients with rheumatic diseases. “Fevers are quite characteristic, and cases are mainly seen in rheumatoid arthritis and lupus patients,” he said.
Other early trends from this cohort have shown that about 35% have been hospitalized and 5% have died, according to Emery. But his assessment of these findings largely applies to much of the data that is emerging from country to country showing how varying strategies are working. “The data are uninterpretable, I’m afraid,” he said. – by Rob Volansky
Emery P. View from Europe. Presented at: United Rheumatology webinar “On Survival and Resilience: Managing A Rheumatology Practice Through the COVID-19 Pandemic”; April 17, 2020 (virtual meeting).
Disclosures: Emery reports speakers bureau roles with AbbVie, Amgen, BMS and Celgene.