{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T18:42:42Z","timestamp":1764873762237,"version":"3.37.3"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:00:00Z","timestamp":1605052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000770","name":"University of Manchester","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000770","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Rheumatol"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The COVID-19 pandemic has led to major changes in clinical practice on a global scale in order to protect patients. This includes the identification of vulnerable patients who should \u201cshield\u201d in order to reduce the likelihood of contracting SARS-CoV2. We used national specialty guidance and an adapted screening tool to risk stratify patients identified from our prescribing and monitoring databases, and identify those needing to shield (score \u2265 3) using information from departmental letters, online general practice records and recent laboratory investigations. We collated underlying rheumatological conditions and risk factors. Two months into the shielding process, we examined the COVID-19 status of these patients using hospital laboratory records and compared to population level data. Of 887 patients assessed, 248 (28%) scored \u2265 3 and were sent a standard shielding letter. The most common risk factor in the shielding letter group was age \u2265 70 years and\/or presence of a listed co-morbidity (199 patients). The most common rheumatology conditions were rheumatoid arthritis (69.4%), polymyalgia rheumatica (8.5%) and giant cell arteritis (8.5%). Coronavirus incidence rates were similar in the shielding letter group (0.403%) and in the UK population (0.397%). However, we found a trend towards lower incidence (0.113%) in our whole cohort (RR 0.28, 95%CI 0.04\u20132.01 for the whole cohort compared to UK population). The trend towards lower incidence in this cohort could be because of prior education regarding general infection risk and response to public health messages. While risk stratification and shielding could be effective, prior education regarding general infection risk and public health messages to enhance health protection behaviours during a pandemic may have equal or more important roles.<jats:table-wrap><jats:table><jats:tbody>\n                    <jats:tr>\n                      <jats:td colspan=\"2\"><jats:bold>Key Points<\/jats:bold>\u2022 <jats:italic>Patients on treatment for rheumatic disorders showed a trend for lower incidence of COVID-19 transmission irrespective of shielding letter status<\/jats:italic>\u2022 <jats:italic>This could potentially be because of prior education regarding infection risk received when starting on disease-modifying medication<\/jats:italic>\u2022 <jats:italic>Health education influencing health protection behaviours may be of equal or more importance than shielding information in reducing transmission of SARS-CoV-2<\/jats:italic><\/jats:td>\n                    <\/jats:tr>\n                  <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s10067-020-05494-6","type":"journal-article","created":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T03:02:21Z","timestamp":1605063741000},"page":"1575-1579","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Incidence of COVID-19 in patients with rheumatic disease: is prior health education more important than shielding advice during the pandemic?"],"prefix":"10.1007","volume":"40","author":[{"given":"Sarah","family":"Kipps","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anindita","family":"Paul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sreekanth","family":"Vasireddy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,11,11]]},"reference":[{"key":"5494_CR1","unstructured":"Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19. https:\/\/www.gov.uk\/government\/publications\/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19\/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 (accessed 27\/05\/2020)."},{"key":"5494_CR2","unstructured":"Price E, Macphie E, Kay L et al (2020) Identifying rheumatic disease patients at high risk and requiring shielding during the COVID-19 pandemic. Clin Med 20(3):256\u2013261. https:\/\/doi.org\/10.7861\/clinmed.2020-01492020"},{"key":"5494_CR3","unstructured":"Public Health England. Coronavirus (COVID-19) in the UK. https:\/\/coronavirus.data.gov.uk\/#category = utlas&map = case (accessed 27\/05\/2020)."},{"key":"5494_CR4","unstructured":"National Office of Statistics. Overview of the UK population: August 2019. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/populationandmigration\/populationestimates\/articles\/overviewoftheukpopulation\/august2019 (accessed 28\/05\/2020)"},{"key":"5494_CR5","unstructured":"Bolton Council. Planning and Research People in Bolton Factfile no. 1, 2018 Population Estimates. https:\/\/www.bolton.gov.uk\/downloads\/file\/2285\/2018-population-estimates-factfile-updated-july-2019-(accessed 27\/05\/2020)"},{"key":"5494_CR6","doi-asserted-by":"publisher","first-page":"m2063","DOI":"10.1136\/bmj.m2063","volume":"369","author":"G Davey Smith","year":"2020","unstructured":"Davey Smith G, Spiegelhalter D (2020) Shielding from COVID-19 should be stratified by risk. BMJ 369:m2063","journal-title":"BMJ"},{"key":"5494_CR7","doi-asserted-by":"publisher","unstructured":"Favalli EG., Ingegnoli F, Cimaz R, & Caporali R (2020) What is the true incidence of COVID-19 in patients with rheumatic diseases? Annals of the Rheumatic Diseases, annrheumdis-2020-217615. https:\/\/doi.org\/10.1136\/annrheumdis-2020-217615","DOI":"10.1136\/annrheumdis-2020-217615"},{"key":"5494_CR8","doi-asserted-by":"publisher","unstructured":"Ko\u0161ir U, S\u00f8rensen K. COVID-19: the key to flattening the curve is health literacy [published online ahead of print, 2020 Jul 10]. Perspect Public Health. 2020;1757913920936717. doi:https:\/\/doi.org\/10.1177\/1757913920936717","DOI":"10.1177\/1757913920936717"},{"issue":"4","key":"5494_CR9","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/j.dsx.2020.04.004","volume":"14","author":"AK Singh","year":"2020","unstructured":"Singh AK, Gupta R, Ghosh A, Misra A (2020) Diabetes in COVID-19: prevalence, pathophysiology, prognosis and practical considerations. Diabetes Metab Syndr 14(4):303\u2013310. https:\/\/doi.org\/10.1016\/j.dsx.2020.04.004","journal-title":"Diabetes Metab Syndr"},{"issue":"5","key":"5494_CR10","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1016\/j.semarthrit.2020.07.012","volume":"50","author":"H So","year":"2020","unstructured":"So H, Mak JW-Y, So J, Lui G, Lun F, Lee J, Chan S, Ho C, Chan JM-C, Kong S-P, Ng W-L, Tam L-S (2020) Incidence and clinical course of COVID-19 in patients with rheumatologic diseases: a population-based study. Semin Arthritis Rheum 50(5):885\u2013889. https:\/\/doi.org\/10.1016\/j.semarthrit.2020.07.012","journal-title":"Semin Arthritis Rheum"},{"key":"5494_CR11","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.jinf.2020.04.024","volume":"81","author":"VCC Cheng","year":"2020","unstructured":"Cheng VCC, Wong SC, Chuang VWM, So SY, Chen JH, Sridhar S et al (2020) The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Inf Secur 81:107\u2013114. https:\/\/doi.org\/10.1016\/j.jinf.2020.04.024","journal-title":"J Inf Secur"}],"container-title":["Clinical Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-020-05494-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s10067-020-05494-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-020-05494-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,9]],"date-time":"2021-03-09T07:12:30Z","timestamp":1615273950000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s10067-020-05494-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,11]]},"references-count":11,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,4]]}},"alternative-id":["5494"],"URL":"https:\/\/doi.org\/10.1007\/s10067-020-05494-6","relation":{},"ISSN":["0770-3198","1434-9949"],"issn-type":[{"type":"print","value":"0770-3198"},{"type":"electronic","value":"1434-9949"}],"subject":[],"published":{"date-parts":[[2020,11,11]]},"assertion":[{"value":"23 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 October 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 November 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 November 2020","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The manuscript does not contain clinical studies or patient identifiable data.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}