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Original research
Impact of COVID-19 on vulnerable patients with rheumatic disease: results of a worldwide survey
  1. Bella Mehta1,2,
  2. Deanna Jannat-Khah1,2,
  3. Mark Alan Fontana1,
  4. Carine J Moezinia1,
  5. Carol A Mancuso1,2,
  6. Anne R Bass1,2,
  7. Vinicius C Antao1,
  8. Allan Gibofsky1,2,
  9. Susan M Goodman1,2 and
  10. Said Ibrahim2
  1. 1Hospital for Special Surgery, New York, New York, USA
  2. 2Weill Cornell Medical College, New York, New York, USA
  1. Correspondence to Bella Mehta; drbellamehta{at}


Objective There is emerging evidence that COVID-19 disproportionately affects people from racial/ethnic minority and low socioeconomic status (SES) groups. Many physicians across the globe are changing practice patterns in response to the COVID-19 pandemic. We sought to examine the practice changes among rheumatologists and what they perceive the impact to be on their most vulnerable patients.

Methods We administered an online survey to a convenience sample of rheumatologists worldwide during the initial height of the pandemic (between 8 April and 4 May 2020) via social media and group emails. We surveyed rheumatologists about their opinions regarding patients from low SES and racial/ethnic minority groups in the context of the COVID-19 pandemic. Mainly, what their specific concerns were, including the challenges of medication access; and about specific social factors (health literacy, poverty, food insecurity, access to telehealth video) that may be complicating the management of rheumatologic conditions during this time.

Results 548 rheumatologists responded from 64 countries and shared concerns of food insecurity, low health literacy, poverty and factors that preclude social distancing such as working and dense housing conditions among their patients. Although 82% of rheumatologists had switched to telehealth video, 17% of respondents estimated that about a quarter of their patients did not have access to telehealth video, especially those from below the poverty line. The majority of respondents believed these vulnerable patients, from racial/ethnic minorities and from low SES groups, would do worse, in terms of morbidity and mortality, during the pandemic.

Conclusion In this sample of rheumatologists from 64 countries, there is a clear shift in practice to telehealth video consultations and widespread concern for socially and economically vulnerable patients with rheumatic disease.

  • Autoimmune Diseases
  • Epidemiology
  • Qualitative research

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  • Contributors BM, CM, SI, SMG, ARB: concept, data collection, data analysis and interpretation, writing, supervision. DJ-K, MF, CM, VA, AG: data collection, data analysis and interpretation, writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests SI receives grant funds from the National Institute of Arthritis and Musculoskeletal and Skin Diseases; SMG grants and personal fees from Novartis—consulting/research support, Pfizer—consulting/research support, BMC Musculoskeletal Disorders—editorial board and Horizon—research support; DJ-K owns stocks in the following companies: Cytodyn, Walgreens, AstraZeneca. All other authors have declared that no competing interests exist.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information.

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