ATLANTA – , according to an investigator at the annual meeting of the American Society of Hematology.
During the first COVID-19 wave in the summer of 2020, Atlanta’s Grady Sickle Cell Center, the nation’s largest adult sickle cell center, recorded two deaths among the 20 COVID-19_infected patients seen there, said Fuad El Rassi, MD, of Emory University, Atlanta.
ASH
Dr. Fuad El Rassi
Virtual visits, launched to deliver health care needs in the wake of a Georgia’s 2020 statewide shelter-in-place order, helped protect patients from COVID-19 infection, Dr. El Rassi said in a press conference at the meeting.
“The patients’ diligence and awareness to stay home during the pandemic have proven crucial to reducing morbidity and mortality in this vulnerable population,” he said. “The option of having virtual visits for health care delivery was key and should be utilized further in sickle cell care.”
However, virtual visits and other best practices to prevent and treat COVID-19 in patients with sickle cell disease can be challenging to implement outside of large, specialized centers such as Grady.
“The majority of sickle cell patients in major metropolitan areas are not plugged into dedicated sickle cell centers, and that’s a key issue,” said Dr. El Rassi.
“There’s a huge shortage of such clinics around major metropolitan areas, and that restricts things for the general population, unfortunately.”
COVID-19 prevention remains a challenge, no matter where patients are treated. Only about 50% of the center’s sickle cell disease patients are immunized, according to Dr. El Rassi, who added that assessment of vaccine response among those patients is ongoing.
Ifeyinwa (Ify) Osunkwo, MD, MPH, a sickle cell disease specialist, said long-term sustainability of virtual visits depends greatly on states’ continuation of laws or policies that facilitate access to telemedicine. A total of 22 states changed laws or policies during the pandemic to promote access to telemedicine, according to the Commonwealth Fund.
Virtual care is more challenging in states where expanded telemedicine coverage is not available or is ended, said Dr. Osunkwo, director of the Sickle Cell Enterprise at Levine Cancer Institute. The institute is part of Atrium Health, a large health system that operates in four states.
“We are no longer able to do virtual visits for our South Carolinian patients, even though across the border in North Carolina, you can still provide virtual care,” Dr. Osunkwo said in an interview.
“Sickle cell patients suffer from social determinants [of health], so getting to their doctor when they have a regular outpatient visit is kind of hard,” she added. “And having that virtual option actually makes them more adherent, and they have better access to care overall.”
In the study presented at the ASH meeting by Dr. El Rassi and colleagues, there were a total of 55 patients with COVID-19 among the 1,343 sickle cell disease patients they tracked. Of the 55 patients with COVID-19, 28 were female and 27 were male, and 35% were on hydroxyurea for disease modification.
Among these 55 patients with COVID-19, 44 (80%) were hospitalized, and the hospitalizations of 15 (27%) were deemed related to COVID-19 signs and symptoms, Dr. El Rassi said. Twelve of the 55 patients (22%) had emergency visits, including 5 (9%) because of COVID-19 symptoms, he added.
The two deaths from COVID-19 occurred in June and July 2020, said Dr. El Rassi, adding that those patients were among 20 total cases diagnosed from March to September of 2020.
Over the second reported wave of COVID-19, from October 2020 to March 2021, there were no deaths seen among 35 total COVID-19 cases, according to the report at the ASH meeting.
In an interview, Kaitlin Strumph, MD, a sickle cell disease specialist at the Children’s Hospital at Montefiore in New York, noted that patients with sickle cell disease who contract COVID-19 are considered at high risk for morbidity and mortality.
“Patients and providers should not let down their guard,” Dr. Strumph said in an interview. “The best way to protect people from COVID-19 right now is prevention, and vaccinations are the key to further improving outcomes.”
Virtual visits can help bridge gaps in care for patients with sickle cell disease, said Dr. Strumph, given that limited access to care is a large driver of health disparities in this population.
“Telemedicine allows patients to stay home and limit their exposure to COVID-19 out in the community and at the hospital,” she said. “I think most providers feel confident that virtual visits are a huge benefit for the community, and we hope they are here to stay.”
Dr. El Rassi reported disclosures related to Cyclerion, Novartis, Pfizer, Global Blood Therapeutics and bluebird bio.