Rare diseases

Lessons from UK: routine care suspended as rheumatologists treat COVID-19 patients


Some UK rheumatology teams have cancelled all their clinics to joint front-line staff in treating patients with COVID-19.

While most rheumatology outpatient appointments have now been switched to telephone consultations, some services have had to suspend their routine work altogether to staff wards of coronavirus patients.

It comes as the UK braces itself for a surge of patients hospitalised with COVID-19 over the next two to three weeks.

Preparations include a 4,000-bed emergency hospital being set up in the ExCeL Centre in London. Other large sites are being considered in other cities.

Dr Chetan Mukhtyar, consultant rheumatologist at the Norfolk and Norwich University Hospital, told the limbic all routine care had now been stopped and the rheumatologists are now part of a rota providing urgent patient cover.

Urgent rheumatology services, including patients with new disease who need to be treated quickly would still be seen but routine care had been suspended for two weeks.

“In our team one person will be going on to a general ward for people who don’t have COVID-19 and another will be on a COVID-19 ward.

“We have become part of the larger team with other specialities. All outpatient activity has been stopped.”

He said they had received refresher training on the use of some equipment.

“As a clinician, this is outside our comfort zone. This is not new territory for me, I was a medical registrar, but we are no longer practising as specialists and that is something that will take some getting used to,” he said.

But he added, his rheumatology patients had been amazing and incredibly understanding.

 

Other hospitals, including in London which currently has the highest number of cases, are preparing to take a similar approach.

Professor Philip Helliwell, Professor in Clinical Rheumatology at the University of Leeds, said he was not switching to treating patients with COVID-19 but had made changes in how the service operated including doing telephone consultations which was not ideal.

“I would prefer to see patients, but they are happy not to come into hospital.”

He had also been working to identify patients at highest risk from coronavirus who are being asked to shield themselves at home for 12 weeks.

The British Society for Rheumatology has published updated information on COVID-19 for their members who they said were receiving a large number of queries from their patients about the risk to their health.

Among the recommendations are that “clinicians should now look to remove the need for patients to attend face-to-face appointments wherever possible”.

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