COVID-19 and People with CF

CFI encourage members to follow the public health advice, while exercising personal judgement.

At the ECFS Conference, Dr Lutz Nährlich, Gießen Germany, provided an overview of COVID-19 in patients with Cystic Fibrosis in Europe. Using registry data from the Covid-CF project, Dr Nährlich outlined the epidemiology of infections during the pandemic up to the 18 th of September. There were 138 PCR-confirmed cases among PWCF notified to the registry, sadly this included four deaths. This gave an incidence (number of new cases per unit of population) of 0.2 and a case fatality rate of 2.9%. The lower incidence may be reflective of efforts to protect PWCF from COVID-19 through “cocooning” and “shielding” strategies.

Although the case fatality rate among PWCF is lower than initially feared, COVID-19 is not a benign disease in CFpatients. While 20% of PWCF were asymptomatic (had no symptoms of COVID-19), 80% had symptoms. The most commonly experienced symptoms include: Fever; Increased cough; Increased dyspnoea; Headaches/joint pain; Fatigue; Increased sputum production; Headache; Pulmonary exacerbation and acute rhinitis. 60% of PWCF who had symptoms of COVID required hospitalisation, and 16% of these needed care in ICU. A quarter of people who were in ICU died.

There are some risk factors associated with more serious COVID-19 infection among PWCF. These include having had a transplant, being of older age, having diabetes or a very low FEV1.

The pandemic has greatly accelerated teleconsultation and the options for patients who are self-monitoring. There remain however challenges, including funding for the necessary medical devices, quality of self-measurements (particularly for respiratory), secure transfer of data to a patients file and the psychological impact which can be felt for some patients (decreased interaction with healthcare staff and increased responsibility for the patient).

Global Impact of COVID-19 in People with CFThe Cystic Fibrosis Registry Global Harmonization Group published an additional report in the Journal of Cystic Fibrosis in November 2020. This paper detailed the global impact of SARS-CoV-2 in people with CF.

Using data collected up to the 13th of June 2020 the report outlines details of 181 people with CF (32 posttransplant) from 19 countries who had been infected with SARS-CoV-2. A similar spectrum of outcomes to those found in the general population can be seen, 11 people were admitted to intensive care (7 post-transplant) and sadly 7 deaths (3 post-transplant). The study found that more severe clinical outcomes may be associated with having CFrelated diabetes, a lower lung function in the year before infection, older age or having received an organ transplant. Many people with CF have avoided infection with SARS-CoV-2.

While outcomes in this paper are better than initially feared, the authors suggest this may be due to the relatively younger age of the CF population compared to other chronic conditions. SARS-CoV-2 is not a benign disease for all people with CF.

COVID-CF project updateCF patient registries throughout Europe have collected data about people with CF who become infected with SARS- CoV-2, causing the illness COVID-19. The COVID-CF project provided an update on the 13th November 2020, please note the data is preliminary and subject to change.

38 countries were invited to contribute data. 20 countries reported 278 known cases, 18 countries reported 0 known COVID-19 cases among PWCF. Of the 278 reported cases, 197 were confirmed by PCR. Some summary information (where available) on the people who caught COVID-19 and the disease outcomes are provided on the next page.

Further information and data available from www.ecfs.eu

Age range (years) of PWCF who had Covid-19