Unexpected Changes in Physical and Psychological Measures Among Georgia Lupus Patients During the Early Weeks of the COVID-19 Pandemic in the United States, March 30-April 21, 2020

Background/Purpose: An infectious disease outbreak can lead to negative physical and psychological consequences in the general public, as shown by the early COVID-19 pandemic, through significant negative global impacts on depression, anxiety, and stress These outcomes are also known to be common among people with lupus To evaluate the early impacts of the COVID-19 pandemic, we examined changes in standardized patient-reported outcomes in a cohort of patients with SLE between 2018-2019 and early 2020 and evaluated how the pandemic's impact on physical and psychological health differed by subgroups, particularly among black persons, who are at higher risk for adverse outcomes from both SLE and COVID-19 Methods: Georgians Organized Against Lupus (GOAL) is a Centers for Disease Control and Prevention-supported population-based validated cohort of patients with SLE in Atlanta who complete patient-matched annual surveys across multiple domains We analyzed sociodemographics and validated measures of lupus characteristics and physical and psychological parameters (see table footnotes) from surveys before (2018-2019) and during the pandemic's early onset (March 30-April 21, 2020) The 2020 surveys closely corresponded to the statewide shelter-inplace order in Georgia (April 3-24) We conducted descriptive analyses of prevalence (%) estimates with standard deviations (SD) and temporal changes in scale scores and paired t-tests for statistically significant differences (?=0 05);analyses were examined overall and stratified by sex and race Results: Overall, 316 participants had survey data from both time points Most were black (76 6%) and female (93 4%);more than a quarter live in poverty (28 5%) (Table 1) Compared with before the pandemic, no physical or psychosocial measure worsened during the early onset of the pandemic Rather, there were small, statistically significant improvements in stress, pain interference, fatigue, depression, anger, everyday discrimination, and emotional support overall, particularly in females and black persons (Table 2) Only Pain Interference improved significantly in males and Discrimination in white respondents (Table 2) No changes were observed in disease activity, disease damage, insurance, or poverty status Conclusion: We expected to see worsening in most measures among patients with SLE early in the COVID-19 pandemic, so the absence of deterioration and even minor improvements is notable and may be explained by several hypotheses These findings may reflect baseline severity of many outcomes for people with SLE The study period was early in the pandemic, so potential negative financial pressures may not have been fully realized and may have been mitigated by economic impact payments from acute policy measures Many negative consequences of living with SLE (isolation, reduced activity, anxiety, and fear of stigma) became a reality for the general population This may have made those with SLE feel closer to the norm while limiting opportunities for certain negative experiences, including discrimination Importantly, longer-term impacts of the pandemic may reverse these findings and ultimately lead to more severe negative outcomes, requiring continued close study