How Did SARS-CoV2/COVID-19 Pandemic Affected Rheumatology Practice in Latin America? A Regional Survey from PANLAR

Background/Purpose: Since December 2019, a novel coronavirus (SARS-CoV-2) pandemic was declared Social isolation became a mainstay for the prevention of disease expansion Outpatient follow-up of patients with rheumatic diseases was restricted Thus, a revolution in rheumatology practice has been observed Attitudes, behaviors, and practice studies are used to investigate patterns of community reactions to a disease The aim of this study was to explore the influence of COVID-19 pandemic in the practice of rheumatologists in Latin America Methods: We performed a cross-sectional observational study by means of a digital anonymous survey (RedCap R) We included rheumatologists from PANLAR non-English-speaking countries We retrieved demographics, COVID-19 diagnosis and perceived risk of being infected, information on practice prior and during the pandemic, the quantitative impact on wage and employment, practices concerning communication with patients and adjustment of immunomodulators, attitudes and behaviors regarding telehealth, the rheumatologist's role on the pandemic, and the perceived discrimination as a health worker We calculated median and interquartile range (IQR) for quantitative variables and frequencies and percentages for qualitative variables Results: Our interim results include 476 rheumatologists from 18 countries The median age is 48 (39-58) years, most of them are women (55%) The most frequent practice scenarios are private practice (73 9%) and institutional outpatient clinics (58 8%) Fifteen (3 2%) responders were diagnosed with COVID-19 A reduction of in-person practice hours was observed prior and during the pandemic;the median proportion of cancelled appointments was 80% (50-100) Forty-fi ve percent perceived a reduction in patient's adherence during the pandemic Most rheumatologists continued DMARDs at the same doses Most of the responders have performed telehealth, with a median of 8 (3-16) hours/week Forty-seven percent of responders have reduced their consult fee, with a median reduction of 50% (30-60) from baseline Most of the responders (88%) reported a reduction of monthly wage, with a median reduction of 50% (40-70) Although 89 7% consider telehealth as a valid strategy during the pandemic, this reduces to 55 7% as a hypothetical alternative after the pandemic More than two-thirds of responders believe that rheumatologists should take part of the development of local COVID-19 guidelines, however, only a third actually got involved in in-stitutional panels Ten percent reported an episode of perceived discrimination during the pandemic Nine percent of rheumatologists have lost their jobs and 14 5% have being required to care for internal medicine patients, including COVID-19 cases Conclusion: SARS-CoV2/COVID-19 pandemic has reshaped rheumatology practice in Latin America and has had a profound impact on rheumatologists' behaviors Telehealth is perceived as a valid alternative to in-person consults during the pandemic A larger effort to participate in the elaboration of disease management strategies should be pursued Our study is still ongoing and we present interim results;it is planned to collect data until July 31th, 2020