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Review
. 2020 Aug;73(2):441-445.
doi: 10.1016/j.jhep.2020.04.005. Epub 2020 Apr 13.

The COVID-19 pandemic will have a long-lasting impact on the quality of cirrhosis care

Elliot B Tapper  1 , Sumeet K Asrani  2
Affiliations
Review

The COVID-19 pandemic will have a long-lasting impact on the quality of cirrhosis care

Elliot B Tapper et al. J Hepatol. 2020 Aug.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has shattered the meticulously developed processes by which we delivered quality care for patients with cirrhosis. Care has been transformed by the crisis, but enduring lessons have been learned. In this article, we review how COVID-19 will impact cirrhosis care. We describe how this impact unfolds over 3 waves; i) an intense period with prioritized high-acuity care with delayed elective procedures and routine care during physical distancing, ii) a challenging 'return to normal' following the end of physical distancing, with increased emergent decompensations, morbidity, and systems of care overwhelmed by the backlog of deferred care, and iii) a protracted period of suboptimal outcomes characterized by missed diagnoses, progressive disease and loss to follow-up. We outline the concrete steps required to preserve the quality of care provided to patients with cirrhosis. This includes an intensification of the preventative care provided to patients with compensated cirrhosis, proactive chronic disease management, robust telehealth programs, and a reorganization of care delivery to provide a full service of care with flexible clinical staffing. Managing the pandemic of a serious chronic disease in the midst of a global infectious pandemic is challenging. It is incumbent upon the entire healthcare establishment to be strong enough to weather the storm. Change is needed.

Keywords: Hepatic encephalopathy; Hepatocellular carcinoma; Liver disease; Telemedicine; Varices.

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Conflict of interest statement

Conflict of interest Elliot Tapper has served as a consultant to Novartis, Kaleido, Axcella, and Allergan, has served on advisory boards for Mallinckrodt, Rebiotix, and Bausch Health, and has received unrestricted research grants from Gilead and Valeant. Please refer to the accompanying ICMJE disclosure forms for further details.

Figures

Fig. 1
Fig. 1
The Impact of the COVID-19 pandemic unfolds in 3 waves. COVID-19, coronavirus disease 19; DDLT, deceased donor liver transplant; LDLT, living donor liver transplant.
Fig. 2
Fig. 2
Adaptations to preserve high quality care. (A) Interventions and (B) changes to program infrastructure. EMR, electronic medical record; ER, emergency room; EVL, endoscopic variceal ligation; PCP, primary care physician.
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