Access to emergency department for acute events and identification of sickle cell disease in refugees.

Throughout the last decade, thousands of refugees arrived on a daily basis on the Mediterranean coast of Southern-European countries. As this influx is not expected to slow down, developing national and European strategies is required to ensure appropriate and accessible health care to these vulnerable populations.1,2 The vast majority of these migrants come from areas in which sickle cell disease (SCD) and other hemoglobinopathies are highly prevalent. Limited data are available on the burden of these disorders in populations of refugees. Here, we present two pieces of evidence supporting the need for specific strategies for the early identification of SCD in refugees. First, we carried out a retrospective study of data collected during the period 2014-2017 across 13 Italian reference centers for SCD and hemoglobinopathies. The primary outcome of this study was to identify events associated with the new diagnosis of SCD in refugees and the secondary outcome was to evaluate the impact of hemoglobinopathies in refugees coming from endemic areas. The descriptive analysis of variables was performed with counts, percentages, mean and standard deviation (SD) or median and interquartile range (IQR: 25th - 75th percentile). Then, we discuss the results of a pilot study which screened all refugees seen in a single second-level refugee center during October 2017, using one of the new rapid point of care screening devices (SickleSCAN\uae BioMedomics, inc.). The aim was to fast-track the care of individuals with SCD and the collection of relevant demographic data.3-5 The results were then validated by HPLC, the standard gold-standard screening method.3-

Italian patients with hemoglobinopathies exhibit a 5-fold increase in age-standardized lethality due to SARS-CoV-2 infection.

Since the beginning of the COVID-19 pandemic, concerns have been expressed worldwide for patients with hemoglobinopathies and their vulnerability to SARS-CoV-2 infection. Data from Lebanon confirmed a role of underlying comorbidities on COVID-19 severity, but no deaths among a cohort of thalassemia patients.1 Patients with sickle cell disease (SCD) displayed a broad range of severity after SARS-CoV-2 infection, spanning from a favorable outcome unless pre-existing comorbidities (UK cohort)2 to high case mortality in US.3 History of pain, heart, lung, and renal comorbidities was identified as risk factors of worse COVID-19 outcomes by the US SECURE-SCD Registry.4 While Italy experienced a death rate in the general population among the highest in the world, preliminary data from the first wave of the pandemic showed a lower than expected number of infected thalassemia patients (updated up to April 10, 2020), likely due to earlier and more vigilant self-isolation compared to the general population.

Access to emergency department of acute events and identification of sickle cell disease in refugees

Throughout the last decade, thousands of refugees arrived on a daily basis at the Mediterranean coast of Southern European countries. Because this influx is not expected to slow down, the development of national and European strategies is required to ensure appropriate and accessible health care to these vulnerable populations.1,2 The vast majority of these migrants come from areas in which sickle cell disease (SCD) and other hemoglobinopathies are highly prevalent. Limited data are available on the burden of these disorders in populations of refugees. Here, we present 2 pieces of evidence supporting the need for specific strategies for the early identification of SCD in refugees. First, we carried out a retrospective study of data collected from 2014 to 2017 across 13 Italian reference centers for SCD and hemoglobinopathies. The primary outcome of this study was to identify events associated with the new diagnosis of SCD in refugees; the secondary outcome was to evaluate the impact of hemoglobinopathies in refugees coming from endemic areas