COVID-19 Related Stress among Lung Transplant Recipients

PURPOSE: Over 43 million COVID-19 cases and 1 million deaths have been reported globally and rates continue to climb. During pandemics people exhibit stress that may be disproportionally felt by LTR due to immunosuppression and comorbidity that increase their risk for poor COVID-related outcomes. Transplant providers have an important role in addressing the physical and emotional impact of COVID, yet COVID-related stress has not been assessed in LTR. The aims of this project, conducted in Oct 2020, were to quantify COVID-related stress, stressors and correlates. METHODS: 540 LTR from a U.S. center were sent an anonymous, on-line survey comprised of 5 reliable and valid subscales of the COVID Stress Scale (CSS): danger, socio-economics, contamination, checking and traumatic stress. Each subscale included 6 ordinal-scale items for a max subscale score of 24 that when summed yielded a total CSS score up to 120. Higher scores indicate higher stress. Other items included socio-demographics, COVID exposure, testing and impact on seeking medical care. RESULTS: The final sample included 226 LTR (42%) who completed all CSS items, including 58% male, 56% over 60 years, 95% white, 74% married/living with partner. Nearly half reported concerns about face-to-face visits with providers; 42% reported delaying or cancelling medical appointments due to COVID concerns; 26% opted for virtual visits. 96% were never exposed to a known or suspected COVID case. Of the 48% who were tested for COVID, only 2 were positive. The primary sources of information sought about COVID in descending order were transplant providers (29%), TV news (28%), and the internet (15%). Mean total CSS scores were 31.8 (17.8). Mean subscale scores in descending order of distress were danger (9.24), contamination (9.19), checking (6.05), socioeconomic (4.98), and traumatic stress (2.33). LTR with higher total scores were significantly more likely to delay medical appointments (p.004) and cancel face-to-face medical visits (p=.000) due to COVID-related concerns. No significant differences were found due to age, marital status, education, years since transplant, or ever having a COVID test. There were too few minorities to examine differences due to race or ethnicity. CONCLUSION: COVID-related stress was low. LTRs with higher stress reported worrisome delays or cancelled appointments. Transplant providers are a trusted source of support and information.