For a study in a cohort assembled at the start of the pandemic in New York City, researchers sought to determine whether perspectives about SARS-CoV-2 risks obtained at enrollment were associated with clinical course and vaccination intent obtained at follow-up with the advent of vaccines.

Patients with various rheumatologist-diagnosed disorders who were taking immunosuppressive drugs were questioned in April 2020 in New York City during the peak of mortality-associated COVID-19 and were asked if they felt a higher infection risk owing to rheumatic diseases/medications. When vaccinations were available, patients were questioned again and asked about flares, medication changes, illness activity throughout the pandemic, and current disease status. In addition, they reported SARS-CoV-2 tests, vaccination intent, and vaccine concerns.

About 96 patients underwent follow-ups (January to March 2021; 83% were women; the mean age was 50 years). At enrollment, 53%/57% perceived a much greater infection risk from autoimmune disease/medications; at follow-up, patients reported flares (63%), increased/unpredictable illness activity (40%), and more drugs at enrolment; at follow-up, patients reported flares (63%), increased/unpredictable disease activity (40%), and more medications (44%). The current illness was excellent/very good/good (73%) and fair/poor (27%). There was no correlation between enrollment viewpoints and follow-up status. 70% of them tested positive for SARS-CoV-2. About 23% would not/were unwilling to be vaccinated. In a multivariate analysis, the primary reasons for not intending/hesitating to be vaccinated were younger age, fear about the impact on rheumatic illness, and skepticism of vaccination information. Rheumatologists were not mentioned as a source of vaccination knowledge by 86% of respondents.

At the outset of the pandemic, clinical state and vaccination intent were not linked with perceived SARS-CoV-2 risk. Patients were discouraged from receiving vaccinations due to concerns about vaccine effects on rheumatic illness and disbelief in vaccine information.