Prevalence and Mortality Due to Outbreak of Novel Coronavirus Disease (COVID 19) in β Thalassemias: The Nationwide Iranian Experience

​Background: The data on Coronavirus Disease 2019 (COVID-19) in patients with β-thalassemias are scarce. Our aim was to determine the prevalence and mortality rate of patients with β-thalassemias compared to the infected general population in Iran, where it is a hot spot for both the prevalence of β-thalassemias and COVID-19 disease. Methods: A multicenter, retrospective cross-sectional study was conducted across all comprehensive thalassemia centers in Iran, from January to April 2020. All suspected and confirmed COVID-19 cases, from a total of 15,950 transfusion- dependent (TDT) and 2,400 non-transfusion dependent thalassemia patients (NTDT) registered by the Iranian Ministry of Health were evaluated. Epidemiological, clinical, imaging and outcome data were extracted from their medical records, using a standardized data collection form. Findings: Fifteen confirmed cases of COVID-19 (12 in TDT and 3 in NTDT) were detected from a total of 18,350 β-thalassemia patients. Concomitantly, 8 symptomatic patients with β-thalassemia (6 TDT and 2 NTDT) who were suspected of coronavirus disease, without performing test were also analyzed.  The mean age of confirmed and suspected patients was 36.1 ± 12.1 (range: 22-66) and 39.6 ± 9.03 (range: 30-54), respectively.  Eleven confirmed patients had mild to moderate symptoms and recovered, and four severe cases, with at least one comorbidity, died. The prevalence of coronavirus disease in the general Iranian population was 11.01 and in patients with β-thalassemias was 8.17 per 10,000 population (P:0.246). The mortality rate of coronavirus disease was significantly higher in patients with β-thalassemias (26.6%) compared to the general population (6.34%) (P: 0.001). Interpretation: To the best of our knowledge, this is the largest nationwide retrospective study among thalassemic patients with COVID-19 who have experienced a definite outcome. Our findings provide further objective evidence to consider a comprehensive risk assessment and prognosis among thalassemic patients with COVID-19. Early vigilant monitoring along with high quality supportive care is needed albeit more detailed information should be collected in patients with thalassemia in future studies. Funding Statement: Shiraz University of Medical Sciences and Iranian Thalassemia Society supported the research Declaration of Interests: The authors report no conflicts of interest. Ethics Approval Statement: The study protocol was approved by the Ethical Committee of Shiraz University of Medical Sciences (Code:1399.228), following the Helsinki Declaration and the good clinical practices. The patients or their legal guardians signed a consent form to protect the confidentiality and their identity.