key: cord-0731626-ldgnr1n9
authors: Crespo, Javier; Díaz-González, Álvaro; Iruzubieta, Paula; Llerena, Susana; Cabezas, Joaquín
title: SARS-CoV-2 massive testing: a window of opportunity to catch up with HCV elimination
date: 2020-10-09
journal: J Hepatol
DOI: 10.1016/j.jhep.2020.10.001
sha: 7430630e6fdfe30fab3706d68ece1ebb6b449043
doc_id: 731626
cord_uid: ldgnr1n9

nan

To the Editor:

The 69 th World Health Organization's assembly approved in 2016 a global strategy for eliminating viral hepatitis (VH), as a threat to public health, by 2030 [1] . Since then, great progresses have been made in reducing the impact of VH, particularly with hepatitis-C virus (HCV).

The effects of achieving viral cure are countless, at both individual and population levels. In this regard, we read with great interest the work published by Calvaruso & Craxi [2] , explaining precisely the present, long-term and expected benefits induced by direct-acting antivirals (DAA). Furthermore, as a consequence of the massive treatment with DAAs, Forns' group foresees a very optimistic scenario: cirrhosis related to HCV will be a marginal cause of hospital admissions in the near future [3] .

Unfortunately, the pandemic caused by SARS-CoV-2 endangers these remarkable advances. In fact, the first wave of the COVID-19 pandemic produced an unexpected overwhelm of health systems, whose consequences were not those virus-related only, but also the drop in the diagnosis of other diseases [4] . Along this line, Blach et al. [5] modeled brightly the devastating consequences of delaying HCV elimination programs. This delay will be reflected in an increase of HCV-related mortality, both as consequence of cirrhosis complications and hepatocellular carcinoma (HCC) development. A single-year delay may result in an excess of 70,000 liver-relateddeaths and 44,000 excess HCC diagnoses.

However, the COVID19 crisis has forced the diversion of the majority health resources towards the care of infected patients, impacting the management of those with other conditions. A clear example are patients infected with HCV [6] . Unfortunately, the closure of harm reduction centers, cancellation of elimination programs and medical consultations, as well as the struggle for accessing to health centers in this pandemic time, is decreasing the rate of HCV diagnoses. In fact, a recent survey evaluating the collateral damages of COVID19 on VH services showed that up to 64% of participants reported the impossibility to access to viral testing, with the closure of testing facilities being its main cause in the United States [7] . Consequently, this diagnosis adjournment J o u r n a l P r e -p r o o f 3 will be translated into a patent delay in starting DAA, whose future consequences have just been predicted by Blach et al. [5] , which we already knew from the past [8] .

Nowadays, we are witnessing that asymptomatic carriers are the most likely spreaders of the SARS-CoV2. Thus, it should be translated into the need of massive population testing, since home confinement -and re-confinement-cannot be a long-lasting measure because of the collateral consequences. Therefore, the vast majority of people are probably undergoing SARS-CoV-2 testing. In this regard, and taking advantage of massive SARS-CoV2 testing, we have a golden opportunity for catching up with HBV control and HCV elimination. Since these patients must approach to sanitary facilities, they could be screened for HCV and HBV using only dried blood spots or with a regular blood draw, granting an opportunistic screening at a single visit.

Although in times of crisis, integrating HCV detection programs [9] into SARS-CoV-2 may have a minimum economic impact, but with maximum profitability as previously J o u r n a l P r e -p r o o f 4 Therefore, in accordance with Wingrove et al [9] we consider that 1)HCV and HBV status should be assessed in every patient undergoing SARS-CoV-2 testing; 2)HCV elimination programs should be restarted as soon as possible, especially in vulnerable populations, where the impact of the interruption of HCV elimination programs will be shocking. Thereby, we will avoid the direct consequences of the paralysis of HCV elimination programs and, simultaneously, we send an optimistic message to people: public health programs are maintained, even in these uncertain times.

Finally, we want to recall that we are still facing the viral-related wave. However, the upcoming waves will be the consequences of the delayed diagnosis of other conditions as the aftereffect of temporary suspension of many health programs. In the setting of liver diseases, we could prevent it by massive anti-HCV and HBV testing in every patient undergoing SARS-CoV-2 testing.

J o u r n a l P r e -p r o o f

WHO | Global health sector strategy on viral hepatitis

Hepatic benefits of HCV cure

Hepatitis Crelated cirrhosis will be a marginal cause of hospital admissions in the near future

Fewer cancer diagnoses during the COVID-19 epidemic in the Netherlands

Impact of COVID-19 on global hepatitis C elimination efforts

COVID-19 and viral hepatitis elimination programs: Are we stepping backward?

The impact of COVID-19 on hepatitis elimination

Too many people with viral hepatitis are diagnosed late -with dire consequences

Elimination of hepatitis C. Positioning document of the Spanish Association for the Study of the Liver (AEEH)

Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic