BACKGROUND: Viral infections can cause significant morbidity in cystic fibrosis (CF). The current Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic could therefore have a serious impact on the health of people with CF (pwCF). METHODS: We used the 38-country European Cystic Fibrosis Society Patient Registry (ECFSPR) to collect case data about pwCF and SARS-CoV-2 infection. RESULTS: Up to 30 June 2020, 16 countries reported 130 SARS-CoV-2 cases in people with CF, yielding an incidence of 2.70/1000 pwCF. Incidence was higher in lung-transplanted patients (n=23) versus non-transplanted patients (n=107) (8.43 versus 2.36 cases/1000). Incidence was higher in pwCF versus the age-matched general population in the age groups <15, 15-24, and 25-49 years (p<0.001), with similar trends for pwCF with and without lung transplant. Compared to the general population, pwCF (regardless of transplantation status) had significantly higher rates of admission to hospital for all age groups with available data, and higher rates of intensive care, although not statistically significant. Most pwCF recovered (96.2%), however 5 died, of whom 3 were lung transplant recipients. The case fatality rate for pwCF (3.85%, 95% CI: 1.26-8.75) was non-significantly lower than that of the general population (7.46%; p=0.133). CONCLUSIONS: SARS-CoV-2 infection can result in severe illness and death for pwCF, even for younger patients and especially for lung transplant recipients. PwCF should continue to shield from infection and should be prioritized for vaccination.

1 Tsitsishvili Children's Clinic CF Centre Tblisi Georgia

Adult Cystic Fibrosis center Department of Pulmonology Lithuanian University of Health Sciences Kaunas Lithuania

Alexandrovska University Hospital Pediatric Clinic Sofia Bulgaria

Ambulatory Cystic Fibrosis and Other Rare Diseases Center Institute for Maternal and Child Healthcare State University of Medicine and Pharmacy Nicolae Testemitanu Department of Pediatrics Chisinau Republic of Moldova

Belarusian Republic Children's Center of Pulmonology and Cystic Fibrosis Pulmonary Department 3rd City Children's Clinical Hospital Minsk Belarus

Centre for Cystic Fibrosis Hospital de Santa Maria Lisbon Portugal

Centre for Cystic Fibrosis University Children's Hospital Skopje North Macedonia

CF Center University of Cologne Faculty of Medicine Cologne Germany

Cystic Fibrosis Centre University Hospital of Bratislava Bratislava Slovakia

Cystic Fibrosis Regional Reference Center Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico University of Milan Department of Pathophysiology and Transplantation Milan Italy

Cystic Fibrosis Registry of the Czech Republic Prague Czech Republic

Cystic Fibrosis Registry of Turkey Ankara Turkey

Cystic Fibrosis Trust London UK

Department of Clinical Sciences and Community Health Laboratory of Medical Statistics Epidemiology and Biometry G A Maccacaro University of Milan Milan Italy

Department of Paediatric Pulmonology University Children's Hospital Ljubljana University Medical Centre Ljubljana Slovenia

Department of Pediatrics and Adolescent Medicine Cystic Fibrosis Center Aarhus University Hospital Aarhus Denmark

Department of Pediatrics and Adolescent Medicine Division of Pediatric Pulmonology and Allergology Medical University of Graz Graz Austria

Department of Pneumology Children's Clinical University Hospital Rīga Stradinš University Riga Latvia

Department of Pulmonology Hôpital Robert Schuman Luxembourg Luxembourg

Dutch Cystic Fibrosis Foundation Baarn The Netherlands

Dziekanow Paediatric Hospital Cystic Fibrosis Centre Institute of Mother and Child Warsaw Poland

European Cystic Fibrosis Society Karup Denmark

Heim Pál National Pediatric Institute Budapest Hungary

Institute for Translational Medicine University of Pécs Medical School Pécs Hungary

Institute of Hereditary Pathology Ukrainian National Academy of Medical Sciences Lviv Ukraine

Laboratory of genetic epidemiology Research Centre for Medical Genetics Moscow Russian Federation

Medical School University of Cyprus Nicosia Cyprus

Mother Thereza Hospital Center Department of Paediatrics Tirana Albania

National Centre for Cystic Fibrosis Mother and Child Health Institute of Serbia Dr Vukan Čupić Belgrade Serbia

Norwegian Resource Centre for Cystic Fibrosis Oslo University Hospital Oslo Norway

Paediatric Pulmonology University Children`s Hospital Zurich Zurich Switzerland

Pediatric Pulmonology and Cystic Fibrosis Unit Virgen de la Arrixaca Clinic University Hospital Murcia Spain

Pulmonary Institute Schneider Children's Medical Center of Israel Petah Tikva Israel

Respiratory Medicine and National Cystic Fibrosis Reference Center Cochin Hospital Assistance Publique Hôpitaux de Paris Université de Paris Institut Cochin INSERM U1016 Paris France

Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

Sciensano Epidemiology and public health Health services research Brussels Belgium

Sismanoglio General Hospital of Attica Adult Cystic Fibrosis Unit Athens Greece

St Vincent's University Hospital and University College Dublin School of Medicine Dublin Ireland

Stockholm CF centre Karolinska University Hospital Karolinska Institutet Stockholm Sweden

Undiagnosed Rare Diseases Interdepartmental Unit National Center Rare Diseases Istituto Superiore di Sanità Rome Italy

Universities of Giessen and Marburg Lung Center German Center of Lung Research Justus Liebig University Giessen Giessen Germany

University Hospital Centre Zagreb Cystic Fibrosis Centre Paediatrics and Adults Zagreb Croatia

Victor Babes University of Medicine and Pharmacy Timisoara National Cystic Fibrosis Centre Timisoara Romania

Yerevan University CF Centre Muratsan Hospital Yerevan Armenia

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