**1. Introduction**

The entire world is currently trying to cope with the global pandemic of a new coronavirus. This was first observed in the city of Wuhan in China at the end of 2019, when cases of new atypical pneumonia were discovered [1]. The International Committee on Virus Taxonomy called this type of coronavirus SARS-CoV-2 due to its similarity to a virus causing severe acute respiratory syndrome (SARS) [2]. The disease caused by the new virus is commonly referred to as COVID-19 and has a higher mortality rate than that for influenza and, unlike SARS, is far more contagious [3]. To date, SARS-CoV-2 has killed 750,000 people and over 21 million have been infected, causing a global pandemic which has posed a serious challenge to medical care systems worldwide. In Poland, there have been 55,000 confirmed cases and 1800 deaths.

Based on available information and clinical knowledge, the Center for Disease Control and Prevention (CDC) announced that the majority of SARS-CoV-2 infections are asymptomatic or oligosymptomatic except for the elderly and people of all ages with chronic diseases, who may experience severe symptoms of COVID-19 [4]. Depending on the report, chronic diseases occur in up to 50% of patients infected with SARS-CoV-2 and mortality rates in this group are significantly higher than in the average population. During the recent coronaviral epidemics, i.e., SARS and MERS, it was

also observed that in the majority of people with chronic diseases, the symptoms were more severe and often led to death due to multi-organ failure [5].

The chronic diseases listed by the CDC as those that can lead to a severe course of COVID-19 include many conditions that can cause immunosuppression, e.g., autoimmune diseases, which are becoming increasingly common although their exact causes are largely unknown. This group of chronic diseases is associated with the dysfunction of the immune system and consists of an undirected reaction against one's own cells, tissues, and organs [6,7]. This reaction results from a complex interaction between environmental and genetic factors. In the United States alone, autoimmune diseases affect more than 25 million people and their incidence is constantly increasing. Despite global progress in the diagnosis of these diseases, it is still difficult to identify them at the preclinical stage.

There are also considerable psychological and psychiatric consequences of the pandemic, and, in general, other adverse epidemiological conditions created by the industrialized world. Researchers have started to take into account the real or perceived sense of social threats, fear, and uncertainty that may be expressed as anxiety, depression, and sleep disorders [8–12]. However, analyses on pandemic-related anxiety mostly concern health care workers, rarely addressing the situation of other groups, e.g., people with systemic lupus erythematosus (SLE) [13]. The current outbreak of SARS-CoV-2 infection has led to global changes in many dimensions of daily lives. Ubiquitous information about the number of deaths, new diseases, diseases predisposing one to a severe and unfavorable course of SARS-CoV-2 infection, lack of targeted treatment, social isolation, change of existing habits, long-term quarantine, and a limited or total lack of access to goods or medical support causes a huge mental burden by generating emotional stress, elevated anxiety, and sleep disturbances. Sleep disturbances, depression, and anxiety are commonly reported in SLE patients. However, their prevalence varies from study to study [6,14,15]. Therefore, the aim of this study was to assess the mental health factors among people with SLE by quantifying the severity of anxiety, depression, and sleep disorders during the SARS-CoV-2 pandemic.
