Corona virus (COVID-19) update and information for IBD patients
Knowledge about the Corona virus (COVID-19) is still accumulating during this global epidemic. The virus causes special concern for patients with IBD (Crohn's disease and ulcerative colitis). Here are some useful facts and tips to help you make the best decisions during these times and also help you should you be traveling
What are the symptoms of Corona virus infection?
In the majority of infected people there will be no symptoms or flu-like symptoms of fever, cough or shortness of breath, and some may experience muscle pain, sore throat, loss of taste/smell's sense and sometimes diarrhea. However, in the minority of patients the disease may become severe and life-threatening.
How does the virus spread and what can I do to protect myself?
The Corona virus spreads by respiratory droplets produced when an infected person coughs or sneezes, but the virus has also been isolated in stool of infected persons and remains viable on physical surfaces. Thus, fecal-oral spread and physical-contact spread may potentially be plausible as well. You should maintain frequent hand washing, avoid close (<2meter) contact with other persons and any contact with sick persons, avoid social gatherings, and adhere to other local recommendation by your national health authorities.
Does my IBD or my medications put me at greater risk to have a severe disease if I do get infected with Corona virus ? Should I therefore stop my medications?
Elderly people, people with hypertension, diabetes or chronic lung or heart diseases and smokers may be at increased risk for a more severe Corona virus disease. IBD patients, including Crohn’s disease and ulcerative colitis, were not found in any of the reports so far to have increased risk to contract the disease or to have a more severe disease. A preliminary report from Wuhan, China has shown no Corona disease among 318 IBD patients, but seven of the patients developed disease flares and two required surgery after their IBD medications were stopped.
More recent information is emerging from an international registry of IBD patients infected with the COVID-19 Corona virus that has been established under the name SECURE-IBD (https://covidibd.org/). As of 8th April 2020 there were 326 IBD patients around the world reported to the registry after being infected with Corona virus. Of these, 255 patients were immune-suppressed, and 71 were not. Patients taking corticosteroids, azathioprine, 6-Mercaptopurine, methotrexate, tofacitinib, or biologic drugs are considered to be immune-suppressed.
The current SECURE registry data show that severe disease or death do not occur more often in patients taking immune-suppressive or biologic drugs when compared to IBD patients not taking these drugs. In fact, there was a slight trend for a less severe disease among immune-suppressed patients. However, these data should still be viewed with caution as the ages of patients’ in the two groups were different.
Overall, the data to date does not show that IBD patients have higher risk to contract Corona virus or to develop a severe disease because of their medications, and patients should recognize the risks of stopping IBD medications and experiencing disease flare and complications. Therefore, expert gastroenterology societies including the American Gastroenterology Association and European Crohn’s & Colitis Organization (ECCO) recommend to continue medications for Crohn’s disease and ulcerative colitis.
However, patients receiving two types of immune-suppressive drugs, such as a biologic and an immunomodulator, and those on corticosteroids, should discuss with their doctor if one of these drugs can still be safely discontinued.
Should I stop the medication if I was exposed to a sick person or if I am sick myself?
In general, exposure to a sick person is not considered a reason to stop or suspend your medications, but individualized decision should be taken with your doctor. If you do develop flu-like symptoms, whether diagnosed with Corona virus or not, than as recommended during any flu or other active infection disease, you should contact your IBD team and stop immune-suppressive drugs until symptoms resolve. Non immuno-suppressive drugs such as mesalamine need not be stopped.
Should I avoid going to the hospital, to the clinic or to the infusion center at these times?
Non-essential clinic visits may be re-considered, after proper advice from your team. Some visits to the clinic may be replaced by tele-medicine consults if these are available. Essential visits such as ER visits for severe IBD exacerbation or getting your biologic infusions at infusion centers should not be avoided.
I got stranded in another country while travelling, and I’m running out of my IBD medications. What can I do until I can fly back home?
If flights blocks have forced you to extend your stay away from your home country, we suggest you look at our ‘IBD Network’ webpage where you can find details of over 330 IBD centers around the world that have joined us to provide care and help with administering biologics to IBD patients abroad (you need to be registered user of IBD Passport to access this network). We suggest you approach the center where you are at, for getting local help in medication provision. If there is no center yet in our network in the country where you are at, you can send us an email at info@IBDpassport.com and we will try to help using our global connections, but please be aware that our response may be slightly delayed due to overwhelming numbers of queries and requests at these times.