COVID-19 and IBD

COVID-19 is on everyone’s mind. My family in Germany is safe, but there are areas that have seen big outbreaks. Three hours away, in Seattle, there has been an outbreak. And people with Chronic Illnesses, often taking immunosupressants, are wondering whether they should go into panic mode, buy lots of toilet paper and disinfectant, or go about their day as usual. Probably all of it? The news on TV, Twitter etc. are not exactly helping, so I was happy to see that the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) have posted an update with the most pressing questions. I am pasting it here, and I’ll link to the original at the end.

IOIBD Update on COVID19 for Patients with Crohn’s Disease and Ulcerative Colitis

The International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) is the only international worldwide organization devoted to Crohn’s disease and ulcerative colitis. The mission of the IOIBD is to promote the health of people with IBD worldwide by setting the direction for patient care, education and research. We have taken particular interest in COVID19 and how it might impact our patient population.  There is clearly much more to learn, and our organization is creating a task force focused on developing and updating recommendations as the global impact of COVID19 evolves. For now, below is a brief summary of what we know and recommendations for patients.

Coronaviruses are a family of viruses that can cause illness from the common cold to more severe diseases. The novel strain of coronavirus  named SARSCoV2 was first detected in Wuhan, China and causes coronavirus disease COVID19.

How is coronavirus transmitted?

Via respiratory droplets produced when an infected person sneezes or coughs and can infect people in close contact (within 6 feet). Touching contaminated surfaces before touching your eyes/nose/mouth might also lead to infection.

How does COVID19 compare with seasonal influenza?

Both are infectious respiratory illnesses that present with symptoms such as fever, cough, and shortness of breath. Both can lead to serious illness especially in older people and those with prior medical conditions. One difference is that you can get vaccinated for the flu, but there is not a vaccine available yet for COVID19. Phase 1 studies of a possible vaccine are starting in the next 2 months according to the Centers for Disease Control in the US.

What does this mean for IBD patients?

IBD is a condition of an overactive immune system, and is often treated with immune modification or immune suppression. IBD patients on immunosuppressive medications are in general, more susceptible to infection. Specifically, being on steroids or immune modulators like azathioprine or 6-mercaptopurine or methotrexate can increase an IBD patient’s risk for viral infections. To date, we don’t have specific IBD research on COVID19.

What are the current recommendations for IBD patients related to COVID19?

Many patients have already asked us if they should stop their medications. Medicines such as mesalamine (brand names include Asacol, Apriso, Balsalazide, Lialda, Pentasa) are all safe. It is always a good idea to get off of steroids such as prednisone/prednisilone, if this is possible. Thiopurines (6-mercaptopurine, azathioprine) and tofacitinib tend to inhibit the body’s immune response to viral infections. The thiopurines take months to leave the body. Thus stopping these will not help in the short term. The biologics we currently use to treat IBD such as anti-TNFs (Cimzia, Humira, Remicade, Simponi), ustekinumab (Stelara), vedolizumab (Entyvio) are generally safe. At present we do not recommend stopping these medications. Moreover, the effect of these medications stay in the body, in many cases, for months. We will keep updating these recommendations as more data become available.

Additional recommendations for everyone: 

  1. Avoid being in close contact with sick people.
  2. Wash your hands frequently.
  3. Avoid touching your nose, eyes and mouth.
  4. Seek medical attention in case of fever, cough or difficulty breathing.
  5. If you haven’t, get your flu shot!

There is still a lot we don’t know about COVID19 and we will update and be more specific about our recommendation in the very near future. In the meantime, use reliable sources of information to stay well informed:
1-  @WHO  (  http://ow.ly/dM1H50yxAlF  )
2-  @CDCgov  (  http://ow.ly/CTKU50yxAlG  )

 

Here is the original article on their website

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