COVID-19 Inflammatory Bowel Disease update
Greetings from the SA Group of Specialists IBD Team
We understand the fear and uncertainty experienced by many patients during the pandemic and hope that this update provides an accurate and up-to-date summary of the latest evidence of COVID-19 and IBD.
COVID-19 in South Australia
Social distancing measures, along with high levels of testing and contact tracing, has led to significant flattening of the curve for new COVID-19 cases in South Australia. There have been no new confirmed cases in 4 days, despite high testing levels. As at 26 April 2020 there were 438 cases, most of which were acquired overseas. There has been very little community transmission documented. These data are reassuring and are a credit to the community for adherence to measures. However, until further Government direction, current social distancing measures remain in place.
There is now a push to broaden coronavirus testing to detect possible ‘silent transmission’ in people with mild or no symptoms.
COVID-19 in people with IBD
As per our earlier recommendations, we endorse the Government’s recommended measures of social distancing, good hand hygiene, and trying to work from home where possible. In most cases, it is appropriate to continue on your IBD medications, and we recommend against stopping your medications without speaking to your doctor first. Theoretically patients with IBD who are on an immune suppressing therapy (e.g. azathioprine, mercaptopurine, steroids, methotrexate, biologics) may be at higher risk of severe infection. However, even on an international level, this has not been shown to be the case to date.
An international registry has been set up to learn more about how COVID-19 impacts on people with IBD. It is called the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD), and we are one of the sites that will contribute should we have a patient diagnosed with COVID-19.
International data through the SECURE IBD registry has reported on 580 patients with IBD and COVID-19 infection (as at 20 April 2020). The majority of these patients were in the USA (192) and only 3 have been reported in Australia. Overall, 70% were managed as outpatients, 30% were hospitalised, 5% required ICU admission, and 3% died. Many of these patients were on immunosuppressive therapies and there does not seem to be a signal toward higher risk of severe COVID-19 in patients on immunosuppressive therapy.
Overall, the current, albeit limited, data of COVID-19 in IBD suggest that:
- Patients with IBD are not at higher risk of COVID-19, and
- Patients with IBD have similar outcomes of COVID-19 than the general population, which does not seem to depend on medications or disease activity.
If you are infected with coronavirus, we suggest you contact us as soon as possible to discuss the best approach to medical therapies. Some medications may be ceased during active infection and restarted as soon as possible thereafter. We would also like the opportunity to anonymously contribute to the SECURE Registry for the benefit of all patients with IBD worldwide.
As most of you are aware, we have changed our clinics from face to face to telephone clinics, which appears to be working well. These measures serve to reduce your exposure to COVID-19. We cannot guarantee the clinic will be running on time, so please have your phone with you and switched on at the time designated with some additional leeway.
It is important to look after your psychological wellbeing during the COVID-19 pandemic. Some tips for managing anxiety and maintaining mental health can be found at https://www.psychology.org.au/COVID-19-Australians
Gastroenterological Society of Australia (GESA) recommendations
Our peak Australian gastroenterology body, GESA, published guidance on 26 March 2020 for IBD clinicians and patients. These may differ slightly from European, British and American guidelines to reflect the current status in Australia. We endeavour to follow these guidelines to provide the best care and advice for you, our patients. Here are some of the changes we have put in place in line with these guidelines:
- Moving face-to-face clinics to telephone clinics.
- Delaying non-urgent colonoscopies (e.g. surveillance, routine post-surgical disease assessment).
- Increased utilisation of non-invasive tests to assess disease activity (e.g. faecal calprotectin, blood test [CRP], Gastrointestinal ultrasound (GIUS), MRI when appropriate.
- Performing colonoscopy only in symptomatic patients where the results will affect management.
- Providing a letter for your employer, on your request, to support you in working from home where possible and/or altering your work conditions if you are on immune suppressing medications.
- If you need to come in to hospital for infusion therapy, we are keeping you safe by having a strict policy of COVID screening for patients entering the facility, including temperature, and recent travel activity and exposure to COVID “hot spots”.
- Minimising if at all possible the use of steroids – if you have Crohns and a flare for example you may be suitable for partial enteral nutrition and the Crohn’s Disease Exclusion Diet (CDED) – further information on this can be obtained by organising an appointment to see Jenny Carney our dietitian who has an interest in this area.
All the best from your SA Group of Specialists IBD Team
Kerrie Moss, Jean Fittock
Jenny Carney, Nick Wray
A/Prof Peter Bampton, Dr Adrian Chung, Dr Paul Spizzo
Gastroenterologists (Tennyson Centre)
Dr Sam Edwards, Dr Mahinda De Silva
Gastroenterologists (Flinders Private)
Dr Laurie Chitti, Dr Raghu Kumar
Gastroenterologists (Western Hospital)
Dr Martin Tan
Gastroenterologists (Calvary Adelaide)
Dr Marc Le Mire
Gastroenterologists (480 Specialist Centre)
Posted 27 April 2020