What you need to know about COVID-19 if you have IBD

Newly released advise may minimize the effects of COVID-19 in those with IBD 

The Coronavirus infection that has caused more than a million deaths and many more serious infections has mostly caused respiratory illnesses. It has also caused worry, particularly among those who are older; those with chronic conditions, like IBD; and those on immune-suppressive medicines.

First, the basics 

• Coronaviruses can cause the common cold or severe infections. 
• The majority of infections form this particular virus, called COVID-19 (because this COrona Virus Infectious Disease was discovered in 2019), are mild (over 80%) or show no symptoms at all. 
• The main route for the virus to enter the body is through the nose and mouth by small respiratory droplets
• It takes about 5 days for the virus to show up, though that can range from 2 to 14 days. 
• The common symptoms are 
  • Fever
  • Cough
  • Loss of appetite
  • Loss of taste and / or smell
  • Muscle aches 
  • Fatigue
  • Difficulty breathing (shortness of breath)
• In severe cases, the average time for the virus to go from its first symptoms to developing difficulty breathing or needing hospitalization is 5 to 8 days. 
• Anywhere from 5 to 25 % of those admitted to the hospital will end up in the intensive care unit (ICU).
• Many of the severe symptoms are accompanied or even caused by a sudden release of the factors that cause inflammation. This is called a cytokine storm.
• Previous coronavirus outbreaks resulted in higher death rates
• Current treatments, while not nearly perfect, have lowered the severity of the illness for many

 COVID-19 and the gastro-intestinal tract

• COVID-19 can enter through the intestine 
• The virus can be found in the stools of those with COVID-19. But Russell Cohen, a member of Nutrition4IBD's Medical Advisory Board and director of the Inflammatory Bowel Disease Center at the University of Chicago, notes that "although the SARS-CoV-2 virus (the virus that causes the illness) has been isolated in the stool, there is very little evidence (if any) that this is a major mode of transmission –it probably is not."
• Covid -19 can cause 
  • Nausea and / or vomiting
  • Diarrhea
  • Abdominal pain
  • Liver abnormalities

COVID-19 and IBD

The Secure Database has tracked over 2400 patients with IBD world-wide (960 in the US and 32 in Canada) who have been infected with the virus. That study, available to everyone at https://covidibd.org/current-data/ and regularly updated shows

• Those with IBD are no more likely to get a COVID infection than the average person
• 1799 were able to stay at home
• 68 deaths (3%); none in those under 19; 1 in their 20s; and only 6 under 60 years old
• The anti-TNF medicines showed it may have a protective effect for severe infections (60% risk) 
• Steroids had an increased risk of almost 7 times as likely to have severe infections; while mesalamine and sulfasalazine had an increased risk of 3 times as likely to result in a more severe infection. Other medicines did not seem to increase the likelihood of severe infections, the need for hospitalization, a ventilator or to result in a death.

Recommendations

A group of physicians, that included Dr. Cohen, used all of the available evidence to create important guidelines for doctors and those with Crohn's disease and ulcerative colitis:

• Those with IBD should try to get into and maintain remission in order to reduce their risk of hospitalization or a flare that requires steroids during the COVID-19 pandemic.
• Those who don't have the virus, should stay on their medications if they are in remission, work with their doctor to get into remission if possible, and try to avoid steroids. 
• Those who have the virus but have no symptoms or mild symptoms should talk to their doctor about reduce their steroids to less than 20 mg (milligrams) of prednisone, stop thiopurines,  methotrexate, or tofacitinib, and delay any of the biologics for 2 weeks while you are at risk for symptoms. The medicines can be resumed after the 2 weeks if no symptoms developed.  
• Those who have severe symptoms and are hospitalized, the doctors will be guided mostly by their treatments for the COVID virus. The doctors will probably follow these same guidelines, though sometimes the biologic medicines will be used very cautiously to see if they can also treat the cytokine storm that causes many of the severe symptoms. 
• Children with COVID-19 often seem to have more stomach and intestinal symptoms, like nausea and diarrhea. Adults and children with these symptoms should also be checked for other intestinal infections.
• Vitamin D is being evaluated as a possible help to boost the immune system during the COVID-19 pandemic.

Hopefully, following this advice will decrease how severe the illness will be. But Dr. Cohen reminds us, "the findings of the IBD COVID database highlight the importance of keeping open communication between you and your medical providers, since staying well during the pandemic is the goal. Stopping effective medications on your own may lead to IBD flares and needing steroids, which are clearly not desirable during this time period."