COVID-19 and IBDUPDATED ON APRIL 2, 2020
Crohn's and Colitis Canada thanks its COVID-19 Task Force for their contributions and guidance in creating this document.
In light of the COVID-19 (COrona VIrus Disease-2019) outbreak, we are providing recommendations based on what we know about inflammatory bowel disease (IBD) and COVID-19. Here, you will find general information about COVID-19, as well as information about how it may uniquely affect people with IBD. With this information, we hope that we can all do our part to ensure the health of our community.
Please be aware that what we know about COVID-19 and how it acts in people with IBD is changing rapidly and so these recommendations may change. We will do our best to update these recommendations as new evidence emerges and will inform Canadians with IBD of these changes through our mailing list, social media, and other avenues. We also suggest that you bookmark this page on your browser and monitor it for any updates.
Please note that these recommendations should supplement, but not replace the recommendations made by your doctor or your local public health authority. Please speak to your healthcare provider if you have any further questions.
WHAT IS COVID-19?
COVID-19 is a new type of coronavirus that is infecting people around the world. Coronaviruses are very common, and typically cause coughs and colds. This form of coronavirus emerged in late 2019.
In 80% of people infected, symptoms include mild cold or flu-like symptoms (fever, cough). In 20% of people infected, more serious respiratory symptoms (pneumonia) develop which might require hospitalization, the need for mechanical ventilation or even result in death. Approximately 2-3% of cases with COVID-19 die, but the risk is highest in vulnerable people (see below). More information is available from the Government of Canada.
On March 11, 2020, the World Health Organization (WHO) assessed COVID-19 as a pandemic. This means it is infecting people around the world in a way that is difficult to control.
CROHN’S AND COLITIS CANADA GUIDANCE
On March 12, 2020, the Scientific and Medical Advisory Council of Crohn’s and Colitis Canada met via teleconference to discuss how people living with inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis and their caregivers should manage their disease in the setting of the COVID-19 pandemic.
Crohn’s and Colitis Canada has made these recommendations for two reasons:
- To reduce the spread of COVID-19 in the general population.
- To directly protect the most vulnerable people, including the elderly and people with compromised immune systems. Patients with IBD on medications that suppress the immune system (immunosuppressive) may be at risk for more severe infection.
HOW DOES COVID-19 AFFECT PEOPLE WITH INFLAMMATORY BOWEL DISEASE (IBD)?
People with IBD who are not using imunosuppressive medications, are not malnourished, and do not have severe active inflammation are currently believed to be at the same risk of infection and complications from COVID-19 as the general population.
Immunosuppressive and biologic medications include:
The following IBD treatments do not suppress your immune system:
- Steroids: prednisone (Deltasone), methylprednisolone, hydrocortisone (Hydrocort, Cortate)
- Immunomodulators: azathioprine (Imuran), 6-mercaptopurine (Purinethol), methotrexate
- Anti-TNF biologics: infliximab (Remicade®, Inflectra®, RenflexisTM), adalimumab (Humira®), golimumab (Simponi®)
- Anti-IL12/23 biologics: ustekinumab (Stelara®)
- Anti-leukocyte migration biologics: vedolizumab (Entyvio®)
- JAK inhibitor small molecules: tofacitinib (Xeljanz®)
If you are on immunosuppressive medications, you may be at increased risk for infection and serious complications of COVID-19. People at higher risk also include older adults, people with an underlying medical condition (e.g., heart disease, hypertension, diabetes, chronic respiratory diseases, cancer), or having a compromised immune system from a medical condition or treatment (immunosuppressive medications).
- 5- aminosalicylates: mesalamine, mesalazine (Asacol®, Mezavant®, Pentasa®), sulfasalazine (Salazopyrin®)
- Locally acting steroids: budesonide (Entocort®), budesonide MMX (Cortiment®), steroid enemas
- Enteral nutrition (formula feeds) or dietary therapies
The below guidance are for people in this group. More information on vulnerable populations are available on the PHAC website.
FOR IBD PATIENTS WE RECOMMEND:
DO NOT TRAVEL
Do not travel outside of Canada. In addition, please see the travel advice provided by PHAC.
Refer to the guidance on the following chart:
 Physical distancing means:
 Please note that not everyone is at the same risk of serious COVID-19 disease. For example, children and adolescents are more likely to have mild symptoms of COVID-19. We don’t know whether children and adolescents on immunosuppressive medications have a higher risk of COVID-19 complications. Therefore, we have considered everyone on immunosuppressive medications to be vulnerable for serious COVID-19 disease.
- Keep a distance of 2 metres from the nearest person
- If possible, cancel group events and hold meetings virtually rather than in-person
- Avoid people who are sick
- Do not shake hands, hug, or engage in physical contact with other people, especially if they are sick
- Practice good hand hygiene. Wash your hands with soap and water regularly after social contact, before meals, and often in between, or use hand sanitizer that contains at least 60% alcohol when soap and water is not available. Avoid touching your face. Cough into your sleeve.
 People working in essential services in the Medium Risk group (such as health care providers) should consider balance the public need for these essential services with the higher risk of contracting COVID-19. Further guidance can be provided by your local public health authority.
 Self-isolation means:
If you have no symptoms of COVID-19, you can still go outside for:
- Stay at home and monitor yourself for symptoms, even if mild, for 14 days
- Avoid contact with others
 Considerations for family members of high-risk people with IBD. In general, avoid being in close proximity with other people, who might give your family member COVID-19, resulting in transmission to you. Your family members should:
- fresh air
- a run
- a bike ride
- to walk the dog
- Try to avoid in-person meetings.
- Try to work from home. If not possible, speak to your employer about physical distancing at work.
- Use services for vulnerable people (e.g. special grocery store times, pharmacy delivery, etc.)
- Clean your residence as best as possible to avoid transmission of the virus. Instructions for disinfecting your residence are available from the Centers for Disease Control and Prevention.
DO NOT STOP YOUR IBD MEDICATIONS
Do not discontinue your IBD medications, unless recommended to do so by your medical health care practitioner. If you get COVID-19, discuss with your doctor whether to stop or hold your medications. Never stop steroids suddenly unless instructed by your doctor.
If your biologic infusion or injection must be delayed because you have COVID-19, or because you are isolated because you are a close contact on someone with COVID-19, contact your physician to reschedule your medication.
AVOID IBUPROFEN AND NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are often used for pain, inflammatory conditions, and to reduce fever, including ibuprofen (Advil®, Motrin®) and naproxen (Aleve®). The association of these drugs with COVID infection and complications is controversial, and Health Canada has stated that there is no association between NSAIDs and COVID complications.
However, NSAIDs have also been associated with flare-ups of IBD, and therefore all IBD patients (whether taking immunosuppressive medications or not) should avoid starting these medications if possible.
While steroids may also be a risk factor for severe complications of COVID-19, the data at this time is preliminary. If you are taking steroids for IBD treatment, never stop them suddenly unless instructed by your doctor. Similarly, do not start using steroids on your own if you think you are having a flare of your IBD.
If you are prescribed steroids for your IBD who is not a gastroenterologist or IBD specialist, the need for these medications should be confirmed if possible with your gastroenterologist or IBD specialist.
CLINIC VISITS AND TESTS
In order to reduce spread of COVID-19, if your IBD is in remission and you are feeling well, delay any in-person visits to your doctor. Consult with your primary care physician and/or gastroenterologists to determine if they can assess you through video-telemedicine or by telephone, instead of an in-person visit.
If your IBD is active, please speak to your doctor about your symptoms and attend any upcoming appointment. Your physician may still wish to see you in-person, or through video-telemedicine or a phone call.
Diagnostic testing (including endoscopies, colonoscopies, CT scans, MRIs, and ultrasounds) may need to be delayed because of pressures faced by the health care system at this time. Please discuss the need to reschedule these with your doctor.
TESTING FOR COVID-19
If you are worried you may have COVID-19, isolate yourself within your home as quickly as possible and speak to your healthcare provider or local public health authority. Be sure to tell your local public health authority that you have IBD, and if you are on immunosuppressant medications.
Do not go to your doctor’s office or the emergency department (unless it is an emergency). If it is an emergency, phone 911 and inform them of your symptoms, travel history, that you have IBD, and that you are taking immunosuppressive medications.
UPDATES and webinars
As our knowledge of COVID-19 and IBD is rapidly evolving, we will be updating the information on this page regularly. We also will be holding webinars every two weeks with IBD experts who will be there to answer your questions. If you are unable to attend the live session(s), you can still register and receive a link to the recording(s) once they become available.
Click here to register for upcoming webinar(s) and watch our past videos(s).