COVID-19 and IBD

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. The novel virus is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease that the virus causes is called COrona VIrus Disease-2019 (COVID-19).

Symptoms typically include mild cold or flu-like symptoms such as fever and a new cough. Most people recover from the illness at home. However, some individuals experience more serious respiratory symptoms (pneumonia) develop which might require hospitalization, the need for mechanical ventilation, or even result in death. More information is available from the Government of Canada.

On March 11, 2020, the World Health Organization (WHO) declared that COVID-19 was a pandemic. This means it is infecting people around the world in a way that is difficult to control.

Watch the 2-minute video below to learn from an expert gastroenterologist about what coronaviruses are, including COVID-19.

For more information about COVID-19 symptoms and outcomes, please click here. 

Currently, Health Canada has approved four vaccines: the Pfizer/BioNTech mRNA vaccine, the Moderna mRNA vaccine, the University of Oxford/AstraZeneca/COVISHIELD non-replicating adenovirus vector vaccine and the Johnson & Johnson’s (Janssen) non-replicating adenovirus vector vaccine.

The mRNA vaccines have a novel “mechanism of action” compared to traditional vaccines that inject either a diluted virus or proteins of a virus. Both mRNA vaccines target the spike protein that sits on the surface of the virus (SARS-CoV-2), which is the part of the virus that allows it to attach to human cells and begin replicating.

Non-replicating adenovirus vector vaccines means the adenovirus is a ‘skeleton’ used to carry the COVID-19 spike genetic material. The adenovirus vector cannot replicate and therefore cannot cause disease. The vector virus uses the machinery of our cells to produce the spike component of the COVID-19 virus.

Our immune system naturally recognizes the spike protein as foreign and triggers our body to develop antibodies against the protein. This allows the body to quickly and effectively fight off future infections of the intact COVID-19 virus. 

None of these vaccines are considered “live virus vaccines”, and therefore they cannot cause disease in anyone, including people who are immunosuppressed. While the clinical trials did not include patients who were immunosuppressed, real-world experience in patients with cancer or who use medications which suppress the immune system has not demonstrated that receiving any COVID-19 vaccine increased the risk of adverse events in this population.

Prior vaccine studies (i.e., non-COVID-19 vaccines) have not shown the risk of side effects from vaccines is different for people with IBD compared to the general population. The novel mRNA vaccines have not been studied in those with IBD. Unlike other vaccine types, there is little information in the general population either, as this is a new type of vaccine, however that is rapidly changing as large numbers of vaccine are given around the world. The use of adenovirus vectors has been well studied by scientists.

There are currently several clinical trials using the adenovirus vectors for protection against infections such as the Ebola virus, HIV, and tuberculosis. However, patients with IBD were not included in the trials of the COVID-19 adenovirus vector vaccines, and therefore no data are available for safety in IBD patients.

There is no reason to believe the COVID-19 vaccines would be more risky or unsafe for people with IBD. There is no evidence to date that non-live vaccines cause disease or IBD flare-ups when given to people with IBD. The CLARITY IBD and ICARUS-IBD studies, which examine immunity after vaccination in IBD patients, have not reported any unexpected problems with safety of the vaccines.

The Pfizer/BioNTech mRNA vaccine and the Moderna mRNA vaccine have been shown in large, randomized controlled trials to be roughly 95% effective. What does 95% effective vaccine mean? The mRNA vaccine was given to ~15,000 people and only five developed COVID-19, but none were seriously ill. Another ~15,000 people were given a placebo shot, and 90 developed COVID-19, with several becoming severely ill.

By comparing the vaccinated group and the placebo group, we can see that these vaccines are highly likely to prevent getting COVID-19 and to reduce the severity of the disease if a vaccinated person does contract COVID-19.

In similar large, randomized clinical trials, the AstraZeneca vaccine has been shown to be roughly 62% effective whereas the Janssen vaccine has been shown to be 66% effective. However, these trials were conducted later in 2020 and in parts of the world where “genetic variants of concern” were more prevalent (e.g. South Africa and Brazil). Therefore, the rates of effectiveness should not be compared to earlier trials. In addition, all of these vaccines are nearly 100% effective at preventing severe COVID-19 disease (hospitalization and death).

Vaccines to SARS-CoV-2—the virus that causes COVID-19—hold the promise of protecting individuals who are immunocompromised, such as people on immunosuppressive medications for their IBD. However, the effectiveness and safety of the COVID-19 vaccines in people with immune-mediated diseases or immunocompromised populations are currently unknown.

The current vaccines approved by Health Canada, were not studied in people with IBD in the clinical trials. Initial randomized controlled vaccine trials excluded people with immune-mediated conditions, autoimmune diseases, and those on immunosuppressive therapy. 

Since then, many people with IBD around the world have received these vaccines. To date, increased risk of adverse events or safety concerns have not been reported. Additionally, international studies like CLARITY IBD and ICARUS-IBD are recruiting and monitoring IBD patients before and after they are vaccinated. 

The COVID-19 pandemic has led to population-level restrictions to flatten the exponential rise of cases that would otherwise overwhelm our healthcare systems. Some individuals living with IBD are immunocompromised due to their medications, which may make those individuals more susceptible to infection with SARS-CoV-2. Age, comorbidities (other existing health conditions), and disease severity are risk factors for severe COVID-19 outcomes in people with IBD. Children and adolescents typically have mild symptoms of COVID-19, but seniors have the highest risk of severe COVID-19 outcomes, including death.

Active disease, particularly which requires high dosages of corticosteroids, is associated with a higher risk of hospitalization, ICU admission, or death. However, to date, the use of biologics has not been associated with a higher risk of these complications. In fact, several trials of biologic therapy aimed at reducing or illuminating dangerous immune response complications (e.g., cytokine storm) associated with COVID-19 are ongoing. Some people with IBD patients are particularly impacted by the pandemic because of mental health problems resulting from the need to remain isolated from others.

Individuals with IBD likely fall into one of three risk for infection and complications of COVID-19 groups:

• High Risk: Over the age of 65 years OR under 65 years AND either moderate or severely flaring, using high doses of prednisone, or moderate to severe malnutrition
• Medium Risk: Under the age of 65 years and immunocompromised with an immunosuppressive or biologic
• Low Risk (i.e. same as the general population): Under the age of 65, IBD is in remission, and not immunocompromised

To find out your level risk and what you should do, please click here.

Many individuals with IBD are prescribed medications that may reduce the immune response (due to lower antibody titres and other immune system changes) following vaccination as compared to the general population. This means people with IBD may not be as protected against COVID-19 from the vaccine as others, or they may require booster doses of the vaccines due to decreasing antibodies over time. However, a reduced immune response to a vaccine does not mean a vaccine is ineffective.

Overall, non-live vaccines (e.g., influenza, zoster, Hepatitis B) are widely recommended for immunocompromised individuals, including people with IBD on immunosuppressing medications. Reduced effectiveness due to immune suppression is NOT a reason to avoid these COVID-19 vaccines. Even partial protection against COVID-19 is preferable to not having protection at all.

Results of CLARITY IBD and ICARUS-IBD:

Both the CLARITY IBD study and ICARUS-IBD study found that people with IBD who are immunosuppressed responded less effectively to the first dose of the vaccine, measured by levels of antibodies to the SARS-CoV-2 virus. However, both studies reported excellent response after two vaccine doses, or after one vaccine dose in people who previously had COVID-19. 

Antibody levels give an indication but not the full picture of the strength of our immune system to fight viruses. Therefore, we recommend getting the first dose of the COVID-19 vaccine as soon as it is available. Also, if possible, we recommend that people with IBD on immunosuppressants receive the second dose of vaccine according to manufacturer recommendations (3 to 4 weeks after the first dose).

While the mRNA and non-replicating adenovirus vector vaccines have not been studied in those with IBD, there is no evidence to date that other non-live vaccines cause IBD flare-ups. We do not have data on the use of mRNA and adenovirus vector vaccines in people with IBD at this point, but the risk is likely low. We do know individuals with IBD who contract COVID-19 often pause their immunosuppressing medication while recovering from infection, which in turn may cause a flare of their IBD. The CLARITY IBD and ICARUS-IBD studies, which examine immunity after vaccination in IBD patients, have not reported any unexpected flares of IBD in patients who get the vaccines.

The National Advisory Committee on Immunization (NACI) has made the following recommendation to the Public Health Agency of Canada:

“NACI recommends that a complete COVID-19 vaccine series may be offered to individuals who are immunosuppressed due to disease or treatment in the authorized age group in this population, if a risk assessment deems that the benefits outweigh the potential risks for the individual, and if informed consent includes discussion about the absence of evidence on the use of COVID-19 vaccine in this population.”

The Canadian Association of Gastroenterology has provided the following guidelines:

“Specifically, in patients with IBD not on immunosuppressive therapy, we recommend the COVID-19 vaccine be given (strong recommendation, moderate-certainty of evidence). In patients with IBD on immunosuppressive therapy, we suggest the COVID-19 vaccine be given (conditional recommendation, low-certainty of evidence).”

People with IBD, whether on immunosuppressive medications or not, should be offered the COVID-19 vaccine after informed consent. Informed consent should be based on a discussion between the patient and healthcare provider, and should balance the safety of the vaccine, the lack of evidence in IBD patients, the risk factors that could result in severe COVID-19 in the IBD patient, and the underlying prevalence of COVID-19 in the patient’s community. After these factors are discussed with the patient, and if the patient wishes to receive the COVID-19 vaccine, it should be provided to them.

These recommendations are aligned with the Canadian Association of Gastroenterology and the International Organization for the study of IBD (IOIBD).

People with IBD should get a COVID-19 vaccine at the first available opportunity, as determined by the rules in each province. There is no research to support “timing” the vaccine at a certain point in the cycle of biologic medication infusions/injections. People with IBD who are taking steroids should discuss with their doctor whether to get the vaccine while on steroids, or whether to wait until the steroids are tapered off.

No! New information is becoming available all the time. If you and your healthcare provider think your risk of COVID-19 infection is low, and you want to wait until there is more information on COVID-19 vaccines for people with IBD, that is an option. With more information, you can assess your risks and benefits again in a few months and reconsider the vaccine at that time. Saying you want to delay until there is more information does NOT mean you should never get the vaccine.

You should get the first vaccine that is offered to you, no matter which brand or type. The effectiveness of the non-replicating adenovirus vector vaccines are just as high at preventing hospitalization and death as other successful vaccines, and will contribute to herd immunity. The trials for the non-replicating adenovirus vector vaccines run by the Oxford/AstraZeneca and Janssen (Johnson & Johnson) took place later in 2020 and in parts of the world where “genetic variants of concern” were more prevalent (South Africa and Brazil).

In addition, the criteria needed to test people in the trials for the adenovirus vector vaccines were less stringent, so more mild cases were probably diagnosed in the Oxford/AstraZeneca and Johnson & Johnson trials. These would all result in the appearance of lower vaccine effectiveness in those trials. Therefore, the rates of effectiveness should not be compared to earlier trials. In addition, all of these vaccines are nearly 100% effective and preventing severe COVID-19 disease (hospitalization and death). Therefore, all of these vaccines will protect you from hospitalization and death, which are the most important outcomes to prevent.

No. The non-replicating adenovirus vector vaccines (from AstraZeneca and Johnson & Johnson) may be associated with a rare, serious immune disorder called Vaccine-Induced Immune Thrombocytopenia (VIIT). This condition results in antibodies to a molecule on platelets (one of the clotting factors in blood) called PF4, resulting in their activation and potentially serious blood clots.

The risk of this condition is approximately 1 in 250,000 people who receive the vaccine in Canada. Because it is so rare, researchers have been able to identify risk factors in people who get this condition. Based on current information, it does not occur with increased frequency in people who have hypertension (high blood pressure), previous blood clots, bleeding disorders, HELLP Syndrome (in pregnancy), or a family history of clots.

As of April 2021, the risk of contracting COVID-19 and dying in Canada far outweighs the risk of developing a blood clot from these vaccines. For this reason, on April 23, 2021, NACI recommended that the AstraZeneca vaccine could be offered to anyone 30+ years old because the benefits outweigh the risks. If you have questions about the safety of the COVID-19 vaccines, speak to your doctor and read the Public Health Agency of Canada page on immunizations.

Yes. Research studies have found that pregnant women are at increased risk for severe COVID-19 if they are infected with the SARS-CoV-2 virus. This includes an increased risk of ICU admission, needing mechanical ventilation and death. There are also increased risks to the baby, such as stillbirth and preterm birth. The Society of Obstetricians and Gynaecologists of Canada recommend the COVID-19 vaccine be offered to all pregnant and breastfeeding women.Some provinces, such as Ontario, are prioritizing pregnant women to receive the vaccine earlier than other groups because their risk of severe COVID-19 is higher.

The Public Health Agency of Canada has extensive information on the vaccines available for COVID-19, their safety and effectiveness.

In March 2020, Crohn’s and Colitis Canada created the National COVID-19 and IBD Taskforce. The Taskforce has met regularly since March 12, establishing recommendations for people with IBD during the pandemic. The Taskforce recommendations are communicated directly with the IBD community through Crohn’s and Colitis Canada’s COVID-19 and IBD Webinars that started on March 19th 2020.

The webinars (~1.5 hours) are co-moderated by Dr. Gil Kaplan and Dr. Eric Benchimol, who provide regular updates and lead a Q&A segment with guest panelists. A recording of each webinar is available on Crohn’s and Colitis Canada’s website and YouTube channel. The webinar series has discussed COVID-19 vaccines in people with IBD. These webinars will continue throughout the pandemic as a source of communication to the IBD community.

If you think that 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 by telephone. Be sure to tell your local public health authority that you have IBD, and if you are on immunosuppressant medications. You can also take a self-assessment tool available from various provinces.

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.

Speak to your gastroenterologist right away if you have tested positive for COVID-19.

Please remain isolated. Refer to your local public health department for information on what to do.

Medications that are not immunosuppressive should be continued. The following IBD treatments do not suppress your immune system:

• 5- aminosalicylates (5-ASA's): mesalamine, mesalazine (Asacol^®, Mezavant^®, Pentasa^®, Salofalk®), sulfasalazine (Salazopyrin^®)

• Locally acting steroids: budesonide (Entocort^®), budesonide MMX (Cortiment^®), steroid enemas

• Enteral nutrition (formula feeds) or dietary therapies

• Probiotics

If you are using immunosuppressive medications (including biologics), you should temporarily stop your medications and speak to your doctor immediately. Immunosuppressive and biologic medications include:

• Steroids: prednisone (Deltasone), methylprednisolone, hydrocortisone (Hydrocort, Cortate)

• Immunomodulators: azathioprine (Imuran), 6-mercaptopurine (Purinethol), methotrexate

• Anti-TNF biologics: infliximab (Remicade^®, Inflectra^®, Renflexis^TM), adalimumab (Humira^®), golimumab (Simponi^®)

• Anti-IL12/23 biologics: ustekinumab (Stelara^®)

• Anti-leukocyte migration biologics: vedolizumab (Entyvio^®)

• JAK inhibitor small molecules: tofacitinib (Xeljanz^®)

NEVER stop prednisone suddenly - speak to your doctor first. We are not yet certain whether it is safe to continue immunosuppressive medications during a COVID-19 infection. In some situations, your doctor may decide to continue treatment instead of stopping it. Speak to your doctor for further advice.

You may resume your immunosuppressive medication (including biologics) two weeks from onset of symptoms, provided that you have recovered from the COVID-19 related symptoms.

Some people with COVID-19 will continue to experience mild symptoms (such as post-viral cough, lack of ability to small/taste) for longer than two weeks. Your doctor may recommend that you resume your immunosuppressive medications. To learn more about COVID-19 and IBD medications, please click here.

If you have very active inflammation due to IBD but are at low risk of complications due to COVID-19, your doctor may recommend restarting your immunosuppressive medications sooner. This depends on your clinical status, and your doctor will balance your risk of complications from IBD with your risk of complications from COVID-19.

If your symptoms last longer than 7-14 days, you should speak to your doctor.

Speak to your doctor about registering you into the SECURE-IBD registry.

The number of people with IBD who have been infected with COVID-19 is constantly changing. There is an international database that reports on the outcomes of COVID-19 occurring in IBD patients, called Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-IBD).

To access the database, please click here. Healthcare providers must submit each case manually and consequently many individuals with IBD who experience a mild infection are not represented in this data.

It is recommend that you continue to take your IBD medications. Do not discontinue any of your medications without speaking to your gastroenterologist first. Patients who discontinue their medications place themselves at risk of an IBD flare, which may elevate their risk of COVID infection and its complications. 

If you experience symptoms or test positive for COVID-19, speak to your gastroenterologists to discuss whether you should temporarily hold your medications.

If you are on immunosuppressive medications, you may be at increased risk for infection and complications of COVID-19. We are basing this on what we know about IBD medications and infections in general. As COVID-19 is a new infection, we do not have enough information to understand whether or not IBD medications increase the risks of contracting COVID-19.

However, that risk may be offset by the benefit of keeping your IBD under control.
Immunosuppressive and biologic medications include:

• 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®)

The following IBD treatments do not suppress your immune system:

• 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
• Probiotics

For more information about risk factors and COVD-19, visit our Are You at Risk page. 

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 appointments. Your doctor may still wish to see you in-person, or through video-telemedicine or a phone call.

Diagnostic testing (including laboratory tests, 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.

For expert recommendations about clinic visits and IBD testing, visit our Clinic Visits page. 

It is normal to feel stressed because the COVID-19 pandemics an uncertain and stressful time. Fear and anxiety about this virus can be overwhelming and cause strong emotions in adults and children. Remember that people react differently to stressful situations and that people who already experience a lot of anxiety may find their anxiety worsening.

It is important to be kind to yourself. Take time for yourself to manage your mental health. You are doing the best you can in a time when simply turning on the news can feel overwhelming. Take care of your body through a healthy diet, regular exercise, and plenty of sleep.

Connect with others and maintain a strong support system. Help others if you can by checking in and being mindful of the supplies you keep at home. Take breaks and try to do activities you usually enjoy. Practice mindfulness and if needed, seek professional help with stress or anxiety.

For more tips on coping with stress and anxiety during COVID-19, visit our Your Wellbeing page. 

There is currently no approved treatment to prevent or cure COVID-19.

However, there are therapies that can help the symptoms of COVID-19 such as breathing support. Therapies can help people get through the disease course.

Although there is currently no approved treatment for COVID-19, there are potential treatments being tested in research studies around the world. These include vaccines, antiviral medications, anti-malaria medications, and biologic medications targeting the immune system. None of these therapies have been shown to be effective to treat or prevent COVID-19 – yet!

Pregnancy alone does not make a person more at risk for COVID-19.

So far, research suggests COVID-19 is not transmitted from mother to baby during pregnancy, during childbirth, or through breast milk. If a mother has symptoms of COVID-19, however, there is the chance that she can transmit the virus to her baby through droplets (from coughing, sneezing, etc.).

For expert guidance on being pregnant and caring for newborns during the COVID-19 outbreak, please visit our Pregnancy and Newborns page. 

Stay home! The best thing pregnant women can do is stay as healthy as possible. Staying healthy will minimize the need to visit clinics or hospitals. This will minimize the potential of being exposed to people who are sick.

Pregnant women with IBD should follow the same guidelines as everyone else, namely staying home, physical distancing, and practicing good hand hygiene. Importantly, people with IBD (pregnant or not) should continue taking their medications. Regardless of COVID-19, the risks of active inflammation from active IBD outweigh any potential risks of using medications.

Mental health is also important for a healthy pregnancy, so see the mental health suggestions above or visit the Your Wellbeing page. 

A lot of the same guidelines for staying safe and healthy apply to those with newborns. Here are some tips:

• Disinfect surfaces in your home that are frequently touched
• Practice good hand hygiene
• Use coughing etiquette (cover your cough by coughing into your elbow)
• If you have even symptoms of illness, contact your doctor or public health
• Stay home!  And keep your baby at home as much as possible
• Minimizing exposing your baby to people living outside your home, except for health care providers.
• Continue breastfeeding

We know that having a baby is an exciting and perhaps scary time that is often share with family and friends. It may be difficult, but it is safest to keep your newborn as isolated as possible during this time.

If you are a breastfeeding mother and are suspected or proven to have COVID-19, there are ways in which you can continue to breastfeed. Please see the guidance from the Canadian Pediatric Society 

Having a baby is exciting and anxiety-provoking at the best of times! It is normal if you are feeling both excited and scared about having a newborn during this uncertain time. 

It is important to maintain psychological closeness with others, even if you can’t be together in person. Connect with loved ones in ways that you can (using technology or the telephone). Send photos of your baby to your family. Have video calls. Connect with other parents with newborns online.

Stay in the now. Be mindful and thankful for what’s around you in the present. Try not to worry about all the “what ifs”. If you do have worries and fears, talk back to those worries and remind yourself of what you have now.

Stay informed from reliable sources. Do your best to maintain overall health by staying mentally healthy, sleeping well, and eating well.

For more guidance on being pregnant and caring for newborns during the COVID-19 outbreak, please visit our Pregnancy and Newborns page. 

If a member of your household is immunosuppressed, you should practice physical distancing (2 metres/6 feet apart) from other people to minimize the risk of becoming infected with the COIVD virus and then transmitting it to the member of your household who is immunosuppressed. Household members should:

• Try to avoid in-person meetings.
• Try to work from home. If not possible, speak to your doctor and 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. While doing these activities, always maintain a distance of at least 2 arm-lengths (approximately 2 metres or 6 feet) from others.

Refer to the Government of Canada guidance for more information on how to self-isolate at home when you may have been exposed and have no symptoms.

Do not travel outside of Canada. In addition, please see the travel advice provided by the Public Health Agency of Canada. Visit the Government of Canada's website for more information.

Physical distancing means:

• Keep a distance of 2 metres (6 feet) 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.

Self-isolation means:

• Stay at home and monitor yourself for symptoms, even if mild, for 14 days
• Avoid contact with others

If you have no symptoms of COVID-19, you can still go outside for:

• fresh air
• a run
• a bike ride
• to walk the dog

See the Government of Canada website for further instruction on when and how to self-isolate.
 

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-19 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.

Having a pelvic pouch, ileostomy, or colectomy alone does not put you at greater risk for COVID-19. If you have IBD but are not taking immunosuppressive medications, are not malnourished, and do not have severe active inflammation, you are at the same risk of infection and complications from COVID-19 as the general population.

Having a pouch or ileostomy puts you at increased risk for dehydration if you have high output, severe diarrhea. If you have more diarrhea, increase your hydration with rehydrating liquids with electrolytes and contact your doctor.

For more information about COVID-19 risk for IBD patients, please click here. 

Currently, there is no clear evidence to suggest that being on biologics causes you to have a more severe disease course. However, if you develop symptoms of COVID-19, speak to your gastroenterologist about whether you should temporarily change your medication schedule.

Our recommendations for physical distancing depend on your level of risk. Refer to our physical distancing risk chart to learn more.

It depends on your risk and exposure at work. If you are at medium or high risk for COVID-19 and have a lot of exposure (e.g. hospital emergency room), speak to your employer about switching to a role with less exposure if possible.

Each case is unique and requires discussion with your healthcare provider and potentially with your employer. You will need to balance the public good from continuing your work as a healthcare worker with the importance of staying healthy and protecting yourself from COVID-19. Each case is unique and requires discussion with between the healthcare provider and the patient and potentially with the employer.

For more guidance on essential work and COVID-19 if you have IBD, please click here. 

Infusion clinics are working hard to make sure they are safe environments for patients and workers. If you are experiencing symptoms or have tested positive for COVID-19, speak to your healthcare provider and infusion site to discuss options to reschedule your infusion. If you are unsure whether you are safe to attend your appointment at the infusion clinic, ask your clinic prior to your appointment.

For more information on visit infusion clinics and access to your medications during the COVID-19 pandemic, please click here. 

Infusion clinics are screening patients and workers for COVID-19. Some of these screening strategies involve calling patients before coming into the clinic, sending online questionnaires when patients are reminded of their appointments, and more.

Their screening tools are continuing to evolve as public health guidelines change. If the clinic asks to delay your appointment because you are symptomatic, please be patient – they are doing their best to protect others.

Infusions clinics are also cleaning even more vigorously than usual. This involves disinfecting surfaces often, and ensuring patients wash their hands well as soon as they enter the clinic. Additionally, clinics are taking steps to maintain physical distancing. These steps include putting up screens, spacing out appointments to avoid crowding, and keeping ample space between patients.

All of this means that clinics are scheduling fewer patients at a time in order to protect you. This might mean you will be rescheduled even if you’re not sick. Please be patient if the clinic needs to reschedule your appointment to another time.

For more information on infusion clinics and access to medication during the COVID-19 pandemic, please click here. 
 

Some clinics and patient support programs are offering virtual assistance to train patients or caregivers in self-administering their medications. This option only exists for patients receiving a subcutaneous injection of their biologic medication. To find out if this is an option for you, please speak to your health care provider or patient support program coordinator.