Guidance

Are You at Risk?

People with IBD who are under 65 years old not using immunosuppressive 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. 

The recommendations below are based on the latest available evidence for people living with IBD. It may change over time as new information becomes available and/or the risk of COVID-19 changes.

This page contains information on: 
IBD Patient Risk Profile and Recommendations
IBD Medications
Vulnerable Populations 
Returning to Work and School

PATIENT RISK profile AND RECOMMENDATIONS

Listed below are the details pertaining to the three risk groups:

IBD PROFILE

• Under 65 years old and NOT TAKING immunosuppressive and biologic medications, and

• IBD in remission, no significantly active inflammation

• Not malnourished

• No comorbidities (respiratory, cardiac, hypertension, diabetes)

RECOMMENDATION

Follow public health guidelines for general population (physical distancing¹, hand hygiene, self-monitoring, etc.

Take steps to minimize COVID-19 transmission including:

• Physical distancing (remain >2 metres apart from others).

• Wear a mask in closed indoor spaces or outdoors among others for prolonged period of time.

• Wash hands frequently with soap and water for >20 seconds.

• Do not go to work/school if you have symptoms of COVID-19.

IBD PROFILE

• Age less than 65 years old, and TAKING immunosuppressive medications²:

  • 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^®)

RECOMMENDATION

In addition to following public health guidelines for general population (physical distancing¹, hand hygiene, self-monitoring, etc.):

• Avoid indoor in-person meetings or gatherings, especially when you cannot remain >2 metres apart from others.

• Wear a mask in closed indoor spaces, or outdoors where you cannot remain >2 apart from others.

• Be aware of local information on numbers of people with COVID-19 in your community (consult your provincial/territorial and municipal health websites); consider additional measures if community cases are increasing or high including:

  • If possible, work at home and hold meetings with virtual technology

  • Avoid indoor gatherings with other people

  • Talk to your physician, and discuss options with your employer for modified duties³

IBD PROFILE

• Age 65 years or older

• Under 65 years, AND using oral or intravenous systemic corticosteroids more than 20 mg/day (or 0.5 mg/kg for children) prednisone equivalents:

  • Prednisone (Deltasone)

  • Methylprednisolone

  • Hydrocortisone (Hydrocort, Cortate)

• Moderate or severely active inflammation (new diagnosis or recent flare)

• Moderate or severe malnutrition

• Requirement of parenteral nutrition (intravenous nutrition through a central line)

RECOMMENDATION

In addition to following public health guidelines for general population (physical distancing¹, hand hygiene, self-monitoring, etc.):

• SELF ISOLATE⁴

• Refer to considerations for other family members and people who live with high risk individuals⁵

1. PHYSICAL DISTANCING means:

• 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.

​RETURN TO RISK PROFILE

2. 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.

​RETURN TO RISK PROFILE

 3. ESSENTIAL WORK AND SERVICES: 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 national public health authority. 

​RETURN TO RISK PROFILE

• 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

• Refer to our guidance for more information on how to self-isolate at home when you may have been exposed and have no symptoms.

​RETURN TO RISK PROFILE

5. FAMILY MEMBERS AND ROOMMATES: Considerations for other family members and people who live with high risk individuals. In general:

• Take steps to minimize COVID-19 transmission including sticking to a very small, consistent social circle and avoiding gathering in groups

• Avoid in-person gatherings where physical distancing is not possible and people are not wearing masks

• Try to work from home. If not possible, speak to your employer about physical distancing at work

• Wear a mask in closed indoor spaces or outdoors with others for a prolonged time

• Clean your residence as well 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 arms-length (approximately 2 metres) from others

• Be aware of local information on numbers of people with COVID-19 in your community (consult your provincial/territorial and municipal health websites); consider additional measures if community cases are increasing or high

• ​Refer to our guidance for more information on how to self-isolate at home when you may have been exposed and have no symptoms

​RETURN TO RISK PROFILE

​6. EVERYONE (unless otherwise advised by your health care provider) should get the flu vaccine this year:

• Since the flu and COVID-19 have similar symptoms, getting vaccinated for flu is very important. Particularly significant for people with IBD, getting the flu can increase the risk of COVID-19 complications (you can get the flu and COVID-19 at the same time), which is best avoided.

• Getting your flu shot will look a little different this year with restrictions in place regarding number of people indoors etc. You may be required to make an appointment or attend a clinic at a specific day and time.

• Contact your health care provider or where you have previously received your flu vaccination to determine new protocols for 2020.​

​RETURN TO RISK PROFILE

Watch the 6-minute video below for a breakdown of patient risk and recommendations:

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IBD Medications 

If you are on immunosuppressive medications, you may be at increased risk for infection and serious complications of COVID-19.

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^®)

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

Watch the 4-minute video below to learn more about the safety of medication use during COVID-19.
 

For more information, please visit our COVID-19 Medications and Treatment page.

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Older Adults and Vulnerable Groups 

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).

More information on vulnerable populations are available on the PHAC website.

Watch the 8-minute video below to learn more from experts about risks of COVID-19 and special considerations for people with IBD.

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Reopening of Schools and the Economy 

Provinces and territories are starting to re-open the economy, including stores, schools, and outdoor activities.

Expert guidance has been developed for different age groups and are meant to help you decide whether to continue self-isolation, or to start engaging in activities outside of your home.

For recommendations on returning to work and activities outside the household, please click here. 

For recommendations on going back to school, please click here. 

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Last Updated: October 8, 2020