Reopening of Schools and Economy
Some provinces and territories are starting to re-open the economy, including stores, schools, and outdoor activities. The following recommendations are based on age groups and are meant to help you decide whether to continue self-isolation, or to start engaging in activities outside of your home.
These recommendations are general guidance, and should not replace the recommendations of your local public health agency or your doctor. If you are unsure and/or have any concerns, please talk to your doctor.
This guidance is based on the latest available evidence and cautious prudence to protect people living with IBD. It will likely change over time, as new information becomes available and/or the risk of COVID-19 changes.
Scroll down to find your age group and what you should do.
Children and adolescents under 20 years old:
Children and adolescents who get COVID-19 tend to have very mild symptoms and rarely require hospitalization. The risk of hospitalization and death in children with COVID-19 is not higher than a typical influenza infection. Several registries studying COVID-19 in children and adolescents with IBD have only reported mild COVID-19 disease, even among children using immunosuppressive or biologic medications.
If your child with IBD is in remission and otherwise healthy, your child should follow the local public health guidance regarding returning to school. This includes children on immunosuppressives or biologics. In general, children/adolescents who are in remission and feeling well may return to school.
There is uncertainty as to the risk of high-dose steroids (more than 0.5 mg/kg/day of prednisone equivalent dose, or more than 20 mg per day), severe active inflammation, and malnutrition in children/adolescents with IBD. Consequently, we recommend a more cautious approach until more data becomes available to help guide decisions.
We recommend that children/adolescents stay home from school if they are:
Newly diagnosed, or
Have severe active inflammation, or
Taking steroid medications (more than 0.5 mg/kg/day prednisone equivalent dose, or more than 20 mg per day) (excluding steroid enemas/creams or budesonide), or
Have moderate/severe malnutrition (were told by their doctor that they were malnourished or underweight)
If your child is newly diagnosed, has severe active inflammation or is taking high-dose steroids, your child should stay at home, and be shielded from COVID-19 using the following strategies:
All household members should employ good hand hygiene, and other strategies to reduce transmission of COVID-19.
Where possible, household members should engage in physical distancing from your child (maintain a distance of at least 2 metres).
Household members should adhere to public health physical distancing recommendations outside of the home (e.g. try to avoid in-person meetings)
Try to work from home; if not possible, speak to their employer about physical distancing at work
Use services for vulnerable people (e.g. special grocery store times, pharmacy delivery, etc.)
Clean their 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
If your child was recently diagnosed or had a flare of IBD, but is now in remission and has tapered the dose of steroids to less than 0.5 mg/kg/day and less than 20 mg per day, you may consider resuming attendance at school. Typically, this might take some time after the disease diagnosis or flare. Please speak to your doctor.
If there is an outbreak of COVID-19 at your child's school, or your child had direct contact with someone with COVID-19, your child should stay home from school for at least 14 days and you should speak with your local public health office.
If your child has other illnesses that put him/her at risk of severe COVID-19, you should speak to your doctor about whether it is safe to return to school.
Adults (20 - 64 years old):
In general, adults in this age group tend to have mild COVID-19 disease. Several registries studying COVID-19 in children and adolescents with IBD have only reported mild COVID-19 disease, even among patients on immunosuppressives or biologics.
If you are in remission and are otherwise healthy, you should follow the local public health guidance regarding returning to work and engaging in activities outside of your house. In general, adults who are in remission and feeling well may return to work.
There is uncertainty as to the risks posed by high-dose steroids (more than 20 mg of prednisone equivalent dose), severe active inflammation, and malnutrition in adults with IBD. In older adults, it appears that severe active inflammation and prednisone may increase the chances of having severe COVID-19. Consequently, we recommend a more cautious approach until more data becomes available to help guide decisions.
We recommend that people with IBD stay home and not engage in non-essential activities outside the home if they:
Have severe active inflammation, or
Take steroid medications (more than 20 mg prednisone equivalent dose) (excluding steroid enemas or budesonide), or
Have moderate/severe malnutrition (were told by their doctor that they were malnourished or underweight), or
Require parenteral nutrition (TPN or intravenous nutrition through a central line), or
Have other comorbidities that put him/her at risk of severe COVID-19 (as per local public health recommendations).
If you were recently diagnosed or had a flare of IBD, but are now feeling well and tapered the dose of steroids to less than 20 mg per day, you may return to work outside the home.
Seniors (65 years and older):
Adults in this age group may be at a higher risk of more severe COVID-19 disease. Registries studying COVID-19 in seniors with IBD have reported some cases of severe COVID-19 disease. The risk appears to increase with advancing age.
Unfortunately, the information in seniors with IBD is limited. Consequently, we recommend a more cautious approach until more data becomes available to help guide decisions.
Consider continued self-isolation, especially if you:
Are using steroids (more than 20 mg/day prednisone equivalent dose),
Have severe active inflammation,
Receive nutrition through a central line (parenteral nutrition or TPN), or
Have other comorbidities that put you at risk for severe COVID-19.
We recommend that people with IBD in this age group speak to their doctor or local public health office for guidance.
New data is emerging on a weekly basis and we will update our recommendations as we learn more about the risks of COVID19 in seniors with IBD.
Last Updated: May 7, 2020