Training

Risk infographic-coded

IBD Patient Risk

Listed below are the details pertaining to the three sections.

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.)

IBD PROFILE

• Age 65 years or older and using immunosuppressive medications²:
• 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^®)
  • AJAK inhibitor small molecules: tofacitinib (Xeljanz^®)

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

• Avoid in-person meetings
• If possible, work at home and hold meetings with virtual technology
• If not possible, talk to your physician, and discuss options with your employer for modified duties³
• Use services for vulnerable people (grocery store times for vulnerable populations, laboratory or health care services for vulnerable populations, etc.) in order to avoid contact with other people

IBD PROFILE
65 years or older, or under 65 years AND 

• 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

NOTES:
 

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.

2. 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.  

3. 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.

4. 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

5. Considerations for other family members and people who live with high risk individuals. In general:
   • avoid being in close proximity with other people, who might give your family member COVID-19, resulting in transmission to you 
   • 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 
   • While doing these activities, always maintain a distance of at least 2 arms-length (approximately 2 metres) from others.
   • Refer to our guidance for more information on how to self-isolate at home when you may have been exposed and have no symptoms.