Corona virus (COVID-19) update and information for IBD patients  

Knowledge about the Corona virus (COVID-19) is still building up during this global pandemic. The virus causes special concern for patients with IBD (Crohn's disease and ulcerative colitis). Here are some useful facts and tips to help you make the best decisions during these times and also help you should you be travelling.

Knowledge about the Corona virus (COVID-19) is still accumulating during this global epidemic. The virus causes special concern for patients with IBD (Crohn's disease and ulcerative colitis). Here are some useful facts and tips to help you make the best decisions during these times and also help you should you be traveling.

What are the symptoms of Corona virus infection?

In the majority of infected people there will be no symptoms or flu-like symptoms of fever, cough or shortness of breath, and some may experience muscle pain, sore throat, loss of taste/smell's sense and sometimes diarrhea. However, in the minority of patients the disease may become severe and life-threatening.

How does the virus spread and what can I do to protect myself?

The Corona virus spreads by respiratory droplets produced when an infected person coughs or sneezes, but the virus has also been isolated in stool of infected persons and remains viable on physical surfaces. Thus, fecal-oral spread and physical-contact spread may potentially be plausible as well. You should maintain frequent hand washing, avoid close (<2meter) contact with other persons and any contact with sick persons, avoid social gatherings, and adhere to other local recommendation by your national health authorities. As there have been several established reports of re-infection with COVID-19 in patients who previously recovered from the disease, these precautions should be adhered to regardless if you previously had COVID-19 disease. Vaccinating against COVID-19 should also be strongly considered as prime mode of protection (see below). The implications of newly discovered mutations of the virus are still being evaluated at this time for their possible effects on viral spreading and immunity after prior disease or vaccination.

Can I take COVID-19 vaccine if I have IBD? Can I take it if I am using immune-suppressants or biologics?

Several vaccines are being developed for COVID-19. At the time of this update, two mRNA-based vaccines (by Pfizer and Moderna companies) have been approved in Canada and by the FDA in the USA and one (Pfizer) also by the European Union. Although RNA vaccines are relatively new and long term experience is limited, trials of mRNA vaccines for other diseases have been conducted since 2017 without any warning signals developing with up to three years’ follow-up of the several hundreds of persons who participated in these trials. It is important to know mRNA cannot bind or alter the DNA and is degraded very fast in human cells so it does not persist long in the body. mRNA vaccines are not ‘live vaccines’ as they are composed of a non-live molecule particle, it does not carry a potential to become infective. Therefore, and although IBD patients were not included in the tested population of the mRNA vaccines, these vaccines are generally considered safe for patients who are immunosuppressed or who are receiving biologics. As any vaccine may stimulate the immune system, there is a slight but purely theoretical risk of augmenting the activity of IBD or instigating auto-immune disorders, but most experts believe the risks of COVID-19 exceed these purely theoretical risks and advise IBD patients to take the vaccine.

Other vaccines being developed are either inactivated (‘dead’) virus vaccine, or comprised of viral protein only, and therefore lack any infection potential and should in principle also be safe for immunosuppressed patients. One such vaccine by SinoPharm is already available for use in China, UAE and Bahrain. In contrast, several companies are developing vaccines using a different live-attenuated virus to carry COVID-19 particles into the body. These live-vaccines, such as those using Adenovirus carrier virus developed by Johnston & Johnston, AstraZeneca and the Russian Gamaleya institute, may have infective potential in immune-suppressed persons and are therefore generally contra-indicated for such patients. As a general rule however, due to the rapid changes in this field and the varying regulations, you should follow your most updated national guidelines regarding the COVID-19 vaccines.

Does my IBD or my medications put me at greater risk to have a severe disease if I do get infected with Corona virus? Should I therefore stop my medications?

Elderly people, people with hypertension, diabetes or chronic lung or heart diseases, overweight persons and smokers may be at increased risk for a more severe Corona virus disease. IBD patients as a whole, including Crohn’s disease and ulcerative colitis, were not found in any of the reports so far to have increased risk to contract the disease or to have a more severe disease. 

An international registry of IBD patients infected with the COVID-19 Corona virus has been established under the name SECURE-IBD (https://covidibd.org/).  As of 22^nd December 2020 there were 4038 IBD patients around the world reported to the registry after being infected with Corona virus. Of these, 2859 patients were immune-suppressed, and 1179 were not. Patients taking corticosteroids, azathioprine, 6-Mercaptopurine, methotrexate, tofacitinib, or biologic drugs are considered to be immune-suppressed. 

The current SECURE registry data as well as studies reported from the USA and elsewhere show that severe disease or death do not occur more often in patients taking immune-suppressive or biologic drugs when compared to IBD patients not taking these drugs. The only factors found to predispose to higher risk for having a more severe COVID-19 disease in patients who contracted the virus was concurrent use of corticosteroids when infected by the virus. It is also possible that IBD patients with uncontrolled activity of IBD are also at higher risk, but this has not been decisively determined by all studies.   

Overall, the data to date does not show that IBD patients have higher risk to contract Corona virus or to develop a severe disease because of their medications, and patients should recognize the risks of stopping IBD medications and experiencing disease flare and complications. Therefore, expert gastroenterology societies including the American Gastroenterology Association and European Crohn’s & Colitis Organization (ECCO) recommend to continue medications for Crohn’s disease and ulcerative colitis. 

However, patients receiving two types of immune-suppressive drugs, such as a biologic and an immunomodulator, and those on corticosteroids, should discuss with their doctor if one of these drugs can be safely discontinued.

Should I stop the medication if I was exposed to a sick person or if I am sick myself?

In general, exposure to a sick person is not considered a reason to stop or suspend your medications, but individualized decision should be taken with your doctor. If you do develop flu-like symptoms, whether diagnosed with Corona virus or not, than as recommended during any flu or other active infection disease, you should contact your IBD team and stop immune-suppressive drugs until symptoms resolve. Non immuno-suppressive drugs such as mesalamine need not be stopped.

Should I avoid going to the hospital, to the clinic or to the infusion center at these times?

Non-essential clinic visits may be re-considered, after proper advice from your team. Some visits to the clinic may be replaced by tele-medicine consults if these are available. Essential visits such as ER visits for severe IBD exacerbation or getting your biologic infusions at infusion centers should not be avoided.

I got stranded in another country while travelling, and I’m running out of my IBD medications. What can I do until I can fly back home?

If flights blocks have forced you to extend your stay away from your home country, we suggest you look at our ‘IBD Network’ webpage where you can find details of over 330 IBD centers around the world that have joined us to provide care and help with administering biologics to IBD patients abroad (you need to be registered user of IBD Passport to access this network). We suggest you approach the center where you are at, for getting local help in medication provision. If there is no center yet in our network in the country where you are at, you can send us an email at info@IBDpassport.com and we will try to help using our global connections, but please be aware that our response may be slightly delayed due to overwhelming numbers of queries and requests at these times.