Update: Coronavirus Covid-19 and people with conditions affecting the gastro-intestinal system

Everyone in the UK should adhere to guidance by the NHS. This now includes:

Stay at home to stop coronavirus spreading. Everyone must stay at home to help stop the spread of coronavirus.

This includes people of all ages – even if you do not have any symptoms or other health conditions.

You can only leave your home:

• to shop for basic essentials – only when you really need to
• to do one form of exercise a day – such as a run, walk or cycle, alone or with other people you live with
• for any medical need – for example, to visit a pharmacy or deliver essential supplies to a vulnerable person
• to travel to and from work – but only where this is absolutely necessary

Do:

• wash your hands with soap and water often – do this for at least 20 seconds
• always wash your hands when you get home or into work
• use hand sanitiser gel if soap and water are not available
• cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
• put used tissues in the bin straight away and wash your hands afterwards
• try to avoid close contact with people who are unwell

Don’t:

• do not touch your eyes, nose or mouth if your hands are not clean

Patients at high risk of severe illness with Covid-19:

Further information can be found on the government website.

This includes advice for “shielding” for those deemed extremely vulnerable.

People falling into this extremely vulnerable group include:

1. Solid organ transplant recipients.
2. People with specific cancers:
   • people with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
   • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
   • people having immunotherapy or other continuing antibody treatments for cancer
   • people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
   • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs
3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.
4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
6. Women who are pregnant with significant heart disease, congenital or acquired.

For these individuals the main implications of shielding, in addition to the “Stay at Home” policy that affects all, are that people in this category should not leave their homes even for shopping and that this is currently expected to continue for 12 weeks.

For other chronic conditions affecting the intestine, pancreas or liver and not specifically covered above:

Regarding other chronic conditions, not listed above and affecting the intestine, pancreas or liver there is little evidence that the conditions themselves affect risk for severe Covid-19 illness unless the affected individual has some other medical problem such as diabetes or hypertension. It is possible though that immunosuppressive treatments for these conditions, including those for Crohn’s disease, ulcerative colitis or auto-immune hepatitis, might in some cases increase the risk of complications if infected. The relevant specialist societies (including British Society of Gastroenterology and British Association for Study of the Liver) have identified categories of risk according to the nature of the immunosuppressive therapy.

People in the highest risk categories are advised to “shield”.  Some people may also be receiving texts from the Department of Health advising shielding if they are on the annual “flu” vaccine call-up list.

Other advice for patients receiving immunosuppression:

If you are taking such medications (oral corticosteroids/prednisolone, azathioprine, mercaptopurine, methotrexate, new injected biologics such as infliximab, adalimumab, golimumab, ustekinumab, vedolizumab, tofacitinib) and think you may be infected you should seek medical advice with your specialist team by telephone. The risks of stopping or altering medication will vary considerably from patient to patient and you should not change your therapy without consulting a doctor. There is some “expert-based opinion” available and you might wish to look at the IOIBD website, which is completely independent of Guts UK.

Advice for patients with other chronic conditions affecting the intestine, liver or pancreas:

The main risks for serious Covid-19 illness are age >70, hypertension, and diabetes. Unless you are receiving immunosuppressive drugs or corticosteroids (prednisolone) for inflammatory bowel disease or auto-immune liver disease (see above) other chronic gastroenterology conditions such as reflux oesophagitis, irritable bowel syndrome, and diverticulitis would not be expected to carry any increased risk for severe Covid-19. Chronic pancreatitis may be complicated by diabetes which is a risk for more severe Covid-19 but we are aware of no evidence to date that chronic pancreatitis uncomplicated by diabetes carries increased risk.

The team at Guts UK want to send you our best wishes in these uncertain times. We want to reassure you, our community, that we’re still here to help, we may just take a little longer to return your calls and reply to your emails. Thank you all for your understanding and kind messages so far, stay safe and #stayathome

– The Team at Guts UK

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