Chronic Pancreatitis and COVID-19

The COVID-19 pandemic has changed life for everyone with major changes to the way we currently live our lives. The promise of hope is on the horizon with better understanding of the virus and the roll out of the vaccine. For people with underlying health conditions, COVID-19 has caused further anxiety. For some groups, there has been guidance on who is at risk. For people with pancreatitis, there has been no specific guidance and therefore calculating the risks associated with COVID-19 is difficult.

Overall, pancreatitis is not listed as one of the conditions noted as leading to a status of clinically extremely vulnerable (CEV) in the UK however it is not as simple as this and individual circumstances need to be assessed.

Acute pancreatitis

Most patients with acute pancreatitis don’t know they are going to develop this condition, which makes it impossible to assess prior to the illness. A recent study led from Newcastle has shown that infection with COVID-19 increases the severity of pancreatitis and is associated with worse clinical outcomes.¹ The best course of action is by prevention using social distancing, regular handwashing and vaccination when offered.²

Recurrent acute & chronic pancreatitis 

As above, these conditions are not currently recognised as leading to a clinically extremely vulnerable status. However, some subgroups may be at greater individual risk and should have their risk assessed by consulting with their GP and pancreas specialist. For those of working age, a risk assessment should also be performed by their employers. This process will identify risks associated with the workplace, in combination with the individual risk and should seek to reduce that risk to as low as is possible. The employer’s occupational health team may be involved in supporting the employer to estimate these risks. The Health and Safety Executive has information for employers on how to conduct appropriate risk assessments: Risk assessment – Working safely during the coronavirus (COVID-19) pandemic (hse.gov.uk)

Frequently Asked Questions:

Below are some factors (not an exhaustive list) to take into consideration when assessing risk in people with pancreatitis:

1. The biggest risk factor for COVID-19 is age, particularly over 70 years.
2. Patients with diabetes of any cause are at higher risk, individuals with pancreatic diseases may have associated diabetes.
3. Those on immunosuppression for any reason. Pancreas specific reasons includes IgG4 disease/autoimmune pancreatitis. Some immunosuppressive agents are more important than others such as methotrexate and rituximab.
4. Those with pancreatic disease due to cystic fibrosis need to follow the national guidance given by the Cystic Fibrosis Foundation.
5. Some might have other reasons to be considered as clinically extremely vulnerable e.g. stage 4 CKD or complications of diabetes.
6. In some circumstances it is the combination of multiple factors that lead to greater risk and ultimately being considered as clinically extremely vulnerable, for example, underlying heart disease, lung disease, liver disease, BMI>35, chronic kidney disease, smoking or cancer treatments.

By Dr John Leeds, Consultant Pancreaticobiliary Physician, Freeman Hospital, Newcastle Upon Tyne, UK. Dr Clare Leeds, Consultant Occupational Health Physician, County Durham and Darlington NHS Foundation Trust, UK.