COVID-19 is the illness caused by the novel coronavirus SARS-CoV-2 virus. In March this year, the World Health Organization declared COVID-19 a global pandemic. Our lives have drastically changed during this difficult time, with the need for social distancing and lock down measures (our hearts go out to Victoria who is still amidst battling their second wave).  

We know that older patients >65 years of and those with cardiovascular disease, diabetes mellitus, morbid obesity, chronic obstructive pulmonary disease or liver disease are at higher risk for severe COVID-19. However, it is unclear if patients with liver disease refer to those with primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), cirrhosis or post-transplant recipients on immunosuppressive therapy.  

The SARS-CoV-2 virus binds to, and is internalized into, target cells through angiotensin-converting enzyme (ACE) 2, which acts as a functional receptor. ACE2 is present in the cells lining our bile ducts and liver (epithelial cells), which makes the liver vulnerable to viral infection. Abnormal liver function tests have been associated with COVID-19, with significant injury occurring more often with severe cases. Liver injury in mild cases is usually transient, and does not require treatment. We do not have enough data at this stage to suggest that COVID-19 exacerbates cholestasis in patients with PSC or underlying cirrhosis. 

At this stage, we recommend that patients with cirrhosis, on immunosuppressive medication or post-transplant patients should be considered at increased risk of severe COVID-19. All patients should still attend clinic as directed by your service for ongoing medical care, and ensure that imaging surveillance for liver or gallbladder cancer continues as close to schedule as circumstances allow. Travel should be minimized, and enhanced social distancing guidelines should be followed. Do not change your medication doses without consulting medical advice. In the current climate, it is more dangerous to have a flare of autoimmune disease or a rejection episode! If you are experiencing symptoms or signs of cholangitis, do not delay in seeking medical attention as antibiotics are required in a timely manner. Do not be afraid of coming to hospital, the risks are low and it is more dangerous to delay treatment for any underlying infections or illnesses! 

If you do develop symptoms of COVID-19, contact your GP or specialist and organize a swab as soon as possible. The next step is to immediately self-isolate. If you do test positive, let your specialist know and they can advise on medication dose changes if needed. If you have severe symptoms and feel very unwell, do not hesitate to contact an ambulance to attend hospital for emergency care. 

With thanks to Dr Tan for preparing this for us.

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