While this is not PSC specific, given many of you also have IBD we thought many of you may find this useful.

What is COVID-19?

The COVID-19 pandemic has emerged as a concerning public health problem and is currently affecting us in Victoria. The COVID-19 pandemic is caused by a virus called coronavirus (SARS-CoV-2) which is a new virus to infect humans. As humans have not been exposed to the SARS-CoV-2 virus before, we do not have immunity and therefore it spreads easily from person to person and can make us sick.

How does the coronavirus SARS-CoV-2 spread?

The coronavirus spreads from person to person by direct contact, through droplets and through touching shared surfaces. Transmission occurs when the virus enters the nose, mouth or eyes.

What are the symptoms of COVID-19?

The term “COVID-19” is given to the disease that is caused by the SARS-CoV-2 coronavirus. The most common symptoms people experience when they contract COVID-19 in order of frequency are: Fever (up to 89% of patients), dry cough, shortness of breath, abdominal pain and diarrhoea (up to 20% of patients), muscle and joint aches and pains, headache, loss of sense of smell.

If you have IBD and you develop a fever (temperature >38°C) with a flare in your IBD symptoms (abdominal pain, diarrhoea), even without cough, you should telephone your specialist/GP and arrange to be tested for SARS-CoV-2 coronavirus.

If I have IBD, am I more likely to contract COVID-19?

To date, studies have found that having IBD does NOT make you more likely to contract COVID-19. The main risk factors for contracting COVID-19 are high exposure risk such as health care professional, and smoking. Therefore this is a good time to quit smoking!

What are Australian Hospitals doing to reduce my chance of contracting COVID-19?

Hospitals across Australia have made many changes to practice medicine safely during the COVID-19 pandemic – these can differ from state to state, and even between hospitals. Most have changed the vast majority of their clinic consults to phone consultations to reduce the risk of COVID-19 exposure. All visitors to hospital are temperature-screened at the entrance. Many infusion centres have been altered to keep patients socially distanced and are cleaned regularly. Some centres are able to arrange for people to have their infusions in their homes.

Only essential procedures, including endoscopies, are being done during the Victorian stage 4 lockdowns.  Each hospital is running their departments according to the current state guidelines and you should expect communications regarding this if you are awaiting a procedure.

What can I do to reduce my risk of contracting COVID-19?

Please comply with state and federal government-issued directives with regard to hand-washing, wearing masks,  social distancing,  and restricting travel.

If your job enables you to work from home, then this is ideal. If you are in a high-risk group, or are unwell after having a flare of IBD talk to your health team and they may be able to provide you with a letter to support you to work from home if this is needed. Again, depending on the current situation in your state this may be different.

Additionally, optimising nutrition and maintaining good physical activity and fitness and stopping smoking may help to prevent you from contracting COVID-19.

Some people appear to get sicker than others with COVID-19. Who is at risk of getting very sick and needing hospital admission?

In general, people aged 65 and older, smokers, and those with other health problems such as chronic heart and lung disease, and active cancer are at risk of severe infection when they contract COVID-19.

Specifically with regard to IBD patients, patients who have moderately or severely active IBD and those who are taking prednisolone doses ³20mg a day are more likely to get sicker if they contract COVID-19. Therefore, it is important for patients with IBD to stay in remission by taking prescribed medication, getting regular phone check-ups and blood tests in order to prevent flares that might require prednisolone.

I am worried about my IBD medication weakening my immune system against COVID-19. What should I do?

Apart from high-dose prednisolone (³20mg daily) and intravenous hydrocortisone, the risk of other IBD therapies appears limited with regard to COVID-19. If you are well, you should continue to take all regularly prescribed medication to keep your IBD under good control.

If you are particularly worried with regard to your medications, please ask questions at your next IBD clinic review or call your IBD helpline if you have one available. If you are not under the care of a specialist check in with your GP. It is very important to continue taking your prescribed medications until you have spoken with your treating team.

I am feeling well during this time. Do I need to get my regular blood tests and come to appointments?

Yes! Please make the effort to go to your local pathology service to get blood tests and stool samples requested. Your scheduled appointments, whether phone or face to face,  are an important part of your care.  For phone or telehealth consultations please make the effort to answer your phone and ensure you are able to speak in an undistracted environment. Your doctor will review how you are feeling along with any test results to help ensure there are no signs of flares.

I think I am flaring with my IBD during the time of the COVID-19 pandemic. What should I do?

If you think you are flaring, please tell your doctor during your IBD clinic review. In between visits you should contact your specialist or GP via your usual means of communication.

If you are flaring with your IBD, it is still important to treat your flares with the right medications. Your treating doctors will avoid using high-risk medications, and substitute them with alternatives (for example budesonide and exclusive enteral nutrition) where possible.

However, sometimes using prednisolone cannot be avoided. If you are prescribed prednisolone, it is recommended that you self-isolate, practice good preventative measures, and contact your treating team well as the Victorian Coronavirus Hotline or your regular GP if you develop COVID-19 symptoms. Again, recommendations for isolation may differ depending on the current pandemic load in your state, so check with your doctor.

If you are having a very severe flare, you may need to attend the emergency department for inpatient treatment. Please note that if you are admitted into hospital as an inpatient, you might need to swabbed for SARS-CoV-2 and isolate you for a short period while your results come back, but your IBD care will not be compromised.  See your treating hospital’s website for their restrictions and guidelines to visitors and attendance.

I think I have symptoms of COVID-19. What should I do?

Contact the Victorian Coronavirus Hotline or your local GP by phone as soon as possible, then arrange to get a SARS-CoV-2 swab. Then, immediately self-isolate and follow your GP’s instructions. Try to keep your fluids up at home. If you test positive for COVID-19, please let your specialist know so they can advise you on what to do with your medications. If you have severe symptoms of COVID-19 and are feeling very unwell, contact the ambulance or have someone take you to the emergency department.

With thanks to Dr Fang who helped prepare this blog.

Please remember this information is not a replacement to your medical care and you should seek instruction from your treating physician.

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