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3/11: Implications of COVID-19 for patients with pre-existing digestive diseases

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Posted 3/13/2020 9:39 AM (GMT -5)
As there's not a lot of information about IBD and CORVID-19, ran across this published a few days back and figured I'd share.

Implications of COVID-19 for patients with pre-existing digestive diseases
https://www.thelancet.com/journals/langas/article/piis2468-1253(20)30076-5/fulltext

Given the use of biologics and immunosuppressive agents, whether patients with inflammatory bowel disease (IBD) are more susceptible to SARS-CoV-2 infection has raised great concern. Currently no patients with IBD have been reported to be infected with SARS-CoV-2 in the IBD Elite Union, which incorporates the seven largest IBD referral centres in China with more than 20 000 patients with IBD.8 Furthermore, no patients with IBD with SARS-CoV-2 infection have been reported from the three largest tertiary IBD centres in Wuhan (Tongji Hospital, Union Hospital, and Zhongnan Hospital) at the time that this manuscript was prepared (March 8, 2020).

Several strategies have been implemented in China to minimise the potential risk of SARS-CoV-2 infection in patients with IBD since the outbreak of COVID-19....
Posted 3/13/2020 10:02 AM (GMT -5)
Maybe we're immune! Woo hoo.

Just kidding
Posted 3/13/2020 10:25 AM (GMT -5)
I am thankful I am no longer taking UC drugs. Between biologics, immune suppressants and prednisone, it creates the perfect storm for a virus to flourish.
Posted 3/13/2020 10:38 AM (GMT -5)
Not THE virus.....ANY virus.
q
Posted 3/13/2020 11:29 AM (GMT -5)

quincy said...
Not THE virus.....ANY virus.
q

Excellent point, quincy.

Superb research, John.

Thanks to both of you!
Posted 3/13/2020 3:57 PM (GMT -5)

Uniform Charlie said...
Maybe we're immune! Woo hoo.


gari said...
Superb research, John

That article is good news.

I really don't understand all the panic about the COVID-19 virus. We've had epidemic scares before with SARS in 2003 and MERS in 2012. Probably the worst was the Swine Flu where President Obama declared a national emergency in 2009 after 4,000 deaths. But that wasn't near the panic we are experiencing now with COVID-19.

And I really don't understand why there is so much hype now. Soon the warm Spring weather will arrive. Even the worst flu pandemic of all, the 1918 Spanish flu, seemed to go into a dormant state during the summer of 1918. Yes it came back with a vengeance later that Autumn with the colder weather, but even if our COVID-19 decides to come back after a dormant summer, then we will probably have a vaccine by then, (I hope).

BTW just to be clear, I am not saying that we don't need to take the usual precautions such as frequent hand washing, etc.

Post Edited (IamCurious) : 3/13/2020 3:02:43 PM (GMT-6)

Posted 3/13/2020 4:02 PM (GMT -5)
Haha! Love it Uniform! I hope you’re right.

Thanks Ipoop for this info. I emailed my Stelara coordinator this am asking for exactly this type of info. I’m not sure if I should further reduce my imuran to 50mg. I reduced in Jan from 150 to 100 because I was getting far too many colds. Thankfully remission has held.

I work in the public and admittedly am in a panic as I’m on Stelara & imuran. Hoping to consult with my GI soon...
Posted 3/13/2020 4:59 PM (GMT -5)
Dear IAC
The reason for hype/panic in Europe is that the disease is highly contagious and 1 in 20 people requires hospital care. The risk is, if a large % of the population are sick at the same time, the health services are overwhelmed. Not enough beds, not enough ventilators, and when the doctors and nurses get sick too, then not enough staff.
This already happened in Italy in the space of just 3 weeks. The reality is that doctors there are having to make choices about which patients get the ventilators and which ones are left to die. They will choose based on age and chances of survival.
That's why most European countries have brought in major social distancing measures, to try to reduce and delay the peak of infections, so that the health services can cope.
As for the mass buying of toilet roll - that's just stupidity.
Posted 3/13/2020 5:34 PM (GMT -5)
It's tough on the meds. The other snippet I posted said steroids, thiopurines (azathiopurine, imuran, and 6-mercaptopurine) and xeljanz might make the virus effect stronger. Stelara, remicade, humira would be fine, one article said humira is being tested in corvid19 patients as a treatment against the deadly creatine storm at end phase. One thing said entyvio is fine, although I do question that as upper respiratory infections and flu is more common in entyvio. Furthermore, the text said quitting thiopurines or biologics is ineffective for short term relief as those meds do stay in your body for many months even after cesation. For that reason, stopping meds isn't recommended.
Posted 3/13/2020 6:28 PM (GMT -5)

IamCurious said...
Yes it came back with a vengeance later that Autumn with the colder weather, but even if our COVID-19 decides to come back after a dormant summer, then we will probably have a vaccine by then, (I hope).

The corona virus won’t kill irony in 2020. Antivaxxer hoping for a vaccine to arrive before it is scientifically and feasibly possible. 12-18 months is the lead time on developing a vaccine and the professionals are saying that it is 12 months at the absolute earliest.

Talk of warm weather slowing down the virus is just pie in the sky and irresponsible because there is no guarantee of that happening. It’s actually wishful thinking and avoiding doing the necessary and tough things to save people from this pandemic. What about if the warm weather doesn’t stop it? The government was warned about this virus back in December and they chose to ignore it. Now you’re hoping for warm weather to stop it when they had 3-4 months to develop a test to identify the corona virus but instead actively discourage CDC scientists from continuing their research?
Posted 3/13/2020 6:31 PM (GMT -5)
iam -- I think that the concerns are because of the unbelievable lack of testing, there is no treatment and the mixed messages coming from the federal government. With the swine flu there was testing and you could at least take Tamiflu to help reduce the length of time you were sick.

Really though I think the biggest issue is the lack of clear coherent information getting to us. Today was the first sign that I saw where they are getting better at the messaging. It's serious. They are taking steps. But until the tests are readily available for anyone who is sick the fear is going to remain.

Don't know if it will die down when the weather gets warm. It's spreading in Australia & South America. Less in Africa, but lower populations there so that could be a factor. Its summer in all those places.
Posted 3/13/2020 6:33 PM (GMT -5)
I was at the hospital yesterday for an iron infusion, someone called while I was there to ask if they should cancel their remicade infusion (not sick, in remission). The nurses said no don't cancel because it's more dangerous to get a flare up. Also they said they didn't really know how long or how deep the peak of immunosuppression was between infusions. I heard all this because they were discussing with each other while the patient was on the phone (at my hospital the ibd specialist nurses do the infusions for ibd patients).
I am on xeljanz, since it has a short half life (i.e. does not stay in the body long) then there is the option to stop it for a week or two if needed. The dr told me to keep taking it for now but call them if I get sick, then they will make a decision how to proceed.
Posted 3/13/2020 7:17 PM (GMT -5)

ks1905 said...
Antivaxxer hoping for a vaccine to arrive before it is scientifically and feasibly possible.


Are you labeling me an antivaxxer? I can show you dozens of posts here at HW where I have said over and over that I am NOT against vaccines and would like to see a prudent vaccine schedule to prevent the most common childhood diseases.

And yes I do hope that a vaccine for COVID-19 virus will be available. Not only a vaccine but all of the peripheral equipment needed such as ventilators, masks, hospital beds, testing kits, etc.

ks1905 said...
Now you’re hoping for warm weather to stop it when they had 3-4 months to develop a test to identify the corona virus but instead actively discourage CDC scientists from continuing their research?


I don't understand the point you are trying to make. Are you saying that I help to discourage CDC scientists from continuing their research?

As far as hoping for warm weather curtailing the virus, someone should tell President Trump from making that very same point in his address to the nation. Perhaps the president's advisers believe that the COVID-19 virus will likely follow the same pattern as the Spanish flu of 1918 and the Swine flu of 2009 which ended in August, 2009. I hope so but of course there are no guarantees and we should prepare for the worse.

Post Edited (IamCurious) : 3/13/2020 6:22:59 PM (GMT-6)

Posted 3/13/2020 7:58 PM (GMT -5)
I am so tired of hearing about the virus everywhere I look. Almost every email I got today was from an organization talking about the measures they're taking. People have lost their minds.

If your UC drugs didn't affect your tendency for catching cold and flu before, or affected your infection time, then that won't change for the coronavirus. If you catch viruses easily because of your status, then yeah, you might want to buy a 3M P100 mask (if you can even find one now) and lay low.

Can't wait for this drama to blow over. The vast majority of the people infected have not shown serious symptoms, or they showed mild symptoms. The majority of the people who died were over 60 years old. Yes, sad... and I don't want to be one of those people who brushes off the vulnerable as nothing. What I'm saying is that the general population that's running out and clearing the stores of all goods have lost their freakin minds.

Epidemiology works like this. The death rates are higher in the beginning because more cases are the vulnerable populace. Once that trend moves on, then the rates drop.

People forget every single time there's a seasonal virus how this works, or they just don't pay attention in the first place. I got H1N1 ("swine flu") in 2011. It wasn't pretty, but I survived at home, and I'm someone from the vulnerable population.

The chicken littles need to stop scaring everyone. Take standard precautions. 52,000 people have died from the flu in the U.S. since October, the CDC reported. Put it in perspective.
Posted 3/13/2020 8:21 PM (GMT -5)
Can we please be respectful of one another? It's fine if you respectfully disagree but we've been over a lot of this in the past and I think people are misunderstanding. IAC, and some others, want to prevent overvaccination. They aren't antivaxxers. They want to continue looking at what works and what doesn't. They don't believe we have it all 100% perfect all of the time. I don't see why people have a problem with people wanting to continue improving.

All that aside, it's pointless to personally attack, it just causes threads to get locked.

Corona is in AU right now and it's summer there, so I don't know about the whole "warm weather" thing...
Posted 3/14/2020 3:39 AM (GMT -5)
I for one am tired of the comparisons with seasonal flu and swine flu. As i wrote above, covid19 is highly infectious and has already overwhelmed hospitals in Italy to the point where they basically have to choose who gets the ventilators and let the others die. I even read they will take older patients off a ventilator if a younger one arrives at the hospital! THAT is why coronavirus is not comparable with earlier flus. Not to mention that there is tamiflu for treating flu and no drugs for covid19.
Plus, being over 60 is not that old...i can think of many people who I really love and/or who make a vital contribution to society, who are 60+ (including my GI doc actually). Young people die from this too, especially healthcare workers exposed to high levels of the virus.
5% of people requiring hospitalization is MUCH more serious than a seasonal flu.
Posted 3/14/2020 4:15 AM (GMT -5)
Also, in my country some of the hospitals have gone into "code red" which means cancelling non urgent operations (want a colectomy? Have to wait...) and calling staff back from vacation. There is also a major shortage of face masks because of stupid members of the public buying them - there is no internal manufacturer, and france and Germany, which normally provide them, put a ban on exports. This has led to dentists cancelling appointments because they're not allowed to work without face masks.
Posted 3/14/2020 7:03 AM (GMT -5)
@Poopydoop, I have been trying to explain this to people but they don't get it. Italy went on FULL LOCKDOWN once they started seeing hospitals overwhelmed. The issue is that hospitals are not set up to deal with large numbers of patients all at once. At the point they become overwhelmed, within the next few days there will be DOUBLE the patients. Now people who have what should be routine problems cannot be treated because all of the hospital workers are busy or sick themselves and there is not enough oxygen to go around. At this point the relatively low fatality rate grows, as it has in Wuhan and parts of Italy. It's looking like this will happen soon in parts of the US starting with the coasts. In a few weeks we will see if the hype was warranted.

People need to stop focusing on total numbers and start trying to understand the speed of this illness and the local emergency it will create for their community if people don't take it seriously. Start taking it more seriously. Your lax attitude can kill people in your community... your friend's parents, your uncle etc.
It's not all about your personal risk. Other people exist.

I don't see anyone panicking...I see common sense measures starting to take place. I went to the store the other day and was relieved that people were stocking up on food. It means they are planning to stay inside.
Posted 3/14/2020 7:29 AM (GMT -5)
https://youtu.be/avjy489euvq

https://youtu.be/iqdydkwtvoo

Food for thought if you think this can't happen here. Not fear mongering, just trying to share the realities of dealing with this illness. Get your heads out of your ***. The goal is slowing this down, not eliminating it. Play your part.
Posted 3/14/2020 8:15 AM (GMT -5)
In the end there's lots of unknowns, and differences in opinions among us on exactly how serious it is and what to do. Let's no belittle or go after each other's throats here (like two people fighting over the very last package of toilet paper at Walmart). Rather share reliant new info from credible sources, and try and not panic. Certainly my top post suggests us IBDers did well in China, perhaps we're already good at disease avoidance and already socially isolated as a general rule even before this CORVID19 crap popped up.
Posted 3/14/2020 1:14 PM (GMT -5)
I wasn't comparing SARS-COV-2 to swine flu. I'm saying that they have the same target populations. Since October 2019, 52,000 people in the USA have died from the flu, mostly over 50.

In Italy, every single person who has died has been over 60 years old. The same demographic as the flu.

The WHO is being overly precautious because there are a lot of unknowns about the virus and not because it has been confirmed to be more harmful.

I don't know what's worse, the media spread unnecessary fear, or the general public scaring each other by showing off how educated they think they are.
Posted 3/14/2020 1:56 PM (GMT -5)
sorry if this is frightening [please skip over this post if you suffer from anxiety] to some but as someone who works in healthcare, those posters who think this virus focus is overdone have not seen I think how overwhelmed the hospital service has been in China, Italy and Iran. Perhaps people think China and Iran are so different but Northern Italy is a rich area. Hospital services are overwhelmed in one of the richest enclaves of Europe, people are being treated in tents like a war zone, medics may never get over the trauma of having to triage people into treatment and not treatment group because they ran out of ventilators, staff to suction lungs etc. Over 1,000 people dying in a small area over a short period is unprecedented the living memory of anyone in Europe born after 1945.

Meanwhile there's no capacity to give critical care to anyone else if this happens (e.g. someone in a severe IBD flare or someone having a heart attack or from a car accident). This is why the whole population needs to take immense care to avoid infection and passing it on. That way the ill who have severe cases needing ventilation or anti-viral treatment (the most sick in China were treated with an HIV drug) can be managed through at a treatable number and others who need care get it too.
Posted 3/14/2020 2:14 PM (GMT -5)

iPoop said...
It's tough on the meds. The other snippet I posted said steroids, thiopurines (azathiopurine, imuran, and 6-mercaptopurine) and xeljanz might make the virus effect stronger. Stelara, remicade, humira would be fine, one article said humira is being tested in corvid19 patients as a treatment against the deadly creatine storm at end phase. One thing said entyvio is fine, although I do question that as upper respiratory infections and flu is more common in entyvio. Furthermore, the text said quitting thiopurines or biologics is ineffective for short term relief as those meds do stay in your body for many months even after cesation. For that reason, stopping meds isn't recommended.

Hi iPoop, where does it state Azathioprine on the link you shared on the first post? I cant find that word mentioned in any of the articles’ page.
Posted 3/14/2020 2:36 PM (GMT -5)
As far as solid medical advice for IBD-specific patients and our meds the reliable information isn't wide spread. A good read on this.

https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis/

Key wording:

What are the current recommendations for IBD patients related to COVID19?

IBD is a condition of an overactive immune system, and is often treated with immune modification or immune suppression. IBD patients on immunosuppressive medications are in general, more susceptible to infection. Specifically, being on steroids or immune modulators like azathioprine or 6-mercaptopurine or methotrexate can increase an IBD patient’s risk for viral infections. To date, we don’t have specific IBD research on COVID19.

What are the current recommendations for IBD patients related to COVID19?

Many patients have already asked us if they should stop their medications. Medicines such as mesalamine (brand names include Asacol, Apriso, Balsalazide, Lialda, Pentasa) are all safe. It is always a good idea to get off of steroids such as prednisone/prednisilone, if this is possible. Thiopurines (6-mercaptopurine, azathioprine) and tofacitinib/xeljanz tend to inhibit the body’s immune response to viral infections. The thiopurines take months to leave the body. Thus stopping these will not help in the short term. The biologics we currently use to treat IBD such as anti-TNFs (Cimzia, Humira, Remicade, Simponi), ustekinumab (Stelara), vedolizumab (Entyvio) are generally safe. At present we do not recommend stopping these medications. Moreover, the effect of these medications stay in the body, in many cases, for months. We will keep updating these recommendations as more data become available.
Posted 3/14/2020 3:27 PM (GMT -5)

London Lurker said...
sorry if this is frightening [please skip over this post if you suffer from anxiety] to some but as someone who works in healthcare, those posters who think this virus focus is overdone have not seen I think how overwhelmed the hospital service has been in China, Italy and Iran. Perhaps people think China and Iran are so different but Northern Italy is a rich area. Hospital services are overwhelmed in one of the richest enclaves of Europe, people are being treated in tents like a war zone, medics may never get over the trauma of having to triage people into treatment and not treatment group because they ran out of ventilators, staff to suction lungs etc. Over 1,000 people dying in a small area over a short period is unprecedented the living memory of anyone in Europe born after 1945.

Meanwhile there's no capacity to give critical care to anyone else if this happens (e.g. someone in a severe IBD flare or someone having a heart attack or from a car accident). This is why the whole population needs to take immense care to avoid infection and passing it on. That way the ill who have severe cases needing ventilation or anti-viral treatment (the most sick in China were treated with an HIV drug) can be managed through at a treatable number and others who need care get it too.

Keep telling people this until they get it.
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