The following is an adaptation of information developed by the Inflammatory Bowel Disease Team at the Royal Melbourne Hospital with regards to coronavirus (COVID-19) and inflammatory bowel disease (IBD)(i.e. ulcerative colitis and Crohn’s disease). COVID-19 will change the way that people in Australia access health care, work and go about day-to-day activities. Below is a summary of important information specific to IBD.
Medications
Many patients are asking if they should stop their medications. Please do NOT stop taking your IBD medications. At present there is no evidence to suggest that these medications will increase your risk of developing coronavirus or increase the severity of coronavirus if you develop it. Ensuring your IBD is well controlled is the best preventative measure for remaining well.
The standard advice for infections while on IBD medications still applies. If you become infected with a mild case of COVID-19, there is no evidence to say stopping your immunosuppressive (i.e. azathioprine, 6-mercaptopurine, methotrexate) or biologic therapy is more beneficial. In cases of any severe infection, your medication may be withheld until you improve.
The exception to this is steroid medication. We do know that high doses and long courses of steroids may increase infection risk. If you are already on steroids, continue to reduce your dose as suggested by your IBD doctor, or contact your IBD doctor to discuss a weaning plan. Do not stop your steroids suddenly, as this may result in you becoming very unwell. If you are not on steroid medication, please do not self-initiate this without advice from your IBD doctor.
Telehealth
Telehealth services will be available for all patients with inflammatory bowel disease review appointments. Telehealth allows you to attend your appointment via a video call or phone call.
Social distancing
Working from home
Where possible patients are encouraged to work from home to prevent the transmission of infection within the community. Your doctor can provide a letters for your workplace to notify them of current recommendations. Even when at work, ask if meetings with large numbers of people can be done by teleconference to avoid all being in the room together.
Collect a few months of medication at once
To further reduce the need to attend pharmacies or travel on public transport, patients may have the option to pick up 3-6 months of therapy at a time at your local pharmacy. This may require you to call ahead at the pharmacy and order stock in. It also requires a specific notification (“Rule 24”) from your doctor on the prescription to do this.
Continue your infusions
If you require infusions, most importantly, please continue to turn up to the centres to receive these, as disease control is the most important factor in controlling inflammation and preventing the need for steroid medications and hospitalisation.
Limiting blood tests
During this time, our IBD doctor will be balancing the safety of your medications with the need for regular blood tests and need to make changes in your doses. Your doctor will only be asking for pathology tests where absolutely necessary to limit your exposure to pathology centres and hospitals.
Handwashing
This is absolutely necessary when visiting hospitals, pathology centres and public spaces. Ensuring adequate hand hygiene will limit your risk of infection. Soap and water or hand rubs (>70% alcohol) can be used.
Travel Please ensure you review the most current advice from the department of health and your workplace guidelines. Smartraveller is advising all Australians not to travel at this time (https://www.smartraveller.gov.au/) and the necessity to self-isolate for 14 days.
Coronavirus (COVID-19) information: what to do if you have it or are concerned
If you have any queries about coronavirus, are concerned about respiratory symptoms, have recently returned from a country deemed to be high risk for coronavirus or have been in contact with someone who has a positive test for coronavirus, please contact the coronavirus hotline 1800 020 080 or visit https://www.health.gov.au/for the most up to date advice regarding self-isolation, testing, and travel.
If you develop COVID-19 please contact your IBD doctor so that they may liaise with the treating doctor about your medications and IBD.
Everyone should follow the following recommendations:
- Wash your hands frequently – soap and water are very effective, so is alcohol based hand rub
- Avoid touching your nose, eyes and mouth.
- Avoid being around other people who you know are unwell
- Practice and encourage others to practice respiratory etiquette, that is cover your mouth and nose with your elbow while coughing or sneezing, or use a tissue and dispose of it afterwards, and wash your hands
- Try to stay 1.5 metres apart from other people when you are sharing the same confined space
- Avoid attending public gatherings or crowded places
- Seek medical attention in case of fever, cough or difficulty breathing.
There is still a lot we don’t know about COVID19 and information is continually evolving, and the above recommendations may change. To ensure you are accessing the correct up to date information, use reliable sources to stay well informed: