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Covid-19 Advice for IBD Patients

Updated advice to all IBD patients attending Royal Liverpool University Hospital

Many of you will have received a letter or text from the Department of Health about your health risk in relation to coronavirus. People who received this were contacted because they were on a database of people who ought to receive the Seasonal Flu vaccine. The advice you received was based purely on that criterion.

The IBD Specialists across the UK, and beyond, have worked together to refine the advice, to make it more personal. The result is that IBD patients have been put into three groups, not two. The advice we are giving you is supported by the British Society for Gastroenterology (www.bsg.org.uk), and Crohn's and Colitis UK (www.crohnsandcolitis.org.uk). Please do look at their websites to verify our message.

Self—certification if vulnerable to coronavirus

If you have are in the ‘Highest Risk’ category (as outlined below), please register for extra government support at: https://www.gov.uk/coronavirus-extremely-vulnerable. For example, you’ll be able to ask for help getting deliveries of essential supplies like food.

 

Your risk is based on age, other illnesses from which you might suffer and the type of medication you take. The three groups are shown below:

Highest Risk - Advise mandatory self-isolation for 3 months

Highest risk patients include:

  1. IBD who either have a co-morbidity (respiratory, cardiac, hypertension or diabetes mellitus)

or are ≥70 years old and are on any therapy for IBD (per moderate group) except 5-ASA (mesalazine), budesonide, beclomethasone (clipper) or rectal therapies

  1. IBD of any age regardless of co-morbidity (other diseases) and one or more of the following:
  • on oral or intravenous prednisolone more than 20 mg per day (only while on this dose)
  • new starters of combination therapy* (starting biologic** within previous 6 weeks). Typically, this would be a combination of a biologic drug and azathioprine, mercaptopurine or methotrexate
  • moderate-to-severely active disease despite immunosuppression/ biologics
  • short gut syndrome requiring nutritional support
  • requirement for parenteral nutrition for IBD

*An example of combination treatment would be Infliximab and Azathioprine

**Infliximab/Adalimumab/Golimumab/Ustekinumab/Vedolizumab

Moderate risk - Recommend enhanced social distancing

(See guidance as to what social distancing means https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults)

Moderate patients are those taking:

  • Ustekinumab
  • Vedolizumab
  • Methotrexate
  • Anti-TNF alpha monotherapy (Infliximab, Adalimumab, Golimumab (without azathioprine))
  • Thiopurines (azathioprine, mercaptopurine, tioguanine)
  • Calcineurin inhibitors (tacrolimus or ciclosporin)
  • Janus kinase (JAK) inhibitors (tofacitinib)
  • Combination therapy in stable patients***

***Combination therapy may increase risk over monotherapy but there is no specific evidence for this situation

Lowest risk -no need for mandatory self –isolation

Patients on the following medications:

  • 5-ASA /mesalazine
  • Rectal therapies
  • Orally administered topically acting steroids (budesonide or beclometasone)
  • Therapies for bile acid diarrhoea (colestyramine, colesevelam, colestipol)
  • Anti-diarrhoeals (e.g. loperamide)
  • Antibiotics for bacterial overgrowth

Please be aware this guidance may change and we advise that you consult the Crohn’s and Colitis UK or The British Society of Gastroenterology website for up to date advice during this evolving outbreak.

If you are flaring or have any queries or questions related to your inflammatory bowel disease excluding coronavirus, we will endeavor to respond as soon as possible.

During the outbreak, most patients will be reviewed 'virtually'. Your specialist will review your notes. If no action is required (you were due a routine checkup for example), we will write to you. If you have recently flare (and we are aware of that) or we have changed your mediation, we will phone you at the time of your outpatient appointment.  Our clerical staff with ensure we have contact details and text you before the appointment - you should not attend the clinic in person.  If we decide that we need to meet in the clinic, we will make specific arrangements.  If you need blood test, we will send the forms to you, with instructions.

In addition to the above advice:

  • If you are unwell, please do not attend Accident and Emergency (A&E) unless it is an absolute emergency and there is a threat to your life or an accident has occurred. Please contact 0151 7062659 or email IBDnurses@rlbuht.nhs.uk if you are flaring, have any queries or questions related to your inflammatory bowel disease or if you have tested positive for Coronavirus (COVID-19), as your first contact.  We are proactively trying to make arrangements to limit the numbers of patients coming to A&E in order to reduce exposure to the coronavirus.   Be aware that our IBD nurses are overwhelmed currently and are having to prioritise calls with the most urgent being answered first.
  • If you are on immunosuppression such as steroids, immunomodulators (Azathioprine, Mercaptopurine, Methotrexate) and biological drugs (Infliximab, Adalimumab, Vedolizumab, Golimumab and Ustekinumab) do not stop taking these unless you become unwell (fever, dry cough) as it is essential your IBD remains under control as much as possible. If you become unwell please do contact the team as above but it likely we ask you to stop some medications depending on what they are and your individual circumstances.   
  • We are continuing giving our infusions of biological treatments at the moment. If this changes or we need to adapt the dose of the frequency of these infusions (or even stop them) we will let you know.  Infusions of iron may be delayed unless they are essential and will be reviewed on a case by case basis.  We are trying to review the infusion clinic seating to reduce social contacts.  Our nursing staff will be following government advice regarding protective wear.
  • Please ensure you have enough oral medications to last for at least a few months if that is possible – do appreciate GPs, pharmacies and primary care services are also overwhelmed.
  • Currently homecare delivery companies are functioning for medications delivered to homes. If this situation changes, we will let you know.  Please let us know if your supplies are running low.

We want to thank you in advance for your cooperation at this very difficult time and can assure you we will do the very best we can for you given the situation the NHS is in.  This international crisis has galvanized the entire healthcare and scientific community to find joint solutions to fighting this virus – not just in IBD patients, but the entire world population.  If there is one good thing that can come out of this crisis, it is that everyone is working together.  This should give you all great hope.

Finally, please all take very good care of yourselves and your families at this difficult time.    Please do keep our team in your thoughts and prayers too.  We hope we can all get through this together.

 

The Entire Royal Liverpool IBD Team

Urgent Contact Details

By Email: ibdnurses@rlbuht.nhs.uk

By. Phone: 0151 706 2659