We welcome Dr Neeraj Narula, McMaster University gastroenterologist and director of the IBD Clinic, to share his thoughts on COVID-19.
Given the use of biologics and immunosuppressive agents, many patients and physicians are concerned about whether IBD patients using these therapies are more susceptible to COVID-19 infection.
In general, although biologic therapies do act on the immune system, they are reasonably specific and do not compromise the entire immune system. Rather, they act on one or two soldiers (molecules) in the entire army (immune system) which tend to be overactive in patients with IBD. Most of the immune system is intact, however and usually able to fight off pathogens like viruses that attack the body.
There is not too much literature on COVID-19 risk in IBD yet. From China, as of March 8, 2020 (two months into the outbreak), no IBD patients from the seven largest IBD referral centres in China (looking after 20,000 IBD patients) have been reported to have COVID-19 infection. Further, no patients from the three largest IBD centres in Wuhan have been reported to have COVID-19 infection (Mao R et al. Lancet Gastroenterol Hepatol. Published March 11, 2020,https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30076-5/fulltext). There is an ongoing registry (covidibd.org) to monitor for worldwide cases of IBD patients. As of April 1, about 239 patients worldwide have contracted COVID-19, and their overall outcomes (i.e. rates of ICU admission, ventilator use, etc) seem comparable to what is seen in the general population.
Current guidance is stable patients on biologic or immunosuppressive therapy should continue these therapies, and should take the same kind of precautions that everyone has been recommended to do (social distancing, frequent hand washing, etc). Some societies that have provided this guidance:
Stay safe out there!
Neeraj Narula MD MPH FRCPC
Director of the IBD Clinic, McMaster University