According to the International Organization for the Study of Inflammatory Bowel Disease (IOIBD), there is no evidence that people with IBD have an increased risk of getting COVID-19 or of complications if they do contract the virus. “We do know that the best state to be in is remission, and we want to avoid inflammatory responses if possible,” says Jami Ann Rothe Kinnucan, MD, an assistant professor of gastroenterology and an IBD specialist at the University of Michigan in Ann Arbor. “There is immune dysregulation during a relapse of IBD, and being in a state of inflammation can alter the immune response.” Dr. Kinnucan says there are two groups of IBD patients: those who are considered immune-suppressed and those who are not. According to the IOIBD, people who take immunosuppressant medications, which are commonly prescribed as long-term treatment for IBD patients, are more susceptible to infection in general, but that does not mean that if you take these medications you are automatically at a higher risk of contracting the virus that causes COVID-19. That, Kinnucan says, is largely dependent on where you live and who you interact with. Either way, the best thing people with IBD can do is get vaccinated, be diligent about managing flare-ups, and reduce their risk of exposure to the virus. Here’s how.
1. Get Vaccinated
Regardless of the types of medicines IBD patients may be taking, vaccination against COVID-19 is the no. 1 most effective thing they can do to protect themselves from infection, according to Brooks Cash, MD, who serves as both a professor of medicine and the division chief of gastroenterology, hepatology, and nutrition at UTHealth in Houston, Texas. “I strongly encourage patients — and the professional societies have all come out and unanimously stated — that patients with IBD and other immunocompromised medical conditions should be getting vaccinated for this infection,” Dr. Cash says. “Vaccination appears to protect not only from infection, but even in those patients who have a breakthrough infection, there is a significant decrease in the severity [of symptoms] and the need for hospitalization,” he says. And that includes getting booster shots. “We know that immune protection wanes over time, and may even wane more rapidly after natural infection,” Cash says. “So we strongly encourage even those patients who have been infected to get vaccinated and get the boosters at the appropriate time.”
2. Keep Taking Your IBD Medications
If you take immunomodulators, including thiopurines (azathioprine, 6-mercaptopurine, cyclosporine, methotrexate) and the JAK inhibitor Xeljanz (tofacitinib), and do not have COVID-19, you should not stop taking them, according to the Crohn’s and Colitis Foundation. The same advice goes for people on biologics. Although these medications usually suppress the immune system and can make it harder for your body to fight off infectious diseases, going off them can throw you into a flare-up and increase your visits to the doctor’s office during a time when the healthcare system is under extreme stress, Kinnucan says. In addition, being at the doctor’s office can increase your risk of exposure to viruses like the one that causes COVID-19. You don’t need to stop taking your medications to get your COVID vaccines, either, Cash says. “When we give vaccinations to patients with immunocompromised status, and specifically IBD, we are concerned about administering live virus vaccines,” he explains. “None of the COVID-19 vaccinations are live-virus vaccines; they’re not even inactivated virus vaccines. They are made to target a specific part of the virus, the spike protein … so there is no risk of getting COVID from the vaccine.” “If you’re doing well, stay on the medication that you’re prescribed and avoid unnecessary travel and crowded places,” says Kinnucan. She recommends working with your provider to get into a remission state, so that you aren’t put on steroid therapy that can suppress your immune system You may want to speak with your healthcare provider if you’re already taking steroids, to learn about extra precautions to keep yourself healthy and away from the virus, Kinnucan says. Even if you do get COVID-19, Cash says, keep taking your medications. “The primary reason for that is that COVID is typically a short-lived infection. And we are getting more and more effective therapies in the form of monoclonal antibodies and other supportive therapies to use in patients, especially if recognized early. So by the time we interrupted immunosuppression [in] somebody with inflammatory bowel disease, they more than likely would have already recovered from their COVID, because it does take quite some time for these immunosuppressive therapies to lose their effect. So, you know, you don’t want to necessarily get on that seesaw of stopping one effective therapy and risking an IBD flare or assuming the risks of subsequent [drug] intolerance or diminished effectiveness.” RELATED: 5 Ways to Build a Positive Patient-Physician Relationship When You Have IBD Your risk of a severe infection that results in ICU admission, ventilator use, or death may be higher if you take the anti-inflammatory medications Azulfidine (sulfasalazine) or 5-aminosalicylates, the study results suggest. People on these medicines were roughly three times more likely to have severe infections. If you have two or more chronic medical issues in addition to IBD, you also have about three times the risk of severe infection. Most of the people in the study who died had other health problems, and half of the fatalities involved people with both IBD and cardiovascular disease. Your risk may be even higher — increased by almost sevenfold — if you take systemic corticosteroids for IBD. Anti-TNF therapies, however, don’t appear to increase your risk of a severe infection, the study results suggest. Even with these increased risks, you will probably want to stay on your medicines, because maintaining remission remains important during the pandemic, says a coauthor of the study, Ryan Ungaro, MD, a gastroenterologist at the Icahn School of Medicine at Mount Sinai in New York City. The study wasn’t a controlled experiment designed to determine whether or how certain IBD medicines or patient characteristics might impact the severity of COVID-19 infections, says coauthor Erica Brenner, MD, a pediatric gastroenterology fellow at the UNC Children’s Hospital in Chapel Hill, North Carolina. “The decision to use these medications should be individualized, and the other options that patients have are dependent on their personal disease characteristics and medical history,” Dr. Brenner says.
4. Reduce Your Risk of Exposure
Because COVID-19 is a global pandemic, “really the only things you can do are related to prevention,” says Kinnucan, who, like IOIBD, says to avoid crowded places and unnecessary travel. The Centers for Disease Control and Prevention (CDC) strongly recommends that everyone wear a mask with at least two layers of breathable fabric — reserve N95 masks for healthcare workers who are on the front lines — in communal spaces like the grocery store to help slow the spread of COVID-19, especially since data now shows that many people who have contracted the novel coronavirus do not show any symptoms. In addition, if you aren’t experiencing any IBD symptoms, Kinnucan says you may be able to telecommunicate with your doctor instead of going into the doctor’s office, to avoid potential exposure. On the flip side, if you are experiencing coronavirus disease symptoms yourself, you should call your general care practitioner to consult with them before you go to the doctor’s office and risk exposing others, she says.
5. Try Not to Stress
The World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic, many flights are being canceled, and some employees are being told to work from home indefinitely. It’s easy to let these measures cause extra stress if you aren’t quite sure what they mean. But managing stress, though not easy, may help keep you in remission. Decades of research has pointed to stress being a trigger for IBD flare-ups. One study, published in 2017 in Current Pharmaceutical Design, found that anxiety can significantly influence the severity of IBD symptoms. Some things you can do to reduce stress include:
Make sure you have at least a month’s supply of medication.Stock up on foods that are healthy and won’t irritate IBD symptoms.Make arrangements with your employer to work from home, if possible.Make sure you are getting adequate levels of exercise by going out for walks in uncrowded parks or looking for an online yoga class.Meditate.
6. Practice Good Hygiene
Health experts have been offering this seemingly simple piece of advice since the COVID-19 outbreak began, and with very good reason. In a study published in December 2019 in Risk Analysis, MIT researchers estimated that if hand-washing improved among airport travelers, going from 20 percent of travelers to 60 percent, the hygiene boost could slow the spread of infectious diseases by 70 percent. Increased hand-washing in just 10 of the most influential airports — which include those in Atlanta and New York — could slow the spread of disease by nearly 40 percent, according to the research. “This is making people wake up to being better about hand-washing hygiene,” says Kinnucan. “People shouldn’t just wash their hands like this during a pandemic, but at all times to prevent the spread of disease.” If soap and water are not available, the CDC recommends using hand sanitizer that is at least 60 percent alcohol. Alcohol-based hand sanitizer shouldn’t be a first line of defense if soap and water are available, because it is less effective (though better than not doing anything at all) at ridding hands of bacteria and some viruses, as well as the dirt and grease that may harbor them, the CDC website states. Make sure you scrub for at least 20 seconds, and don’t forget the backs of your hands and under your fingernails. Additional reporting by Lisa Rapaport and Monroe Hammond.
