COVID-19 Information for IBD patients

updated 23rd March 2020

The British Society of Gastroenterology has issued its latest guidance and advice regarding Covid-19. The advice for children is the same as for adults. There is a grid at end of this guidance which gives specific advice on self-isolation.

https://www.bsg.org.uk/covid-19-advice/bsg-advice-on-ibd-patient-risk-groups/

Our medical advisers have helped compile the following FAQs about the current Coronavirus outbreak.

Please refer to the main UK government website for information about Coronavirus and guidance for everyone on what to do.

We appreciate that parents are seeking reassurance at the moment and that this is a worrying time. There is a sense of confusion about the current coronavirus (COVID-19) situation with advice seeming to change on a day to day basis. The facts about how COVID 19 may specifically affect our children and young people are not as clear as we would like them to be, largely because this is a new virus and we don’t as yet have firm scientific evidence. Please be assured we are doing everything in our power to find information specifically for those we support.

What does COVID19 mean for children with IBD?

Coronavirus is a common mild respiratory virus that's been affecting people for a long time. COVID19 is a new strain that people haven't built up immunity to. Data is still unclear on how severe this version is versus the more common one in the general population. There's a natural bias towards infections taking hold in "at risk" populations first where complications are generally higher. However, early evidence suggests children are less susceptible to complications of the virus than adults, though for unknown reasons at present. This is good news, but it will be some time before we can say with confidence that this is the case.

Should a child stop their medication?

IBD is a condition of an overactive immune system,and is often treated with immune modification or immunosuppression. Children on immunosuppressive medicines are not at an increased risk of catching coronavirus, but may be at an increased of complications if they are infected, but stopping them is not recommended because the effect of the medications will continue for months anyway, and stopping them may cause an IBD flare, potentially requiring hospital treatment.

Medications that contain mesalazine are all safe. Some medications that children with IBD take tend to inhibit the body’s immune response to viral infections - these include steroids, azathioprine, 6-mercaptopurine and methotrexate. Immunosuppressants can take months to leave the body, so stopping them will not help in the short term. The biologics (e.g. anti-TNF, vedolizumab & ustekinumab) are generally safe. At present we therefore do not recommend stopping any of these medications.

What preventative measures should parents and carers practice with their children?

Everyone wash your hands, wash your hands, and wash your hands! Children like to touch their face. The nose, mouth, and eyes are all portals of entry for viruses into the body. Regular hand washing is important, particularly before eating food. (And not just for now, it’s a good habit to maintain!) Soap and water are at least as good as alcohol gels for cleansing hands of coronavirus.

When should parents keep their children home from school?

No-one knows your child’s situation better than you. The final decision is yours, we can only give you the most current advice as issued by Public Health England as linked to above.

The Department for Education, Scottish, Welsh and Northern Irish governments have announced that after schools shut their gates on Friday 20th march 2020, they will remain closed until further notice except for children of key workers and vulnerable children, as part of the country’s ongoing response to coronavirus:

https://www.gov.uk/government/news/schools-colleges-and-early-years-settings-to-close

Other useful sources of information include:

OFFICIAL COVID19 NHS WEBSITE
Crohn's and Colitis UK advice page
Public Health England FAQ
World Health Organisation (WHO) daily updates

Further information

We have been advised that hospitals clinics are considering ways to limit hospital attendances for patients where appropriate, such as:

• rescheduling non urgent out-patient appointments

• virtual or telemedicine appointments

• home delivery of immunosuppression

You will be notified directly by your hospital team if this occurs.

If a young person or child is experiencing symptoms of COVID 19 use the 111 online service. If symptoms are mild without a fever over 37.8 you can follow the advice about self-isolating at home. Any deterioration in condition should be referred through NHS 111. Immunosuppressed children with a fever over 37.8 will need review by the clinical team.

It is important that all of us follow the advice being given by Public Health England. There are some pieces of encouraging news for our patient group coming from other countries affected by COVID 19 who are slightly ahead and have seen more cases than we have, but it is very early days.

Young people, children especially, have made up very few of the confirmed cases so far. However, it is still important for children and young adults to be vigilant not least to limit the spread and keep the demands on the NHS as low as possible.

There are also some suggestions that the disease course in immunosuppressed patients isn't necessarily more complex and that the risk for patients receiving immunosuppression does not seem to be increased.

While these reports are encouraging, it is important to note that greater evidence is needed. Furthermore, it is vital that families continue to follow all UK government guidance and measures and crucially, children and young people need to keep taking their immunosuppression and other medications are prescribed unless told otherwise by their medical teams. It is also important that you and your child have enough medication to last the month in case of the need for self -isolation so make sure your repeat prescriptions are up to date.

We will keep you all updated with any further communications we receive from our contacts within the UK.

Throughout the next few weeks we will be providing resources, tips and advice on coping with social distancing and isolation for families, children and young people. We are here for you please do get in touch, we want to help, however the only direct guidance we can give is as stated.