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Patients who are infected with the novel coronavirus,
called SARS-CoV-2 may develop a disease called COVID-19.
The symptoms of COVID-19 are most frequently
fever, cough, and other respiratory symptoms,
which might progress to shortness of breath.
Other symptoms people commonly have include a fatigue
or muscle aches.
More recently, colleagues have described
that you can have digestive symptoms associated
with the infection with the SARS-CoV-2
development of COVID-19.
The digestive symptoms most often
described include a loss of appetite,
but also a loss of smell or taste and abdominal discomfort
or more frequent bowel movements or loose stools.
In patients who have inflammatory bowel disease,
where the primary problem with their underlying condition
affects the intestines, having digestive symptoms
can be confusing, and it could be
confused for activation of the inflammatory bowel disease.
We haven't seen enough patients who
have IBD who've developed COVID-19 to know
whether the patients have different types of symptoms,
but the unique concern here is to distinguish between someone
who is having a relapse of their Crohn's disease or colitis,
compared to someone who might be having
symptoms of an infection.
And to make it even more complicated
is the infection actually triggering a relapse.
So we're working hard with our patients
and with additional research to try and figure
some of this out.
Patients who have Crohn's disease and ulcerative colitis
have a chronic condition in which
the immune system of the intestines,
which exists to protect us from getting infected or having
other problems, is overactive.
So what happens in patients with Crohn's and colitis
is that the immune system the intestine
continues to be activated and cause symptoms or problems.
Because of this and because we haven't yet
found the cause of these conditions,
the primary treatment for many patients
is to use immune modifying or immune-suppressive therapies.
It makes sense then to be concerned
that if you're on a therapy that's
modifying your immune system, are you
at increased risk for infection?
Some of the therapies we use have
been associated with increased risks of viral infections,
including influenza, the common viral infection we talk about,
as well as other viral infections,
like Epstein-Barr virus or even viruses that can cause warts
on your hands or other things.
Because of this, we've had a particular interest
in whether our patients with IBD and the therapies they're on
might increase their risk for infection with the novel
coronavirus that causes the COVID-19 pandemic.
So far, we haven't seen that and in fact, quite the contrary.
We believe some of these therapies
may actually prevent progression of COVID-19, and some of them
are actively being studied for patients
who are suffering from COVID-19 to control the disease.
It's important to understand that the goal of treatment
for Crohn's disease and ulcerative colitis
is not to immune suppress the patient.
It's to modify that overactive immune system so
that it's under better control.
So in general, we don't think of our IBD patients
at baseline as being immune suppressed.
In fact, it's the opposite.
Their immune system is a bit overactive.
And when we treat them effectively,
our general strategy is to just turn down the immune system
enough, so their body takes over.
And we minimize the risk that they're
going to have any infections.
So our general message to patients
right now has been stay on your existing therapies
and stay in remission.
And obviously, for concerns about this,
we encourage them to call their doctors
and have conversations about whether there might
be any adjustments to be made.
Patients with inflammatory bowel disease who develop COVID-19
will have the same symptoms as the general population
of patients who don't have inflammatory bowel disease.
These symptoms include fever or cough or shortness of breath
or other congestion in the upper airways.
It can also be that it presents with digestive symptoms,
abdominal discomfort, loss of appetite,
or change in your bowel habits.
Because patients with inflammatory bowel disease
are often on immune therapies, it's
important that you let your doctor and your doctor's team
know right away if you develop some of these symptoms
or if you're worried that you might have developed COVID-19.
We can test you for that, and now we
have reliable testing and results
that come back quite quickly.
And then we can make some modifications.
Based on the treatments you're on,
we might have you hold your therapy for a couple weeks
to let this pass.
And most patients will recover uneventfully from this problem.
We know so far, based on an international registry
of inflammatory bowel disease patients
and patients who developed COVID-19, that there does not
appear to be an increased risk overall in patients with IBD
developing COVID-19 or having a different set of outcomes
from COVID-19.
What that means is that most people recover uneventfully,
regardless of what treatments they're on.
We're obviously studying this carefully,
so we understand it more.
But the most important thing to know
is that you should be calling and having
a conversation with your doctor, with your doctor's
team of nurses and nurse practitioners,
and have a good sense for when it would be important to be
tested and when we might have you hold your therapies
for a couple of weeks.
I don't recommend that you do that on your own
and stop your medicines without talking to us
because we really do want to make sure we have
a good handle on this for you.
Most people who have this won't require hospitalization,
but if you get sicker or develop more shortness of breath,
it is important to know that we're here for you.
We're available, and we can take care of this together.
Please be in touch with us.
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