For people with conditions involving the immune system, such as inflammatory bowel disease (IBD) and Crohn’s disease, COVID-19 may cause extra concern.

Although current data doesn’t indicate that people with Crohn’s disease are developing COVID-19 at higher rates than other people, physicians and researchers who specialize in these conditions have made important recommendations to address risks posed by gut inflammation and some medications commonly prescribed for Crohn’s disease.

A brief primer on virus terms

The language used to refer to the virus causing the pandemic can be confusing. SARS-CoV-2 is the official name of the specific coronavirus that causes the illness known as COVID-19. In other words, if you contract the virus, SARS-CoV-2, you may develop the disease, COVID-19.

Health officials are still learning about what increases the risk of developing COVID-19. So far, there’s no data indicating that people with Crohn’s are at greater risk of COVID-19.

A recent study of 1,918 people with irritable bowel diseases like Crohn’s, found that just 12 of them were COVID-19 cases. Of these 12 cases, 8 were hospitalized and 4 isolated at home. Two of the 12 died.

Researchers concluded that, compared with the general population, patients with IBD weren’t at a greater risk of developing COVID-19 or of death as a result of COVID-19.

Some people with COVID-19 have reported experiencing gastrointestinal symptoms like nausea, vomiting, and diarrhea. The above study found that people with IBD also experienced diarrhea as a symptom of COVID-19. For a few people, diarrhea was their first symptom.

Current research indicates that although some children with COVID-19 do experience gastrointestinal symptoms like nausea, vomiting, and diarrhea, the percentage is low — around 10 percent of cases. Children with chronic inflammatory bowel diseases like Crohn’s don’t have a higher risk of developing COVID-19 than the general population.

If your child doesn’t have COVID-19, researchers recommend that they continue taking their medications. A flare-up of Crohn’s symptoms could mean that your child would need treatment in a hospital, which increases the risk of contracting the new coronavirus.

If your child does test positive for SARS-CoV-2, talk to their Crohn’s healthcare team about which, if any, medications should be stopped until the virus is under control.

Always talk to your doctor before changing or stopping your child’s medication. Stopping any prescribed medication without guidance from their healthcare team could cause serious health risks.

It might also be wise to reschedule any elective medical procedures, such as endoscopies, until after the risk of infection drops. If you’re not sure whether your child’s procedure should be postponed, talk to their healthcare team about the risks involved.

Many people with Crohn’s disease take immunosuppressants or immunomodulators to help regulate an overly active immune system. Some of the more common medications include:

  • adalimumab (Humira)
  • azathioprine (Azasan, Imuran)
  • methotrexate (Trexall)
  • natalizumab (Tysabri)
  • ustekinumab (Stelara)
  • vedolizumab (Entyvio)

For many patients, taking immunosuppressants doesn’t keep your immune system from working — it just calms an overactive immune response in your body. A few immunosuppressant or biologic/biosimilar medications may increase the risk of SARS-CoV-2 infection.

In July 2020, the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) published a list of recommendations for people with Crohn’s and other inflammatory bowel diseases. The IOIBD confirmed that people with IBD, including people with Crohn’s, are no more vulnerable to SARS-CoV-2 infection than other people.

The physician-scientists at the IOIBD recommend the following:

  • Postpone elective medical procedures until after the pandemic has subsided.
  • Avoid nonessential travel.
  • Continue your infusion therapy as long as the infusion clinic follows appropriate infection control protocols.
  • Prednisone increases the risk of an infection with SARS-CoV-2, and it increases the risk of developing COVID-19. Work with your treatment team to reduce or stop therapy with prednisone.
  • Researchers aren’t sure whether azathioprine and methotrexate increase your chance of a SARS-CoV-2 infection. If you test positive for SARS-CoV-2 or develop COVID-19, work with your treatment team to stop therapy with these two medications.
  • Researchers aren’t sure whether anti-TNF therapy increases your risk of infection. If you develop COVID-19, work with your healthcare providers to stop taking anti-TNF therapy.
  • There’s no evidence that ustekinumab increases your risk of infection, but if you develop COVID-19, work with your healthcare team to stop taking this medication.
  • Researchers don’t know whether tofacitinib increases your risk of infection. If you test positive for SARS-CoV-2 or develop COVID-19, work with your treatment team to stop using this medication.
  • If your therapy involves a combination of anti-TNF, thiopurine, and methotrexate, work with your treatment team to stop the thiopurine-methotrexate if you test positive for SARS-CoV-2 or develop COVID-19.
  • If you’re participating in clinical trials of any medication, work with your healthcare providers to stop the medication if you test positive for SARS-CoV-2 or develop COVID-19.
  • If you’ve just been diagnosed with Crohn’s disease, or if you’re experiencing an active relapse, use the same therapies prescribed for you before the pandemic.
  • If you’ve tested positive for SARS-CoV-2 but haven’t developed COVID-19, you can restart any stopped medications after 14 days.
  • If you had COVID-19, you can restart any stopped medications after your symptoms resolve or after two nasal tests come back negative for the new coronavirus.

It’s very important to work with your healthcare team anytime you reduce or stop your medications, as stopping suddenly can have serious health consequences. Always talk to your doctor before changing your Crohn’s medications.

Unless your healthcare team advises otherwise, it’s very important to continue your Crohn’s therapies during the pandemic. Protecting your health is more important now than ever, as a flare-up could lead to hospitalization, which could increase your risk of coming into contact with the new coronavirus in a hospital setting.

It’s especially important to maintain your nutritional therapies. A healthy intestine is essential to a properly functioning immune system.

According to the Centers for Disease Control and Prevention (CDC), people who may be at higher risk for developing COVID-19 are those with:

  • cancer
  • chronic kidney disease
  • COPD
  • immune systems weakened by organ, bone marrow, or blood transplants
  • obesity
  • serious heart conditions
  • sickle cell disease
  • type 1 and type 2 diabetes
  • asthma
  • cardiac or cerebral blood vessel diseases
  • cystic fibrosis
  • high blood pressure
  • immune systems weakened by HIV, steroid use, or immune-weakening medications
  • dementia and other neurological disorders
  • liver disease
  • pulmonary fibrosis
  • thalassemia
  • a history of smoking
  • pregnancy

Not everyone who tests positive for SARS-CoV-2 experiences symptoms. The symptoms of COVID-19 include:

  • body aches
  • chills and shaking
  • cough
  • diarrhea
  • fever
  • headache
  • loss of taste or smell
  • sore throat
  • stuffy nose
  • tiredness
  • trouble catching your breath

COVID-19 is diagnosed using one of several types of tests. The most common test is known as a polymerase chain reaction (PCR) test, which may involve placing a swab in your nose, testing fluid you have coughed up, taking a sample of your saliva, or processing a stool sample.

Antigen tests can reveal whether you’ve had the new coronavirus in the past. Antigen tests check for bits of protein that signal an immune response to the virus in your body. These tests aren’t yet as accurate as PCR tests.

It may not be possible to eliminate your risk of SARS-CoV-2 infection, but researchers at the Crohn’s & Colitis Foundation advise you to take the following precautions to lower your risk as much as possible:

  • Avoid travel and large gatherings, especially if you’re using immunosuppressant or immunomodulator therapies.
  • Practice scrupulous hand hygiene.
  • Keep your hands away from your face.
  • Maintain physical distance when you’re in public.
  • Wear a mask in public (in accordance with your local mandates or recommendations).
  • Wear a mask when you’re around someone who may have been exposed to the new coronavirus.
  • Stay on your medications, stay on schedule, and stay in remission.
  • Make sure you’re getting information about the new coronavirus from reliable sources.

If you experience a flare-up, it’s a good idea to contact your Crohn’s or IBD healthcare team as soon as possible. You may be able to get help via telemedicine or telehealth, which could keep you from having to visit a healthcare facility in person.

When to seek help

You know your body best. If you experience any of these flare-up symptoms more often than usual, or if your symptoms become more severe, it’s time to reach out to your healthcare team:

  • going to the bathroom more often
  • having diarrhea
  • seeing blood in your stool
  • feeling pain in your abdomen
  • feeling fatigued
  • losing weight

If you have Crohn’s disease, part of your treatment for COVID-19 may include temporarily stopping some of your usual therapies until your symptoms resolve or until you have two negative tests back-to-back. Otherwise, your treatments won’t necessarily differ from treatments other patients receive.

If you test positive for SARS-CoV-2, it’s important to contact your Crohn’s or IBD treatment team right away so you can take steps to lessen the risk of developing COVID-19.

There’s no data indicating that people with Crohn’s have worse symptoms if they develop COVID-19, and no evidence that people with Crohn’s are more likely to die from COVID-19.

If you want to learn more about the outcomes for people with IBD and COVID-19, you may want to take a look at the SECURE-IBD database, which tracks physician-verified cases worldwide.

Current research indicates that people with Crohn’s disease aren’t at a greater risk of contracting SARS-CoV-2 or developing COVID-19. Some medications, especially corticosteroids like prednisone, increase your risk of developing COVID-19 because they weaken your immune system.

Researchers aren’t sure whether some of the immunosuppressants or immunomodulators prescribed for Crohn’s could make it more likely for you to develop COVID-19.

If you test positive for SARS-CoV-2, or if you develop COVID-19, talk to your gastroenterologist and your healthcare team right away, as it may be necessary to stop some of your therapies until your symptoms resolve.

To lower your risk for COVID-19, follow CDC recommendations and stay on your medications to protect the health of your immune system.

Read this article in Spanish.