COVID-19: What people with Crohn’s disease and ulcerative colitis need to know
By Dr. Brian Bressler, MD, MS, FRCPC
What is COVID-19?
It is the disease caused by an infection from a new coronavirus, SARS-CoV-2. COVID-19 stands for “coronavirus disease 19.” COVID-19 is spread in a similar way to the common cold or to influenza. Like other coronaviruses, it has crownlike spikes that protrude from its surface.
What are the symptoms of COVID-19?
People can carry the COVID-19 virus for 2-14 days before noticing symptoms. Common symptoms include:
- Cough that may become more severe over time
- Shortness of breath
Most people who are infected with COVID-19 have mild symptoms. Some people show no symptoms at all. However, symptoms can become severe, and some have died from the illness. Symptoms require immediate medical attention include:
- Difficulty breathing or shortness of breath
- Persistent chest pain or pressure
- Blueish color in the lips or face
In general, COVID-19 can cause more severe symptoms in higher-risk people, including older adults, those with weakened immune systems, or people with severe underlying health conditions, such as heart disease, lung disease and diabetes.
How does COVID-19 affect people with Crohn’s disease or ulcerative colitis?
Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a disease of an overactive immune system. It is often treated with medications that suppress the immune system. While IBD patients on immunosuppressants are not at increased risk of catching COVID-19, they may be at higher risk of having a more severe case of COVID-19 if they are infected.
If someone with IBD is not on immunosuppressants and is not flaring, it is believed that they have the same risk of infection and severity of disease from COVID-19 as the general population.
What Crohn’s and colitis medications lead to “higher risk” for COVID-19?
Common immunosuppressants used to treat IBD may put patients in a higher risk group for COVID-19. These include:
Azathioprine (Imuran), 6-mercaptopurine (Purinethol), methotrexate
Infliximab (Remicade®, Inflectra®, Renflexis®), adalimumab (Humira®), golimumab (Simponi®), ustekinumab (Stelara®), vedolizumab (Entyvio®)
The following IBD treatments do not suppress the immune system. Patients on these are not considered higher risk for COVID-19:
Mesalamine, mesalazine (Asacol®, Mezavant®, Pentasa®), sulfasalazine (Salazopyrin®)
Locally acting steroids
Budesonide (Entocort® EC, UCERIS™), methylprednisolone (A-Methapred®, Depo-Medrol®, Medrol Dosepak®, Solu-Medrol®), prednisolone (Orapred®, Prelone®, Pediapred®), prednisone (Deltasone®)
Do not stop taking IBD medications because of COVID-19
Do not stop taking IBD medications unless recommended to do so by a physician. If immunosuppressants are stopped, it could cause a flare, increasing the risk of complications for someone with COVID-19. Most importantly, a flare may very well require hospitalization, which is best avoided and may be treated with steroids, significantly increasing your risk.
How can you protect yourself?
Like all viral illnesses, there are steps everyone can take to reduce the risk of catching or spreading the virus. These include:
- Avoid touching your face, particularly your eyes, nose, and mouth.
- Wash your hands frequently with soap and water. Wash for at least 20 seconds when doing so. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
- Carry tissues with you and use them to catch your cough or sneeze.
- Avoid traveling.
- Practice social distancing: avoid large groups of people; avoid close contact (e.g. < 2 meters) with people outside your home; avoid people who are sick and avoid physical contact with other people, such as shaking hands or hugging.
- Disinfect surfaces inside the home that are touched frequently, such as doorknobs, light switches and phones.