Crohn's Disease and COVID-19: What You Need to Know

Navigating the world with a chronic condition like Crohn's disease can present unique challenges, and when a new health threat like COVID-19 emerges, it's natural to feel a wave of concern. Many individuals living with Crohn's disease, an inflammatory bowel disease (IBD) that affects the digestive tract, wonder if they are at a higher risk of contracting or experiencing severe outcomes from COVID-19. Let's break down what the current understanding is, based on available research and expert recommendations, to help you feel more informed and empowered.

It's important to clarify the terminology. The virus that causes the recent pandemic is officially named SARS-CoV-2. The illness it causes is known as COVID-19. So, if you contract the SARS-CoV-2 virus, you may develop the COVID-19 illness.

Are You More Likely to Get COVID-19 with Crohn's Disease?

This is a primary concern for many. Health authorities have been diligently studying COVID-19, and as of now, the data does not suggest that people with Crohn's disease are at a significantly greater risk of developing COVID-19 compared to the general population. A notable study involving over 1,900 individuals with IBD, including Crohn's disease, found a relatively low incidence of COVID-19 cases. Among those who did contract the virus, a portion required hospitalization, and sadly, some passed away. However, the researchers concluded that, when compared to the general population, individuals with IBD did not face a heightened risk of contracting COVID-19 or a greater risk of death from the disease.

This is reassuring news, but it doesn't mean we can disregard precautions. The situation is constantly evolving, and staying informed is key.

COVID-19 Symptoms and Their Overlap with Crohn's

Some individuals who contract COVID-19 report experiencing gastrointestinal (GI) symptoms such as nausea, vomiting, and diarrhea. For people with Crohn's disease, diarrhea is a familiar symptom. The study mentioned earlier also noted that diarrhea was experienced by some IBD patients with COVID-19, and for a few, it was the very first symptom they noticed. This overlap can sometimes make it tricky to distinguish between a Crohn's flare-up and a COVID-19 infection based on symptoms alone.

Scenario: Imagine Priya, who has had Crohn's for five years, starts experiencing increased abdominal pain and diarrhea. She's unsure if it's a mild Crohn's flare or if she might have been exposed to COVID-19 at the grocery store. This uncertainty is common and highlights the importance of medical guidance.

COVID-19 in Children with Crohn's Disease

For parents of children with Crohn's disease, the pandemic brought an extra layer of worry. If your child has Crohn's and has not contracted COVID-19, the general recommendation is to continue their prescribed medications. Preventing a flare-up of Crohn's symptoms is crucial, as a severe flare could necessitate hospital treatment, which in turn increases the risk of exposure to SARS-CoV-2. If your child does test positive for SARS-CoV-2, it is absolutely vital to consult their Crohn's healthcare team immediately. They will advise on whether any of their Crohn's medications need to be temporarily adjusted or stopped until the infection is managed. Never change or stop your child's medication without explicit guidance from their doctor, as this can lead to serious health complications.

Immunosuppressants and COVID-19 Risk

Many individuals with Crohn's disease rely on medications that modulate or suppress the immune system to keep inflammation under control. These include immunosuppressants and immunomodulators. Examples include medications like azathioprine, methotrexate, and certain biologics.

The physician-scientists at the International Organization for the Study of IBD (IOIBD) have offered recommendations for people taking these medications:

• Postpone elective medical procedures: This includes non-urgent appointments and surgeries, such as endoscopies, until the risk of widespread infection decreases.
• Continue infusion therapy: If you receive Crohn's treatments via infusion, continue with your scheduled therapy, provided the clinic adheres to strict infection control protocols.
• Managing active disease: If you have a new Crohn's diagnosis or are experiencing an active relapse, continue with the therapies that were prescribed to you before the pandemic.
• Medication changes: It cannot be stressed enough: always work closely with your healthcare team before reducing or stopping any medications. Abruptly stopping certain drugs can have severe health consequences.
• Nutritional support: Maintaining adequate nutrition is paramount. A healthy gut plays a significant role in a robust immune system.

These recommendations are particularly important for individuals whose immune systems are already compromised due to other conditions, such as organ transplants, certain heart or brain conditions, HIV, or long-term steroid use.

Testing for Past Infection

Antigen tests are available that can indicate if you've had a past SARS-CoV-2 infection. These tests look for specific proteins from the virus that trigger an immune response. While useful, it's important to know that antigen tests may not be as accurate as PCR tests for detecting current infections.

Protecting Yourself: Practical Steps

Given the potential for respiratory viruses to cause illness, and the general advice for those with chronic conditions, taking preventive measures is wise:

• Vaccination: Stay up-to-date with recommended COVID-19 vaccinations and boosters. Vaccines are a powerful tool in preventing severe illness.
• Masking: Consider wearing a mask in crowded indoor public spaces, especially if you are immunocompromised or live with someone who is.
• Hand hygiene: Wash your hands frequently with soap and water for at least 20 seconds, or use an alcohol-based hand sanitizer.
• Social distancing: Maintain physical distance from others, particularly in crowded environments.
• Avoid large gatherings: Limit your participation in large gatherings, especially indoors.
• Monitor symptoms: Be vigilant about any new or worsening symptoms, whether they seem related to Crohn's or could be indicative of COVID-19.
• Stay connected with your doctor: Maintain regular communication with your gastroenterologist and primary care physician. They are your best resource for personalized advice.

When to Consult Your Doctor Immediately

You should contact your healthcare provider promptly if you experience any of the following:

• Worsening Crohn's symptoms such as severe abdominal pain, persistent vomiting, or significant changes in bowel habits.
• Symptoms suggestive of COVID-19, including fever, persistent cough, shortness of breath, loss of taste or smell, or severe fatigue.
• Any concerns about your medication regimen or potential side effects.
• Uncertainty about whether to proceed with or postpone medical procedures.

Your doctor can assess your specific situation, provide tailored advice, and help you manage both your Crohn's disease and any potential COVID-19 concerns.

Frequently Asked Questions (FAQ)

Q1: Can COVID-19 cause a Crohn's flare-up?

While COVID-19 itself doesn't directly cause Crohn's disease to flare, the stress of the illness on your body and the potential for inflammation could theoretically trigger or worsen symptoms in susceptible individuals. More importantly, a severe Crohn's flare might lead to hospitalization, increasing exposure risk.

Q2: Should I stop my Crohn's medication if I think I have COVID-19?

No, do not stop your medication without consulting your doctor. Stopping certain Crohn's medications abruptly can lead to serious health consequences and potentially severe disease flares. Always seek medical advice before making any changes to your treatment plan.

Q3: Are there specific COVID-19 treatments for people with Crohn's?

The general COVID-19 treatments are available to individuals with Crohn's disease. However, your doctor will consider your underlying Crohn's condition and medications when deciding on the best course of treatment for you. If you are on immunosuppressants, your doctor might adjust your Crohn's therapy or recommend specific antiviral treatments for COVID-19.

Q4: What about travel for people with Crohn's during the pandemic?

It is generally advised to avoid travel, especially to areas with high COVID-19 transmission, and to avoid large gatherings. This advice is amplified for individuals with Crohn's disease, particularly those on immunosuppressive therapy. If travel is unavoidable, take all necessary precautions, including vaccination, masking, and frequent hand hygiene.