How can I protect myself and/or my child from severe Covid-19 disease?
First, protection at this time is best achieved by making sure you/your child and your family are vaccinated. Vaccination is the best protection against severe disease.
If you/your child are/is NOT immunocompromised — For most of you under the age of 18 years, to be protected requires two doses of the Pfizer vaccine. You can schedule vaccination at Rady Children’s via MyChart and at many locations throughout San Diego (local pharmacies as well). We also recommend the booster at five months from your last Pfizer dose (for those receiving Pfizer). Note that eligibility for the booster may be limited by age according to CDC/FDA/ACIP approval.
If you or your child are/is immunocompromised, we encourage three doses to be considered fully vaccinated. For those of you who have had two vaccination doses, the third dose is recommended at 28 days out from your second dose of the vaccine series. We recommend three doses for those who are immunocompromised because of the lower rate of development of immunity to the vaccination.
Who is immunocompromised?
Anyone who is taking the following medications:
1) Prednisone
2) 6-mercaptopurine or azathioprine
3) Methotrexate
4) Infliximab (Remicade or Inflectra)
5) Humira
6) Stelara
7) Tofacitinib (Xeljanz) 8) Tacrolimus
9) Entyvio
I am due for a followup clinic visit. What are my options?
We highly recommend that you keep your clinic visit with us. Monitoring of your disease during this time will continue to be important as always.
Telehealth visits are available if you have been previously seen by the clinic. To schedule, please contact the clinic. If you are interested in this option, please make sure to download and activate MyChart (call into the clinic to set this up) as well as the Zoom app prior to your telehealth visit.
How will IBD Telehealth visits run?
IBD Telehealth visits will run very similarly to your regular IBD visits. Please make sure to log in to MyChart at least one day prior to your visit to complete the required questionnaires so that your visit can run smoothly. Make sure to answer each question (and click any pictures to answer questions) and to click “submit” to complete your questionnaires.
How is coronavirus transmitted?
Coronaviruses spread via respiratory droplets produced when an infected person sneezes or coughs and can infect people in close contact (within 6 feet). Touching contaminated surfaces before touching your eyes/nose/mouth might also lead to infection. There has been concern that COVID-19 may be in feces, so handwashing is vital.
What do we know about COVID19 in inflammatory bowel disease patients?
COVID19 has been in Europe and China prior to arriving in the US, so we can learn from our colleagues how other people with IBD have experienced COVID. There is an international registry to track outcomes of IBD patients who are infected with Covid-19. As of March 23, 2020, there have been 41 reports of COVID in IBD patients, all in adults, with 10 hospitalized and two deaths. Children <21y overall are doing well – only 1 case reported and managed on an outpatient basis (not hospitalized).
What are the current recommendations for IBD patients related to COVID-19?
IBD occurs as a result of an overly active immune system, thus many of the medications used to treat IBD suppress the immune system. Some patients have asked if they should stop their medications.
We advocate STAYING ON MEDICATIONS. If you stop medications, this could lead to an IBD flare and associated abdominal pain and diarrhea, which if significant may require a clinic or hospital visit to treat your IBD leading to unnecessary risk of COVID-19 exposure.
Medicines such as mesalamine (brand names include Asacol, Apriso, Balsalazide, Lialda, Pentasa) are all safe as they do not suppress the immune system. Steroids such as prednisone/prednisolone are judiciously prescribed so if you and your doctor have decided that you need them, then you should continue to take them as prescribed. You should not stop taking steroids abruptly as this can lead to devastating effects including a rapid drop in blood pressure. Topically administered steroids such as budesonide (Entocort and Uceris) cortenemas, hydrocortisone suppositories have minimal absorption into the bloodstream are not likely to suppress the immune system. Thiopurines (6-mercaptopurine, azathioprine) and tofacitinib inhibit the body’s immune response to viral infections. The thiopurines take months to leave the body. Thus, stopping these medications will not help in the short term and may lead to worsening disease. The biologics we currently use to treat IBD such as anti-TNFs [Cimzia-certolizumab pegol, Humira-adalimumab, Remicade-infliximab or biosimilars (Inflectra, Remsima, Renflexis) Simponi-golimumab), ustekinumab (Stelara), vedolizumab (Entyvio)] are generally safe.
Again, we recommend STAYING ON MEDICATIONS. Moreover, in many cases the effect of these medications in the body lasts for months. There is some discussion that biologic therapy for IBD in particular anti-TNF antibodies may have some protective effects potentially by blunting the immune response which leads to excess mucous production and subsequent breathing difficulties. Additionally, sometimes steroids are used to decrease mucous production in pneumonia so they may also be somewhat protective.
Additional recommendations for everyone including people with IBD in order to limit viral transmission and protect each other:
1. Practice social distancing -maintain a minimum of 6-foot distance from other people.
2. Avoid any contact with sick people – those with cough/fever/sneezing.
3. Wash your hands and use hand sanitizer frequently – sing Happy Birthday or Mary Had a Little Lamb to make sure you are washing for an adequate amount of time.
4. Avoid touching your nose, eyes and mouth.
5. Call your pediatrician or gastroenterologist in case of fever, cough or difficulty breathing.
6 . Disinfect surfaces prior to eating, especially in public areas since these viruses survive longer on surfaces
What should I do to prepare for COVID-19?
Given the potential for an outbreak within a community that may require people to stay home for a prolonged period of time, the CDC recommends that patients with chronic medical conditions and families are adequately prepared. People should have extra medication, extra medical supplies or equipment, and sufficient over the counter medications for treatment of fever or other symptoms. Families should plan to have enough household items and groceries on hand – ideally for at least 2-4 weeks. Families of immunocompromised patients should also have a plan in place for contacting healthcare providers if they become sick during this time.
For more information, the above summary was compiled with information from the following sources:
2. ESPGHAN COVID-19 Case Report Page
3. https://www.ioibd.org/ioibd-update-on-covid19-for-patients-with-crohns-disease-and-ulcerative-colitis
4. https://www.crohnscolitisfoundation.org/coronavirus/what-ibd-patients-should-know
5. https://www.cdc.gov/coronavirus/2019-nCoV/index.html
Should I postpone or reschedule my injection or infusion?
As noted, it is recommended to continue your current IBD therapy, even if this includes immunosuppression. Our infusion centers at Rady Children’s Hospital are responding to the pandemic and implementing recommended precautions, including social distancing and enhanced cleaning procedures.
What should I do if I develop symptoms of coronavirus?
Like everyone, people with IBD should follow the advice of public health officials. As always, we do not recommend use of non-steroidal anti-inflammatory drugs (e.g., NSAIDs, such as ibuprofen, Motrin, Advil, naproxen, Aleve, etc.) as these medications may trigger an IBD flare. Acetaminophen (Tylenol) is preferred for fever and pain control. If you are symptomatic and planning to seek medical care, then you should contact your pediatrician or gastroenterologist for guidance before coming to the clinic, urgent care or the emergency room.
What can I do if I am home or on quarantine?
We know that mindfulness, meditation, exercise and adequate sleep are helpful for patients with IBD and this a good opportunity to prioritize self-care. Please consider practicing meditation, mindfulness and yoga using the following resources or taking a walk outside with your dog (who can’t get corona virus) – but don’t forget about social distancing! Note many apps have free trials! YouTube is free – skip the ads (to be clear we are not endorsing that stuff) Also structure your day get up and go to bed at the same time, stay active and get your learn on!
Yoga to Stay Active
Yoga for Teens: 9 Poses for Calming http://www.yogjournal.com/poses/yoga-by-benefit/calm/start-stress-free-9-poses-beat-back-school-jitters/
10 Poses to Quiet Anxiety http://www.huffingtonpost.com/2013/05/19/yoga-for-anxiety-10-poses_n_3281986.html 10 Yoga poses for instant Energy – FIT from WebMD http://fit.webmd.com/teen/move/slideshow/slideshow-yoga-for-energy
Easy Yoga Poses for Teens – Youtube
http://www.youtube.com/watch?v=ph-zDXZHfQE
Introducing Yoga into the Lives of Teens http://www.lianalowenstein.com/articleProfYoga.pdf
User Friendly yoga and meditation
https://www.youtube.com/user/yogawithadriene
Yoga for Beginners with Adrienne
School-Age kid-friendly Yoga and Mindfulness
https://adventuresofsuperstretch.com
Mindfulness Apps
https://apps.apple.com/us/app/breathe2relax/id425720246 https://apps.apple.com/us/developer/omg-i-can-meditate-inc/id920161005
For Parents: How do I talk with my child or teen about COVID-19?
NPR
Just for Kids: A Comic Exploring The New Coronavirus A resource for children about coronavirus, what it is and how to protect oneself.
National Association of School Psychologists
Talking to Children About COVID-19 (Coronavirus): A Parent Resource A resource for parents on how best to talk to children about the coronavirus.
Psychology Today
How to Talk to Your Kids about COVID-19. 7 practical steps for helping your children feel safe, not scared. https://www.psychologytoday.com/us/blog/hope-resilience/202003/how-talk-your-kids-about-covid-19
New York Times
Talking to Teens and Tweens about Coronavirus
This article details advice from experts on how parents can help teens be prepared and have the right information about the coronavirus.
Best Wishes and Stay Safe,
Your Inflammatory Bowel Disease Team at Rady Children’s Hospital
