What You and Your Child with IBD Should Know about COVID-19
We have been receiving many questions about how COVID-19 (the Novel coronavirus) might impact our patients with IBD (inflammatory bowel disease), and have collected the following recommendations and points to consider.
*** If you are sick and need immediate attention call 911 or call Health Link at 811 ***
Returning to School
Alberta K-12 students will return to school daily at the beginning of the new school year. We know how complicated and confusing these times are, and imagine that this situation is creating some stress.
We have researched this topic and have reached the following conclusions, but we do respect that in many ways this is a personal decision and each family may see this differently (whether there is a family member with IBD or not).
According to Crohn’s and Colitis Canada, if your child with IBD is in remission and otherwise healthy, your child should follow the local public health guidance regarding returning to school. This includes children on immunosuppressives or biologics. In general, children/adolescents who are in remission and feeling well may return to school.
There is uncertainty as to the risk of high-dose steroids (more than 0.5 mg/kg/day of prednisone equivalent dose, or more than 20 mg per day), severe active inflammation, and malnutrition in children/adolescents with IBD. Consequently, we recommend a more cautious approach until more data become available to help guide decisions.
Please read the full article on Crohn and Colitis website for more guidance.
We value the importance of learning and maintaining some normalcy (while not exposing ourselves and our children to additional risk). We advise our patients to follow provincial guidelines if returning to school.
You can find the official guide for parents here.
SOME IMPORTANT POINTS
MAKING AN INFORMED DECISION
These recommendations are general guidance that we provide to our patients. When making a decision regarding returning to school this year, also consider your individual/family situation and any other factors that may affect the decision.
Families with children receiving steroids or multiple IBD medications (beyond Infliximab/Remicade or Adalimumab/Humira, which are often given with Methotrexate or Azathioprine/Imuran) should discuss the risks and benefits of returning to school with their IBD physician.
If you have questions about your specific situation, please discuss them with your physician.
COVID-19 and IBD
COVID-19 in Children with IBD. There have been 625 reported cases between ages 0-19 years up to March 18th, 2021 from international pediatric IBD centers. There have been no reported deaths.
COVID-19 in Adults with IBD. There have been a total of 4971 COVID-19 cases reported amongst adults from 13 different countries. There have been a reported 91 deaths amongst adults with IBD infected with COVID-19.
Given the number of people living with IBD, these numbers remain reassuring. However, we still strongly recommend our patients and families to observe strict hand washing, social distancing and self isolation where needed according to the Alberta Health Services guidelines.
What We Recommend
The risk for transmission in Canada, and specifically in Alberta, remains low. However, this is a dynamic situation and you need to follow updates from the media/Alberta Health Services (AHS). For the most up-to-date details from AHS, please visit https://www.albertahealthservices.ca/topics/Page16944.aspx
Please use the AHS Self-Assessment Tool to see whether you need to be tested for COVID-19
Don't stop your IBD medications without consulting your doctor. Your IBD is likely more of a concern than getting sick from COVID-19.
COVID-19 does not travel through the air over long distances or times; however, it can spread person-to-person by larger droplets, like from a cough or sneeze, or by touching contaminated objects or surfaces, then touching your eyes, nose, or mouth.
It’s important to remember that while the risk of becoming severely ill with COVID-19 is higher than with influenza, you can still protect yourself, your family, and those who are vulnerable in our communities by using the same practices recommended for protecting against all respiratory illnesses.
The best thing to do are the same instructions for the general population – common sense and good hygiene are the best measures:
Avoid touching your face, nose, or mouth with unwashed hands
Use elbow bumps or waves instead of handshakes to greet
Avoid close contact with people who are sick
Clean and disinfect surfaces that are frequently touched
Stay at home and away from others if you are feeling ill (especially postponing visits to friends or family in hospitals or long term care facilities)
Call Health Link, at 811 if you are concerned about your symptoms or believe you may be at risk.
COVID-19 Vaccination and IBD
The Government of Alberta has announced that individuals with underlying health conditions 16 years and over are eligible to receive the COVID-19 vaccine under the Phase 2B. This includes patients with IBD who are on immunomodulator including Imuran (Azathioprine), Methotrexate and Biologics [Infliximab (Remicade and its biosimilars), Adalimumab (Humira and its biosimilars), Vedolizumab (Entivio) and Ustekinumab (Stelara)]. We endorse the strong opinions of Crohn’s and Colitis Canada, The Canadian Association of Gastroenterology, and The International Organization for the Study of IBD (IOIBD) and believe that it is safe and important to receive the vaccination, even while on these treatments. Experience from around the world has shown that there is no more than expected adverse effects from receiving any of the approved COVID19 vaccinations while on treatment. We believe it is also safe to receive all the COVID19 vaccines that are approved by Health Canada (Pfizer, Moderna or Astra-Zeneca). Your IBD team does not have a preference for one vaccine over the other – take the first one you are offered.
The only time we would ask that you postpone your vaccination, is if you are currently on high dose corticosteroid such as prednisone for a disease flare up. Data are not clear on this buy you may not get as much protection from the vaccination while on high dose corticosteroid.
As well, under Phase 2C, Care providers of children under 16 years of age with Inflammatory Bowel disease on immunomodulator and biologic therapy are also eligible to receive their vaccine.
These vaccines are not yet approved for children below the age of 16 but once they are we anticipate a similar recommendation to get the vaccine as soon as you can.
If you have recently returned to Canada (within 14 days) and have fever or respiratory symptoms, or if you believe you may be at risk for COVID-19 for any reason and you are ill, please contact Health Link at 811 for advice.
For more information specific recommendations on IBD patients, you can visit the Crohn’s and Colitis foundation website (including a section for children with IBD): https://www.crohnscolitisfoundation.org/what-ibd-patients-should-know-about-2019-novel-coronavirus-covid-19
We know these are stressful times and hope this information will help you manage this stress. We are here to care for you at all times! If you have any specific concerns or questions please contact us using the phone numbers you have.
Your EPIC team
Last Updated: August 6, 2020