Are You at Risk?

IBD Patient Risk

People with IBD who are not using imunosuppressive medications, are not malnourished, and do not have severe active inflammation are currently believed to be at the same risk of infection and complications from COVID-19 as the general population.

Listed below are the details pertaining to the three sections:

IBD PROFILE Under 65 years old and NOT TAKING immunosuppressive and biologic medications, and

immunosuppressive and biologic medications, and IBD in remission, no significantly active inflammation

Not malnourished

No comorbidities (respiratory, cardiac, hypertension, diabetes) RECOMMENDATION

Follow public health guidelines for general population (physical distancing1, hand hygiene, self-monitoring, etc.)

IBD PROFILE Age 65 years or older and using immunosuppressive medications 2 :

: Age less than 65 years old, and TAKING immunosuppressive medications 2 : Immunomodulators: azathioprine (Imuran), 6-mercaptopurine (Purinethol), methotrexate Anti-TNF biologics: infliximab (Remicade ® , Inflectra ® , RenflexisTM), adalimumab (Humira ® ), golimumab (Simponi ® ) Anti-IL12/23 biologics: ustekinumab (Stelara ® ) Anti-leukocyte migration biologics: vedolizumab (Entyvio ® ) AJAK inhibitor small molecules: tofacitinib (Xeljanz ® )

immunosuppressive medications : RECOMMENDATION

In addition to following public health guidelines for general population (physical distancing1, hand hygiene, self-monitoring, etc.):

Avoid in-person meetings

If possible, work at home and hold meetings with virtual technology

If not possible, talk to your physician, and discuss options with your employer for modified duties 3

Use services for vulnerable people (grocery store times for vulnerable populations, laboratory or health care services for vulnerable populations, etc.) in order to avoid contact with other people In addition to followingfor general population (physical distancing, hand hygiene, self-monitoring, etc.):

IBD PROFILE

65 years or older, or under 65 years AND Oral or intravenous systemic corticosteroids more than 20 mg/day (or 0.5 mg/kg for children) prednisone equivalents: Prednisone (Deltasone) Methylprednisolone Hydrocortisone (Hydrocort, Cortate)

Moderate or severely active inflammation (new diagnosis or recent flare)

Moderate or severe malnutrition

Requirement of parenteral nutrition (intravenous nutrition through a central line) RECOMMENDATION

In addition to following public health guidelines for general population (physical distancing1, hand hygiene, self-monitoring, etc.): SELF ISOLATE 4

Refer to considerations for other family members and people who live with high risk individuals5 In addition to followingfor general population (physical distancing, hand hygiene, self-monitoring, etc.):

NOTES:

PHYSICAL DISTANCING means: Keep a distance of 2 metres from the nearest person

If possible, cancel group events and hold meetings virtually rather than in-person

Avoid people who are sick

Do not shake hands, hug, or engage in physical contact with other people, especially if they are sick

Practice good hand hygiene. Wash your hands with soap and water regularly after social contact, before meals, and often in between, or use hand sanitizer that contains at least 60% alcohol when soap and water is not available. Avoid touching your face. Cough into your sleeve.

Please note that not everyone is at the same risk of serious COVID-19 disease. For example, children and adolescents are more likely to have mild symptoms of COVID-19. We don’t know whether children and adolescents on immunosuppressive medications have a higher risk of COVID-19 complications. Therefore, we have considered everyone on immunosuppressive medications to be vulnerable for serious COVID-19 disease.

ESSENTIAL WORK AND SERVICES . People working in essential services in the Medium Risk group (such as health care providers) should consider balance the public need for these essential services with the higher risk of contracting COVID-19. Further guidance can be provided by your local public health authority.

SELF-ISOLATION means: stay at home and monitor yourself for symptoms, even if mild, for 14 days

avoid contact with others

If you have no symptoms of COVID-19, you can still go outside for: fresh air a run a bike ride to walk the dog

Refer to our guidance for more information on how to self-isolate at home when you may have been exposed and have no symptoms .

FAMILY MEMBERS AND ROOMMATES . Considerations for other family members and people who live with high risk individuals. In general: avoid being in close proximity with other people, who might give your family member COVID-19, resulting in transmission to you

Try to avoid in-person meetings

Try to work from home. If not possible, speak to your employer about physical distancing at work

Use services for vulnerable people (e.g. special grocery store times, pharmacy delivery, etc.)

Clean your residence as best as possible to avoid transmission of the virus. Instructions for disinfecting your residence are available from the Centers for Disease Control and Prevention

While doing these activities, always maintain a distance of at least 2 arms-length (approximately 2 metres) from others.

Refer to our guidance for more information on how to self-isolate at home when you may have been exposed and have no symptoms.

Watch the 6-minute video below for this breakdown of level of risk to patients from lowest to highest risk level.





IBD Medications

If you are on immunosuppressive medications, you may be at increased risk for infection and serious complications of COVID-19.

Immunosuppressive and biologic medications include:

Steroids: prednisone (Deltasone), methylprednisolone, hydrocortisone (Hydrocort, Cortate)

prednisone (Deltasone), methylprednisolone, hydrocortisone (Hydrocort, Cortate) Immunomodulators : azathioprine (Imuran), 6-mercaptopurine (Purinethol), methotrexate

: azathioprine (Imuran), 6-mercaptopurine (Purinethol), methotrexate Anti-TNF biologics : infliximab (Remicade ® , Inflectra ® , Renflexis TM ), adalimumab (Humira ® ), golimumab (Simponi ® )

: infliximab (Remicade , Inflectra , Renflexis ), adalimumab (Humira ), golimumab (Simponi ) Anti-IL12/23 biologics : ustekinumab (Stelara ® )

: ustekinumab (Stelara ) Anti-leukocyte migration biologics : vedolizumab (Entyvio ® )

: vedolizumab (Entyvio ) JAK inhibitor small molecules: tofacitinib (Xeljanz®)

The following IBD treatments do not suppress your immune system:

5- aminosalicylates (5-ASA's) : mesalamine, mesalazine (Asacol ® , Mezavant ® , Pentasa ® , Salofalk®), sulfasalazine (Salazopyrin ® )

: mesalamine, mesalazine (Asacol , Mezavant , Pentasa , Salofalk®), sulfasalazine (Salazopyrin ) Locally acting steroids : budesonide (Entocort ® ), budesonide MMX (Cortiment ® ), steroid enemas

: budesonide (Entocort ), budesonide MMX (Cortiment ), steroid enemas Enteral nutrition (formula feeds) or dietary therapies

(formula feeds) or Probiotics

Watch the 4-minute video below to learn more about the safety of medication use during COVID-19.





For more information, please visit our COVID-19 Medications and Treatment page.

Older Adults and Vulnerable Groups

People at higher risk also include older adults, people with an underlying medical condition (e.g., heart disease, hypertension, diabetes, chronic respiratory diseases, cancer), or having a compromised immune system from a medical condition or treatment (immunosuppressive medications). More information on vulnerable populations are available on the PHAC website.

Watch the 8-minute video below to learn more from experts about risks of COVID-19 and special considerations for people with IBD.





Reopening of Schools and the Economy

Some provinces and territories are starting to re-open the economy, including stores, schools, and outdoor activities. Expert guidance has been developed for different age groups and are meant to help you decide whether to continue self-isolation, or to start engaging in activities outside of your home.



Please click here for the recommendations on returning to school and work.