We read with interest the Correspondence from Ping An and colleagues1 describing their efforts to prevent coronavirus disease 2019 (COVID-19) in patients with inflammatory bowel disease (IBD) in Wuhan, China. The team reported that of the 318 patients who were registered with IBD during the COVID-19 pandemic in the Wuhan region, only five patients were admitted to hospital because of IBD, and none were reported to have COVID-19. This information was obtained by use of social media and online educational materials, as well as by contacting 100% of their IBD population.
In the UK, this approach would prove difficult, especially as our understanding of all at-risk groups in this pandemic evolves. Indeed, the National Health Service, in conjunction with the British Society of Gastroenterology (BSG), relied on individual health-care trusts to highlight patients at high risk with IBD so advice could be delivered by post regarding shielding and stringent physical distancing.2
A further challenge for the UK is the large difference in IBD incidence and prevalence between China and the western world. The age-standardised prevalence of IBD in China is 136·2 (95% uncertainty interval 125·4–147·4) per 100 000 population compared with 449·6 (420·6–481·6) per 100 000 in the UK;3 the prospect of protecting this population from COVID-19 is likely to be a much greater challenge.
With concerns regarding a second wave of COVID-19 cases, it is imperative that we protect the most sick and susceptible in our society. An and colleagues1 show the importance of IBD registries and the ability to contact at-risk groups via innovative means such as social media and the internet. These methods can result in rapid development of virtual telephone clinics, but they still ultimately require people to run them. The UK and other countries should therefore urgently seek to improve their IBD digital resources and staff resources to potentially reduce the burden of further waves of COVID-19.
Of further interest, An and colleagues1 also reported measures to avoid immunosuppression, including ceasing infliximab infusions in exchange for aminosalicylates or thalidomide. BSG guidance suggests that patients should continue on their current medications, including infliximab, as active disease remains the biggest risk to a patient with IBD.4 Furthermore, the use of thalidomide for patients with IBD in the UK is uncommon, with a systematic review highlighting that there is insufficient evidence for its use in IBD and that it is potentially associated with adverse effects.5 It would therefore be of interest to see the long-term implications of this practice to guide future health-care systems in their approach to their patients with IBD at risk from COVID-19.
As further evidence accumulates, our understanding of COVID-19-related risks in IBD populations globally will improve. We could potentially be overprotecting patients with IBD, but overprotection is better than undue risks given the current uncertainties.
Acknowledgments
MJB reports grants, travel support, conference fees, and honoraria from Vifor International, grants, travel support, and conference fees from Tillotts Pharma, grants from National Institute for Health Research (NIHR) UK Research, NIHR HTA funding stream, and NIHR Health Foundation, outside the submitted work. All other authors declare no competing interests.
References
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