This morning the World Health Organization raised its threat level to “Very High” its top-level, global markets are in continued free-fall, and countries are scrambling to prepare or cope. Time to panic? Definitely not. However, there has probably never been a better time to get organized regarding your IBD or other chronic health conditions than right now, however, this does not mean that you need to up-end your life or be frantic. The largest threat to people with chronic health conditions may not be just the virus itself, but how the (likely pandemic) could affect our way of life. Many of us depend on medications, specialized diets, lifestyle interventions, and yes most importantly our healthcare systems.

I’ve been watching this closely for a few weeks and after lots of research, following prominent GIs on twitter and chatting with astute friends (professionals in the field who are more-expert-than-me in the area of infectious disease), I’ve decided to share what I have learned. I welcome anyone’s comments, corrections, or insight. Here are 3 big considerations that I have been thinking about and gathered up to now:

> Immunosuppression

The mortality rate of those with COVID-19 who are under the age of 70 years old appears to be much lower than the 2% number reported. For some, the virus can be mild. However, most health experts agree that if you are immunocompromised, i.e you are taking Prednisone, Imuran, 6mp, Methotrexate, etc. then it’s possible you are at a higher risk of contracting the virus. Some prominent GIs like David Rubin, MD (chief of gastroenterology at U-Chicago) state that the biologics (Remicade, Humira, Entyvio, Stelara, Xeljanz, etc) may pose a lower risk due to the fact these medicines usually increase fungal and bacterial infections but not viruses. If you were to become infected with COVID-19 its possible your physician will instruct you to discontinue your medication depending on your unique circumstances. Do not change anything unless you speak to your physician. If you are on budesonide or mesalamine most believe that these medicines will have a nominal impact on virus severity or likeliness of contracting it given their local action in the gut, but again this is something to discuss with your healthcare provider. There is at least one report out of China suggesting that a person who was immunocompromised due to receiving a kidney transplant was able to recover normally from the virus, but there is little to no information out there right now. If I was immunocompromised, and while some of the advice listed here may be overkill, I’d be paying extra-close attention to these recommendations: https://theprepared.com/wuhan-coronavirus/ I’d be considering which of these recommendations are realistic for me and which are necessary. Lastly, if you have not gotten your flu shot then GIs are still recommending you do this. The bottom line is that we don’t understand how COVID-19 affects those who are immunocompromised but the above information is the best guess.

> Access to specialized food, medications, and supplements

Many of us with IBD (and every single member of our program) eat healthy whole-food diets. We tend to eat a lot of fresh foods that need to be replenished with regularity. It is anticipated that this may become disrupted on a supply level (less likely) or if self-quarantine (more likely) is warranted. Considerations to have extra non-perishables may be a good idea. Keep in mind some canned food contains a lot of easy to prepare soluble fiber that you can continue to emulsify and feed your microbiome: beans, artichoke hearts, sunchokes, palm hearts, other fruit etc. Canned wild salmon is also easy to find for protein and is a good source of omega 3. And I might add on a lighter personal note that conveniently with spring right around the corner I’m going to be restarting my veggie garden (I’m just not willing to risk forgoing fresh veggies, and it seems like a relaxing at-home activity). Lastly as listed all over, given many of our medications are manufactured in China (and for other reasons too) it is possible that medications will be more difficult to access. Make sure you have a 3 months supply of any at-home meds – and this goes for supplements too.

> Access to healthcare

Some are suggesting that even healthcare delivery systems in industrialized countries may become overwhelmed. This is yet to be determined but this might mean longer wait times, limited hospital beds, and difficulty accessing care. Sadly there is not much any of us can do about this, except to keep in extra close contact with our medical and health teams, accept the extraordinary nature of the situation and to get organized, stay disciplined, and avoid behaviors that we know will exacerbate our IBD. If there was ever a time to stick to your lifestyle protocol, to be kind to yourself, and learn about your disease then now is the time.

That’s all for now and I hope that was helpful for you all. Let’s remember the importance of our mental health and weigh our needs for human connection with the precautions we are taking. There are no perfect answers here. It’s already difficult enough having IBD or another chronic condition by itself – but then again that means we are more experienced than most with adverse circumstances. We know what it’s like to be sick and we know how to prepare beforehand. Let’s find our resilience, our strength, and our unity in the face of the events that are unfolding around us.

Any of you are more than welcome to reach out and again I welcome your comments.

In finding health,

Andrew