Crohn’s Disease and COVID: Fact Versus Fiction
Everything you need to know about how the virus does (and doesn’t) impact your healthcare.
Let’s face it, life in the time of COVID is no joke—for anyone. But navigating this new normal while dealing with a chronic disease like Crohn’s is enough to make you want to pull up the covers indefinitely—skipping doctor appointments, missing meds, and avoiding necessary bloodwork altogether. Basically, everything you should NOT be doing. For the approximately 780,000 Americans living with this inflammatory bowel disease, symptoms like persistent diarrhea, abdominal pain, rectal bleeding, and fatigue can escalate to severe levels without treatment.
While it’s totally understandable to have concerns about COVID risks and complications when you have Crohn’s, letting your fears get in the way of your regular care can wreak havoc on your system and make the condition worse. “Staying on top of your treatment plan can prevent flares, hospitalizations, invasive procedures, surgeries, and complications from this disease,” says Ghazaleh Aram, M.D., a gastroenterologist with Gastro Health-Virginia. Here, we’re taking a look at things we've been hearing patients say about Crohn's treatment during COVID to help separate fact from fiction.
People with Crohn’s should skip doc visits right now.
False. “Crohn's patients need regular care for two reasons: one is to assess whether they are having signs and symptoms of ongoing intestinal inflammation; the other is to monitor the effects and side effects of medications they may be on,” says Maria Abreu, M.D., gastroenterologist and director of the University of Miami Health System Crohn's & Colitis Center. “Some patients who are quite sick with diarrhea, weight loss, and abdominal pain may need frequent visits once a month,” she says.
If you’re feeling well, missing a routine maintenance appointment is OK.
False. While patients who are on a stable treatment plan for years and doing very well may only need to be seen about twice a year, that doesn’t mean it’s OK to skip those appointments, Dr. Aram says. “Remaining compliant with treatment is extremely important; we need to make sure patients are staying up to date with all of their routine vaccinations, labs, and other general healthcare with their primary doctors,” she says. “Also, we ask them not to wait until they run out of meds to make an appointment. Sometimes they may need to come in every few months if they’re having symptoms and their meds need to be adjusted.” Not to mention, patients also need lab work at least every six months to make sure there’s no inflammation in the intestine.
I’m more likely to have a flare if I am stressed about going to the doc.
True & False. “Stress in general has been known to contribute to a flare regardless of what the cause may be,” Dr. Aram says. While the angst about seeing your doc during COVID won’t necessarily put you at an increased risk for a flare compared to any other stressor, it is very important to get all that agita under control, she says. Having an overall sense of calm can help keep Crohn’s symptoms in check, so embrace meditation, go for long walks, exercise—do whatever you need to do to encourage Zen.
There’s nothing my doc can tell me in person that he can’t diagnose/tell me via Zoom.
False. While telemedicine can be helpful when patients have general questions about their care, virtual appointments can’t replace in person visits for patients with Crohn’s. To find out what’s going on internally, your doctor may need to do an abdominal or rectal exam so she can make recommendations for the right prescriptions and treatment plans, Dr. Aram says. And there are particular times when going to the doctor’s office are even more important—if you’re experiencing pain or a new fistula (ulcers that tunnel through the intestine and into the surrounding tissue), Dr. Abreu says.
I am more likely to catch COVID than another patient.
False. “There is no evidence that patients with Crohn’s are more susceptible to contracting COVID-19,” Dr. Abreu says. A study published in Crohn's & Colitis found that patients with inflammatory bowel disease (IBD), including those on immunosuppressant medications, were not contracting COVID at a higher rate than those who did not have IBD. And most cases of COVID in patients with IBD were mild. So basically, if you have Crohn’s or another IBD, you should be following the same safety protocols—hand washing, minimizing contact with others, etc—as the rest of the population.
Catching COVID will make my Crohn’s worse.
Possibly, but the jury is still out. “It seems patients with IBD—Crohn’s or ulcerative colitis—have more diarrhea from COVID-19 than those who don’t have IBD. Whether the increase in diarrhea is truly a flare is not known,” Dr. Abreu says. However, a 2020 study in Gastroenterology found corticosteroids, which are commonly prescribed to treat IBD, at high doses (usually defined as greater than 20mg), have been shown to make people more susceptible to complications from COVID-19. If you are on a corticosteroid, talk with your doctor, who may shorten the length of time on the medication or opt to replace it.
Crohn’s & COVID Risk: Crohn's & Colitis. (2020). “The Risk of SARS-CoV-2 in Immunosuppressed IBD Patients.” academic.oup.com/crohnscolitis360/article/2/2/otaa026/5820482
Corticosteroids & COVID Complications: Gastroenterology. (2020). “Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry.” gastrojournal.org/article/S0016-5085(20)30655-7/pdf