This evening, the Prime Minister has issued specific COVID-19 guidance for the 1.5million most vulnerable people living with chronic illness in the UK. This advises ‘shielding’ measures to reduce the transmission of COVID-19 infection and the risks from COVID-19 disease. Under category 5 are those patients with chronic illness requiring immunosuppressant medication.
The instruction for ‘shielding’ is an enhanced form of self-isolation. To compensate individuals for these necessary restrictions on personal freedom, governmental support will be provided. There is therefore a careful balance to strike to ensure we get the risk stratification right for the approximately 500,000 people living with IBD across the UK today. On the one hand, we do not wish to place restrictions on all IBD patients on medical therapy. On the other, we don’t want the most vulnerable to miss out on valuable support during this challenging period.
To address this, many colleagues from IBD centres across the UK have helped draw up the enclosed risk assessment. This consists of three levels of risk:
- Higher risk: these patients are instructed to following ‘shielding’ guidance
- Moderate risk: possible increased risk from COVID-19, to follow enhanced social distancing
- Lower risk: as background population
We recognise this assessment of risk is imperfect and will be inherently dynamic. We fully expect some patients to move between risk groups during this 12 week period. Data on the impact of both IBD and its treatments on the risks and consequences of COVID-19 infection are very limited. This risk assessment acknowledges this uncertainty. We have been careful to prioritise those risk factors where evidence in COVID-19 outcomes exists (particularly older age and co-morbidity). National and international efforts will capture as much data as possible during the next phases of the pandemic to help inform updated guidance.
The risk grid is now in the public domain. Crohn’s and Colitis UK and the BSG executive have been working closely together to develop a clear messaging strategy for patients. We have had long discussions about how best to identify those patients in the higher risk strategy. We are very aware the limitations of current registries / databases and the huge pressures that all centres are currently under.
Notwithstanding this, we now ask for your help:
- Where available please use existing electronic records, registries, and databases to identify higher risk patients
- Collaborate with IBD BioResource and IBD Registry efforts to help identify patients
- Respond as best possible to patients self-identifying as higher risk
- Collate a list of unique patient identifiers as best possible from #1, #2 and #3 to prepare for submission.
The IBD COVID-19 working group has prepared a detailed consensus document. This addresses 1) COVID-19 and IBD 2) changes to primary and secondary care practices 3) general considerations regarding IBD medicines 4) therapy specific considerations and 5) service considerations.
We appreciate that this is a hugely demanding period of time for us all, and that the pressures we face are set to multiply in the coming weeks and months. This piece of work has been undertaken with very tight time-tabling set by other agencies. We have done our very best to provide clear and pragmatic guidance to allow us to provide as good care as possible to our patients.
Cathryn Edward, BSG President
Charlie Lees on behalf of the UK COVID-19 working group