Important update from the BSG VP Hepatology and the BASL and BSG Presidents
Recent government announcements have indicated that the liver patients to be included in the ‘shielding group’ should be those receiving immunosuppression for a liver transplant or for autoimmune hepatitis. Government is mandating 12 weeks self-isolation for these groups of people.
The consensus view in our specialty acknowledges the higher risk for patients with decompensated cirrhosis, who are not included in the shielding cohort. We recommend that these patients with decompensated cirrhosis should be advised to adhere strictly to social distancing measures in order to protect themselves. Clinicians will not however have to identify this group to their GPs for coding as COVID at RISK. This is reflected in the updated Liver Risk Grid issued by BSG and BASL.
During the COVID-19 outbreak the NHS is doing everything it can to keep patients with liver disease safe. However, risks relate not just to the infection itself, but also to the significant disruption of routine care due to the pandemic.
Information from China and Italy suggest that hospital admissions for non-COVID-19 illness can lead to further spread of infection. Changes in routine care are now required to keep vulnerable patients with liver disease out of hospital as much as possible. However, changes to the way care is delivered for patients with liver disease must be balanced against the risks of undertreating them.
The impact of immunosuppression on the severity of COVID-19 disease remains unclear. Factors associated with more severe disease are older age and presence of other medical conditions.
‘Social distancing’ and ‘self-isolation’ are measures to reduce spread within a population and to protect high risk groups. These are also an understandable source of anxiety for patients with liver disease. Government guidance in this area is dynamic and all people in the UK should follow up to date recommendations from the government.
The government recommends social distancing for all in the UK, but this guidance defines a ‘high-risk’ group of patients with liver disease who are advised to take additional measures and go into self-isolation.
Box 1. Patients with liver disease in high risk group*
- Patients aged ≥70years of age
- Patients with other co-morbidities
- Cardiac disease
- Respiratory disease
- Diabetes Mellitus
- All recipients of a liver transplant taking immunosuppression
- Patients with autoimmune hepatitis taking immunosuppression.
Patients with decompensated liver cirrhosis have increased risk and we recommend they adhere strictly to social distancing measures in order to protect themselves.
*There may be others not in the above groups felt by the treating physician to also be at higher risk and these should be assessed on a case-case basis.
Drafted on behalf of British Society of Gastroenterology and the British Association for the Study of the Liver