COVID-19 in GI: 1 year later
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In March 2020, there was so much we did not know about COVID-19 and how it would impact the world of gastroenterology. Were our patients at risk? How long would endoscopy be disrupted? When will things be normal again?
More than a year later, we are still in the middle of the pandemic. But thankfully, we have a few more answers than we did a year ago.
We had a lot of concerns initially that our patients with inflammatory bowel disease — who are often immunosuppressed — might be at increased risk for more severe COVID. However, for the most part that fortunately has not played out.
There appears to be no increased risk for severity with the biologics, and in fact, in some analyses it looks like medications like ustekinumab are associated with decreased severity of COVID when it happens. If we have a patient who is diagnosed with COVID-19, it is probably worthwhile to taper that patient’s steroids more quickly and maybe hold their immunomodulator. But I would still practice medicine the way I usually do, meaning if a patient with IBD needs something, give them what they need if they don’t have an active infection.
Until 15 months ago, we did not know anything about this virus, yet we have already seen so much innovation and learned so much. The CDC guidelines are 250 pages long and there are already randomized trials on multiple therapies. The body of knowledge that has accumulated in that time is impressive.
In GI, we have seen the growth of valuable registries — such as SECURE IBD — that have become quite robust. These registries have thousands of patients and have a significant amount of data behind them (covidibd.org). While there is always a risk for some bias because these resources are based on whoever is reporting the information, it is great to see these resources grow.
To catch up on the amount of endoscopy we missed in 2020, we must have an all-hands-on-deck mentality. We must remain vigilant and work hard to get our patients in for screening.
In some cases, if they need to be screened with alternate methods, like Cologuard (Exact Sciences), that’s still a great thing. At least you are getting some coverage.
In many ways it was a lost year. Everybody’s memory seems to just subtract 2020 and it becomes a forgotten year. We must stay on top of things and ensure that our patients do not fall behind.
As medical providers, we are another touch point for patients. We are not infectious disease specialists, we are not COVID experts, but GIs should be a trusted resource for patients. It is incumbent upon us to have a general sense of where things stand and where things are going with the pandemic.
Everyone is supposed to have a primary care physician, but it does not always work that way. We might be their only medical contact, and it is important for us to be a trusted source of information. That includes when patients ask us about the COVID-19 vaccines, which appear to be effective and safe.
Lastly, we also need to remember just how tough this last year has been on everyone, and not just the patients. This virus has had an impact on all facets of medicine, and the toll it has had on the mental health of patients, providers and allied health staff has been tremendous. We need to keep in mind the whole process of empathy and just realize that we have all been through it, but that it affects some of us more than others.
Overall, we should be hopeful, and we should be sending that message to our patients. It has not gone away completely, but in the second half of the year, things will feel a lot more normal than they do right now.
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