COVID-19 guidance in chronic diseases: a need to reach across the borders of the traditional medical specialities

• Published in: Frontline gastroenterology 2020-07, Vol.11 (4), p.332-333
• Main Authors: Thomas, Tom, Chandan, Joht Singh, Verma, Ajay Mark, Cockwell, Paul, Vaux, Emma, Bhala, Neeraj
• Format: Article
• Language: English
• Subjects: Chronic illnesses; Coronaviruses; COVID-19; Dermatology; Gastroenterology; Infections; Inflammatory bowel disease; Kidney diseases; Letter; Mortality; Pandemics; Patients; Public health; Rheumatology; Risk factors; Society
• ISSN: 2041-4137; 2041-4145
• DOI: 10.1136/flgastro-2020-101515

Both BSR and BAD guidelines include chronic kidney disease (CKD) in their risk stratification guidance for identifying high-risk patients who would benefit from ‘shielding’ and early identification for self-isolation by the NHS.2 3 In contrast, BSG guidelines for such patients with IBD are centred around disease activity and associated respiratory/cardiometabolic comorbidities without mention of CKD.1 Current estimates place 20% of the at-risk population (as per Public Health England guidelines4) for COVID-19 in the UK, of which around 31.5% are less than 70 years with at least one underlying condition, such as CKD.5 Moreover, in a recent UK retrospective study of more than 80 000 persons, IBD was associated with increased risk of CKD, with hazard ratios highest among younger patients.6 It is important to acknowledge that the risk conferred by CKD in the setting of UK COVID-19 infection remains unknown, given the rapidity of the evolving risk factor data.7 However, given that mortality in COVID-19 is attributable to cardiometabolic and pulmonary issues and also multiple organ failure,8 patients with CKD do likely represent an at-risk population. [...]the most recent ISARIC data (predominantly from UK sites) suggest CKD prevalence of more than 9.5% of 1123 suspected or proven COVID cases.9 Formulating guidelines at this time is an exceptionally difficult task given the rapidly evolving knowledge base surrounding outcomes in a pandemic and the BSG guidance for high-risk grouping leads the international IBD arena.10 Nevertheless, we would suggest erring on the side of caution when evaluating risk factors, such as CKD, for incorporation into guidelines. Estimating excess 1- year mortality from COVID-19 according to underlying conditions and age in England: a rapid analysis using NHS health records in 3.8 million adults. 6 Vajravelu RK, Copelovitch L, Osterman MT, et al.