key: cord-258930-60yn4hg7 authors: D’Amico, Ferdinando; Peyrin-Biroulet, Laurent; Danese, Silvio title: Inflammatory bowel diseases and COVID-19: the invisible enemy date: 2020-04-16 journal: Gastroenterology DOI: 10.1053/j.gastro.2020.04.032 sha: doc_id: 258930 cord_uid: 60yn4hg7 nan A new beta-coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was recently identified in Wuhan, China 1 . The virus proved to be transmitted from person to person and to be highly contagious, causing the onset of a pandemic in a short time 2 . SARS-CoV-2 infection can be asymptomatic or cause coronavirus disease 2019 (COVID- 19) , which mainly includes respiratory and gastrointestinal symptoms and in severe cases it can be fatal 3 . Several measures have been taken to prevent the further spread of the virus, including the use of masks, gloves, and disinfectants, and restrictions to avoid traveling to risk areas and having close contact with other people 4 . Moreover, many countries have imposed quarantine and lockdown of schools and all non-essential activities 5 . In this context, particular attention should be paid to patients treated with immunosuppressive drugs or biologics, as they have a higher risk of infection 6 . Other risk factors identified for the development of COVID-19 are the elderly age, the presence of chronic diseases such as hypertension and diabetes, some professional categories (e.g. health personnel, policemen, and supermarket clerks) and exposure to infected people 4 . In a recent work published in Lancet 7 , precautions taken by a Wuhan center for inflammatory bowel diseases (IBD) were reported. All biological and immunosuppressive treatments were discontinued, visits in person were replaced by online consultations, and 318 patients were daily recommended to wash their hands frequently, to reduce the time spent outside the home and to use masks outside the home 7 . It is important to underline that a relevant percentage of evaluated patients had risk factors of infection: chronic diseases (15.4%), immunosuppressive agent therapy (11.0%), elderly (10.4%), high-risk professional categories (7.5%), and biological therapy (6.3%) 7 . Recommendations were followed by 90% of subjects and no cases of COVID-19 infection were detected after a period of approximately 2 months 7 . Finally, the authors stressed the importance of daily warnings and recommendations, which favored a wide adherence of patients and contributed to avoid viral contagion 7 . The COVID-19 health emergency has forced physicians to deal with problems never before and to take quick decisions in consideration of the urgent needs. In addition, the limited knowledge regarding transmission modalities, clinical symptoms, and natural history of the virus infection has made the management of IBD patients and the adoption of preventive measures even more complex and difficult. Currently, the main source of transmission seems to be mediated by air droplets 8 , although ever-increasing evidence supports the possibility of a fecal-oral infection 9 identify the best way to prevent COVID-19 in IBD patients, to understand whether IBD patients are at increased risk of being infected, and to clarify whether they should be considered as a high-risk population as well as the impact of IBD-related drugs on COVID-19. Another aspect suggested by An et al. 7 is the relevance of the continuous assistance to IBD patients also at home. Home patient management has been called "telemedicine" and it is a well-accepted approach by patients, as evidenced by the high adherence to home therapies or recommendations from physicians 22, 23 . Telemedicine has also been associated with a reduction in gastroenterological consultations and hospitalizations and could be a valid alternative to improve the quality of IBD patient care during the COVID-19 outbreak 23 . follow-up of this cohort is essential to confirm the real impact of the preventive strategies. Furthermore, the biggest challenge for western countries will be to extrapolate Chinese success and overcome cultural differences that could hinder adhesion rates. In conclusion, the coronavirus pandemic is straining the existing health systems and will leave an indelible mark on both patients and physicians, but it is providing new insights and could be a starting point for investing in new approaches and increasingly personalizing patient care. A Novel Coronavirus from Patients with Pneumonia in China WHO Director-General's opening remarks at the media briefing on COVID-19 -11 Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China Q&A on coronaviruses (COVID-19). Available at The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China Comparative Risk of Serious Infections With Biologic and/or Immunosuppressive Therapy in Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis Protection of 318 inflammatory bowel disease patients from the outbreak and rapid spread of COVID-19 infection in Wuhan Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission Imbalance of the renin-angiotensin system may contribute to inflammation and fibrosis in IBD: a novel therapeutic target? Gut Increased incidence of systemic serious viral infections in patients with inflammatory bowel disease associates with active disease and use of thiopurines IOIBD Update on COVID19 for Patients with Crohn's Disease and Ulcerative Colitis | IOIBD Management of IBD during the COVID-19 outbreak: resetting clinical priorities Withdrawal of immunosuppressant or biologic therapy for patients with quiescent Crohn's disease Evolution After Anti-TNF Discontinuation in Patients With Inflammatory Bowel Disease: A Multicenter Long-Term Follow-Up Study European Crohn's and Colitis Organisation Topical Review on Treatment Withdrawal Facing Covid-19 in Italy -Ethics, Logistics, and Therapeutics on the Epidemic's Front Line Fair Allocation of Scarce Medical Resources in the Time of Covid-19 Implications of COVID-19 for patients with pre-existing digestive diseases Feasibility and acceptance of a home telemanagement system in patients with inflammatory bowel disease: a 6-month pilot study Telemedicine platform myIBDcoach reduces hospitalisations and outpatient gastroenterology visits in patients with IBD Amico declares no conflict of interest. L Peyrin-Biroulet has served as a speaker, consultant and advisory board member for Merck Danese has served as a speaker, consultant, and advisory board member for Schering-Plough FD wrote the article. LPB critically reviewed the content of the paper and supervised the project. SD conceived and critically revised the manuscript. The manuscript was approved by all authors.