The American College of Gastroenterology, American Gastroenterological Association, American Association for Study of Liver Diseases and the American Society for Gastrointestinal Endoscopy outlined everything they knew about COVID-19 in a joint statement.
What gastroenterologists should know:
1. Early evidence suggests COVID-19 can be spread through droplets and fecal shedding. Endoscopy and colonoscopy could put patients, endoscopy personnel and clinicians at risk.
2. The frequency of GI symptoms, including nausea and/or diarrhea, is uncertain in COVID-19 cases. Reports vary between 5 percent to 50 percent of cases. There have been additional reports of isolated diarrhea preceding cough and fever.
3. The virus potentially is present in GI secretions, and viral RNA is detectable in stool. Gastroenterologists must be aware of fecal-oral transmission.
4. The virus spreads asymptomatically during the prodromal phase, and viral shedding is greatest when symptoms begin.
5. Up to 30 percent of patients with COVID-19 had abnormal liver enzymes.
6. Leukocyte count drops are common in COVID-19 patients, and elevated white blood cell counts are associated with poor prognosis.
7. Older adults and adults with severe conditions are at risk of developing more serious illnesses. Pregnant women may also be at risk.
8. The societies recommend people wash their hands, avoid touching their faces, cover their mouths when coughing or sneezing, practice social distancing, and avoid crowds.
Society recommendations for GIs and clinics:
1. Reschedule elective non-urgent endoscopic procedures. The U.S. Surgeon General recommended all elective surgeries be rescheduled March 14.
2. Pre-screen all patients at high risk for exposure or with symptoms. Ask patients about a history of fever or respiratory symptoms before treatment.
3. Ensure clinics are stocked with the appropriate personal protective equipment, including gloves, masks, eye shields/goggles, face shields and gowns.
4. Take off this personal protective equipment appropriately. Click here for more information.
5. Clinicians should check the body temperature of patients when they arrive at the endoscopy unit or a clinic.
6. Centers should keep patients at least 6 feet apart from each other during their time in the endoscopy unit.
7. GIs should conserve personal protective equipment, and centers should schedule only essential personnel during this time.
8. Centers should isolate positive COVID-19 patients and perform procedures in negative pressure rooms.
9. GIs should use phones or telemedicine for postoperative follow-up. Also consider using telemedicine for all elective office visits.
10. Centers should strategically assign available personnel to minimize concomitant exposure. Use non-physician practitioners and fellows to screen and triage patients or perform virtual visits.
11. GIs should ensure patients on immunosuppressive drugs for IBD and autoimmune hepatitis continue taking their medication. "The risk of disease flare outweighs the chance of contracting coronavirus," the guidance reads. The societies recommend these patients follow CDC guidelines, avoid crowds and limit travel.
The statement is available on all four organizations' websites and is hyperlinked here.