The threat of a second wave must remind us why the clinically vulnerable need our support now more than ever

12/10/2020

Monica Nijher
Inflammation & Immunology Medical Lead, Pfizer UK

While everyone has been impacted by the COVID-19 pandemic, those considered ‘extremely clinically vulnerable’ have arguably felt the impact more than most. Prior to COVID-19, day-to-day life was already tough for people suffering from inflammatory bowel disease and long-term, chronic conditions like Ulcerative Colitis and Crohn’s disease, but we now have a role to play in ensuring these individuals are supported?

At the beginning of ‘lockdown’ back in March, over 2 million people with underlying health conditions were asked to shield, to help protect them from being infected and the increased risk of complications.¹ Those receiving treatment for inflammatory bowel conditions may take biologic and immunosuppressive medicines or corticosteroids, which could increase their vulnerability to COVID-19.²

For many on the shielding list, being careful about avoiding unnecessary viral risks – especially over the winter months – is not new. For anyone, being told you or your family are at increased risk is frightening. With approximately 300,000 people living with IBD³ (including many children and young people) COVID-19 has meant months of anxiety, isolation and worry, exacerbated with potential challenges around accessing routine medication or care. The impact of the potential return to shielding should not be underestimated.

Some patients have coped with delayed surgery, or disruption to vital, ongoing treatment,⁴ with the British Society of Gastroenterology redeploying 66% of gastroenterologists to look after Covid-19 patients at the peak of the crisis.⁴ And the psychological impact can go hand-in-hand with the increased medical risk. For patients, increased stress can cause a stress-induced flare up and potentially the need for emergency hospital treatment.⁵

With approximately 300,000 people living with IBD³ (including many children and young people) COVID-19 has meant months of anxiety, isolation and worry, exacerbated with potential challenges around accessing routine medication or care."

It has not been all bad news. COVID-19 has accelerated change in how patients can access healthcare. The huge increase in video and phone consultations has demonstrated significant benefits through delivering high-quality, easy-to-access online care which could lead to more innovative delivery of healthcare in the longer term.⁶ However, while some patients may value the added flexibility of virtual care models, the true benefits will be seen over time to ensure digital is not a barrier to some accessing care.

Over the summer, the ease of lockdown and end of shielding was welcomed by many – the chance to see family and friends, go to the pub, travel abroad; to return to a semblance of normality. However, for people with conditions like IBD and Crohn’s disease, a return to ‘normal’ remains out of reach. Returning to work or school safely, attending family gatherings, or even a trip to the local supermarket may still pose too high a risk. There even remains ongoing practical issues around everyday activities like a simple trip to the park. Many public toilets remain unopened. The lack of available public facilities has always been a problem for those with IBD, and this has been made even worse in recent months.

With cases rising and some restrictions tightening, we have an important role to play as a society in supporting the clinically vulnerable. Many people living with IBD (and plenty of other underlying health conditions too) may have an ‘unseen’ disability and are even more susceptible to infection. That’s why wearing masks, increased handwashing, social distancing, and adhering to local guidance becomes even more important – protecting yourself but more importantly, helping protect some of the most at-risk who may be shielding again – or perhaps never stopped.

From a mental health perspective, we should be mindful that for some IBD sufferers – and those with other underlying health conditions – the ongoing uncertainty around a return to shielding may in itself cause fear and anxiety. Above all, we need to remain understanding, sensitive and supportive, and show our willingness to protect each other and minimise the risk of infection.

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