PBC and Covid-19
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PBC and Covid-19

PBC and Covid-19

From the PBC Foundation Medical Advisory Board, 16th April 2020.

The last few weeks have been a worrying time for everyone and even more so for those with PBC. As the pandemic progresses, we are learning more about the virus, how to prevent spreading the virus, how to reduce the risk of getting the virus and what to do if you may have the virus.

The Government have developed policies, and these are developed by experts and, where possible evidence based. As the situation changes and knowledge increases, the advice is being modified.

Links for information include those below:

 NHS: (https://www.nhs.uk/conditions/coronavirus-covid-19/)

 Department of Health and Social Care and Public Health England:          (https://www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public)

and

https://www.nhs.uk/conditions/coronavirus-covid-19/

 Health Protection Scotland

(https://www.hps.scot.nhs.uk/a-to-z-of-topics/wuhan-novel-coronavirus/)

 Welsh Government: (https://gov.wales/coronavirus-covid-19)

 Northern Ireland: (https://www.health-ni.gov.uk/coronavirus)

THE PBC FOUNDATION STRONGLY URGES ALL PEOPLE WITH PBC AND THEIR FAMILIES TO FOLLOW THE NATIONAL GUIDELINES

Comments from the PBC Foundation

There is a great spectrum of disease amongst people with PBC: most will have early disease and the liver is functioning normally. Others will have advanced fibrosis and some may have cirrhosis. Others will have had a transplant which may be associated with recurrence of PBC in the graft. Some will be taking immunosuppressive medication (such as prednisolone, azathioprine, mycophenolate, cyclosporine or tacrolimus). Some will have also other conditions such as diabetes or lung disease.

The Scottish Government have provided some clarification about the risks to people with liver disease (see reference at end of the note). This states:

The following provides practical guidance on whether you might be in the high risk group or not. The risk to an individual will also take account of other factors such as age and other health conditions.

 1) High Risk: If you are either on immunosuppressants or you have severe scarring (cirrhosis). You are likely to be in this group if you usually see your liver specialist about once a year or more (and usually you would have been offered a flu jab). 

 2) Normal Risk: If you have a liver condition but no or very little inflammation and no or very little scarring and you are not on immunosuppressant medication and you are younger than 60 years old. You are likely to be in this group if you usually see your liver specialist less than once a year.”

Reducing the risk of becoming infected: people with PBC are at no greater risk of getting infected with PBC and so should follow the national guidance. Social distancing and isolation, hand-washing and use of tissues for sneezes are the key elements here. Hospital and GP visits are discussed below.

Reducing the severity of complications if infected: there is a great variation in the response to the virus. Some risk factors are well defined, such as age, diabetes, obesity, lung disease. The national guidance gives clear advice and we recommend you follow this. Everyone can be affected and youth is no protector from death from the virus. There is a great deal of work going on to look at the impact of immunosuppression. Lessons from similar viruses suggests that the impact of many immunosuppressive agents may be small and even sometimes beneficial so please remember this if you are taking immunosuppressive agents. Equally, most clinicians believe that in non-advanced PBC, the immune system responds pretty well to infections, so again, do not worry unduly.

Ongoing medical care: this is a source of worry for people with PBC. Hospitals and GP surgeries are being bombarded by people and have made a number of changes. Clinical appointments are being reviewed and all but the most essential are being postponed or conducted by telephone or video link. Procedures such as endoscopy and ultrasound are reviewed on an individual basis. The benefits from the procedure have to be balanced against the risks entailed in coming to hospital and possibly being exposed to the virus. Hospital resources are being stretched so if a procedure or clinic visit can be safely postponed, it will be.

Medication: do not change your medication without discussing with your doctor or nurse. If you are worried, give them a call. Do ensure you do not run out of medication and contact your doctor or nurse in plenty of time to ensure you will not run out. Surgeries and pharmacists are under stress and so getting your medication may take  longer than normal. People with PBC can usually safely take paracetamol up to 6 tablets (3gm total) each day; non-steroidal anti-inflammatories such as Ibuprofen are usually best avoided.

If you have any questions, do contact the Foundation: we can give you support and a listening ear. We can give medical information but cannot give medical advice.

Do stay safe and follow national guidance.

Reference:

https://www.gov.scot/binaries/content/documents/govscot/publications/advice-and-guidance/2020/03/coronavirus-covid-19-tailored-advice-for-those-who-live-with-specific-medical-conditions/documents/chronic-liver-disease/chronic-liver-disease/govscot%3Adocument/Patient%2BInformation%2BLeaflet%2B-%2Bfor%2Bpeople%2Bwith%2Bchronic%2Bliver%2Bdisease%2B-%2Bupdated%2B2%2BApril%2B2020.pdf

Other sites you may find of use include:

Well being

https://mentalhealth.org.uk/coronavirus

Current advice from the NHS

https://www.nhs.uk/conditions/coronavirus-covid-19/

Latest news from Public Health England (PHE)

https://www.gov.uk/government/organisations/public-health-england

Latest news from the Government

https://www.gov.uk/coronavirus

Coronavirus Q&A from the World Health Organisation

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

Latest advice on social distancing/isolation from the Government

https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people