Social distancing has become the new norm across the U.S. during what the World Health Organization has classified a global pandemic. The novel coronavirus, which causes the disease COVID-19, has infected 163,539 people in the U.S. and caused 2,860 deaths, according to data updated from the U.S. Centers for Disease Control and Prevention on March 31.

For gastroenterologists and their staff, this has meant postponing elective procedures and, in some cases, assisting in the care of COVID-19 patients.

In addition, gastroenterologists regularly see patients that are more susceptible to contracting COVID-19 because of the immunosuppressant drugs they must take to manage inflammatory bowel disease (IBD) or autoimmune hepatitis. The CDC warns that those with compromised immune systems due to underlying health conditions are at a greater risk of having more severe cases of the novel coronavirus.

Gastroenterologists should advise their IBD and autoimmune hepatitis patients to continue to take their immunosuppressant drugs, as the risk for disease flare up is greater than the risk of contracting COVID-19, according to a joint statement from the American College of Gastroenterology (ACG), American Gastroenterological Association (ASA), the American Association for the Study of Liver Diseases (AASLD) and the American Society for Gastrointestinal Endoscopy (ASGE).

The March 15, 2020, joint statement included 13 recommendations for gastroenterologists in weathering the COVID-19 pandemic:

• Reschedule elective, non-urgent endoscopic procedures (cancer evaluations should proceed)
• Pre-screen every patient for high-risk exposure symptoms, including history of fever and respiratory symptoms and possible exposure
• Personal protective equipment (PPE) should be available and worn by all members of the endoscopy team
• Proper PPE etiquette should be followed
• Check body temperature of every endoscopy patient
• Maintain 6 feet distance between patients
• Conserve PPE, and only allow essential personnel in on cases
• Isolate potential and confirmed COVID-19 patients
• Consider implementing more phone screenings or post-op appointments
• Be strategic about assigning available personnel to minimize exposure
• Implement telehealth visits for elective office visits
• Institute policies to protect staff
• Patients taking immunosuppressive drugs for IBD and autoimmune hepatitis should be advised that the risk of disease flare outweighs the risk of contracting COVID-19

The most common symptoms for COVID-19 are respiratory, including cough, shortness of breath, and fever. The WHO and CDC have advised that hand washing and social distancing are the best ways to prevent the spread of the disease as respiratory droplets created by coughing or sneezing are considered the most common form of transmission.

New research from China has pointed to potential GI symptoms and fecal transmission of COVID-19. According to two new studies accepted for publication by Gastroenterology, fecal-oral transmission is a possible way to spread the disease. These studies cited a case study in which half of 73 confirmed cases of COVID-19 had evidence of the disease in their stool samples.

The two new studies suggest that vomiting and diarrhea may be early symptoms of COVID-19, and the ACG joint statement stated that GI symptoms should be considered when assessing potential cases. The statement also noted abnormal liver enzymes are observed in 20 to 30 percent of confirmed cases of COVID-19.