Dr John Nik Ding: lessons from a successful model in managing COVID-IBD

IBD

By Mardi Chapman

23 Apr 2020

Dr John Nik Ding

Fast and effective action taken to protect IBD patients in Wuhan during the early stage of the COVID-19 pandemic could provide a model for health services globally, an Australian gastroenterologist says.

Correspondence published in The Lancet Gastroenterology and Hepatology describes the strategies implemented by the Renmin Hospital of Wuhan University from as early as January 3. These included:

  • temporary cessation of infliximab infusions and transition to lower immunosuppressive drugs;
  • single-occupancy rooms for inpatients;
  • strong advice to patients around self-isolation and personal protective measures;
  • a move to telehealth for all routine, non-urgent patients;
  • close communication with outpatients using the social messaging app WeChat.

University of Melbourne researcher and gastroenterologist at St Vincent’s Hospital, Melbourne, Dr John Nik Ding told the limbic there was a lot to be learnt from the experiences of COVID-19 in Wuhan.

“It’s impossible to know what prevented deaths or infections but the example there of no detected COVID-19 cases in their IBD population would seem to say that there was some benefit.”

He said an international registry of IBD patients who contracted COVID-19 had to date recorded 638 patients, of which 3% had died.

“So one can extrapolate from that, that with the epicentre of COVID having zero cases and zero deaths, their model of care seems to have worked.”

“I’m not saying stopping the drugs did it but the model of care is how they were able to prevent cases.”

Dr Ding said Australia had followed in a similar vein, such as providing information and health literacy, and ensuring a prompt move to telehealth for all but very sick and severe patients.

“In Australia, we have only three cases recorded in this registry of IBD with COVID. At St Vincents, we are one of the largest IBD centres in Australia, managing over 1,000 patients and so far we haven’t recorded a single case.”

However, context and consideration of local factors such as transmission rates, behaviours and policy was also important when deciding whether to make changes such as stopping biologics.

“If the case fatality rate is high such as seen in Wuhan, and later Italy where the demographics are significantly favouring a high rate of transmission and death then you need to consider medications in the context of that.”

He said locally patients appreciated that a IBD service could be run despite COVID-19.

“The main thing is we are adapting quickly. We are utilising all the available tools in digitising medicine. It is a way forward which is no doubt going to help in the future.”

He added that the opening up of Wuhan from last week will also provide an example of how things might go as Australia starts to return to elective surgery, etcetera.

A Comment article in the journal said that no IBD patients with COVID-19 had been reported from the three largest tertiary IBD centres in Wuhan (Tongji Hospital, Union Hospital, and Zhongnan Hospital).

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