Four major gastroenterological societies joined together to provide some clinical insights about COVID-19 as the United States responds to the epidemic.
The American Association for the Study of Liver Diseases, The American College of Gastroenterology, The American Gastroenterological Association and the American Society for Gastrointestinal Endoscopy issued a joint message to keep their members up to date on the necessary information on the disease to promote health and safety for patients, staff and providers.
Mark B. Pochapin, MD, director of the department of gastroenterology and hepatology at NYU Langone Health and president of the ACG, told Healio Gastroenterology and Liver Disease that working with the other societies to put out this guidance was both unprecedented and critical as information and practices change in real time in response to the crisis.
“We don’t know all of this yet, but by looking toward our colleagues in Wuhan and Italy, particularly, we should be able to learn quite a bit that will hopefully help us to prevent what they have gone through,” he said.
In addition to general information about symptoms and risk about the disease, the statement provided some specific information related to gastroenterology and hepatology.
- The incidence of GI symptoms including nausea and/or diarrhea are uncertain with some reports below 5% and others at 50%. There have been some reports of isolated diarrhea preceding cough and fever.
- The virus may be present in GI secretions and viral RNA is detectable in stool. Gastrointestinal infection and potential fecal-oral transmission must be considered.
- Abnormal liver enzymes are observed in 20% to 30% of persons with COVID-19 infection.
Additionally, Pochapin said the GI societies are monitoring the potential for the disease to spread through fecal-oral transmission.
The societies also provided several recommendations for GI endoscopy and clinical practice. They strongly recommend rescheduling elective, non-urgent endoscopic procedures in accordance with the advice provided by the surgeon general.
They also encouraged proper pre-screening patients for high-risk exposure or symptoms. This includes asking them about history of fever or respiratory symptoms and if they have had any contact with people with similar symptoms or contact with a confirmed case of COVID-19.
Isolation precautions should be taken for patients with positive COVID-19 or those who are waiting for test results. Patients should have their temperatures taken when they arrive at the clinic and be kept at least six feet apart throughout the entire time in the endoscopy unit.
The societies also encouraged proper use and conservation of personal protective equipment for all members of the endoscopy team.
“Centers should strategically assign available personnel. It is important to minimizing concomitant exposure of those with similar or unique skill sets. Non-physician practitioners and fellows that cannot participate in cases may be helpful screening and triaging patients, or performing virtual visits,” the statement said. “It is important to address our collective staff needs and institute policies that protect our workforce.” – by Alex Young