If you have IBD, you already know your immune system in your intestines is in overdrive, says David Rubin, M.D., chief of the section of gastroenterology, hepatology and nutrition, and co-director of the Digestive Diseases Center at the University of Chicago. In 2021, Rubin will also be the chair of the National Scientific Advisory Committee of the Crohn's & Colitis Foundation. “[That’s] either because something is continuing to stimulate it or because [your] body has lost the ability to regulate it and shut it down or turn it off.” It’s this overdrive response that causes inflammation of the gastrointestinal tract and, if you suffer from Crohn’s disease or ulcerative colitis, you likely face a multifaceted regime of medications and therapies to help manage your symptoms.
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There are six different medication categories for IBD patients, depending on your diagnosis and symptoms: antibiotics, aminosalicylates, immunomodulators, corticosteroids, biologic therapies and Janus kinase (JAK) inhibitors, and Rubin says the goal of most of these is to turn down your body’s overactive response so it can reset itself.

The introduction of steroids to treat IBD in the 1950s changed the game for managing both Crohn’s disease and ulcerative colitis. “We’ve learned a lot more about steroids since then, however,” Rubin says.  
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While steroids are effective at reducing inflammation and getting an IBD patient into remission, they don’t actually heal the bowel. Rubin is quick to point out that steroids are not maintenance medications, and if they’re part of your treatment, you should use them as a bridge to improve symptoms so other therapies can help repair the bowel. 
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Drawbacks of steroids may include: psychosocial impacts such as sleep disturbance or anxiety, infection, bone loss, neurological changes and even physical appearance changes (such as weight gain, acne and swelling), and these adverse effects could be worse with higher doses and longer exposure, Rubin says. “In general, a patient who needs steroids more than once in a year needs to be on a more effective maintenance strategy for disease control.” 
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He continues: “Keeping patients with IBD in remission is key to keeping them healthy during the pandemic.” 
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So is it safe for you to be on steroids while COVID-19 continues to spread? “We’ve learned that using them long-term isn’t acceptable even before and certainly during a pandemic,” Rubin says. “Get on medicines that can keep you off steroids and that will keep you healthy long-term. Our modern therapies are specifically suited to be steroid-sparing.”   

The key goal for IBD patients, whether during the pandemic or in more “normal” times, is clear: to partner with the patient to achieve a deep remission (mucosal healing) and while working toward that goal we strive to keep inflammation under control.
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To fully realize the potential effect of COVID-19 on your IBD, you first need to understand its stages. 

Rubin also emphasizes that this last phase mimics the overactive inflammatory phase of Crohn’s disease and ulcerative colitis. However, there’s greater risk for patients already on a steroid regimen. Growing research shows that if you’re on steroids you may have worse outcomes. “The issue regarding steroids and COVID-19 is based on when in the illness patients are on them,” Rubin says. Patients on doses greater than 20 milligrams per day at the time they get sick with COVID-19 have worse outcomes. “This is likely related to impaired early immunity but also perhaps [occurs] because patients on high-dose steroids have worse or poorly controlled IBD,” he says.   
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Conversely, if the steroid use comes later, it may have some benefit. Rubin says some medications may actually reduce complications seen in COVID-19’s inflammatory phase. 

People with IBD experience higher risks of COVID-19 complications if they suffer from ulcerative colitis or Crohn’s disease and have contributing factors like age, high blood pressure, diabetes or heart disease. “If you have more than two of those, you’re more at risk,” Rubin says. 

Always consult with your health care team if you’ve been exposed to someone with COVID-19 and/or you develop symptoms. You need to discuss your treatment plan with your doctor and whether or not you need to quarantine.

If you test positive for SARS-CoV-2 but don’t exhibit symptoms, Rubin says the consensus recommendation from infectious disease experts and physicians is to work with your IBD treatment team to taper off steroids and other immunosuppressive therapies for two weeks. This will allow the body’s immune system to do its work and, hopefully, fight the virus off. 

Always taper off any IBD therapies or medications under the care and observation of your health care team. “Even if some medicines are still in [your] system or [you were] on them in the early phase of the illness, [you] should be OK,” he says. 
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If you do ultimately develop symptoms, the consensus recommendation is that you can restart medication three days after those symptoms go away However, Rubin stresses that you should check with your doctor to determine when you can safely restart any IBD medications.

To reduce your risk of contracting COVID-19, follow the Centers for Disease Control recommendations. And for more scientific-backed, timely information on increased risk factors you may face as an IBD patient, visit the Crohn’s & Colitis Foundation website. Among the many resources available here are how to safely navigate the workplace during the pandemic and what to do if you get sick as well as how to address the mental and emotional aspects as an IBD patient, some of whom may be at higher risk of complications from COVID-19 infection.