Rama Behara D.O., M.S.
DHR Health Gastroenterology
With the dramatic rise of SARS-CoV-2 (COVID-19) in the Rio Grande Valley, there is certainly a high level of stress and anxiety amongst the community. While symptoms such as cough, shortness of breath, fevers are of utmost priority when seeking guidance, gastrointestinal symptoms are not surprisingly common in patients diagnosed with COVID-19. Abdominal pain, diarrhea, loss of appetite, nausea, and vomiting are some of the many symptoms a person can experience during the course of their illness. In fact, studies have shown that about half of patients hospitalized with COVID-19 have GI symptoms. And though it takes a back seat to the respiratory complaints that get individuals hospitalized, the GI symptoms may actually start first.
Diarrhea appears to be the most common symptom associated with COVID-19, and can last anywhere between one to 14 days, but roughly 5 on average according to a study from Wuhan, China. The problem with this issue is that there’s a large group of people who have GI symptoms but can’t get tested because they don’t have a cough or shortness of breath. The type of diarrhea from COVID-19 is generally not a dehydrating type though it still makes sense for people to stay well hydrated and monitor for symptoms of dehydration, such as decreased urination. To make things more confusing, since GI symptoms are so common, it’s hard to differentiate COVID symptoms from non-COVID related symptoms. For example, stress can cause similar complaints such as diarrhea, abdominal pain, headaches and rapid heart rate, which may make someone feel like they’re infected. Fever is the key deal breaker, since stress does not cause a fever. If you have these symptoms and a fever, let your doctor know as it may clue them into testing sooner. If you’re concerned about transmitting the virus, keep in mind that in some cases, viruses in the GI tract may spread via the fecal –oral route, which emphasizes the importance of hand washing and avoiding touching your face.
The other major concerning population is in patients with underlying inflammatory bowel disease, such as Crohn’s disease or Ulcerative colitis. Many of these patients are on immune modulating drugs or steroids, which could potentially make you more susceptible to getting infected. The consensus from expert panels suggest continuing these medications to prevent a flare up, or even worse a hospitalization where risk of getting COVID is higher. But, steroid drugs are the exception and should be weaned or stopped if at all possible as suggested by the most recent guidelines.
Just recently, there has even been data suggesting the use of proton pump inhibitors (or PPIs) may increase risk for COVID-19 related illness. These medications are typically used to manage reflux or GERD symptoms. As with any medication, these findings suggest using medications when clinically indicated, but at the lowest effective dose.
In the end, what precautions can be taken to help limit spread from the GI route? Well, when you flush a toilet, a “whiff” of viral aerosols may be released. Though unclear if these are infectious particles or not, it’s always better to stay precautious. Simple tips such as putting the toilet down before flushing, cleaning the toilet seat handle and seat with a disinfectant, and not touching your face until washing your hands are reasonable preventive measures. If sharing a restroom with someone who might be sick, consider using a different restroom, but if not possible, a different toilet paper roll for each person is suggested.
The same general precautions need to be taken—hand washing with soap and water or use of hand sanitizer with at least 60% alcohol, avoid touching your mouth/eyes/nose with unwashed hands, and staying home as much as possible. If you need to go out, cover your face with a face covering and maintain a minimum 6 feet of distance. Rest assured, if you need to visit with your GI doctor, telemedicine visits are readily available and are an effective means of delivering high quality care. Please do not neglect abnormal symptoms such as rectal bleeding, unintentional weight loss, trouble swallowing given that of these symptoms may require emergent or urgent attention. The state of the pandemic in the Rio Grande Valley is at a critical juncture and as a community, we must recognize when to seek guidance from local health professionals, but also practice sensible, safe, preventive measures, to defeat this virus.