Coronavirus (COVID-19) Latest: What your risk means for you

09 July 2021

Not everyone with Crohn's or Colitis will have an increased risk of complications from coronavirus, but some may need to take extra precautions. This information only describes the risks for Crohn's and Colitis - if you have an additional health condition or other risk factors contact your healthcare professional for additional guidance. 

As restrictions start to ease, you may be feeling excited or worried as we get back to doing things we did before. You will need to make personal decisions about what activities you do or don’t feel comfortable doing. After over a year of strict rules, this change of approach may cause some level of unease for everyone. If you have Crohn’s or Colitis you may have even more concerns about your risk level and what you should do to keep yourself safe. The information below may help you weigh up your risks and make choices. 

See our Coronavirus hub page for more information on COVID-19, including questions about vaccines.

About the risk levels
Risk levels for adults
Highest Risk (Extremely clinically vulnerable)
Moderate Risk (Clinically vulnerable)
Lowest Risk
What's the risk for children?
Why are the risk levels different for children?

Managing daily life
What are extra precautions I can take to stay safe when restrictions ease?
Is it safe to go to work?
Will I recover from coronavirus if I'm at increased risk?
Will stopping my medicine reduce my risk?
Should my child go to school?
Is it safe to go to university?
Can I travel this summer?

Understanding your risk
I have other risk factors which aren’t covered here
How were the risk categories developed?


Risk levels for adults

Having a diagnosis of Crohn’s or Colitis alone does not increase your risk of getting COVID-19 or developing severe illness if you do catch it. However, other factors such as the medication you take and whether you are in a flare may affect your risk. Your symptoms and medications for Crohn’s or Colitis may change a lot over time. This will mean your risk level can change a lot too. You can quickly check your risk level using our decision tree.  

You can also use the IBD Registry's COVID-19 UK IBD Tool to assess your risk and provide you with a personalised PDF explaining your risk level if you need to show employers. It is important to also consider other factors such as increasing age, and other medical conditions like diabetes which may increase your risk. 

If you are still unsure whether you are at increased risk, speak to your GP or IBD team for further advice. 

My experience with coronavirus felt no different to when I have a bad flare up. I was scared going into the coronavirus ward but a lot of the fear I think was generated from watching too much news of coronavirus.  The reality of me having had severe flare ups is that it prepared me well to deal with what coronavirus threw at me.

Emma
Living with Colitis and a stoma


Highest Risk (Extremely clinically vulnerable)

If you meet the criteria below, you have a higher risk of severe illness from COVID-19. You are strongly advised to carry on taking your medication as stopping your medication will put you at higher risk.

You are at highest risk if any of the below apply to you:

  • I'm currently taking oral or intravenous steroids equivalent to 20mg or more of prednisolone per day (except budesonide or beclometasone)
  • I have started a new biologic medicine within the last 6 weeks, in combination with another immunosuppressant or steroids (except budesonide or beclometasone)
  • My Crohn's or Colitis is active despite taking a medicine listed in the 'Moderate risk' section. For example, if you are experiencing a flare or your Crohn’s or Colitis has not been well controlled over the last month.
  • I have short gut syndrome (less than two metres of small bowel left after surgical removal) which requires nutritional support 
  • I take parenteral nutrition 

You are also at highest risk if any of the below apply you AND you are also taking one of the medicines listed in the 'Moderate Risk' section AND/OR your condition has become very active with moderate to severe symptoms.  

  • I’m over 70 years old
  • I take medicines for high blood pressure
  • I take insulin or tablets for diabetes 
  • I take inhalers or tablets for asthma everyday
  • I have emphysema, COPD or another respiratory condition which limits how much I can do day-to-day
  • I’ve been diagnosed with angina (chest pain caused by your heart) or had a heart attack or a stroke
  • I have heart failure which limits how much I can do
  • I have heart valve disease which limits how much I can do, or I’ve had heart valve surgery

You are no longer advised by the government to stay at home (shield). You should follow the Government guidance on protecting people who are clinically extremely vulnerable from COVID-19. You may want to take extra precautions to keep yourself safe such as getting your first and second dose of the vaccine and following hygiene advice.  See our information on staying safe when restrictions are lifted.

There is separate guidance for clinically extremely vulnerable people living in Scotland, Wales and Northern Ireland.

Am I still in the high risk group even though shielding has paused?

Yes - if you were to catch coronavirus, your risk of complications would still be high if you meet the criteria for being at high risk.

You should follow the national guidance alongside the rest of the population, but are still advised to take extra precautions to keep safe. 


Moderate risk (Clinically vulnerable)

If you are taking any of the medicines listed below, you have a moderate risk of severe illness from COVID-19. Moderate risk means your chances of severe illness from coronavirus are higher than the general population, but not as high as people who are seriously ill.

You are also at moderate risk if you have stopped taking any of the below medication (apart from steroids) within the last three months. This is because they can stay in your blood for this amount of time. 

You should follow the Government guidance that is place for everyone in EnglandNothern IrelandScotland and Wales.

You may want to take extra precautions to keep yourself safe.

You are strongly advised to carry on taking your medication, as stopping your medication can lead to a flare-up, which will put you at higher risk.

BIOLOGICS

IMMUNOSUPPRESSANTS

  • Azathioprine (Imuran, Azapress), Mercaptopurine (6-MP), Tioguanine (6-thioguanine), Methotrexate (Maxtrex, Methofill, Metoject, Ebetrex, Namaxir, Nordimet, Zlatal), Tacrolimus or Ciclosporin

OTHER

  • Tofacitinib (Xeljanz)
  • Steroids equivalent to less than 20mg prednisolone per day (except budesonide or beclomethasone)
  • Any other immunosuppressant/biologic trial medication prescribed by your doctor as part of a clinical trial
  • You are taking any of the medicines in the 'Lowest Risk' section or no medicines for your Crohn’s or Colitis and your condition has become active. For example, if you are experiencing a flare or your Crohn’s or Colitis has not been well controlled over the last month.

If you are taking any of the above medicines or are in the 'other' group, your risk is moderate unless you are:

over 70 years old

or have another health condition as listed in the 'high risk' group, in which case you will be classified as highest risk.


Lowest Risk

If you are taking any of the medicines listed below, and if you do not fall into the highest and moderate risk categories above, your risk is the same as the general population.

You should follow the Government guidance that is place for everyone in England, Nothern Ireland, Scotland and Wales.

This includes people who do not take any medicines for their Crohn's or Colitis, or stopped taking any of the medicines in the moderate risk column more than three months ago. 

  • 5-ASAs (e.g. mesalazine, Sulphasalazine, Olsalazine)
  • Rectal therapies (e.g. steroid or 5-ASA suppositories or enemas)
  • Orally administered topically acting steroids (budesonide or beclometasone) 
  • Medicine for bile acid diarrhoea (colestyramine, colesevelam, colestipol) 
  • Anti-diarrhoeals (e.g. Imodium (loperamide)) 
  • Antibiotics for bacterial overgrowth or perianal disease.

But if you are taking any of these medicines and your condition has become very active with moderate to severe symptoms (e.g. you’re in a flare) then you are in the Moderate Risk group.


What's the risk for children?

Children aged 16 -19 years old should ask their IBD Team whether they should follow the risk guidance for children or adults.

COVID-19 can affect children, but it doesn't seem to be as serious and most children will only get a mild form of the illness.

The British Society for Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) has put together specific guidance on the risk categories for children with Crohn's or Colitis. We've used this information to create a decision tree for the risk in children.


Why are the risk groups different for children?

The risk of serious illness is very low for children and cases of children with Crohn's or Colitis being admitted to hospital with COVID-19 are extremely rare. Based on this evidence, children with Crohn's or Colitis who were previously in the moderate risk group are no longer considered to have an increased risk of serious illness from COVID-19. Therefore, there is no need for a moderate group.

Crohn's and Colitis are fluctuating conditions so it's possible that your child's risk may change over time. If you're worried about a change to your child's risk you should speak their IBD team.


What are extra precautions I can take to stay safe when restrictions ease?

If you are at increased risk, there are things you can do to lower your risk of getting COVID-19. These include:  

  • If you haven’t had your first and second dose of the vaccine, have it as soon as you can. You might want to wait until 14 days after your second dose of a COVID-19 vaccine before being in close contact with others.
  • Consider whether the people you spend time with have been vaccinated. 
  • If meeting up with others, meet outdoors where possible. If you meet up indoors, keep doors or windows open. 
  • Try to keep the number of different people you see low – maybe meet fewer people but spend more time with them. 
  • Consider frequent rapid COVID testing and maybe asking people you are going to meet to have a rapid COVID test too. Use this service to order free packs of rapid lateral flow tests to be sent to your home.  
  • Avoid crowded places.  
  • Avoid travelling on public transport during peak times. 
  • Check the COVID rates in your area. 
  • Continue to follow hygiene advice, such as washing your hands regularly and avoid touching your face.

 


Is it safe to go to work?

We have detailed information about going to work during the coronavirus pandemic on our working, benefits and finances page, including information for people at higher risk of severe illness from coronavirus and how to raise a concern if you're worried your employer isn't taking all possible precautions to ensure your safety.


Will I recover from coronavirus if I'm at increased risk?

Most people who catch COVID-19, including people who take immunosuppressant medicines, make full recoveries. You might find our blog from people with Crohn's and Colitis who caught COVID-19 reassuring.

Being in the high risk group does not mean you won't recover from COVID-19 - it means your chances of getting serious complications are higher than the average person. It isn't possible to predict exactly who will have more serious symptoms as everyone is different. Even people with no health issues sometimes develop serious complications, while some people with increased risk have only mild symptoms.

The best thing you can do to decrease your risk of serious complications is to stay well and keep taking your medicines to control your Crohn's or Colitis. If you have a fever it's very important to keep hydrated, as Crohn's and Colitis can increase your risk of dehydration.

If you do develop symptoms of coronavirus, you may have to make some changes to your Crohn's or Colitis medicine. Always discuss any changes with your IBD team.

There are a number of research studies investigating coronavirus and Crohn's and Colitis - you can find out about some of them here.

I am on azathioprine, and on the day that I tested positive for coronavirus I had just finished a course of prednisolone, but my experience was fairly mild. I had many of the symptoms, including a fever, cough and loss of taste and smell but it wasn’t anywhere near as bad as I imagined it would be. I had some lingering fatigue for probably 2 or 3 weeks after I recovered, but then got back to full health.

Marcus
Living with Colitis


Will stopping my medicine reduce my risk?

Medicines that affect your immune system can stay in your body for up to three months after you stop taking them, so you will still be at risk.

If you stop taking your medicine, you may have a flare-up of your Crohn's or Colitis. A flare-up increases your risk of serious complications if you catch coronavirus, so it is important to keep taking your medicine, unless your IBD team advises you otherwise. 

If you develop any coronavirus or flu symptoms, you may have to delay taking your medicine until you feel better.  See our guidance on medication if you have coronavirus symptoms. ​

 


Should my child go to school?

All schools and colleges are open for face-to-face teaching during term time. You may feel worried about sending your child to school, and it may help to contact your child's IBD team to talk through your concerns. You could also contact your child's school to see what specific measures they're putting in place to protect your child.

The government has created some information on what parents need to know about sending their children to pre-school, school or collages.

My child is at high risk (extremely clinically vulnerable)
Your child's healthcare team will assess whether your child is at high risk, as the risk is now considered to be lower in children. Children who are at high risk can attend school as shielding has now ended in all UK nations. If your child's healthcare professional says they should continue to shield at home, you are advised to follow their advice. If your child is unable to attend in person, their school should support them to study at home.

My child lives with someone who is at high risk (extremely clinically vulnerable) and is shielding
Your child can attend school with everyone else. It is not required for your child to distance themselves from the person at high risk, but it is your choice if you wish to take extra precautions. 

My child lives with someone who is at moderate risk (clinically vulnerable)
Your child can attend school with everyone else.


Is it safe to go to university?

All students are now able to take part in in-person teaching and learning. Students should take a test twice a week and before they travel away from university before the break.

There is government guidance for universities and students starting and returning to higher education.

If you are worried about attending in-person classes, it is best to have an open and honest conversation with your tutor about your concerns. Our Talking Toolkit can also help you find the words to explain your condition to your tutor.

If your Crohn’s or Colitis has an impact on your ability to study, you may find it helpful to look into claiming Disabled Students Allowance. You may be eligible for assistance with purchasing items such as a laptop or printer to enable you to study from home if your condition makes travelling to classes difficult.

For extra support and information on managing uncertainty during this time, see Student Space.


Can I travel this summer?

Travelling abroad at the moment is a very personal decision for individuals to make.

If you do plan to travel, you should check what rules are in place for the country you are travelling to. There are currently no restrictions on travel within the UK.

You may need to meet certain requirements to enter the country, such as producing a negative coronavirus test, proving your vaccination status or there may be a period of quarantine or self-isolation. You should also check if there are any rules for your return to the UK.

Specific advice for each country can be found on the Foreign, Commonwealth & Development Office (FCDO) website.

Travel advice for each country can change last minute. Check what your travel insurance covers and the specific booking conditions of your trip. Know what could happen if your trip is cancelled or postponed due to a change in FCDO travel advice or because you or someone you're travelling is unwell or isolating.

See our information about travelling with Crohn’s or Colitis.


I have other risk factors which aren’t covered here

There are many factors which can affect a person’s risk of complications from coronavirus. We are only able to give information about risks specific to Crohn’s and Colitis, and are not able to say whether your risk category would change based on the below factors. It’s best to talk to your GP or healthcare team if you’re worried, and take extra precautions if you feel you are at high risk.

Other factors which have been found to increase a person’s risk are:

Other health conditions
People with certain serious health conditions have been found to be at a higher risk of coronavirus complications. See the full NHS list of conditions which increase a person’s risk.

Age
Risk of coronavirus complications seems to increase with age and is highest for people over 70 years old. The risks are very low for children under 18.

Ethnicity
Risk of coronavirus complications is higher for people from black, Asian and minority ethnic groups than for those from white ethnic groups.

Gender
Risk of coronavirus complications is higher for men than women.


How were the risk categories developed?

These risk categories are specific to Crohn's and Colitis.

The risk categories were developed by the British Society of Gastroenterology (BSG) working with a large group of their members, nurses and doctors, who are specialists in Crohn's and Colitis. Many of your doctors and other members of your IBD team will be part of the society. These risk categories have been endorsed by the National Institute for Health and Care Excellence (NICE), who provide guidance, advice and information for health, public health and social care professionals.

The BSG is a large group of UK specialist IBD professionals. The risk guidance was developed at the request of the government, which asked the BSG specialists to give a very detailed response to how risk should be categorised for IBD patients (as opposed to other patients) on immunosuppression medicines. Similar grids were produced by other specialists for their patient groups, who suffer from skin, joint and kidney problems and conditions affecting the nervous system.

The guidance is based on the available evidence at the time. The BSG continues to work with research groups nationally and internationally, which means there may be updates to the categories as scientific data emerges and we learn more about COVID-19.

As we went into lockdown, I received a text from the Government telling me I was high risk. I knew that this was related to my immunosuppressive medication, but it was still difficult to understand what this pandemic meant specifically for me. I later found out this message was sent to patients who take azathioprine, regardless of what condition they have or what dosage they take. 

The Government’s information can often be generic. The saving grace during this time has been charities, and specifically for me, Crohn’s & Colitis UK. Their information has been invaluable in working out what this pandemic means for me and my chronic disease.

Henry, age 27
Living with Colitis