Management of coexisting conditions in the context of COVID-19

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Last reviewed: 23 Jun 2024

Last updated: 13 Feb 2024

This page compiles our content related to Management of coexisting conditions in the context of COVID-19. For further information on diagnosis and treatment, follow the links below to our full BMJ Best Practice topics on the relevant conditions and symptoms.

Considerations for perinatal care

Severity of COVID-19 in pregnant women

Pregnant women are at risk of more severe COVID-19 infection and should take extra precautions, especially those above 28 weeks' gestation.[1][2][3][4][5]

Pregnancy increases the risk of hospitalization, intensive care admission, and receipt of mechanical ventilation.[2][6] Pregnant women should be counseled about the risk of severe illness from COVID-19 and the importance of preventive measures.[6]

Risk factors for hospital admission with COVID-19 infection during pregnancy include: being unvaccinated; being from a black, Asian, or other minority ethnic group; having a BMI of 25 kg/m² or more; prepregnancy comorbidity (such as diabetes or hypertension); age 35 or older; increased socioeconomic deprivation.[7][8] In the US, Hispanic and non-Hispanic black women seem to be disproportionately affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy.[6] Pregnancy-related mortality during the COVID-19 pandemic increased more among American Indian/Alaska Native women, compared with women of other ethnicities.[9]

Maternal COVID-19 is associated with a higher risk of preeclampsia/eclampsia, preterm birth, birth by emergency cesarean section, prolonged maternal admission following birth, venous thromboembolism, myocardial infarction, and maternal mortality or serious morbidity from obstetric complications.[7][10][11][12][13][14][15][16][17][18] Preexisting comorbidities, high maternal age, prepregnancy obesity, gestational diabetes, pregestational diabetes, preeclampsia, and nonwhite ethnicity are associated with more severe COVID-19 disease during pregnancy.[2][12][19][17]

Disease severity is associated with higher rates of preterm birth, cesarean delivery, maternal intensive care admission, neonatal intensive care admission, and maternal death.[2][20][21][22] Maternal SARS-CoV-2 status does not appear to affect postpartum hemorrhage, infant 5-minute APGAR score, or birth weight for gestational age.[10][23]

Impact of maternal COVID-19 infection on the neonate

Infants born to mothers who test positive for SARS-CoV-2 have an increased risk of admission for neonatal care, prolonged neonatal admission, hyperbilirubinemia, respiratory distress syndrome, and any other respiratory disorder.[13][23][24] A US study found that risk for stillbirth was higher among women who had COVID-19 at delivery hospitalization compared with those without COVID-19; association was higher during period of Delta-variant predominance compared with the period before Delta.[25] A registry study conducted in Scandinavia found that maternal COVID-19 infection after 22 weeks’ gestation was associated with an increased risk of stillbirth (adjusted hazard ratio 2.40; 95% confidence interval [CI] 1.22 to 4.71). The risk was highest during the first two weeks following infection.[26]

Fewer than 2% of babies born to mothers with COVID-19 have confirmed SARS-CoV-2 infection. Transmission may occur in utero, perinatally, or in the early postpartum period. Severe maternal infection, maternal death, maternal admission to an intensive care unit, and postpartum maternal infection were associated with an increased risk of SARS-CoV-2 positivity in the newborn.[27]

Vaccination of pregnant and lactating women

Guidance is available on use of COVID-19 vaccines during pregnancy.[28][29][30] Women who are breast-feeding may also be offered any suitable COVID-19 vaccine.[31] Local guidance should be followed.

Vaccination with an mRNA vaccine is 89.5% effective against SARS-CoV-2 infection 7 days after the second dose.[32] There is no association between COVID-19 vaccination during pregnancy and spontaneous abortion, postpartum hemorrhage, chorioamnionitis, cesarean delivery, 5-minute APGAR score <7, stillbirth, preterm birth, or small for gestational age infant.[32][33][34][35][36][37][38][39][40][41][42][43] Vaccination is associated with a significantly decreased risk of stillbirth, compared with unvaccinated women (OR 0.85, 95% CI 0.73 to 0.99).[32] Vaccination is associated with a decreased risk of neonatal intensive care admission.[42] Unvaccinated women are more likely to be admitted to hospital with COVID-19, compared with vaccinated women.[44][45]

Prospective and retrospective studies have demonstrated the safety of SARS-CoV-2 vaccination in pregnant women.[46][47]

Analysis of pregnancies occurring during clinical trials of the AZD1222 (AstraZeneca) vaccine demonstrated no difference in rates of conception between women who received the SARS-CoV-2 vaccine and women who received the control vaccine.[48] Cohort data have also suggested that administration of COVID-19 mRNA vaccines is not associated with oocyte or embryo development, implantation, or early pregnancy loss in patients undergoing IVF.[49]

The number needed to vaccinate (NNV) to prevent one symptomatic case of COVID-19 has been calculated as between 41 and 206 pregnant women. The NNV to prevent severe COVID-19 is between 412 and 2058. Numbers needed to harm are 37,037 for vaccine-related myocarditis and 48,780 for vaccine-related thrombosis with thrombocytopenia syndrome.[50]

Transfer of SARS-CoV-2 antibodies to cord blood and breast milk after maternal vaccination has been described.[51][52][53][54][55] Maternal and neonatal anti-SARS-CoV-2 antibody titers are higher following a third (booster) dose of mRNA vaccine in the second trimester, compared with a two-dose primary vaccination course in the second trimester.[56] Case-control studies have found that maternal completion of a 2-dose mRNA COVID-19 vaccination series during pregnancy is associated with a reduced risk of COVID-19 hospitalization among infants ages <6 months.[57][58][59][60]

Considerations for newborn care

The American Academy of Pediatrics has published guidance on the care of babies born to mothers who have COVID-19.[61]

Observational cohort studies have found that the risk of the newborn acquiring SARS-CoV-2 infection is low when contact and droplet precautions are taken to protect the newborn from maternal respiratory secretions.[62][63][64] A mask should be worn, and meticulous breast and hand hygiene performed, for direct skin-to-skin contact between mother and child.[1][61]

Breast-feeding should be encouraged; the benefits substantially outweigh the risks of transmission.[4][65] There is currently no evidence that COVID-19 can be transmitted through breast milk.[7][66][67][68] Women who are breastfeeding may be offered any suitable COVID-19 vaccine.[30][31]

Babies should not wear face masks or other face coverings because this may risk suffocation.[7]

Condition	Description
Acute lymphocytic leukemia	go to our full topic on Acute lymphocytic leukemia Patients with hematologic malignancies are at increased risk for severe COVID-19 infection.[69] Guidelines for treating COVID-19 in patients with hematologic malignancies are available.[70] Patients with hematologic malignancies have an attenuated response to COVID-19 vaccination.[71]
Acute myelogenous leukemia	go to our full topic on Acute myelogenous leukemia Patients with hematologic malignancies are at increased risk for severe COVID-19 infection.[69] Acute myelogenous leukemia (AML) is associated with worse survival in patients with COVID-19.[72] Guidelines for treating COVID-19 in patients with hematologic malignancies are available.[70] Patients with hematologic malignancies have an attenuated response to COVID-19 vaccination.[71]
Aplastic anemia	go to our full topic on Aplastic anemia Patients who have received a hematopoietic stem cell transplant are at increased risk of severe COVID-19.[69] Guidelines for treating COVID-19 in patients with immunosuppression caused by a hematologic condition are available.[70] One small study reported a reduced seroconversion rate and lower antibody response after a first dose of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine in people with aplastic anemia, compared with healthy controls. After a second vaccination, seropositivity and antibody levels were equivalent in people with aplastic anemia, and healthy controls.[73]
Autoimmune hepatitis	go to our full topic on Autoimmune hepatitis Autoimmune hepatitis (AIH) is associated with an increased risk of severe COVID-19.[69] COVID-19 may cause abnormal liver function tests in patients with AIH; these should not be attributed to a disease flare without biopsy confirmation.[74]
Breast cancer	go to our full topic on Breast cancer COVID-19 vaccination is associated with a higher incidence of axillary lymphadenopathy on breast MRI and mammography.[75][76] One study reported the incidence of mammographic axillary lymphadenopathy following COVID-19 vaccination as 3%.[76] Guidelines have been published to help avoid biopsies of reactive nodes. MRI-detected, unilateral, axillary lymphadenopathy ipsilateral to the vaccination arm is most likely to be COVID-19 vaccination-related if within 4 weeks of either dose. A follow-up ultrasound 6 to 8 weeks after the second vaccine dose is recommended.[75]
Bronchiolitis	go to our full topic on Bronchiolitis UK guidance recommends optimizing preventive treatment, including influenza vaccination and palivizumab for eligible children.[77] Key features of assessment are oxygenation, hydration, and nutrition, irrespective of the child’s potential COVID-19 status. Children who require admission to hospital should be tested for respiratory viruses, including SARS-Cov-2, influenza, and respiratory syncytial virus.
Cardiopulmonary resuscitation (CPR)	go to our full topic on Cardiopulmonary resuscitation (CPR) UK guidance advises that for those working in healthcare settings, the use of FFP3 masks or respirators and eye protection is recommended when performing chest compressions for patients with suspected or confirmed COVID-19. Personal protective equipment (PPE) should be donned as swiftly as possible to avoid any delays in treatment.[78] US guidelines published during the COVID-19 pandemic advise that chest compressions or defibrillation should not be delayed for providers to don PPE, but that initial resuscitation personnel should be relieved by providers wearing appropriate PPE as soon as possible.[79] If the patient cannot be placed supine, cardiopulmonary resuscitation may be provided in the prone position, particularly if the patient has advanced airway and circulatory support.[80]
Chronic kidney disease	go to our full topic on Chronic kidney disease People receiving dialysis are at increased risk of severe COVID-19 infection.[69] The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) BNT162b2 mRNA vaccine induces comparable neutralizing antibody titers in patients receiving hemodialysis and healthy controls. The adenovirus-associated vector vaccine ADZ1222 induced suboptimal neutralizing antibodies in seronaive patients receiving hemodialysis.[81] A retrospective observational study in the US found that, among patients receiving hemodialysis, vaccination with BNT162b2 or mRNA-1273 was associated with a lower risk of COVID-19 diagnosis and a lower risk of hospitalization or death among those diagnosed with COVID-19.[82] Another retrospective cohort study in the US found that among patients receiving maintenance dialysis, vaccine-induced seroresponse wanes over time across vaccine types.[83]
Chronic lymphocytic leukemia	go to our full topic on Chronic lymphocytic leukemia Patients with hematologic malignancies are at increased risk for severe COVID-19 infection.[69] Guidelines for treating COVID-19 in patients with hematologic malignancies are available.[70] Patients with hematologic malignancies have an attenuated response to COVID-19 vaccination.[71]
Chronic myelogenous leukemia	go to our full topic on Chronic myelogenous leukemia Patients with hematologic malignancies are at increased risk for severe COVID-19 infection.[69] Guidelines for treating COVID-19 in patients with hematologic malignancies are available.[70] Patients with hematologic malignancies have an attenuated response to COVID-19 vaccination.[71]
Chronic obstructive pulmonary disease (COPD)	go to our full topic on Chronic obstructive pulmonary disease (COPD) People with COPD are at higher risk of hospitalization, intensive care unit admission, and death from COVID-19, compared with people without COPD.[84] A large prospective cohort study found that patients aged 50 years and older with COPD, with or without asthma, were more likely to require supplemental oxygen and noninvasive ventilation, but were less likely to receive invasive mechanical ventilation or critical care, compared with patients without a respiratory condition. Mortality in this group exceeded 40%.[85] See Coronavirus disease 2019 (COVID-19) (Management). To reduce the risk of acute exacerbations, and a poorer outcome from COVID-19 infection, strongly encourage patients who are still smoking to stop.[86]
Cirrhosis	go to our full topic on Cirrhosis People with cirrhosis are at higher risk of severe COVID-19.[69] Patients with chronic liver disease have a higher mortality rate from COVID-19 infection, and mortality is associated with liver disease severity.[74][87] COVID-19 infection may precipitate acute-on-chronic liver failure in patients with decompensated cirrhosis.[88] European guidelines advise that patients who have cirrhosis and COVID-19 should be admitted to the hospital for inpatient care. Such patients are at high risk of new or worsening hepatic decompensation, severe COVID-19, and death.[87] Patients with cirrhosis and portal hypertension should avoid nonsteroidal anti-inflammatory drugs. Care should be taken to avoid acetaminophen overdosing in patients with cirrhosis.[89] Patients with cirrhosis may have an attenuated response to SARS-CoV-2 vaccination.[90] One cohort study of individuals with cirrhosis found that use of COVID-19 mRNA vaccines were associated with a reduction in COVID-19 infection and a reduction in hospitalization or death due to COVID-19 infection after 28 days.[91]
Clostridium difficile-associated disease	go to our full topic on Clostridium difficile-associated disease As there is a potential risk of transmission of severe acute respiratory disease coronavirus 2 (SARS-CoV-2) via fecal microbiota transplantation (FMT), the US Food and Drug Administration (FDA) has made the following new recommendations for stool donated after 1 December 2019:[92] - Screen donors to identify those who may be currently or recently infected with SARS-CoV-2. - Test donors and/or donor stool for SARS-CoV-2, if possible. - Patients should give informed consent after being advised about the potential risk of transmission of SARS-CoV-2 via FMT. Stool used for FMT should have been donated before 1 December 2019 if these criteria are not met.
Congenital heart disease	go to our full topic on Congenital heart disease People with congenital heart disease (CHD) may be at increased risk for more severe COVID-19 infection, particularly those with more severe anatomic and physiologic features of CHD.[93][94] Simple biventricular defects, complex ventricular defects, and heart surgery are associated with severe COVID-19.[95] Recommendations for prevention and management of COVID-19 in adults with CHD, based on risk stratification, have been published.[94][96] It is recommended that cardiac medications, including aspirin, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers, diuretics, and antiarrhythmic medications are continued during COVID-19 illness, unless there is a clear contraindication.[93]
Diabetes (type 1)	go to our full topic on Diabetes (type 1) Patients with type 1 diabetes are at higher risk for severe COVID-19 infection.[69][97] They are more likely to need hospitalization, intensive care, and mechanical ventilation if they develop COVID-19, compared with patients who do not have diabetes, and have a higher case fatality rate and increased odds of inhospital death with COVID-19.[98][99][100][101][102][103] Poor glycemic control, hypertension, recent diabetic ketoacidosis, previous stroke, previous heart failure, renal impairment, body mass index <20 kg/m² or ≥40 kg/m², male sex, older age, non-white ethnicity, and socioeconomic deprivation are associated with increased mortality from COVID-19.[100][103][104][105][106] See Coronavirus disease 2019 (COVID-19) (Management).
Diabetes (type 2)	go to our full topic on Diabetes (type 2) Patients with type 2 diabetes are at higher risk for severe illness.[69][97] They are more likely to need intensive care and mechanical ventilation if they develop COVID-19, compared with patients who do not have diabetes, and have a higher case fatality rate and increased odds of inhospital death with COVID-19.[98][98][100][101][102][107] Poor glycemic control, hypertension, previous stroke, previous heart failure, renal impairment, cancer, body mass index <20 kg/m² or ≥40 kg/m², male sex, older age, non-white ethnicity, socioeconomic deprivation and elevated C-reactive protein are associated with increased mortality from COVID-19.[104][105][106][108]
HIV infection	go to our full topic on HIV infection People with HIV are at increased risk for severe COVID-19.[69] If a patient is admitted to hospital with COVID-19, antiretroviral therapy should be continued without interruption.[109]
Idiopathic pulmonary fibrosis	go to our full topic on Idiopathic pulmonary fibrosis Patients with idiopathic pulmonary fibrosis are at increased risk of hospitalization and death due to COVID-19.[110] Guidelines for the management of patients with interstitial lung disease, including idiopathic pulmonary fibrosis, during the pandemic are available.[111] Patients with persistent respiratory symptoms following recovery from COVID-19 should be evaluated for post-COVID pulmonary fibrosis and/or exacerbation of pre-existing interstitial lung disease.[111]
Influenza	go to our full topic on Influenza During the 2021-2022 influenza season, SARS-CoV-2 coinfection was detected in 6% of children hospitalized for influenza cases, and in 16% of pediatric influenza-associated deaths. Coinfection with both viruses was associated with a higher risk of noninvasive and invasive respiratory support, compared with influenza infection alone.[112] Signs and symptoms of influenza infection and COVID-19 infection are similar and can be difficult to distinguish clinically; only testing can distinguish between them. The US National Institutes of Health (NIH) COVID-19 Treatment Guidelines recommend testing for both SARS-CoV-2 and influenza viruses in all hospitalized patients with acute respiratory illness when both viruses are co-circulating.[113] The guidelines advise that treatment of influenza is the same in all patients, regardless of SARS-CoV-2 coinfection, and that hospitalized patients should be started on empiric treatment for influenza as soon as possible without waiting for influenza testing results (antiviral treatment for influenza can be stopped when influenza has been ruled out by nucleic acid detection assay in upper respiratory tract specimens for nonintubated patients, and in both upper and lower respiratory tract specimens for intubated patients).[113]
Mucormycosis	go to our full topic on Mucormycosis Mucormycosis has been reported in patients with coronavirus disease 2019 (COVID-19), particularly in patients who have diabetes and have also received corticosteroids.[114][115][116][117][118][119]Clinicians should have a low threshold of suspicion for diagnosis. Warning signs and symptoms include: nasal congestion; blackish/bloody nasal discharge; sinus or facial pain; toothache or loosening of teeth; vision disturbances; hemoptysis; and necrotic eschar on skin, palate, or nasal turbinates. Management strategies in the context of COVID-19 include, but are not limited to: controlling hyperglycemia, diabetes, or diabetic ketoacidosis; reducing corticosteroid dose with the aim to rapidly discontinue; discontinuing immunomodulating drugs; extensive surgical debridement to remove all necrotic material; antifungal therapy (e.g., amphotericin-B) for 4 to 6 weeks; and appropriate supportive care and monitoring.[120][119] Prevention involves: controlling hyperglycemia; monitoring blood glucose level in COVID-19 patients after discharge (whether or not they are diabetic); and judicious use of corticosteroids, antibiotics, and antifungals.[120]
Multiple sclerosis	go to our full topic on Multiple sclerosis Observational studies of patients with MS have found that risk factors for severe forms of COVID-19 are older age, increased levels of disability (Expanded Disability Severity Scale [EDSS] score ≥6, requiring assistance to walk, or being unable to walk), black race, cardiovascular disease, diabetes, obesity, and corticosteroid treatment within the previous 2 months.[121][122] One study found no association between use of disease-modifying therapies and severity of COVID-19.[121] Another study found that patients taking rituximab had an increased risk of hospitalization compared with patients who did not take any disease-modifying therapy, but there was no significantly increased risk of intensive care unit admission, need for mechanical ventilation, or death among the patients taking rituximab.[122] Some disease-modifying therapies may impact efficacy of COVID-19 vaccines, and this should be considered in the timing of treatment courses and vaccinations.[123][124][125][126] Effective cytotoxic T-cell responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported in patients with MS who were treated with ocrelizumab and received two or three doses of SARS-CoV-2 vaccine.[127]
Obesity in adults	go to our full topic on Obesity in adults Obesity (body mass index [BMI] ≥30 kg/m²) is associated with increased risk of a positive COVID-19 test, hospitalization, severe COVID-19 requiring admission to intensive care, and mechanical ventilation.[101][128][129][130][131][132][133][134][135][136][137] The association is strongest in patients <65 years.[129][133] Patients with obesity who develop COVID-19 are also at higher risk for venous thromboembolism and dialysis.[131] People with class 3 obesity (BMI ≥40 kg/m²) are at increased risk of death, compared with people without obesity.[137] One meta-analysis found that obesity was associated with a 12% increase in absolute risk of COVID-19 death.[138] Being overweight (BMI >25 kg/m² and <30 kg/m²) might increase the risk of severe illness from COVID-19, and is associated with increased risk of mechanical ventilation.[128][101][133][135] There is currently no high-quality research on the effects of weight loss on COVID-19, but that the role of excess weight as a risk factor for serious COVID-19 complications warrants further consideration.[130] For those living with obesity, weight loss has been shown to bring general long-term health benefits. Patients with obesity who recover from COVID-19 may be at increased risk of postacute sequelae. One study found that patients with obesity who did not require ICU admission and survived the acute phase of COVID-19 had an increased risk of hospital admission and needing diagnostic tests over the subsequent 8 months compared with patients with normal BMI.[139] Vaccination against COVID-19 is effective in people with overweight or obesity. Vaccination reduces the risk of COVID-19-related hospitalization 14 days or more after a second dose of vaccine by 68% in people with overweight and obesity, compared with 66% in people of healthy weight.[140] However, humoral immunity against COVID-19 wanes more quickly in people with severe obesity, compared with people with normal BMI.[141]
Psoriasis	go to our full topic on Psoriasis People with inflammatory skin diseases have a higher risk of COVID-19 related death than the general population, after adjusting for confounding and mediating factors (HR 1.07, 96% CI 1.02 to 1.11). They are also at higher risk of hospital and critical care admission. South Asian people and mixed ethnicity people with inflammatory skin diseases are at higher risk of COVID-19-related death, compared with white people with inflammatory skin diseases.[142]
Sickle cell disease	go to our full topic on Sickle cell disease Patients with sickle cell disease are at higher risk of severe disease and death if they develop COVID-19. A registry of patients with sickle cell disease and COVID-19 in the US reported that the rate of hospitalization amongst adults with sickle cell disease was 69%, the intensive care admission rate was 11% and mortality was 7%.[143] A cohort study conducted in the UK reported a 4-fold increased risk of hospitalization with COVID-19, and a 2.5-fold increased risk of mortality from COVID-19, in people with sickle cell disease, compared with the general population.[144] Sickle cell trait is associated with increased risk of COVID-19 mortality and an increased incidence of acute kidney failure in the 60 days following COVID-19 diagnosis.[145] Patients with confirmed COVID-19 should be monitored closely for signs of rapidly progressive acute chest syndrome (thrombocytopenia, acute kidney injury, hepatic dysfunction, altered mental status, and multiorgan failure). The symptoms of acute chest syndrome may overlap significantly with symptoms of COVID-19. Clinicians should consider the possibility of undiagnosed pulmonary hypertension in acutely ill patients and be alert for signs of fat emboli syndrome. Signs of fat emboli syndrome include worsening anemia and mental status, hemolysis, thrombocytopenia, hypoalbuminemia, respiratory distress, and petechial rash; it may progress quickly and carries a high mortality.[146]
Syphilis	go to our full topic on Syphilis The US Food and Drug Administration has published an alert advising that false-positive Rapid Plasma Reagin (RPR) test results can occur when using the Bio-Rad Laboratories BioPlex 2200 Syphilis Total & RPR kit, in some people who have received a COVID-19 vaccine. Based on information provided by the manufacturer, Bio-Rad Laboratories, RPR false reactivity was observed in some individuals for at least five months following a COVID-19 vaccination.[147] Treponemal testing for syphilis such as Treponema pallidum particle agglutination (TP-PA) and treponemal immunoassays do not appear to be impacted by this issue and patients who received a reactive RPR result using the Bio-Rad BioPlex 2200 Syphilis Total & RPR test kit should be aware that they may need to be retested for syphilis with another test to confirm results.
Tuberculosis	go to our full topic on Tuberculosis Coinfection with tuberculosis (TB) and COVID-19 is common globally, and is associated with higher mortality than infection with COVID-19 alone. The mean in-hospital fatality rates for TB and COVID-19 coinfection are 6.5% in high-income countries, and 22.5% in low/middle-income countries.[148] Symptoms of tuberculosis may mimic those of COVID-19, and testing for tuberculosis may be considered in selected patients presenting with COVID-19.[149] The Centers for Disease Control and Prevention advise that administration of mRNA COVID-19 vaccines should not be delayed because of testing for tuberculosis (TB) infection. Immune-based testing (tuberculin skin testing or interferon-release assay) may be done before or at the same time as COVID-19 vaccination. If this is not possible, immune-based testing should be delayed for at least 4 weeks after completion of COVID-19 vaccination, but generally should not be cancelled. Patients who have active TB, or an illness that is being evaluated as active TB, may receive COVID-19 vaccination. Severe or acute illness is a precaution to administration of all vaccines. Patients who have symptoms or other diagnostic findings consistent with active TB should receive further evaluation, regardless of immune based testing results.[150]
Ulcerative colitis	go to our full topic on Ulcerative colitis People with inflammatory bowel disease are at increased risk of COVID-19-related critical care admission or death, compared with the general population, after adjusting for confounding and mediating factors (HR 1.08, 95% CI 1.01 to 1.16). South Asian, black, and mixed ethnicity people with inflammatory bowel disease have a higher risk of COVID-19-related death, compared with white people with inflammatory bowel disease.[142] Patients taking JAK inhibitors have an increased risk of COVID-19 related hospital admission, compared with patients on standard systemic therapy.[142] Prognostic models for predicting the probability of adverse COVID-19 outcomes in patients with IBD are being developed.[151]

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Management of coexisting conditions in the context of COVID-19

Introduction