Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic

Abstract

During the early stages of the coronavirus disease 2019 (COVID-19) pandemic, EASL and ESCMID published a position paper to provide guidance for physicians involved in the care of patients with chronic liver disease. While some healthcare systems are returning to a more normal routine, many countries and healthcare systems have been, or still are, overwhelmed by the pandemic, which is significantly impacting on the care of these patients. In addition, many studies have been published focusing on how COVID-19 may affect the liver and how pre-existing liver diseases might influence the clinical course of COVID-19. While many aspects remain poorly understood, it has become increasingly evident that pre-existing liver diseases and liver injury during the disease course must be kept in mind when caring for patients with COVID-19. This review should serve as an update on the previous position paper, summarising the evidence for liver disease involvement during COVID-19 and providing recommendations on how to return to routine care wherever possible.

The Liver’s Fate Amid COVID-19 Pandemic

“…To decrease the potential spread of the disease via hospital-associated transmission, patient's visits should be limited or at least staggered to prevent crowding and to achieve proper social distancing at the clinics. Several professional associations including the APASL [8,18] , American Association for the Study of the Liver Diseases (AASLD) [19] , and the European Association for the Study of the Liver (EASL) [20] released position statements and consensus. For patients with viral hepatitis undergoing ongoing treatment, it is recommended to continue treatment whenever possible.…”

“…Similarly, patients with MAFLD should also be made aware of their condition and susceptibility, because obesity alone is a risk factor for more severe COVID-19 infection [21,22] . Lifestyle modification, weight loss, and diabetes glycemic control should be emphasized [18,20] , and patients should be informed of their crucial role in managing MAFLD.…”

“…However, for patients who did not fulfill the treatment criteria, the initiation of antiviral therapy should be discussed with the patient due to the long-term duration of the treatment. For patients with hepatitis C, it is recommended to defer treatment until COVID-19 infection is resolved [19,20] .…”

“…The transport of patients with COVID-19 should be limited as it increases personal contact with the patients and the risk of transmission; therefore, imaging such as ultrasound, MRI/MRCP, is not recommended unless it is highly likely to alter management. Ultrasound indicated for surveillance should be deferred until recovery [20] .…”

“…In patients with chronic HBV who are infected with COVID-19, it is recommended to continuing treatment [18,20] . Justification for the recommendation is due to the fact that some drugs such as corticosteroids and tocilizumab, which used to treat COVID-19, may cause reactivation of HBV and hepatitis flare [36][37][38] .…”