What gastroenterologists should know during COVID-19 Pandemic!

The WHO has declared a Pandemic due to Novel Corona virus-19 (COVID-19). Patients usually have respiratory symptoms but gastrointestinal and hepatic dysfunction are not uncommon presentations and can lead to a delay in diagnosis and management. Virus shedding can continue even after the nasopharyngeal swab gets negative and could lead to faecal-oral transmission. The effects of COVID-19 on patients with decompensated liver disease is still not clear. Managing immunosuppressive drugs in liver transplant and inflammatory bowel disease is a major challenge without clear guidelines. Only emergency endoscopy is to be done with personal protection equipment. Chloroquine and Hydroxychloroquine has shown some beneficial effects and is being used off-label. Without effective treatment, it is imperative to take precautionary measures.

Problems faced by patients and health service utilization experiences of gastrointestinal patients during lockdown due to COVID-19 pandemic.

Objectives: The COVID-19 pandemic undermined the health service delivery and utilization of essential health care services globally. The current study therefore aimed to explore the health-seeking behaviors and challenges faced by patients for the management of gastrointestinal diseases. Methods: A cross-sectional study was conducted at the outpatient department of Gastroenterology, Liaquat National Hospital, Karachi from March 2020 to July 2020 during the COVID-19 lockdown phase to explore patient experiences. Data was collected using a survey questionnaire. All patients of either gender were included after informed consent. Statistical analysis of the data was conducted using SPSS 21.0. Results: A total of 184 patients were included who visited the hospital to seek medical services during the COVID-19 lockdown phase. The mean age of the population was 42.7 years (±16.13). Of these, n=94 (51.1%) were males All patients had gastrointestinal issues with different comorbid conditions. One forty-seven n=147 (79.9%) presented with active complaints whereas, n=37 (20.1%) patients visited the hospital for their follow-up checkup. Out of 184 patients, n=33 (17.9%) patients reported of having fear of visiting hospital due to COVID-19 outbreak. A statistically significant difference p<0.001 was noted between the history of comorbidities and patient delaying a visit to the healthcare due to the fear of COVID-19. Additionally, 61 (73.5%) patients with co-morbidity faced difficulty in finding public transport (p=0.01). Nevertheless, n=171 (93.0%) patients expressed satisfaction with the services provided by the hospital during the lockdown phase. Conclusion: Patients with gastrointestinal conditions were largely affected by lockdown largely due to fear of contacting COVID-19 disease and inaccessibility to the public transportation. Widely available telemedicine service might overcome these shortcomings and ensure continuity of quality care.