Action on COVID-19

* Revised February, 09 2021 *

The health and safety of each member of our community is our highest priority. As such, we are in regular communication with our regional offices to ensure everyone is following the protocols that support their health and wellbeing. Specifically, we have taken the following steps:

• Our National and Regional offices are closed, but our staff is working remotely to ensure a continuation of service. Our sharpest focus is on maintaining our National Help Line and other patient support services to answer questions from our community members. We are continuing to keep our community informed via social media.
• We have cancelled all in-person events until further notice. Please see the advisory notice below regarding in-person events.
• We encourage everyone to follow us on social media to stay connected and learn more about our upcoming online events/programs.

Individuals living with liver disease might be wondering about COVID-19 recommendations specific to their situation. There are a number of important points to make that will be of interest for these members of our community:

• Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has rapidly escalated into a global pandemic.
• COVID-19 elevates liver enzymes, even in individuals who do not have a liver disease diagnosis. In mild cases, the liver damage is temporary and usually does not require treatment, but severe cases may result in long-term or permanent liver injury.
• Currently, there is limited information about whether people with a chronic liver disease, including liver cirrhosis, hepatitis B, hepatitis C, and chronic non-alcoholic liver diseases are at increased risk for getting COVID-19 or having severe COVID-19. However, based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions, including people with advanced liver disease (decompensated liver cirrhosis), may be at higher risk for severe illness from COVID-19, particularly if the underlying medical conditions are not well controlled.
• Patients who are overweight or obese with non-alcoholic fatty liver disease (NAFLD) often have additional metabolic risk factors which may aggravate the severity of COVID-19, if they become infected.
• Autoimmune liver disease is not a known risk factor for getting COVID-19 or having a more severe COVID-19 infection.
• People with liver cancer may be at higher risk of severe COVID-19 illness and/or developing more problems from their existing liver disease. COVID-19 should not prevent patients from receiving cancer therapy. Treatment options may vary depending on their availability within the center and your stage of cancer. All of these options will be evaluated carefully by the your health care providers.
• Children with liver disease or post-transplant, who are on more than one immunosuppressive medicine (after transplant or for autoimmune hepatitis), other medical conditions may be at higher risk of severe COVID-19 if they become infected.
• Heavy alcohol use is toxic to the liver and can limit the bone marrow’s ability to make the cells needed for a healthy immune system. Health care providers are encouraging their patients to abstain from excessive alcohol use during the pandemic, especially since patient with alcohol-related liver disease are at particularly high risk of developing severe illness from COVID-19 infection.
• Recent reports suggest that liver transplant recipients may not have a greater risk of developing severe illness from COVID-19 infection. However, most of these patients may require hospital admission should they become infected. Severe complications has been observed only in older patients (>60 years of age) and more data of COVID-19 in transplant recipients will be forthcoming.
• The decision to proceed with organ donation and transplantation must balance the risk the virus poses to potential recipients with the risk of delaying transplantation. Undoubtedly, this will cause concern for those waiting for a transplant and for transplant recipients. Those awaiting liver transplant should know that the risk of acquiring COVID-19 by organ donation is very low, as all donors—living and deceased—are screened for the virus. As the situation is unique in each province, provincial transplant programs are working with patients to provide information and updates. Most programs in Canada are continuing to perform liver transplants with appropriate testing of both donors and recipients. For the latest information from the Canadian Society of Transplantation (CST), please visit www.cst-transplant.ca/COVID-19_Information.html

The safety of returning to work or other in-person activities depends on the severity of your liver disease, how strongly immunosuppressed you are, whether you have any other medical problems, current COVID-19 transmission in your community, and whether measures to prevent transmission are being practiced (physical distancing, wearing face coverings, handwashing or using a hand sanitizer). We strongly recommend following Health Canada’s public health guidelines: www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

The COVID-19 pandemic has increased stress and anxiety for many people—around health, family, economic security, and other issues. These are real and important issues for everyone, and we are united in delivering a singular message to each member of our community: you are not alone! Reaching out for mental health support and maintaining healthy habits, such as exercising regularly, getting fresh air, eating wholesome foods, and getting regular sleep, remain very important during the pandemic.

• Our National Help Line will continue to be available throughout the pandemic. Reach us by email at info@liver.ca or by phone at 1-800-563-5483 (Mon-Fri 9:00-5:00).
• We encourage everyone to follow us on social media to stay connected. We are committed to frequent communication throughout the pandemic, focusing on ways to stay healthy and well in our current circumstances, news from throughout our national network, and encouragement for those affected.