Dr. Sudheer Vinnamala
Consultant Gastroenterologist, Hepatologist & Therapeutic Endoscopist
KIMS Hospitals, Kondapur.

Very few of us would have lived through a pandemic. Some of us have seen epidemics.

Today on the eve of World Liver day and amidst the WHO declared Global Corona virus pandemic-let’s take the opportunity to raise our awareness of the specific risks and precautions that need to be taken by patients suffering from liver diseases. Liver diseases can result from several causes such as alcohol, viral infections (hepatitis B, hepatitis C virus and other infections), autoimmune, drug / medications etc. Every year about 10 lakh patients are newly diagnosed with liver cirrhosis around the world. Recent World Health Organization data showed liver disease related deaths in India has reached 259,749/ yr. i.e., 2.95% of total deaths.

Liver disease ranges from mild spectrum of self-limiting illness due to infection or fat deposition in liver to the severe form with cirrhosis, acute or acute on chronic liver failure requiring transplantation. With advancing age and increasing epidemic of obesity more and more people are now developing obesity related liver disease called NASH or Non-alcoholic steato hepatitis. There is a shift from traditional infection related liver disease to the 21^st century causes like weight gain, decreasing exercise, increased alcohol consumption, increased incidence of diabetes and longer life expectancy leading to advanced liver disease in patients with multiple other comorbidities.

Despite finding cure for Hepatitis C the increasing burden of obesity related cirrhosis is expected to increase liver transplants in a small minority of these patients at a time when there is severe deficit of donor organs.

The current pandemic:- Corona virus  belongs to a family of viruses that cause cold, flu and more serious severe Acute Respiratory Syndrome (SARS). COVID-19 is a disease caused by a newly discovered coronavirus. The outbreak began in Wuhan, China, in December 2019. The disease can spread from person to person through small droplets from the nose or mouth when a person with COVID-19 coughs, exhales or sneezes (droplets spread about 6 feet), some faecal-oral transmission is also possible. We do not yet have immunity through prior exposure. There is also limited data if there is community spread in India, so social distancing and isolation are vital.

People with suppressed immune systems due to immunosuppressive medication, age > 60, people with other comorbidities such as diabetes, HTN, heart disease or as a component of other illnesses are at elevated risk of both contracting the infection and having a more severe disease.  Some liver disease patients have several of the above-mentioned concurrent conditions such as diabetes, obesity, heart disease, kidney disease and anaemia which increases susceptibility

Whilst most patients with mild liver disease do not require any additional precautions other than social distancing and general safety measures, people with cirrhosis or those taking immunosuppressive medications such as steroids, patients awaiting liver transplant or already those who have received one are at high risk of developing a severe form of disease if develop infection with corona virus.

The following precautions are needed for all patients:

Staying at home, only going outside for grocery, health reasons or work (i.e if you cannot work from home). Even if you go out, stay at least 2 metres (6ft) away from other people and wear a mask at all times. Wash your hands as soon as you get home. It is important to understand that one can spread the virus without symptoms in the early stage of the disease. Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19), especially high temperature and/or new and continuous cough. Avoid all non-essential travel and public transport if possible. Avoid any gatherings and keep in touch using remote technology such as phone, internet, and social media.

Patients with more severe forms of liver disease require more stringent measures in addition to above and may need to isolate themselves. Try to arrange doctor appointment via tele or video consultation if needed. If you are on medication to treat your liver disease, please keep enough supply to last this lock down and pandemic

Crucially important are lifestyle changes such as stopping alcohol, staying fit and healthy through indoor exercises to optimise weight, eating healthy with diet rich in fruits and vegetables is necessary. Contact your liver specialist for any specific advice especially if you are on immunosuppressants such as steroids. It is vital to continue the medication whilst making every effort to avoid getting the infection. In these testing times when we have no definite vaccine or cure for this corona virus – prevention is our best hope of containing the infection and protecting the vulnerable in society. Stay home, stay safe and healthy.