EASL–ESCMID Position Paper: a review, six months into the pandemic

Six months into the COVID-19 pandemic, an article has been published to provide guidance for physicians involved in the care of patients with chronic liver disease.

5 August 2020 – Geneva, Switzerland: This newly published review serves as an update, summarising the evidence for liver disease involvement during COVID-19 and providing some recommendations on how to return to routine care wherever possible. It follows the European Association for the Study of the Liver (EASL) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) EASL–ESCMID Position Paper, published in April 2020 in EASL’s open-access journal, JHEP Reports.

During the early stages of the COVID-19 pandemic, the original EASL–ESCMID Position Paper was published to provide guidance for physicians involved in the care of patients with chronic liver disease. In the meantime, many countries and healthcare systems have been, or are still overwhelmed by the pandemic, significantly impacting on the care of this group of patients, while others have started to return towards their usual routine. 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.

The review, “Impact of COVID-19 on the care of patients with liver disease: EASL–ESCMID position paper after 6 months of the pandemic” by Boettler et al, was published on 4 August 2020 in JHEP Reports.

Caption: Liver disease progression and poor outcomes from SARS-CoV-2 infection are closely associated. There must therefore be a concerted effort to resume standard of care and restore hepatology/transplantation services in order to improve patient outcomes.

While many aspects of how COVID-19 affects the liver remain poorly understood, it has become increasingly evident that pre-existing liver diseases and liver injury during the course of the disease have to be kept in mind when caring for patients with COVID-19.

The review outlines:

Pre-existing liver disease as risk factor for COVID-19
Liver injury secondary to COVID-19
Recommendations for the management of patients with chronic liver disease (general and specific)
Liver-related diagnostic procedures, and
Liver specific considerations in the pharmacological management of COVID-19.

It also includes graphics: a flowchart showing the association between liver disease progression and poor outcomes from SARS-CoV-2 infection (shown above); and a summary of recommendations.

Subsequently, EASL then conceptualised a lay version of this follow-up paper: Lay summary of Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID Position Paper after 6 months of the pandemic.

This lay summary, co-written by Martine Walmsley, Mojca Matičič, and Maria Butí, is intended to reach the general public. It answers these important questions:

What are the risks of COVID-19 infection and its severity for people with chronic liver disease?
What is the impact of COVID-19 on the liver?
How should people with liver disease be cared for during the COVID-19 outbreak?
Which procedures can go ahead/be delayed?
What is known about COVID-19 treatments and the liver?

Six months into the COVID-19 pandemic, an article has been published to provide guidance for physicians involved in the care of patients with chronic liver disease.

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