Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus.

According to official information issued by the World Health Organisation (WHO), most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness. The disease is easily spread and it is vital that every effort is made to control the spread of the disease and ensure health systems are able to provide services to all that need them.

The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 and was declared  a pandemic on 12 March 2020.

Evidence is emerging all the time about the impact of COVID-19 on specific disease areas. Currently there is no specific guidance for people living with viral hepatitis, however the World Hepatitis Alliance is working with the global liver societies to get the most up to date guidance for people living with viral hepatitis.

During the COVID-19 pandemic it is highly likely that services for people who are living with viral hepatitis will be affected. The impact on hepatitis services will vary between each country but it may mean that testing, prevention and treatment services are limited or suspended. Services may also be delivered remotely by telephone or web link.

Those awaiting treatment for hepatitis C may experience a delay in receiving the medication, this is to ensure your safety during this time and the safety of medical professionals.

Those on hepatitis B treatment may be asked to ensure that you have enough medication for the duration of any period of self-isolation, if you are concerned about the provision of your treatment please contact your medical services provider.

Please follow guidance from your health service to get the correct information for where you are, you can also contact members of the World Hepatitis Alliance should you have concerns, you can find out how to contact them at www.worldhepatitisalliance.org/our-members. 

For those awaiting a liver transplant the procedure may be delayed due to the immunosuppressant medication that is used post procedure. This will be determined by your medical services.

For those that have received a liver transplant they may be asked to self -isolate during the pandemic, national governments are issuing guidance on this which should be followed.

Communities at the highest risk from viral hepatitis are often the most marginalised and undeserved by health systems and may be disproportionately affected by COVID-19. World Hepatitis Alliance members and other community groups play an important role in ensuring that people get adequate information on what they need to do during the COVID-19 pandemic.

People who use drugs (PWUD) 
For countries where they are available, safe consumption rooms and needle exchanges may not be able to operate as normal for people who inject drugs (PWID), please contact them to find out how services will be affected. People on opioid agonist treatment (OAT) or opiod substitution therapy (OST) may need to contact their medical provider to

People who are in group therapy programmes or fellowship programmes may not be able to attend group work, classes or fellowship meetings. Many health care providers and fellowship meetings are providing online and telephone support during this time.

The European Monitoring Centre for Drugs and Drug Addiction have issued guidance, click here to view.

The International Network for People Who Use Drugs has issued guidance, click here to view. 

Correlation, The European Harm Reduction Network have established a Resource Centre, click here to view.

The USA’s Harm Reduction Coalition has released multilingual COVID-19 Guidance for People Who Use Drugs and Harm Reduction Programs, click here to view.

Yale University have released guidance for people who use drugs, click here to view.

People in prison (PIP)
People in prison may experience a reduction in the hepatitis programmes within the prison, this may mean peer support is unavailable or limited. Speak to the prison health care provider for more details. People in prison may also be restricted from receiving visitors during the pandemic.

WHO EURO has released interim guidance that may be useful, click here to read the guidance.

The ASHM Taskforce on BBVs has issued interim recommendations for people in prison during the COVID-19 pandemic, including people living with viral hepatitis

Refugees and migrants
Refugees and displaced people often have limited access to adequate health care, it may also be more challenging for them to maintain adequate physical distancing or social distancing. Services for this community may be affected during the pandemic. Civil society play an important role in ensuring that basic health provision is provided and that adequate information is provided to refugee communities during the pandemic.

UNHCR, The UN Refugee Agency has a live blog with guidance, click here to view. 

Switchboard, a resource hub for refugee service providers in the United States, has released a roundup of multilingual resources on COVID-19, click here to view.

People living with HIV
There are currently no specific recommendations for people living with HIV and hepatitis, however please speak to you medical services provider for more detailed information.

 UNAIDS has issued guidance for people living with HIV, click here to view. 

IAS has created an information hub and webinars for people living with HIV, click here to view.

People experiencing homelessness 
People experiencing homelessness who rely on drop-in services and day centres for supplies including food and clothing may not be able to access these services during the pandemic. In some areas, outreach services are still available. As many homeless people will have limited or no access to digital information or other telecommunication methods, civil society play a key role in ensuring they have access to adequate information about changes to services and about basic precautions that can be taken to reduce the risk of contracting COVID-19.

People experiencing homelessness may also have limited access to adequate hygiene and sanitation facilities, and may struggle to maintain adequate physical distancing or social distancing. Is it important that people experiencing homelessness have access to basic necessities, basic health provision, and hygiene facilities.

The Centre for Disease Control (CDC) has released a guidance document for people experiencing homelessness, view the guidance here.

Mental Health
The COVID-19 pandemic may have an effect on an individuals mental health. The pandemic and self-isolation may increase worries and anxieties. People living with viral hepatitis may have existing mental health issues as a result of stigma and self stigma. There are many resources available for those with mental health issues during this time.

MIND, a UK charity for mental health has released guidance here,

Stay aware of the latest information on the COVID-19 outbreak, available on the WHO website and through your national and local public health authority. Most people who become infected experience mild illness and recover, but it can be more severe for others. The WHO advises that you can take care of your health and protect others by doing the following:

As the COVID-19 (Coronavirus) pandemic spreads across the globe, it is affecting all of our lives. WHA members and other civil society groups have always worked passionately with some of the most marginalised and underserved communities in the world and these communities will also be disproportionately affected by COVID-19.

Every WHA member will be working around the clock to minimize the impact of this pandemic on their communities and fight for the rights of their patients. The hepatitis elimination community stands ready to assist in the fight against COVID-19. We bring significant experience in working with communities to ensure health care systems and effective and efficient.

This will be a challenging for organisations. The stark reality is that many WHA members face suspending vital hepatitis prevention, testing and treatment services.

WHA s working hard to adapt so we can support WHA members, patients, and the hepatitis elimination community during this pandemic.

If there is anything WHA can do to help you, please get in touch. Please also share your stories and experiences of overcoming the challenges of the current situation. You can email us on contact@worldhepatitisalliance.org.

• WHO EURO report on COVID-19 in prisons and other places of detention.
• American Association for Study of Liver Diseases (AASLD) Clinical Insights for Hepatology and Liver Transplant Providers During the COVID-19 Pandemic
• European Monitoring Centre for Drugs and Drug Addiction guidance for people who use drugs
• The International Network for People who Use Drugs guidance 
• UNAIDS guidance for people living with HIV 
• Correlation, European Harm Reduction Network Guidance.
• Centre for Disease Control Guidance for people experiencing homelessness 
• EASL-ESCMID Position Paper on care of patients with liver disease during the COVID-19 pandemic
• Hep Free NYC COVID-19 community resource