Caring for Immunocompromised Patients in the COVID-19 Context

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The Caring for Immunocompromised Patients in the COVID-19 Context tool is revised often and new content is added regularly to guarantee that the latest evidence and regulatory recommendations are included. The CEP is committed to ensuring this information is accurate and up to date.
Last reviewed: February 2, 2021
Last updated: January 22, 2021

Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.

This tool has has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’, with considerations and recommendations on what’s ‘new’ and what’s ‘changed’ in the delivery of care for immunocompromised patients. While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.

Key takeaway

Immunocompromised patients are at higher risk of getting severely sick from COVID-19 (CDC, December 16, 2020), and should take precautions to protect against acquisition of the virus. Immunocompromised patients include (CDC, December 29, 2020):

  • Individuals using immunosuppressant medications.
  • Bone marrow or solid organ transplant recipients.
  • Individuals with inherited immunodeficiency.
  • Individuals living with poorly controlled human immunodeficiency virus (HIV) infection.
  • Patients receiving chemotherapy.

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What's new, what's changed

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Immunocompromised patients should self-isolate for their own protection (PHO, October 28, 2020), keep physically active, and continue practicing condition-specific preventative measures (ECDC, September 24, 2020).

Immunocompromised healthcare providers must make decisions that reflect their own unique situations, while also considering public health advice and the best available evidence (CPSO, January 15, 2021).

Putting it into practice

  • Encourage patient to take their medications, follow the advice of their healthcare providers, and call their healthcare provider if they have concerns about their condition or feel sick (CDC, December 29, 2020).
  • Make sure that they have at least a 30 day supply of medications if possible (CDC, December 29, 2020).
  • Do not delay life-saving treatment or emergency care (CDC, December 29, 2020).
  • Leverage virtual platforms to engage with a patient’s multidisciplinary management team (specialist, nurse case manager, dietitian, social worker, pharmacist, etc.).
  • Consider risk mitigation options in consultation with the patient’s specialist (NICE April 3, 2020NICE, April 23, 2020NICE, April 9, 2020):
    • Enable virtual or in-home monitoring (see local community services and resources for Homecare in your area).
    • Enable in-home laboratory sample collection (see local community services and resources for Diagnostic centres and laboratories in your area).
    • Reduce the frequency of in-person appointments.
    • Increase the time interval between blood tests in patients who are stable on treatment (taking age and comorbidities into account).
    • Modify dose, treatment schedule, and/or administration protocol to reduce the need for hospital attendance (including use of community outreach teams if available) and/or reduce the likelihood of subsequent hospital admission.

Supporting evidence

According to a study in the BMJ, inflammatory bowel disease (IBD) medication has been shown to be associated with significant increased risk of severe COVID-19 (October 20, 2020).

  • Specifically, thiopurine monotherapy and the combination thiopurines with TNF antagonists are associated with significantly increased risk of severe COVID-19.
  • Mesalamine/sulfasalazine may be associated with an increased the risk of severe COVID-19, particularly when compared with TNF antagonists.


These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.

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