People living with hepatitis C, viral hepatitis activists, medical providers, and public health officials have advocated for universal HCV screening for years. We finally got our wish: On April 10, the Centers for Disease Control and Prevention recommended HCV testing for all adults age 18 and older without any requirement to talk about potential risk factors such as injection drug use that people are less likely to talk about due to stigma and fear of judgment. Universal screening is an excellent way to discover previously unknown HCV infections, and creates an opportunity for people who are living with HCV to find out their status and get connected to care, treatment and ultimately, cured.
Unfortunately, this recommendation fell smack in the middle of the COVID-19 outbreak when so many cities and states have instituted “shelter-in-place” (SiP) rules to minimize transmission of the coronavirus in public settings. The real challenge will be in finding a place to get a test due to safety concerns. We are starting to see testing facilities re-open, but many organizations that do community-based testing aren’t doing it right now. Similarly, there is concern that many cities and states will experience a resurgence of COVID-19 cases after they’ve re-opened, and community-based organizations, clinics, and hospitals will have to limit services again to deal with a new onslaught of patients.
The importance of HCV (and other liver diseases) is great, but the urgency of coping with the COVID-19 public health emergency surpasses everything else at this time.
The good news, per the American Association for the Study of Liver Diseases (AASLD), is that there is no evidence that patients with chronic liver disease without advanced fibrosis due to hepatitis B and/or C are at greater risk of COVID-19 infection or for having worse health outcomes when infected. People with cirrhosis do appear vulnerable to the more serious negative health outcomes from COVID-19 infection, and they should take special precautions to stay safe and healthy. That said, we still want to get people tested and treated for HCV, but to do so as safely as possible.
There are AASLD recommendations for safely doing HCV care and treatment, a selection of which follow:
• When COVID-19 is prevalent in the community, severely limit outpatient visits to only patients who must be seen in person, even in areas without significant COVID-19 community spread.
• Follow CDC recommendations for PPE.
If PPE is unavailable, keep a distance of at least 6 feet from the patient.
• Strongly consider phone visits or telemedicine as appropriate and available to replace in-person appointments.
• There is no contraindication to initiating treatment of hepatitis B and C in patients without COVID-19 as clinically warranted.
You may find places that are still doing HCV testing, but be prepared for lots of protective practices in place to prevent both you and the staff from getting COVID-19. Allow for extra time as a result. Your best bet to keep up with changes is to call ahead of time. Call HELP-4-HEP (877-4357443) for local HCV resources, and then follow up by calling those places to see if they are currently offering HCV testing and treatment.