Given this is a new strain of Coronavirus, there is currently no specific data that people with eating disorders are at an increased risk of COVID-19. However, given our knowledge of the physical effects of eating disorders on the body, there is reason to believe that some people experiencing eating disorders may be particularly vulnerable to more severe forms of the illness during this pandemic.

• Malnutrition, reduced body fat stores and impaired gut functioning affect the body’s ability to mount a defence against infections, including viruses such as COVID-19.
• Reduced muscle strength may result in difficulties mounting a strong cough, which can impair the ability to clear the lungs adequately.
• Respiratory reserves may already be low for some patients, increasing the need for possible inpatient medical care and mechanical ventilation.
• Malnourished individuals have low carbohydrate stores, which places them at additional risk of hypoglycaemia (low blood sugar) during periods of stress.
• People with both restricting and purging eating disorders and those undergoing re-feeding are at risk of metabolic and electrolyte imbalances, which can increase risk of respiratory failure and cardiac arrest.

Implications for the presentation of COVID-19 symptoms

It is important to note that the typical presentation of infection may not always be present in those that are malnourished. This includes:

• Absence of fever
• Absence of increased heart rate
• Lack of substantial cough

It is recommended that patients with eating disorders as well as their carers and loved ones follow the measures advised by the Department of Health and Human Services in minimising their risk of contracting COVID-19.

No additional precautionary measures for patients with eating disorders are advised at this stage.

• Call your GP clinic in advance as per government guidelines
• Inform the clinic of your own or your loved one’s vulnerable status due to an existing eating disorder. Use the information on this page to support you if needed.
• If it is an emergency, present to your local emergency department or call 000.
• Keep your treatment team informed of your condition

During this period, it is essential that you remain in contact with your treating clinicians so that they can best advise you on how to maintain or pivot your treatment plan. Whilst external factors may affect the way your treatment takes place, it is important to continue to prioritise your recovery.

The federal government has announced MBS item numbers for the provision of telehealth for many services.

This means that clients with eating disorders will be able to consult their clinicians (such as GP, paediatrician or psychologist) via video link or telephone, rather than in person. These new telehealth item numbers are bulk billed for certain eligible individuals.

Telehealth includes people who are currently seeing a psychologist and/or dietitian through an Eating Disorder Plan. We encourage you to talk to your clinical team about best options for you at this time.

Special consideration for supermarket food delivery

Woolworths have created a Priority Assistance program for vulnerable members of the community. People with eating disorders and carers are encouraged to apply to access online food shopping and delivery. Visit:

https://www.woolworths.com.au/shop/discover/priorityassistance

To support your application, you can ask your treating practitioner to sign off on this template letter designed by healthcare professionals.

Working from home for parents and carers

Carers are encouraged to work from home where possible.

Use this template letter for carers to assist with the request to work from home. You will need your treating practitioner to sign off on it.

In times of challenge we can find our mood changes and we may notice increased worry or anxiety creep in. Sometimes we may even notice the signs in those around us. Here we’ve provided a few strategies to help in managing anxiety and worry.

• Try to focus on things within your control – write out things that worry you and take active steps to address them.  Recruit support people and use tools and strategies to reduce anxiety and stress.
• Don’t obsessively look things up on google, news pages, facebook, Instagram, and so on.  When you do use credible sources and stick to the facts.  Find the balance between information seeking and information overload.
• Watch out for unhelpful thinking styles:
  Catastrophising – building things up to the worst possible case scenario in your mind
  Future predicting – worrying excessively about outcomes not based upon fact
• Increase self care, practice mindfulness, deep breathing and grounding tools
• Let your behaviour be driven by fact and what’s sensible rather than by fear and panic.
• If you have concerns seek medical advice!  There are telehealth options available to you if person to person support is not an option.
• Think about ways you can use gratitude and compassion such as by running errands for those who cannot do this for themselves, donate to food banks, join the #viralkindness campaign and so on.
• Be mindful of the conversation and behaviours we are role modelling for children.  Ask yourself, am I role modelling calm and compassionate behaviour or panic and worry?

Staying at home more? Our tips for enjoying the great indoors.

The EDV Hub
Mon – Fri 930am – 430pm
Ph. 9994 0354 or email [email protected]

Information regarding EDV and COVID-19
https://eatingdisorders.org.au/find-support/edv-and-covid-19/

The Butterfly Foundation
National Helpline 8am – midnight (AEST), seven days a week
Ph. 1800 33 4673 or webchat via https://thebutterflyfoundation.org.au/

Information from The Butterfly Foundation about COVID-19 and tips and advice for people affected by eating disorders
https://www.thebutterflyfoundation.org.au/covid-19/

F.E.A.S.T Community Pandemic Support
https://www.feast-ed.org/f-e-a-s-t-community-pandemic-support/

Eating Disorders Families Australia
https://www.edfa.org.au/
EDFA are running their strive support groups online until further notice.

Victorian Centre of Excellence in Eating Disorders (CEED)
https://www.ceed.org.au/ (refer to page with COVID19 info)
Phone: (03) 8387 2673
Email: [email protected]

National Eating Disorders Collaboration (NEDC)
https://www.nedc.com.au/

Australia and New Zealand Academy for Eating Disorders (ANZAED)
http://www.anzaed.org.au/

COVID-19 Hotline
1800 675 398 (24 hours, 7 days a week)

Victoria’s Department of Health and Human Services
https://www.dhhs.vic.gov.au/coronavirus

Federal Government Coronavirus health alerts
https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert

Thank you to the following people and organisations for contributing to this information:

• Dr Suba Rudolph, Paediatrician, Austin Health
• Dr Suzy Redston, Medical Director, Mental Health Division, Austin Health
• Kate McHardy, Team Leader, Inner West Area Mental Health Service Specialist Unit
• Dr Jacinta Coleman, Head of Adolescent Medicine, Monash Children’s Hospital
• Dr Michele Yeo, Paediatrician / Adolescent Physician, Royal Children’s Hospital
• Victorian Centre of Excellence in Eating Disorders (CEED)
• National Eating Disorders Collaboration (NEDC)
• Eating Disorders Families Australia (EDFA)