The World Health Organization (WHO) declared a global pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on March 11, 2020. Due to rapid rate of infection, most of us are overwhelmed by the increased demands that this infection has exerted on our healthcare systems and our personal work. The below mentioned guidelines are provided by World Gastroenterology Organization (WGO) which summarizes the current most appropriate way forward for management of liver diseases in COVID-19 patients.

WGO recommendations about liver tests in all patients with COVID-19 

• Routine outpatient testing is not recommended, which is applied to both developed and developing countries.
• Check for viral hepatitis causes in patients with elevated ALT or AST.
• Monitor worsening of COVID-19 with platelets, albumin, ferritin and CRP in severe cases.
• Routine investigation should be done on the basis of local context and availability to exclude other aetiologies.
• Routine imaging is not recommended unless it will change management.

WGO recommendations about liver comorbidities and COVID-19

• COVID-19 evaluation in low-income countries should include blood tests for AST, ALT, and if any are elevated, patients should be examined for HBsAg and anti-HCV.
• Hepatitis B and C, HBsAg and anti-HCV should be calculated in all patients with COVID-19 who are admitted to the hospital.
• Treat patients with HBV or HCV with direct acting antiviral (DAAs), especially in those with signs indicative of advanced liver disease.
• Do not discontinue antiviral medications for HBV or HCV in patients infected with COVID-19
• Avoid procedures that could put others at risk such as liver ultrasound or other advanced imaging during the COVID-19 illness, unless there is a clinical suspicion.
• Provide 90-day supplies instead of 30-day supplies for HBV oral antiviral drugs and complete the full course of DAA medications to complete HCV treatment, if this has been initiated.

WGO recommendations about metabolic dysfunction associated fatty liver disease (MAFLD) and COVID-19

• The identification and monitoring of patients with metabolic disease is crucial to diagnose the stage and grade of MAFLD during and after the COVID-19 crisis. 
• Patients with MAFLD are counselled for adopting healthy lifestyle, which can thus; prevent risk factors such as obesity that can cause poor prognosis for COVID-19 patients.