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    Do People with Celiac Disease Face Higher Covid-19 Risks?

    Jefferson Adams
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    Reviewed and edited by a celiac disease expert.   eNewsletter: Get our eNewsletter

      Here are some answers to some basic questions, along with some helpful tips for dealing with the Covid-19 outbreak.


    Do People with Celiac Disease Face Higher Covid-19 Risks?
    Caption: WV meeting on Covid-19. Image: CC PDM 1.0--GovJustice

    Celiac.com 03/19/2020 - The Covid-19 outbreak has people searching for answers regarding the virus, its symptoms and course, and any risk factors for certain groups. One question we are seeing a lot is: Do people with untreated celiac disease face a higher risk of developing complications with the coronavirus? Should they take extra precautions?

    The answers are not totally clear, but in the interest of keeping people with celiac disease informed, healthy and safe, here are some answers to some basic questions, along with some helpful tips for dealing with the Covid-19 outbreak. 



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    We know that the coronavirus can cause extreme respiratory distress, and pneumonia, especially in the elderly and/or people with compromised immune systems. 

    According to Wikipedia, "Coronavirus disease 2019 symptoms include fever, cough and shortness of breath. Muscle pain, sputum production and sore throat are less common. While the majority of cases result in mild symptoms, some progress to severe pneumonia and multi-organ failure."

    It's true that epidemics of flu and other viruses tend to cause more severe issues for people with pre-existing health conditions. So if you are already sick from celiac disease and could Covid-19 increase the chances you have a more severe case? Could you be at higher risk for pneumonia? 

    Viral vs. Bacterial Pneumonia

    Possibly, but the answers just aren't clear. One main concern is clearly pneumonia. We know that coronavirus can cause severe respiratory distress, and can lead to pneumonia. Now, there are two types of pneumonia: Viral and Bacterial. Without getting too technical, bacterial pneumonia is treated with antibiotics. Viral pneumonia is not treated with antibiotics. People with Covid-19 are mainly coming down with viral pneumonia. That means antibiotics are not helpful. 

    Higher Pneumonia Risk for Celiac Patients

    We also know that people with celiac disease can face higher risk for bacterial pneumonia and hyposplenism. Doctors generally recommend that celiac disease patients receive pneumococcal vaccination, but little has been done to quantify risk levels.

    Celiac UK advice to celiac patients points out that up to 30 per cent of people with celiac disease suffer from reduced splenic function, or hyposplenism. This points to a weakness in the immune system that supports the adoption of stringent social distancing measures.

    Some Positive News

    Some say that people with celiac are not immunocompromised and are not at higher risk for covid-19. Celiac.com forum member LJR1989 shared this helpful link. There's also some good research to show that mucosal healing does not influence the risk of serious infection requiring hospital-based medical attention in celiac patients. There's also a reassuring message from Dr. Andrew Fasano:
     

    No Good Data on Virus Risk in Celiac Patients

    However, there just isn't much good research specific to virus risk and celiac disease, and no research specific to Covid-19 and celiac disease, so we can only go by the little we know.

    The issue of celiac disease, pneumonia risk and Covid-19 is serious enough to prompt this message from Dr. Benjamin Lebwohl, MD, MS, Director of Clinical Research, The Celiac Disease Center at Columbia University:

    Quote

    We have been asked by our patients about whether celiac disease is an 'underlying condition' that may predispose to more severe outcomes. There have been some helpful responses by celiac organizations with an overall reassuring tone. Still, there are theoretical concerns related to the fact that patients with celiac disease have a slightly higher risk of developing zoster and complications from influenza and pneumococcal pneumonia, risks that persist in the long term after adoption of the gluten-free diet.  Thankfully, these  increases are small in magnitude, far smaller than risk factors such as immunosuppressant use or chronic lung disease.

    In the face of uncertainty, we should be studying this. Our group is working to set up an international, web-based registry of celiac disease patients with Covid-19. We will be inviting health care professionals to submit clinical details in a concise and easy-to-input way. The registry will contain only de-identified data.

    Here's a Helpful Video on Symptoms and Progression of Coronavirus

    https://www.youtube.com/watch?v=H2E1t3yMXgE

    Covid-19 Advice for People with Celiac Disease

    Take Precautions
    If you have treated celiac disease, your risk for coronavirus is probably about the same as any comparable non-celiac. Probably. But, there's just not much good evidence to say for sure. The coronavirus is serious enough, even in healthy people, to be avoided if possible. From a prevention standpoint, if you have celiac disease, even if it's treated, it's probably wise to behave as if you are in a higher risk group, and to take the precautions necessary to avoid exposure to coronavirus, which include isolating yourself from strangers for two to three weeks. 

    Consider Getting a Pneumococcal Pneumonia Vaccine

    The vaccine against pneumococcal pneumonia will help to prevent bacterial pneumonia. This may or may not help if you contract coronavirus, but it's unlikely to hurt, and will be helpful against bacterial pneumonia, which can affect people with celiac disease.  For people with celiac disease, it's probably a good idea to get a pneumonia vaccine. The vaccine is currently recommended in the UK for people with celiac disease. Read more about how the Coeliac UK Recommends Pneumonia Vaccine.

    It's probably not a bad idea to get a vaccination. It can't hurt, and might help. Check with a doctor for details.

    Don't Panic

    Celiac disease or no celiac disease, if you do come down with Covid-19, don't panic. If you have celiac disease and get Covid-19, there's no reason to assume you'll be worse off than those without celiac disease. Here's what to do if you believe you've been exposed to the coronavirus, or become sick. People who suspect infection with coronavirus should shelter at home, contact local health officials for information, and seek medical attention as directed. 

    Covid-19 Topics on Celiac.com Forums
    Keep up with the conversation or share information about coronavirus (Covid-19) and celiac disease on the Celiac.com Forum:
    Covid-19
    Coronavirus More Susceptible to Celiacs?

    Covid-19 Resources
    Center for Disease Control
    UK Health Advice on Social Distancing

    This is a developing story. Please share any information in our comments below, or on our forums above.

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    It's not a matter of isolating oneself for just 2 or 3 weeks: it's for the foreseeable future, likely months, until scientists develop a medication or cure or vaccine. Isolating soon helps reduce the number of us requiring hospitalization all at once. It doesn't mean we can expect to go back to the old normal at that point.

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    Had symptoms after a cruise one month prior and a plane trip. Doctor sent me for testing. Negative results. Quarantined while waiting for results. Then, freed with precautions. Now they want quarantining for 14 days after negative results.  
    Celiac on gluten free diet. 

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    Interesting article, I wonder if there are higher rates of people with celiac disease in other countries where the death rate is so high. Much of what i have read over the years about celiac has made me believe there may be more people in European countries that have celiac or maybe just a higher rate of diagnosis.  This might be something to look into.

    Thanks

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    One would hope that statistics are being kept for people hospitalized and dying of COVID-19. Then the question becomes whether there is a means to categorize the data once collected. I'm skeptical but hope that we are doing both. 

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    On 3/24/2020 at 8:04 AM, Guest Diane C. said:

    It's not a matter of isolating oneself for just 2 or 3 weeks: it's for the foreseeable future, likely months, until scientists develop a medication or cure or vaccine. Isolating soon helps reduce the number of us requiring hospitalization all at once. It doesn't mean we can expect to go back to the old normal at that point.

    An excellent point. We are all hostage to the lowest common denominator here. If people stay home, and follow social distancing rules, this will pass faster than if people are lax and scattershot in their approach. We also need testing once people have gone through quarantine.

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,500 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.


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