One of the main questions I have received since the COVID-19 pandemic started is “am I more susceptible to complications from COVID-19 if I have an autoimmune disease.” Initially I had a hard time answering this question because we didn’t have answers. New viruses are tricky. And initially there was not a lot of evidence to what types of populations were more at risk. At most we had some broad speculations of what might happen and to whom.
We are now 5 months into the pandemic in the US, and there is a little more data on the subject. In short, it’s kind of what was predicted. Those with autoimmune diseases are not at a higher risk of contracting COVID-19. Nor are they at a higher risk of complications. Those with autoimmune diseases ARE at higher risk of autoimmune flares if they contract COVID-19. This was something I suspected would happen given viral triggers for autoimmunity. As time as gone by, it’s definitely something I’ve noticed clinically with my patients.
Here we will break down what we know so far.
COVID-19 Risk of Contraction and Risk of Complications
As of now, we have no evidence to suggest that those with autoimmune diseases are more at risk of contracting COVID-19. Nor is there any evidence there is greater risk for COVID-19 complications. We do know that from recent studies that those who are immunodeficient are more at risk. But immunodeficiency is different than autoimmunity. Immunodeficient means that the immune system can’t work as hard as it needs to. Autoimmunity on the other hand means the immune system is working too hard when it shouldn’t.
We do know that there are several risk factors that increase risk of complications from COVID-19. Some of these can coincide with autoimmune diseases. These include:
- People 65 years and older
- People living in nursing homes or long-term care facilities
- Chronic lung disease or moderate to severe asthma
- Serious heart conditions
- People who are immunocompromised
- Severe obesity
- Metabolic disorders like diabetes
- Chronic kidney disease undergoing dialysis
- Liver disease
While these things can increase a persons risk of having complications from COVID-19, it is usually not the autoimmune process that contributes.
Risks of Being on Immunosupressive Medications
There have also been concerns about those who are on immunosuppressive medications. Many people with autoimmune diseases are on medications that suppress the immune system. While having an autoimmune disease may not risk your chance of complications, being on one of these medication might.
As of now, we don’t have good evidence that suggests that these medications cause greater risk for COVID-19 specifically. But we do know from history that certain medications do increase risk of viral infections.
The oral steroids (including Prednisone, Methylprednisolone, Budesonide…etc) are strongest immunosuppressants. Being on oral steroids can increase the likelihood of contracting any infection. Those who are taking more than 20mg of prednisone a day are at higher risk than others. Topical steroids like Clobetasol, or steroid inhalers like Flonase, usually do not systemic immune suppression. So the risk of viral infection with those types of steroids is much lower than taking an oral pill.
Other immunosuppressants like methotrexate, azathioprine, enbrel and humira can also increase risk. These medications are likely reduce your bodies ability to fight viruses and can make viruses last longer or cause more severe symptoms. These medications though are generally less likely to increase risk than high dose oral steroids.
Some immunosuppressants like hydroxychloroquine (Plaquenil) are being studied as treatments for COVID-19. As of now, there is no definitive evidence to suggest that Plaquenil is helpful for treating COVID-19.
Autoimmune Flares with COVID-19
There is some anticdotal evidence to suggest that those with autoimmune diseases are more likely to see a flare in their autoimmune condition if they have contracted COVID-19. Most of the patients in our office who have contracted COVID-19 have seen flares in their autoimmune conditions. We have not seen a significant portion of this population have any respiratory complications from COVID-19 so far.
Options for Prevention
If you have an autoimmune disease that is well managed without medication, then it’s likely that you risk of having complications from COVID-19 is low. There is a greater risk though that you may have a flare of your autoimmune diseases.
If you are on an immunosuppressive medication like prednisone or methotrexate, you may be at greater risk for contracting COVID-19. If this is the case, it is best to adhere by strict social distancing guidelines and hygienic practices like handwashing and wearing a mask.
The best prevention though for all populations is to maintain healthy practices. This includes making sure you are drinking enough water, getting enough sleep, reducing stress where possible, and exercising. If you want additional anti-viral support, there are several good herbs and supplements that you can add to your prevention protocol.
If you have an autoimmune disease, or you have concerns about being on an immunosuppressant during the pandemic, you can schedule an appointment to speak with one of our physicians.