COVID-19 & Autoimmune Disease

Visit our evolving timeline for updates on COVID-19 as it relates to autoimmune disease. For an in-depth look at the relationship between the virus and autoimmunity, check out COVID-19 and Autoimmune Disease: What We Know Now.

Looking for resources on COVID-19 and autoimmune disease, holistic health, and mental health? Scroll down to the Resources section!

The World Health Organization (WHO) describes COVID-19 as an infectious disease caused by the most recently discovered coronavirus, a family of viruses known to cause respiratory infections in humans. This new virus and disease were unknown until the recent outbreak in Wuhan, China in December 2019 (1).

As of late October 2020, over 42 million cases have been reported throughout the world. This steadily growing number does not take into full account the potentially high number of asymptomatic individuals and carriers.

Tip: scroll down to the Resources section for links to detailed articles on autoimmune disease and COVID-19

The most common symptoms are fever, dry cough, flu-like aches, sore throat, fatigue, chest pain, shortness of breath, loss sense of taste and smell, and can range from mild to severe.

Most known cases have been mild to moderate and not life-threatening.
Infected persons fall into one or more of the following categories based on severity of symptoms: asymptomatic, mild, moderate, severe, and critical. Further details on asymptomatic and mild cases can be found here. Learn more about what coronavirus symptoms can look like on a day by day basis in the video below:

If you have an autoimmune disease, some of your autoimmune symptoms may mimic those of COVID-19. You may be wondering how to tell them apart. The data is still limited, and there’s no hard and fast rule about which symptoms—like shortness of breath, fever, and fatigue—would signal the virus and which would belong to an autoimmune flare-up.

However, below are a few promising thoughts from rheumatologists—thanks to the Global Healthy Living Foundation and Creaky Joints:

• rheumatic conditions (SLE, RA, scleroderma) do not seem to experience increased rates of infection or severe complications
• if you experience a coronavirus-like symptom (like fever), be aware of other symptoms that may indicate patterns consistent with a flare-up
• notice if your dry cough, fever, fatigue, etc. is typical for your condition, or if it feels like something new

Experiencing unusual symptoms that may be consistent with COVID-19? Call your healthcare provider. They may instruct you to visit a drive-up testing site. The CDC offers information about testing here. You may also call your area’s hotline number (may vary by state, province, region, etc.) for any concerns or questions about what to do in your particular situation.

In the case of emergency warning signs such as difficulty breathing, persistent chest pressure or pain, confusion, or bluish lips or face, get medical attention immediately.

According to the CDC, an exposure means spending at least 15 minutes of time in close proximity (within six feet) of someone with a confirmed or suspected case of COVID-19 (34).

Scientists are discovering that the less time you’re exposed to the virus, the more likely it is to remain in the nose and throat, instead of continuing into the lungs where the disease becomes serious (35). The respiratory tract, including the nose and throat, contains a clean-sweeping army of cilia and mucus to brush out potential pathogens before they have a chance to dig deeper into the body. With a lower viral exposure or load, the body is better able to use this system and manage the threat.

If you’ve been exposed to someone with COVID-19, you should self-monitor symptoms, take your temperature, stay away from people who are high-risk, and self-quarantine until 14 days after your last exposure. Minimizing or eliminating contact with others for 14 days (incubation period for the virus is 2-14 days) will ensure that you have not been infected and will not infect others.

The CDC has an informative page about when to quarantine in various situations.
Although you’ve been exposed, the people you’ve been in physical contact with do not need to be in quarantine. If there is a lot of community spread in your area, however, your local public health officials may advise otherwise (2).

If you test positive for SARS-CoV-2 and are asymptomatic or have mild symptoms, you may only need to self-isolate for 10 days. The CDC revealed new guidelines in July, stating that “for most persons with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours.” For asymptomatic individuals, 10 days after your first positive test.

Coronavirus data is limited, and prevalence statistics are difficult to clearly define.

Mortality, hospitalization, and other rates are constantly being reevaluated due to testing, diagnoses, population age and density, under- and over-reported cases, and strong indications that asymptomatic carriers and mild, undocumented occurrences account for more of the total COVID-19 cases than previously thought (24, 25, 26, 27). However, testing is imperfect and no one study or estimation will give us the all answers—there is still much to learn.

For a clearer picture of what the pandemic looks like in your particular country or region, stay informed through your local public health department.

• 80% of known cases have been mild to moderate (according to WHO report in China), and don’t require hospitalization (4) (10)

• High risk of severity in elderly persons and people with chronic health conditions and altered immune systems; roughly 90% of hospitalized cases are those with underlying conditions, including those over age 65 (21)

• Healthy individuals may also contract severe cases. In a Georgia report, 1 in 4 hospitalized cases had no risk factors for COVID-19 (29). Despite this, the number of healthy individuals with severe cases generally seems to be small. The reasons for this are largely unknown; researchers are searching for explanations through genetics, pollution, immune system response, and exposure to varied viral loads (18, 19, 20).  

• Severe cases may be associated with hyperactive immune responses, in both healthy and chronically ill individuals. A preexisting but possibly undetected issue with the immune system may enable the virus to move from the nose and throat, and into the lungs, resulting in a severe case of COVID-19. Some people may not be able to make the antibodies responsible for barring the virus entry into a cell, which is how it multiplies (35).

• 12% of known U.S. cases have been hospitalized, with 20% aged 20-44, 35% aged 45-64, and 45% aged 65 and up (as of March 16th) (11)

• 35-40% of U.S. cases may be asymptomatic, preliminary findings from the CDC suggest (32, 36). Asymptomatic individuals can provoke rapid spread of the virus, as many cases are unknown and undocumented (12, 13)

• COVID-19 disproportionately affects people of color in cases with known race and ethnicity, as roughly 33% of persons have been Hispanic, 22% black, and 1.3% American Indian/Alaska Native (37)

• .66% fatality rate at minimum, which increases with age; this analysis of Chinese cases attempts to include mild or asymptomatic cases (from March 30th) (24). These numbers are not easy to determine and there is a wide range of estimates, including a 5.6% case-fatality rate in the U.S. reported by Johns Hopkins (30) and a 1.3% rate in the U.S. from a Health Affairs study (31).

• Fatality rates may not include undetected and asymptomatic cases, and differ greatly by country, region, state, etc. For example, in New York, the number of cases was found to be 10 times higher than data indicated, meaning fatality rate may be around .5% (26)

• Spreads mainly through droplets from coughing, sneezing, shouting, or singing. Droplets can travel about six feet.

• New research reveals coronavirus can spread through the air. Aerosol transmission of infectious virus is possible from over 15 feet away. The paper has not yet been peer reviewed and experts are still learning how the virus spreads (38)

• Low risk of virus spreading via surfaces or objects (33)

• Coronavirus has a reproductive number (R0) of about 2-3, meaning that on average, one infected person infects between 2 to 3 new people (22). In comparison, measles has a reproductive number of 12-18 (23). However, this does not take into account dispersion patterns and the circumstances involved in cases of transmission

• Coronavirus may spread in clusters. New information on transmission reveals that 10-20% of infected people may be responsible for 80-90% of virus transmission. The measure of dispersion, otherwise known as k, is one variable that has been out of focus. It is now thought that the coronavirus is an over-dispersed pathogen—one infected person may be the cause of many infections simultaneously, while another may cause none. This knowledge may drive changes in the way we approach the pandemic (39)

• Not seasonal like the flu, as warmer temperatures seem to have no effect on the virus

• No one has immunity (unlike the flu), and there is no vaccine. A vaccine is under development, but could take years

• Trials are currently ongoing for drugs to treat people with the virus (5). Current research on COVID-19 could have the unexpected benefit of discovering treatments for other related conditions or adding to medical knowledge for future research endeavors

• Children may have a similar risk as adults, but milder symptoms. Higher risk children may be those with underlying health issues, as well as toddlers and babies (14, 15, 28)

• Pregnant women have generally had mild to moderate cases and seem to be at no higher risk than the general population, based on a WHO report in China. There is also no evidence that the virus can be passed to their children (7, 10). However, there is still not enough known about the virus to paint a clear picture of the risk for pregnant women (16)

If you’re also concerned about the rapid spread of misinformation, check out WHO’s list of coronavirus mythbusters.

The phrase “high risk” most often refers to individuals who are more likely to develop severe symptoms or illness when infected.

High-risk individuals include those over age 65, and anyone with altered or compromised immune systems or underlying health conditions such as HIV, diabetes, obesity, heavy smokers, cancer, lung and heart disease, asthma, and other respiratory conditions.

The high-risk category may also include many autoimmune diseases or chronic inflammatory conditions (as any infection can cause severe flares), and especially individuals treated with immunosuppressants like corticosteroids, or chemotherapy.

Tip: scroll down to the Resources section for links to detailed articles on autoimmune disease and COVID-19

CDC High Risk List
Primary Group (at increased risk)

• Cancer
• Chronic kidney disease
• COPD (chronic obstructive pulmonary disease)
• Heart conditions (coronary artery disease, cardiomyopathy)
• Immunocompromised state from organ transplant
• Obesity
• Sickle cell disease
• Smoking
• Type 2 diabetes

Secondary Group (may be at increased risk)

• Moderate to severe asthma
• Cerebrovascular disease
• Cystic fibrosis
• Hypertension
• Immunocompromised state from blood or bone marrow transplant, HIV, immunodeficiencies, use of corticosteroids or other immunosuppressants
• Neurological conditions, such as dementia
• Liver disease
• Overweight
• Pregnancy
• Pulmonary fibrosis
• Thalassemia
• Type 1 diabetes
• Children with congenitial heart disease or neurologic, genetic, or metabolic conditions

Many people with autoimmune disease are likely to be high-risk, but some may not be. Certain autoimmune conditions may also be more susceptible to contracting the virus or developing severe symptoms than others. As we are still learning about this virus, there is simply not enough information out there to know for sure.

Physician-researchers at The Benaroya Institute emphasize that while there is still no clear connection between autoimmunity and the development of COVID-19, there are a few things people with autoimmune disease should know during this time, including the risks of stopping or continuing medications like steroids and what it means to have a compromised immune system.

At the end of the day, your personal risk depends on your unique situation, any medications you’re taking, if your disease is under control, and if you have multiple conditions. It is a determination to be made by both you and your doctor.

Whether you think you may be high-risk or not, physical distancing (more commonly known as social distancing) and heeding the advice of doctors and public health officials are absolutely critical. These efforts help to prevent high-risk individuals from becoming infected and from experiencing serious symptoms in a further effort to stem the flood of new cases in hospitals.

• Stay home when possible, avoiding non-essential travel

• Focus on your personal health by eating nutrient-dense whole foods and staying hydrated. This helps optimize immune system function and that of other body systems, which may prevent the virus from triggering severe complications

• Wash hands often with soap and water for at least 20 seconds. If unavailable, use hand sanitizer with at least 60% alcohol

• Sneeze or cough into your elbow

• Disinfect frequently touched surfaces and objects daily with EPA-approved cleaners—effective yet milder options include 70% isopropyl alcohol solutions, hydrogen peroxide, and even plain soap and water

• Choose drive-through, delivery, or pick-up options instead of sit-down restaurants

• Limit close contact with others (leaving 6 feet of space)

• Do not visit nursing homes or long-term care facilities

• Take care of the emotional health of household members, especially children

• If you’ve been in contact with an infected person, remain under quarantine for up to 14 days if you’ve been in contact with an infected person

• If you’re sick, self-isolate in your home or a room in your home if you live with others

• Especially for high-risk individuals:
  • Stock up on supplies like groceries, medical supplies, and other household items in case you need to stay at home for an extended period of time
  • Take advantage of special early hours that many grocery stores are setting aside for the elderly or high-risk individuals
  • Contact your healthcare provider to ask about obtaining extra necessary medications
  • Avoid touching high-touch surfaces in public places, and wash hands if you do
  • Avoid crowds, particularly in poorly ventilated spaces
  • If the virus is spreading in your area, consider getting food brought to your house by friends, family, social networks, nonprofit programs, or food delivery services

The above information was gathered from the CDC’s Guide to Protecting Your Home the CDC’s steps to Prevent Getting Sick.

A Note on Face Masks
The CDC urges the use of cloth face covers when in public settings, regardless if you’re symptomatic or not. The WHO suggests reducing your risk by using masks in conjunction with proper and frequent hand cleaning and physical distancing.

Face masks are critical barriers for those who are sick with COVID-19, their caregivers, and healthcare workers. At the start of the pandemic, as many places were dealing with mask shortages, the CDC advised against the purchase of surgical masks or N-95 respirators for the general public. This helped save them for use in hospitals, where the risk of infection is especially high (3).

As an alternative, order a mask online from various retailers or at the grocery store, or use a homemade mask, bandana, or cloth from an old t-shirt to cover your nose and mouth. 

The efficacy of homemade face coverings is an ongoing conversation, as they are not comparable to N-95 respirators or surgical masks. The general consensus is that something is better than nothing, but wearing a thin, loose piece of cloth is not be sufficient – the material and fit matter. The CDC’s face covering recommendation is a thick, double layer of cotton that fits tightly around the face.

While they are not a surefire way of completely filtering the air or preventing tiny droplets from escaping, cloth face covers do help to protect against fluids from coughing, sneezing, and speaking, and are another vital tool in slowing the spread of the virus. This is especially important in poorly ventilated, indoor spaces where physical distancing is more difficult, as well as in areas where there is strong community spread of the virus.

Cancelling events, closing businesses, washing hands often and disinfecting surfaces, staying home, and wearing a mask will slow down the rate of the epidemic. 

Physical (or social) distancing is an especially vital tool epidemiologists employ to control outbreaks like COVID-19. This practice minimizes the risk of spreading the infection to immunocompromised individuals and of overwhelming the healthcare system. 

If proper measures aren’t taken, hospitals can be bombarded with a swarm of new patients all at once, in addition to their current caseload. This means slower, lower quality care for individuals with the virus, as well as those with other serious conditions like autoimmune disease and cancer.

We’re encouraged to practice physical distancing not only to flatten the curve, but also to stop the spread. The graphic below explains how our attitudes and actions can help or hurt this situation.

Our fears about this unprecedented situation are 100% valid; however, they drive us to overreact in the hope of maintaining control—overbuying groceries, supplements, and supplies, obsessively sanitizing, holding our breath around others, letting our thoughts be consumed by coronavirus “what if’s”… It’s natural to feel this way, but it’s important to recognize when we’re tumbling into a panic.

Elevated stress, anxiety, and fear can keep our bodies in “fight or flight” mode. Research studies have repeatedly demonstrated the effects this state of being can have on our bodies—including our immune systems. The impacts of stress are especially important to all individuals with chronic conditions like autoimmune disease. A healthy stress response is one of many components (including sleep, nutrition, nature, social interaction, and emotional support) essential to controlling symptoms and keeping conditions stable.

There is a lot of uncertainty and that’s ok. We can’t do anything about that. What we can do is keep our gaze on the next small step ahead, follow the basic recommendations from public health officials, practice self-care, and simply stay informed.

Head over to Psychology Today for some helpful tips on managing COVID-19 anxieties. You can also call the Helpline from the National Alliance on Mental Illness (NAMI) at (800) 950-6264, or check out their comprehensive guide to navigate concerns like coronavirus anxiety, quarantine and isolation, and loved ones with mental illness.

Note: consult your psychologist about any mental health concerns.

The coronavirus pandemic is affecting the health and well-being of high-risk individuals, while simultaneously creating financial and logistical difficulties for families, hourly wage employees, and small businesses, among many challenged populations—not to mention potential economic crises and famine in developing countries all over the world.

During this time, it’s important to stay calm and connected to your support community, help each other, do your part in slowing the rate of infection, and know that we will move on from this crisis.

• Monitor your local situation, but take breaks from reading, thinking, and talking about the coronavirus situation

• Connect with loved ones through video calls, audio texts, social media challenges, online games, and sending packages and letters

• Spend time outside in nature, in low-trafficked areas (depending on local guidelines)

• Incorporate movement into your day – such as stretching, dancing, yoga, tai chi, or online workout classes

• Prioritize nutrient-dense foods

• Stay well-hydrated

• Get 7-9 hours of sleep per night

• Practice mindfulness and stress-reduction by:
  • Making a list of things you can control
  • Diffusing calming essential oil blends
  • Tactile activities like puzzles, knitting, painting
  • Reading
  • Journaling
  • Reframing negative thoughts
  • Writing down or repeating a mantra
  • Deep breathing
  • Meditating with these simple tips from yoga instructors

• Help others by:
  • Delivering food to neighbors with weakened immune systems
  • Supporting small businesses and hourly workers in your community
  • Donating to organizations like Feed America, who are supporting low-income hourly wage earners and their families, especially while schools are closed
  • Connecting with nonprofits, including those on Food Tank’s list of 31 organizations who are helping restaurants, workers and farmers survive the outbreak

1. Primary Sources
   1. World Health Organization (WHO)
   2. Centers for Disease Control (CDC)
   3. National Institutes of Health (NIH)
2. COVID-19 Resource Hubs
   1. American Medical Association (AMA)
   2. Creaky Joints
   3. Global Healthy Living Foundation (GHLF)
   4. John’s Hopkins Coronavirus Resource Center
   5. Mayo Clinic’s News Network
   6. National Organization for Rare Disorders (NORD)
   7. The Institute for Functional Medicine (IFM)
   8. Patient.info
3. Autoimmune Disease and Holistic Health
   1. COVID-19 and Autoimmune Disease –  Autoimmune Wellness resident medical advisor and functional practitioner, Dr. Rob Abbott, explains what COVID-19 is, the risks, and how to respond
   2. COVID-19: An Integrative MD’s Common Sense Approach – series of articles on naturally and safely preventing and treating the virus. Included is a page on the virus and autoimmune disease
   3. Natural, Science-Backed Approaches to COVID-19 – by Dr. Sarah Ballantyne, The Paleo Mom
   4. Living with Immunosuppression During the Coronavirus Outbreak – personal account of Kevin Brennan, who has an autoimmune disease
   5. Creaky Joints: Living with Arthritis – articles on COVID-19 topics (medications, using telehealth, managing pain and symptoms, caring for mental health and physical well-being during stressful times) for people with chronic and autoimmune rheumatic diseases and co-existing conditions
4. Mental Health 
   1. Coronavirus Anxiety: Key Advice for Chronic Illness Patients from Health Psychologists
   2. Comprehensive guide from the National Alliance on Mental Illness (NAMI) on navigating the current situation
   3. Managing Life at Home During the COVID-19 Outbreak from Yale Medicine
   4. How to take charge of fear during the outbreak
   5. Tips on coping with coronavirus anxiety from psychologists
   6. A Zen Master’s Tips for Staying Sane in Challenging Times from Plum Village monks and Thich Naht Hanh’s teachings on the art of living each day well
   7. Mindfulness exercises, techniques, and activities
   8. Simple meditation tips from yoga instructors
   9. Reframing negative thoughts
   10. Calming essential oil blends
5. Miscellaneous
   1. The Do’s & Don’t of Social Distancing – explanation of exactly what it means through real-life scenarios and responses by public health experts
   2. EPA-approved disinfectants for protecting against coronavirus
   3. Common household cleaning products that kill coronavirus if you use them properly
   4. Resources for Parents from Children’s National – how to talk to your kids about coronavirus, tips for homeschooling, gluten-free cleaning products, and more
   5. A Medical Review of COVID-19 Testing Options – Autoimmune Wellness Medical Director Dr. Rob Abbott provides empowering, honest info about the challenges of testing
6. Info on COVID-19 from specific autoimmune disease organizations:
   1. Beyond Celiac
   2. Celiac Disease Foundation
   3. Crohn’s & Colitis Foundation
   4. JDRF (Juvenile / Type I Diabetes)
   5. Lupus Foundation of America
   6. Lupus Research Alliance
   7. Multiple Sclerosis Foundation
   8. Multiple Sclerosis Society UK
   9. National MS Society
   10. Myasthenia Gravis Foundation of America
   11. National Rheumatoid Arthritis Society
   12. Scleroderma Foundation
   13. Sjogren’s Syndrome Foundation

Other: American Autoimmune Related Diseases Association | Asthma & Allergy Foundation of America | Autoimmune Wellness | Creaky Joints | Global Healthy Living Foundation