Environmental Health:

COVID-19 & Autoimmune Disease

*updated April 3, 2020

What is COVID-19 (aka coronavirus)?

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).

What Are the Symptoms?

The most common symptoms are fever, dry cough, flu-like aches, sore throat, fatigue, chest pain, and shortness of breath, 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. Fruther 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:

Experiencing symptoms? Call your healthcare provider. Other options are using the Center for Disease Control & Prevention (CDC) Coronavirus Self-Checker bot, or calling 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, the CDC recommends getting medical attention immediately.

What To Do If You’ve Been Exposed

If you’ve been exposed to someone with COVID-19, you should self-quarantine.  Minimizing or eliminating contact with others for a maximum of 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 people you’ve been in physical contact with do not need to be in quarantine. However, if there is a lot of community spread in your area, your local public health officials may advise otherwise (2).

The Facts About COVID-19

For a number of reasons, statistics can vary greatly depending on the country or region you are in. For a clearer picture of what the pandemic looks like in your area, 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
  • 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)
  • Highly contagious, as droplets from coughing or sneezing can travel six feet; however, experts are still learning how the virus spreads
  • Asymptomatic individuals can provoke rapid spread of the virus, as many cases are unknown and undocumented (12, 13)
  • Coronavirus is not seasonal like the flu, as warmer temperatures have no effect
  • No one has immunity, 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-10 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, however symptoms tend to be more mild. Higher risk children may be those with underlying health issues, as well as toddlers and babies (14, 15)
  • 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.

What Does It Mean to Be "High-Risk"?

  1. More susceptible to catching the virus
  2. Potential to develop severe symptoms when infected

High-risk individuals include those over age 60, 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 can also include many autoimmune diseases or chronic inflammatory conditions (as infections can cause severe flares), and especially individuals treated with immunosuppressants, corticosteroids, or chemotherapy.

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

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.

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.

COVID-19 Prevention

  • Stay home when possible, avoiding non-essential travel
  • 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 for high risk groups, and 30 Days to Slow the Spread from the White House.

A Note on Face Masks

New information from the CDC now urges the use of cloth face covers when in public settings, regardless if you’re symptomatic or not.

Face masks are critical barriers for those who are sick with COVID-19, their caregivers, and healthcare workers. As many cities are dealing with mask shortages, the CDC advises against the purchase of surgical masks or N-95 respirators for the general public. This saves them for use in hospitals, where the risk of infection is especially high (3).

As an alternative, use a bandana or cloth from an old t-shirt to cover your nose and mouth. This is especially important in indoor spaces where physical distancing is more difficult, as well as in areas where there is strong community spread of the virus. 

While they are not a surefire way of completely filtering the air, 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.

Why the Precautions?

Cancelling events, closing businesses, washing hands often and disinfecting surfaces, staying home, and wearing a mask if sick 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.


Panic vs Precaution

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, 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: Always consult your psychologist with any mental health concerns.

The Bottom Line

The coronavirus pandemic is affecting the health of high-risk individuals all over the world, while simultaneously creating financial and logistical difficulties for families, hourly wage employees, and small businesses, among many challenged populations. The anxiety is real! 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.

COVID-19 Self-Care Tips

  • 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
  • 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)
    4. John’s Hopkins Coronavirus Resource Center
    5. Mayo Clinic’s News Network
  2. 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-19Dr. Sarah Ballantyne, The Paleo Mom
    4. Living with Immunosuppression During the Coronavirus Outbreak – personal account Kevin Brennan, who has an autoimmune disease
  3. Mental Health 
    1. Comprehensive guide from the National Alliance on Mental Illness (NAMI) on navigating the current situation
    2. Managing Life at Home During the COVID-19 Outbreak from Yale Medicine
    3. How to take charge of fear during the outbreak
    4. Tips on coping with coronavirus anxiety from psychologists
    5. Mindfulness exercises, techniques, and activities
    6. Simple meditation tips from yoga instructors
    7. Reframing negative thoughts
    8. Calming essential oil blends
  4. 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. Info on COVID-19 from specific autoimmune disease organizations:
    1. American Autoimmune Related Diseases Association
    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: Asthma & Allergy Foundation of America


  1. Article Sources and Footnotes
    1. Q & A on Coronaviruses (COVID-19) (March 9, 2020). World Health Organization

    2. Dr. Azar, N. (March 12, 2020). What Constitutes a Compromised Immune System? MSNBC News.

    3. Katella, Kathy. (March 17, 2020). 5 Things Everyone Should Know About the Coronavirus Outbreak Yale Medicine.

    4. Kritz, Fran. (March 13, 2020). Coronavirus Symptoms: Defining Mild, Moderate, and Severe. National Public Radio.

    5. Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). (March 7, 2020). Centers for Disease Control and Prevention.

    6. Coronavirus Disease 2019 (COVID-19) Situation Report 46. (March 6, 2020). World Health Organization. 

    7. Cassella, C. Pregnant? Current Corona Headlines Might Give You Some Peace of Mind. (March 13, 2020). Science Alert.

    8. Wu, J., Leung, K., Bushman M., Kishore N., Niehus, R., Salazar, P., Cowling, B., Lipsitch, M., Leung, G. (March 19, 2020). Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, ChinaNature Medicine.

    9. Begley, Sharon. (March 16, 2020). Lower death rate estimates for coronavirus, especially for non-elderly, provide glimmer of hope. Stat News.

    10. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). (February 16-24, 2020). World Health Organization.

    11. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) – United States. (March 26, 2020). CDC COVID-19 Response Team, Centers for Disease Control and Prevention.

    12. Li, R., Pei, S., Chen, B., Song, Y., Zhang, T., Tang, W., Shaman, J. (March 16, 2020). Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV2)Science. doi: 10.1126/science.abb3221

    13. Lawton, Graham. (March 24, 2020). You Could Be Spreading the Coronavirus Without Realising You’ve Got ItNewScientist.

    14. Bi, Q., Wu, Y., Mei, S., Ye, C., Zou, X., Zhang, Z., Liu, X., Wei, L., Truelove, S., Zhang, T., Gao, W., Cheng, C., Tang, X., Wu, X., Wu, Y., Sun, B., Huang, S., Sun, Y., Zhang, J., Ma, T., Lessler, J., Fend, T. (March 19, 2020). Epidemiology and Transmission of COVID-19 in Shenzhen China: Analysis of 391 cases and 1,286 of their close contacts. medRXiv. doi:

    15. Cruz, A., Zeichner, S. (March 16, 2020). COVID-19 in Children: Initial Characterization of the Pediatric DiseasePediatrics. doi: 10.1542/peds.2020-0834

    16. Q&A on COVID-19, pregnancy, childbirth, and breastfeeding. (March 18, 2020). World Health Organization.

    17. What to Do If You Are SickCenters for Disease Control and Prevention.