Are people with coeliac disease more at risk of COVID-19?
Maintaining a gluten-free lifestyle is difficult on a good day. As we enter a time of uncertainty as South Africa braces itself to face coronavirus, those with chronic health disorders may feel particularly anxious. Let’s look at the facts:
The coronavirus pandemic originated in China in December 2019 and the first case was reported in South Africa on the 5th of March 2020. To date there are more than 255,000 cases of COVID-19 in at least 180 countries. South Africa is seeing a rapid rise in confirmed cases, including cases of community transmission.
COVID-19 is the name given to the viral respiratory syndrome caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Most people who contract the virus will experience mild symptoms, however, around 16% of people will have severe illness, which may be fatal.
Children usually have a mild infection and can been infected without displaying any symptoms at all. This means children are much less at risk of becoming very sick but can be important in the spread of the virus to others.
What are the implications for those with coeliac disease?
As COVID-19 is a new disease data around the infection is evolving and at present there is no specific, evidence-based information about infection in people with coeliac disease. What we do know is that coeliac disease is an autoimmune disorder that occurs in those with a genetic predisposition. Those with the condition have an immune system that is overactive to gluten in the diet. The immune reaction causes damage to the intestines and may result in problems with absorbing certain nutrients. Some individuals with coeliac disease have other autoimmune conditions such as diabetes, thyroid disease and arthritis.
A healthy person with coeliac disease is not in an immunocompromised state (does not have an underactive immune system). Those who are immunocompromised are unable to fight infections as they should and are considered at higher risk for COVID-19.
The North American Society for Paediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) Coeliac Special Interest group states that healthy individuals with coeliac disease are not an increased risk of being infected with coronavirus and are not at risk of more severe disease.
Those with coeliac disease that have other medical conditions, particularly the elderly and those with heart or respiratory illnesses may be at greater risk of severe COVID-19 illness.
Individuals who have coeliac disease who are on treatment with medications that suppress the immune system for other autoimmune conditions, may be at risk of severe COVID-19 illness.
Coeliac UK has highlighted that there are individuals with coeliac disease who have impaired ability to fight certain bacteria that worsen the course of COVID-19, due to impairment in the function of their spleens. This is known as hyposplenism and seems to occur in adults with prolonged gluten exposure. Hyposplenism appears to be far less common in children, particularly those diagnosed early who follow a gluten free diet. It is essential that all those with coeliac disease are up to date with all vaccinations, particularly those for the bacterial infections that may complicate COVID-19, namely Pneumococcal and Haemophilus Influenzae infections.
What can those with coeliac disease do?
Everyone should practice social distancing and avoid any unnecessary visits to public spaces. Don’t travel locally if not essential.
Self-quarantine for 14 days after travel must be strictly adhered to.
Pay attention to basic hygiene including hand washing and using hand sanitizer; avoiding touching other people, your face and surfaces where the virus may be found; discarding used tissues immediately and keeping a suitable distance between yourself and other people.
Adhere strictly to a gluten-free diet and continue with all necessary nutritional supplements and chronic medications.
Ensure ALL vaccinations are up to date and strongly consider having the influenza vaccination, which will be available at the end of the month.
Responsibly source gluten-free products and necessary medications. Bulk buying creates strain on producers and retailers and must be discouraged. We strongly appeal to the public to avoid buying gluten-free products to replace regular items that are in shortage. Let’s keep the ‘free-of’ for those who need to be ‘free-from’.