Am I at increased risk for COVID-19?
Updated: May 13, 2020
YES. Sjogren’s patients are at higher risk for infection and serious complications of infection.
My opinion about this is shared by many, but not all, rheumatologists. Because the virus is new, at this time there are no data to analyze that will show how Sjogren’s patients will fare with COVID-19 disease. This could take a year or more to determine. We don’t have the luxury of waiting to find out. Patients need to know now if they should take extra precautions to prevent serious outcomes, including death. Fortunately, a lot is known about the impact of Sjogren’s on the lungs and the immune system. The existing facts strongly suggest that Sjogren’s patients should take extra precautions to avoid COVID-19.
The UK National Health Service just published a guide for rheumatology care, stating that Sjogren's patients ARE at high risk. Being older (60 +), being on immune-suppressing drugs, or having lung disease will further increase the risk.
Why Sjogren’s patients are likely to be at increased risk for serious complications with COVID-19:
1. Dryness decreases surface immunity, the first line of defense.
The mucus layer is a critical first step to avoiding infection. This moist layer creates both a physical barrier and an immune system barrier from the outside world to the lungs. Dryness decreases this important surface immunity, making the airways and lung tissue more vulnerable to infection.
2. Lung disease, a common problem, increases the risk for complications if infection does occur.
About 10% of patients have interstitial lung disease (ILD) with symptoms. Many more (up to 50% plus) have signs of ILD on high-resolution CT. Moreover, there are many other types of lung disease that Sjogren’s patients have, often undiagnosed. Lung disease is a known risk factor for COVID-19 complications.
3. Dysfunctional immune system
Sjogren’s patients do not have normal immune systems. An overactive immune system does not mean better protection against infection; the overactivity is misdirected.
4. Immune suppressing drugs
Many drugs such as methotrexate, prednisone, Cellcept, Rituxan, and others suppress the immune system. These increase the risk of serious infection.
Note: Hydroxychloroquine (HCQ, aka Plaquenil) is not an immune suppressant, but an immune system modulator. Do not assume that taking HCQ will protect you from infection. Despite media reports, this has not been proven with reliable studies!
5. Sjogren’s patients are at increased risk for severe infections.
Severe infections are known to contribute to a higher rate of hospitalization and death in Sjogren’s patients (61). This is another reason for Sjogren’s patients to protect themselves in the time of COVID-19. Everyone, but especially those with chronic illness, needs to take social distancing seriously. We need to stay physically apart to protect ourselves from getting the infection, but don’t stop calling and connecting virtually with people. This is a huge, but necessary step.
Trust the Experts!
Medical experts such as infectious disease doctors and epidemiologists are the best source of information about COVID-19. Your rheumatologist should be able to answer questions about your individual circumstances, how to manage medications, etc. If you encounter resistance from your rheumatologist with regards to being at high risk for COVID-19, please consider sharing these facts and the UK National Health Services Guidelines (pp. 4-7) with them. At this time there are no formal statements about COVID-19 risks in rheumatology patients from the CDC or the ACR.
The CDC, local health departments and Dr. Anthony Fauci from the NIH are reliable sources of information. The CDC provides a number of excellent resources, including a webpage that includes guidelines for cleaning, disinfecting and what to do if a household member becomes ill.