A Coronavirus Guide for People With an Autoimmune Condition
If you're living with an autoimmune disorder, here's what you need to know about COVID-19, including vaccine safety.
By now, it’s obvious: The novel coronavirus does not discriminate. Young people, older adults, healthy individuals and those with preexisting conditions are all at risk. If you have an autoimmune disorder, it’s understandable that you are worried about how your condition—or treatment for your condition—could make you more susceptible to either getting COVID-19 or struggling with the symptoms if you are infected.
Approximately 24 million Americans have some form of an autoimmune disease—a class of illnesses that encompasses 80 different conditions, ranging from lupus to multiple sclerosis to rheumatoid arthritis. Another 8 million people in the U.S. are believed to carry auto-antibodies, blood molecules that raise your chance of developing an autoimmune disease, according to the National Institute of Environmental Health Science.
When you have an autoimmune disease, it basically means your immune system is malfunctioning, and rather than protecting your body from external diseases and infections, it mistakenly begins attacking your body’s healthy tissue instead.
If you fall into this category, it’s likely that you have two very pressing questions right now: First, will your compromised immune system have a harder time fighting off COVID-19 than a healthy person—either in terms of contracting the virus or in handling the symptoms if you get it? And second, will the medications you take to for your autoimmune condition—frequently, types of immunosuppressants—make you more vulnerable to this virus?
Here’s what the experts told us.
Will a Compromised Immune System Raise Your Risk of COVID-19?
While scientists know that people with autoimmune disorders have a greater risk of infection stemming from bacteria (think, a bout of pneumonia after the flu), little research has been done looking at how viral infections themselves affect people with autoimmune disorders. And even less is known about whether these conditions increase your risk of being hit with COVID-19, the disease that results from the infection of the SARS-CoV-2 virus.
“We don’t know, honestly,” says Eric Ruderman, M.D., a rheumatologist at Northwestern University Feinberg School of Medicine in Illinois. “We are taking an abundance of precaution, and assuming that patients may be at a somewhat higher risk.”
Other experts agree. “We advise our patients to be very vigilant, even under the best of circumstances.” says Beth Jonas, M.D., chief of the rheumatology, allergy and immunology division at the University of North Carolina School of Medicine in Chapel Hill. “Now, we’re in the worst of circumstances.”
But contrary to what you might think, while your immune system may be going haywire attacking your joints in the case of RA, or your myelin in the case of MS, that doesn’t necessarily mean you’re more susceptible to getting a viral infection or being unable to fight it off. “We don’t have data to support that,” says Dr. Jonas.
Do Autoimmune-Disease Meds Raise the Risk of Severe COVID-19 Symptoms?
It’s logical to wonder whether the drugs you take for lupus, rheumatoid arthritis, and other autoimmune diseases could inadvertently make a case of COVID-19 worse. After all, immunosuppressants work by dampening the activity of the immune system (which is overactive in the case of these disorders). So does that mean when a virus like SARS-CoV-2 comes along, you have fewer tools with which to fight it?
“We know with certainty that all of the medicines that we give to people with RA suppress the immune system, and to some degree increase the risk of serious infections,” says Dr. Jonas. A class of medications known as JAK inhibitors, commonly used to treat rheumatoid arthritis, have been shown to increase the risk of certain viral infections. Other medicines called TNF inhibitors that treat a variety of autoimmune disorders, have been shown to increase the risk of bacterial infections, like tuberculosis, and certain fungal infections.
Despite this, taking your usual meds is still the best thing you can do to protect yourself in the case of a COVID-19 infection. “We are very clearly recommending that patients continue their medications, including their biological medications,” says Dr. Ruderman. “A patient who flares because they aren’t taking their medicine isn’t really doing themselves a favor.”
Think about it: You don't want your body's energy to be spent trying to fight a flare at the same time it's trying to cope with symptoms of the virus. This is also the worst time to have to go to the hospital to handle a flare—when medical resources are stretched thin and you risk picking up the virus from a trip to a crowded waiting room.
To that end, if you receive your medication through an infusion that requires you to go to a healthcare facility, you may want to consult your provider about alternatives that allow you to stay home for the time being. “It’s really a balancing act that we’re facing right now,” says Dr. Jonas. And if you do develop COVID-19 symptoms or test positive, consult with your doctor about whether you should temporarily stop taking your immunosuppressants.
In December 2020, we finally got the news we've been waiting for: two COVID-19 vaccines received FDA approval, now being distributed nationwide. On February 27, 2021, we learned that the FDA had approved the Johnson & Johnson single-dose viral vector vaccine with the promise of 100 million doses being made available in the U.S. by June. All three vaccines are considered safe and effective for the general public, but what about immunocompromised folks? Is there anything they should be worried about?
Unfortunately, experts still know very little about the vaccines' effects in this population. Immunocompromised people were not included in any clinical trials, so it will be several months before conclusive data can vouch for the vaccines' safety for this group. In terms of Pfizer's and Moderna's vaccines, the theory is that because mRNA vaccines do not contain live or weakened virus, they should be safer than some traditional vaccines. But experts don't know this for sure. No data are yet available for J & J's vaccine, either.
For now, people with autoimmune conditions are given the option to receive the COVID-19 vaccine if they wish. But you can never be too careful, so experts recommend talking to your doctor to get their advice before making that choice.
As vaccine researchers continue to gather more information, there are still things you can do to stay healthy. Yes, the ubiquitous “wash your hands and socially distance yourself” applies. And be extra-conscious to steer clear of anything that is a potential trigger for your condition. And finally, during these anxious times, do what you can to minimize one of the biggest immune system suppressants of all: Stress. Sleep 7 to 9 hours, eat well, and exercise a little on most days. “Those are small things, but they just might help some people to stay a little healthier,” says Alison Ehrlich, M.D., a dermatologist in private practice at FoxHall Dermatology in Washington, D.C. They’re sure not going to hurt.
- Autoimmune Statistics: National Institute of Environmental Health Science. (2020). “Autoimmune Diseases.” niehs.nih.gov/health/topics/conditions/autoimmune/index.cfm
- Coronavirus and Rheumatoid Arthritis: Autoimmunity Reviews. (2020). “COVID-19 Infection and Rheumatoid Arthritis: Faraway, So Close!”
- JAK Inhibitors and Risk of Infection: Therapeutic Advances in Musculoskeletal Disease. (2020). “Reactivation of Hepatitis B Virus Infection in Rheumatic Diseases: Risk and Management Considerations.” ncbi.nlm.nih.gov/pubmed/32206094#
- TNF Inhibitors and Risk of Infection: Journal of Clinical Investigations. (2009). “Anti-TNF Immunotherapy and Tuberculosis Reactivation: Another Mechanism Revealed.” ncbi.nlm.nih.gov/pubmed/19422095
- Drug Shortage: American College of Rheumatology. (2020). “Announcements.”
- Coronavirus and Hydroxychloroquine: Zhejiang University Journals. (2020). “A Pilot Study of Hydroxychloroquine in Treatment of Patients with Common Coronavirus Disease-19 (COVID-19)”