UPDATED 4/1/20 | Coronavirus FAQs
Information is evolving about coronavirus. Beyond Celiac will provide updated evidence-based information and guidance to this page as it becomes available.
Our Science Team, including Salvatore Alesci, MD, PhD, Ken Kilgore, PhD, MBA, Kate Avery, MPH, and medical and science news analyst Amy Ratner, are answering the questions on the page. Learn more about our Science Team.
Read our March 31, 2020 Research News story: Beyond Celiac grant recipient plays key role in helping combat COVID-19.
A UK scientist who received a 2019 Beyond Celiac research grant is now applying some of the same tools used in his celiac disease work to study of COVID-19.
Watch our Beyond Celiac Chief Scientist and Strategy Officer Salvatore Alesci, MD, PhD, discuss COVID-19 (recorded March 24, 2020). Read a transcript of the video here.
Watch our recording of our March 9, 2020 Facebook Live on celiac disease and coronavirus, or listen to the audio on our podcast, Celiac Straight Talk:
People with celiac disease who are otherwise healthy are not immunocompromised and not at higher risk for coronavirus. According to the CDC, people who are at higher risk are older adults and people with serious chronic medical conditions, such as heart disease, diabetes and lung disease. Currently, there is no evidence that children are more susceptible.
The immune system of someone with celiac disease activates in response to gluten when it shouldn’t. The immune system is over-active rather than suppressed. In contrast, the immune system of someone who is immunocompromised doesn’t react when it should. It is less effective at fighting off germs like those causing the flu and the coronavirus. Treatments such as chemotherapy, certain drugs for autoimmune conditions, steroids and some conditions (like AIDS), suppress the immune system’s response. Therefore, people with those conditions or taking those treatments are more at risk.
If you are taking corticosteroids and other immunosuppressant medications, you are at increased risk for coronavirus. While not typically used for celiac disease, these medications are often used to treat other autoimmune diseases, such as rheumatoid arthritis and lupus, which those with celiac disease are at higher risk of also having.
The CDC says the data from China suggest that those with diabetes (a common celiac disease comorbidity), heart disease, and lung disease are all at higher risk of getting more sick from coronavirus.
If you are not sick, it is still important to take precautions that will keep you from contracting coronavirus. Current recommendations from the CDC include:
In general, it could be useful to have a small stockpile of food on hand, in case you or a family member gets sick and you can’t go to the grocery store. This may be especially important for people with celiac disease and other gluten-related disorders so that they are ensured that there is food safe for them to eat if they were to be quarantined.
It can also be helpful to make sure you are getting timely refills of your prescription medications and have a small supply of gluten-free cold and flu type medications.
Coronavirus symptoms include fever, cough, and shortness of breath. (Learn more about the symptoms associated with COVID-19.)
According to the CDC: Call your doctor: If you think you have been exposed to COVID-19 and develop a fever and symptoms, such as cough or difficulty breathing, call your healthcare provider for medical advice.
Over-the-counter cold and flu medications may be helpful to relieve symptoms. Gluten in medications is a worry for those with celiac disease. For over-the-counter medications, you may be able to review the active and inactive drug ingredients either in the store or online. More information is available on our website about key ingredients that may contain gluten.
If you feel like you may have the coronavirus, you stay at home as long as you have mild symptoms. Call your healthcare provider before seeking medical attention, unless it is an emergency.
The CDC recommends that you stay at home, and do not go to school or work or use public transportation. As much as possible, stay away from others in your household, especially those at increased risk. If you must go out in public or be in the same area as someone else, wear a facemask to prevent the spread of the virus.
Cover your mouth with a tissue if you cough or sneeze, and dispose of tissues in a lined trash can. Continue to wash your hands frequently, especially after coughing, sneezing, and blowing your nose.
More information from the CDC is available here: https://www.cdc.gov/coronavirus/2019-ncov/about/steps-when-sick.html
Information on how to disinfect shared surfaces in your home or workplace is available here: https://www.cdc.gov/coronavirus/2019-ncov/community/home/cleaning-disinfection.html
If you become more sick and have more urgent symptoms, such as having trouble breathing, you should seek medical attention. Call your healthcare provider before going into the office, and wear a face mask to avoid spreading the virus to others at the office.
You may want to also discuss the gluten-free food safety measures with your hospital ahead of time so you know whether you need to bring your own safe foods or not. However, do not let this process delay you in getting to a hospital if you need to.
Cancelling travel plans is a decision that should be made based on where you are traveling and your health condition. If you are traveling overseas, the State Department lists travel warnings for each country on their website.
Updated information about the spread of the coronavirus in the United States is available from the CDC.
CDC recommends that travelers avoid all nonessential travel to the following destinations. Most foreign nationals who have been in one of these countries during the previous 14 days will not be allowed to enter the United States.
Airplane air filters can filter out particles as small as the coronavirus, but travel presents a risk that you may come into contact with someone who is sick. Frequent hand washing and use of hand sanitizer is recommended.
Follow all government regulations regarding travel.
At this time, there is no compelling scientific evidence to indicate that you are at greater risk to contract COVID-19. There is research that indicates that viral infections may trigger the onset of celiac disease, but no scientific evidence that having celiac disease “per se” increases risk of contracting a virus.
According to the CDC: “Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID-19 illness.” You may be at higher risk because of one of these factors.
You may also be at greater risk of contracting COVID-19 if you have other diseases associated with suppression of the immune system or requiring treatments that suppress the immune system (e.g., corticosterois, TNF inhibitors, etc.)
Regardless of whether you are in a higher risk group or not, Beyond Celiac recommends that you adhere to the recommended guidelines from the CDC to maintain your health and the health of others, including hand washing, not touching your face and keeping a social distance of 6 feet. If you feel ill, stay home. If you have a dry cough and fever, follow the guidance of your local health agency for whether and how to get tested for COVID-19.
When you get glutened, your immune system reacts to the gluten in the same way it would to a germ. At this time, there’s not compelling scientific evidence that shows that the reaction to gluten keeps your immune system from responding to other threats, including virus infections, or amplifies the immune response to a viral threat . Nevertheless, we recommend that you continue to carefully avoid getting glutened.
Yes, hand sanitizer is safe for those with celiac disease to use. Most hand sanitizers do not contain gluten. Additionally, research has found that gluten cannot be absorbed through the skin. So as long as you do not apply it to an open wound and you’re taking care to not ingest it, hand sanitizer should be safe. If you have a reaction to a hand sanitizer, consider an alternate culprit like an allergic reaction instead of gluten. The CDC recommends washing your hands with soap and water, but if they are not available, use a hand sanitizer with at least 60% alcohol.
A number of common viral infections are already suspected as possible reasons celiac disease develops, including enterovirus, reovirus and Epstein-Barr. Covid-19 is too new to know if it will cause autoimmune diseases to develop/be triggered in those at risk of developing them. Future research is needed to answer this question definitively, however, a study did show a link between respiratory viral infections, such as coronavirus, and the development of the autoimmune disease rheumatoid arthritis.
Selective immunoglobulin A (IgA) deficiency is a genetic immunodeficiency condition in which individuals do not make or have very low blood levels of IgA antibodies. It is estimated that 1 in 500 people have selective IgA deficiency. Diagnosis can be established through a blood test measuring immunoglobulin levels in blood serum. For some with IgA deficiency, the condition is ‘silent,’ meaning they have no symptoms, however for others it is associated with a heightened risk of infections, allergies, asthma and autoimmune diseases. Some affected by IgA deficiency face serious health issues such as chronic infections or diarrhea. You are considered at heightened risk if you have IgA deficiency. If you were diagnosed with IgA deficiency, you should consult your physician for further guidance.
Malfunctioning spleen, called hyposplenism, can be the result of chronic deficiency of folic acid and has been documented in celiac disease.
The spleen, a small, fist-shaped organ in the upper left part of the abdomen protected by the rib cage, is a filter for the blood as part of the immune system. It clears pathogens from the bloodstream and helps control infection.
“People with celiac disease who also have a malfunctioning spleen can be at higher risk of any infection, including COVID-19,” said Salvatore Alesci, MD, Beyond Celiac chief scientist and strategy officer. However, the connection between celiac disease and malfunctioning spleen has not been extensively investigated in studies that follow patients over a long period of time, called longitudinal studies. “Of course, there have been no specific studies on COVID-19 and malfunctioning spleen in general,” Alesci noted.
Also, while chronic deficiency of folic acid is common in those who have celiac disease, it does not always lead to hyposplenism. Typically, the lack of folic acid is managed with a vitamin that contains folic acid.
Even in people with a normal spleen, viral infections might cause the spleen to over function leading to enlargement, which is often asymptomatic. However, it may also be associated with pain in the left abdomen that may spread to the shoulder. Fatigue, anemia and easier bleeding can also occur. It is not known if COVID-19 could cause this, but everyone should be on the look out for these symptoms, especially if they have a malfunctioning spleen.