Celiac Disease and COVID-19: FAQs and Patient Survey

It’s been almost a month since the Center for Celiac Research and Treatment here at MGH posted the first video concerning celiac disease and COVID-19 infection. We had more than 30,000 visits and a list of questions that I would like to address. Some of them are very frequent questions that we received from our celiac community. I will start with the issue of hyposplenism and how this can impact the risk of people with celiac disease contracting COVID-19 infection. It’s well described that people with celiac disease have a low function of the spleen (30% of the cases) and the question is what this means. Well, most of the time, this poor function of the spleen doesn’t translate into any clinical outcomes. In other words, it does not have any consequences and therefore there is no increased risk, because of this poor function of the spleen, in contracting the SARS-CoV-2 virus. For those very small percentage of people with hyposplenism that translate in symptoms, they, in general, have increased susceptibility to infection, including that for SARS-CoV-2. Therefore, for that small percentage, maybe there is an increased risk. Another question that we received is, “What is the risk of people with celiac disease who have other comorbidities, for example type diabetes, in being more susceptible to having the infection?” Here again, there are no solid data. But it looks like unless, because of this other condition, you are taking drugs/medications that will weaken your immune system, your increased susceptibility to get the coronavirus is not higher than the general population. Another question that we received was, “What is the risk to perform a gluten challenge during the pandemic?” Here, I will suggest that this is not a wise decision. Gluten challenge implies that your immune system will react to exposure to gluten if you’re a celiac, and therefore you will have an inflammatory response. That will weaken your immune system to fight other enemies, in this case the virus, and therefore will make you more susceptible. So definitely, I don’t think it is advisable to do a gluten challenge during these times. One more question that we received was, “What is the risk for people with refractory celiac disease to contract SARS-CoV-2 virus?” Here the answer is, well, if the treatment for your refractory celiac disease involves immunosuppressants, because your immune system is weakened by these medications, of course you have an increased susceptibility to contract the virus and therefore you have to take extra precautions, in terms of exposure and social interactions that will increase your risk to develop a COVID-19 infection. There was another question related to the reason why, while celiacs with celiac disease are at increased risk for the flu, they do not have an increased risk (as we mentioned last time provided that celiac disease is well controlled) to contract this coronavirus infection. Here we need to really clarify the fact that people with celiac disease are NOT at an increased risk for flu. However, if they got the flu infection, they have a higher risk for more severe outcomes. In other words, the symptoms can be more severe that will eventually lead to pneumonia and possible hospitalization. The last question, that is very intriguing and that we received from several people was, “Given the fact that the COVID-19 infection started earlier in Italy (they have been a month ahead of us), do they have any data that may eventually link exposure to this virus with increased risk in the celiac population?” There are no official data out there yet, but unofficially there are surveys that seem to suggest that, once again, people with well-controlled celiac disease do not seem to be at increased risk to contract the coronavirus infection. In this venue, I believe that there are different possible initiatives here in the United States. But I will urge you, eventually, as a celiac patient, to answer 3 quick questions that we want to pose to you to try to figure out, “What is the situation here in the United States?” The first question being, “Have you been tested and resulted positive for COVID-19 infection?” That will be the first question. The second question is, “If so, were you sick enough to require hospitalization?” And finally, the third question that we would like you to answer is, “If not tested, did you experience COVID-19-like symptoms and quarantine yourself because your physician suggested you to do so?” If you would be so kind to answer these 3 questions, we may have a sense of what’s going on here in the United States as well, and be more precise in answering your questions. Thank you again for reaching out. Stay safe, stay well and, most importantly, let’s continue to help each other by maintaining social distance until new drugs or vaccines will be available. Have a great day.