Celiac Disease and COVID-19

Coronaviruses are a large family of viruses which may cause illness in animals or humans. In humans, several coronaviruses are known to cause respiratory infections, ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The most recently discovered coronavirus causes coronavirus disease COVID-19. The coronavirus that causes COVID-19 is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

The CDC has a comprehensive Frequently Asked Questions page about the COVID-19 vaccines that can be found here.

The FDA maintains an up-to-date website for COVID-19 vaccine information that can be found here.

The most effective ways to protect yourself and others are to get vaccinated, cover your nose and mouth with a face mask when in public, maintain a distance of at least six feet from other people, and frequently wash your hands for at least 20 seconds with soap and water.

Omicron and Delta Variants

On July 27, 2021, CDC announced updated Guidance for COVID-19 Prevention Strategies.

As of December 20, 2021, Omicron has been detected in most states and territories and is rapidly increasing the proportion of COVID-19 cases it is causing. The Omicron variant likely will spread more easily than the original SARS-CoV-2 virus, and how easily Omicron spreads compared to Delta remains unknown. CDC expects that anyone with Omicron or Delta infection can spread the virus to others, even if they are vaccinated or don’t have symptoms.

CDC continues to recommend wearing a mask in public indoor settings in areas of substantial or high community transmission, regardless of vaccination status.

To see the level of community transmission in your county, visit COVID Data Tracker.

Guiding Principles for Fully Vaccinated People

• Outdoor activities pose minimal risk to fully vaccinated people.
• Most indoor activities pose low risk to fully vaccinated people, especially in areas with low or moderate transmission.
• Fully vaccinated people who become infected with the Delta or Omicron variant can transmit it to others.

To reduce their risk of becoming infected with the Delta or Omicron variant and potentially spreading it to others, CDC recommends that fully vaccinated people:

• Wear a mask in public indoor settings if they are in an area of substantial or high transmission.
  • Fully vaccinated people might choose to mask regardless of the level of transmission, particularly if they or someone in their household is immunocompromised or at increased risk for severe disease, or if someone in their household is unvaccinated.
• Get tested if experiencing COVID-19 symptoms.
• Isolate if they have tested positive for COVID-19 in the prior 10 days or are experiencing COVID-19 symptoms.
• Get tested 3-5 days after exposure to someone with suspected or confirmed COVID-19 and wear a mask in public indoor settings for 10 days after exposure or until they receive a negative test result.
• Continue to follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations.

More information on quarantine and isolation guidelines can be found here.

Celiac Disease and Increased Risk of Severe Illness from COVID-19

To date, there have been no studies or reports suggesting patients with celiac disease are at increased risk of severe illness from COVID-19 compared to patients without celiac disease. In fact, in the largest study characterizing celiac disease patients with COVID-19 to date exploring clinical outcomes of celiac disease patients with COVID-19, researchers concluded that patients with celiac disease who are infected with COVID-19 are not at higher risk of hospitalization, mortality, thrombosis, or ICU care requirement compared to COVID-19 patients without celiac disease.

Data is now being collected in an international adult and pediatric registry called SECURE-Celiac. We encourage all celiac patients diagnosed with COVID-19 to have their physician file a report at covidceliac.org. In conjunction, we are collecting patient-reported data in the iCureCeliac patient registry. You are able to share your experiences whether or not you or your child have been diagnosed with COVID-19 infection. Data from these registries will show the true impact of COVID-19 on celiac patients.

The Celiac Disease Foundation Medical Advisory Board states that celiac disease patients in general are not considered to be immunocompromised. A small proportion of celiac disease patients with severe malnutrition and weight loss, the rare complication of Type 2 refractory celiac disease, on immunosuppressive medications, or with other serious illnesses, may be at increased risk of severe illness from COVID-19 and should consult with their physicians.

The Celiac Disease Foundation Medical Advisory Board does not consider occasional gluten exposure from cross-contact to put a patient with celiac disease at increased risk of severe illness from COVID-19, but cautions that patients should adhere to a strict, gluten-free diet for overall health.

It is important to know that celiac disease is a chronic medical condition in which there appears to be an increased risk of infections with pneumococcal bacteria that cause pneumonia and herpes zoster (causing shingles). In addition, there appears to be increased risk of worse outcomes with influenza infections and an inadequate response to vaccination with hepatitis B. Still, these risks, while measurable in several studies, are small in magnitude.

Society for the Study of Celiac Disease Statement on COVID-19 Vaccination

With the recent news that the Food and Drug Administration has granted Emergency Use Authorization for a vaccine against SARS-CoV-2, the virus that causes Covid-19, patients with celiac disease are asking for guidance about the advisability of this and other Covid-19 vaccines in the context of celiac disease, an immune-mediated condition. As scientists and clinicians who care for people with celiac disease, we urge people with celiac disease to receive a Covid-19 vaccine that has met government regulatory approval. This includes agents comprised of RNA (a vaccine technology that has been in development and has undergone safety testing for years) and peptide (protein) vaccines.

During the onset of the Covid-19 pandemic, there was initial concern that people with celiac disease might be at a slightly increased risk of severe outcomes from SARS-CoV-2 infection, given prior studies suggesting risks related to pneumonia and viral infections. Studies thus far, including the international registry www.covidceliac.org, have indicated no increased risk of severe outcomes. Even though the risk among people with celiac disease is comparable to that of the general population, we have seen that Covid-19 can nevertheless have devastating effects, and we share in the consensus belief by the public health community that mass vaccination is crucial. As the safety and efficacy data on Covid vaccination has emerged, there is no evidence to suggest that people with celiac disease would be more prone to an adverse effect of vaccination. Celiac disease is not considered an allergy, and by itself does not prompt additional precaution when proceeding with vaccination. Patients with concerns about vaccination and their particular circumstance should speak with their health care provider. We will undergo Covid-19 vaccination as soon as it is offered to us, and we urge our patients to do so.

Ciarán P. Kelly, MD, President
Benjamin Lebwohl, MD, MS, President-Elect
Alessio Fasano, MD, Secretary
Dawn W. Adams, MD, MS, Treasurer
Elena F. Verdú, MD, PHD, Past President
Sheila Crowe, MD, Councilor
Amy R. DeFelice, MD, Councilor
M. Ines Pinto-Sanchez, MD, MSc, CNSC, Councilor
Ritu Verma, MBChB, Councilor

Pneumococcal and Flu Vaccinations Strongly Recommended for People with Celiac Disease

To protect against secondary infection of pneumonia, the Celiac Disease Foundation Medical Advisory Board strongly advises people with celiac disease, aged 15-64 years, who have not received the scheduled pneumococcal vaccination series as a child, to consider vaccination. An annual flu vaccine is also recommended. This applies to all people with celiac disease, whether or not they are on a gluten-free diet.

The COVID-19 Virus is Thought to Spread Mainly from Person-to-Person:

• Between people who are in close contact with one another (within about six feet)
  • Respiratory droplets are produced when an infected person coughs, sneezes, or talks
  • Respiratory droplets can land in the mouths or noses of people who are nearby or can possibly be inhaled into the lungs
  • Respiratory droplets can land on objects and surfaces around the infected person and be transmitted by people touching them and then touching their eyes, nose, or mouth
• Cleaning & Disinfecting Surfaces
  • Surfaces may be cleaned with a simple disinfectant to kill the virus
  • Hand-washing regularly with soap and water for 20 seconds will kill the virus
  • Covering all surfaces of your hands with an alcohol-based hand sanitizer with at least 60% alcohol and rubbing them together until they are dry will kill the virus
• Anyone infected with COVID-19 can spread it, even if they do NOT have symptoms.

As of December 31, 2020, the World Health Organization (WHO) and the Centers for Disease Control (CDC) report that there is currently no confirmed case of COVID-19 transmitted through food or food packaging.

CDC’s Most Recent List of Those at Higher Risk for Severe Illness from COVID-19 Currently Includes:

• People 65 years or older
• People who live in a nursing home or long-term care facility
• People of all ages with underlying medical conditions, especially if they are not well controlled
  • Cancer
  • Chronic kidney disease
  • Chronic lung diseases, including COPD (chronic obstructive pulmonary disease), asthma (moderate-to-severe), interstitial lung disease, cystic fibrosis, and pulmonary hypertension
  • Dementia or other neurological conditions
  • Diabetes (type 1 or type 2)
  • Down syndrome
  • Heart conditions (such as heart failure, coronary artery disease, cardiomyopathies, or hypertension)
  • HIV infection
  • Immunocompromised state (weakened immune system, which can be caused by genetic defects that can be inherited, or prolonged use of corticosteroids or other immune weakening medications)
  • Liver disease
  • Overweight (body mass index [BMI] between 25 and 30) and obesity (BMI of 30 or higher)
  • Pregnancy
  • Sickle cell disease or thalassemia
  • Smoking, current or former
  • Solid organ or blood stem cell transplant
  • Stroke or cerebrovascular disease (affects blood flow to the brain)
  • Substance use disorders

Avoid COVID-19 Infection by Practicing Careful Infection Control:

• Get vaccinated – visit Vaccines.gov to find vaccination providers near you in the United States.
• Social distancing – stay home as much as possible, avoid social gatherings of more than 10 people, and stay at least six feet away from others when in public.
• Frequent hand washing – wash hands with soap and hot water for at least 20 seconds or with hand sanitizer that contains at least 60% alcohol, especially after being in a public place or after blowing your nose, coughing, or sneezing.
• Cleaning and disinfecting frequently touched surfaces daily – including tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks.
• Avoiding touching of eyes, nose, and mouth with unwashed hands.
• Covering of mouth and nose with a face mask when in public for anyone over the age of two.

Prepare to Stay-at-Home or Quarantine:

• Create a Stay-at-Home and Quarantine plan
• Stock up on staples and gluten-free foods
  • Finding gluten-free food is a challenge for many due to panic buying. We have coordinated with our sponsors and vendors to assure a steady supply of direct-to-you and in store products at Gluten-Free Resources .
• Plan your gluten-free meals
  • Whether you are now learning to cook or have been cooking for years, planning for three gluten-free meals a day plus snacks can be overwhelming. Browse our Gluten-Free Meal Plans to determine which is the right fit for you.
• Try new gluten-free recipes
  • For nutritious and delicious recipes, visit Eat! Gluten-Free or download the free app for iPhone or Android.
• Pay attention to your mental health and practice self-care to reduce stress and anxiety
• Learn how to talk to your children about COVID-19

What to Do if You or Your Child is Ill:

While fewer children have been sick with COVID-19 compared to adults, children can be infected with the virus that causes COVID-19, can get sick from COVID-19, and can spread the virus that causes COVID-19 to others. Children, like adults, who have COVID-19 but have no symptoms (asymptomatic) can still spread the virus to others. Evidence to date suggests that children and young adults are less likely to get severe disease, but severe cases can still happen in these age groups.

The time between exposure to COVID-19 and the moment when symptoms start can range from 2-14 days. Symptoms include:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness.

If you think you have COVID-19 symptoms or have been exposed to someone who has it:

• Stay home, self-isolate, and monitor your symptoms for 10 days, even if they are very mild.
• If possible, keep at least six feet away from household members and use a separate bathroom.
  • If you need to share a bedroom, open a window and turn on a fan to bring in and circulate fresh air.
  • Maintain at least six feet between beds if possible and sleep head to toe.
  • Put a curtain around or place a physical divider (e.g., shower curtain, room screen divider, large cardboard poster board, quilt, or large bedspread) to separate the ill person’s bed.
  • Clean and disinfect the bathroom surfaces. Open any doors or windows and turn on any fans to increase air circulation.
  • If you are too sick to clean the bathroom, make sure the person who cleans it waits as long as possible before entering the bathroom to clean it.
  • Wear a face mask over your nose and mouth if you must be around other people or animals.
    • Face masks should not be worn by children under two years, or anyone who has trouble breathing or who cannot remove the covering without help.
• Tell your close contacts that they may have been exposed to COVID-19.
• Call your healthcare provider and let them know about your symptoms. Tell them that you have or may have COVID-19. This will help them take care of you and keep other people from getting infected or exposed.
  • View Celiac Disease Centers to see which experts are offering telehealth.
• If you are not sick enough to be hospitalized, you can recover at home. Follow CDC instructions for What to Do if You Are Sick.
• Some over-the-counter (OTC) medications may help relieve fever, body aches, and nasal congestion.
  • Although rare, some OTC medications can contain traces of gluten. Learn how to effectively evaluate the ingredients in these products.