Celiac Disease and COVID-19 FAQs

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 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).
• Through respiratory droplets produced when an infected person coughs, sneezes, or talks.
• These droplets can land in the mouths or noses of people who are nearby or can possibly be inhaled into the lungs.
• These 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 – data from surface survival studies indicate that the risk of surface transmission is minor after three days. Surfaces may be cleaned with a simple disinfectant to kill the virus.
• Anyone infected with COVID-19 can spread it, even if they do NOT have symptoms.

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

A recent international study conducted by the Colombia University Celiac Disease Center and Farncombe Family Digestive Health Research Institute at McMaster University Medical Center found those with celiac disease are not at increased risk of COVID-19. Out of 18,022 patients that completed the study survey, 10,737 had self-reported celiac disease. Researchers found that participants with celiac disease were no more likely to have a positive COVID-19 test than participants without celiac disease.

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.

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. It is reasonable to consider that those with celiac disease, especially older individuals, may be at a small increased risk of worse outcomes with infections with this new virus.

Get Vaccinated for Pneumococcal Infection and Flu:

To protect against infection, 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.

How to Protect Yourself and Others:

Children and adults with celiac disease, like everyone in our communities, are at risk for COVID-19 infection and should exercise careful infection control practices:

• 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 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.
• Ask your healthcare provider about the COVID-19 vaccine and if it may be right for you.

People with COVID-19 have a wide range of symptoms from mild symptoms to severe illness. People with these symptoms may have COVID-19:

• 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

Some people become infected but don’t develop any symptoms and don’t feel unwell.

When to Seek Medical Attention 

If you develop emergency warning signs for COVID-19 get medical attention immediately. Emergency warning signs include*:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

Most children with COVID-19 have mild symptoms or have no symptoms at all. However, some children can get severely ill from COVID-19. Symptoms of COVID-19 are similar in adults and children and can look like symptoms of other common illnesses, such as colds, strep throat, or allergies. The most common symptoms of COVID-19 in children are fever and cough, but children may have any of these signs or symptoms of COVID-19:

• Fever or chills
• Cough
• Nasal congestion or runny nose
• New loss of taste or smell
• Sore throat
• Shortness of breath or difficulty breathing
• Diarrhea
• Nausea or vomiting
• Stomachache
• Tiredness
• Headache
• Muscle or body aches
• Poor appetite or poor feeding, especially in babies under one year old

Babies under one year old might be more likely to have severe illness from COVID-19. Other children, regardless of age, with the following underlying medical conditions might also be at increased risk of severe illness compared to other children*:

• Asthma or chronic lung disease
• Diabetes
• Genetic, neurologic, or metabolic conditions
• Sickle cell disease
• Heart disease since birth
• Immunosuppression (weakened immune system due to certain medical conditions or being on medications that weaken the immune system)
• Medical complexity (children with multiple chronic conditions that affect many parts of the body, or are dependent on technology and other significant supports for daily life)
• Obesity

*This list does not include every underlying condition that might increase the risk for severe illness in children. As more information becomes available, the CDC will continue to update and share information about risk for severe illness among children.

The CDC has a comprehensive Frequently Asked Questions page for COVID-19 vaccine information that can be found here.

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

Pneumococcal infection is a common complication of reduced spleen function, known as hyposplenism. About 30% of celiac patients have hyposplenism. Since this is not routinely assessed, not everyone will know if they have reduced spleen function and are at higher risk for developing infections.

The spleen is an organ in the body which plays an important role in the immune system, controls the level of blood cells, and filters the blood to remove old or damaged red blood cells. It also has a specific immune function in helping to protect against a small number of bacterial infections such as pneumonia.

There doesn’t seem to be an increased risk of viral infection if someone has hyposplenism, but there is a small risk of having a “secondary bacterial infection” like pneumonia during or after another infection, like a virus. Because of this potential, the Celiac Disease Foundation Medical Advisory Board recommends that all people with celiac disease be vaccinated against pneumococcal infection with a booster every five years.

• 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

The Centers for Disease Control (CDC) recommends the use of alcohol-based hand sanitizers with greater than 60% ethanol or 70% isopropanol to inactivate COVID-19. While gluten cannot be absorbed through the skin, we know there is concern in our community about inadvertently ingesting gluten through transfer to food or by touching your mouth after using hand sanitizer. While the basic active ingredients in hand sanitizer are gluten-free, some may contain gluten-derived products, like wheat germ oil. Though wheat germ oil is highly processed and likely gluten-free, some less processed additives may contain traces of gluten. As with all products that you might ingest, careful label reading is recommended.

To find gluten-free hand sanitizer, please visit our Gluten-Free Resources.

According to the CDC, hand sanitizer should be applied to one palm then rubbed all over the surfaces of both hands until they are dry. If you wipe sanitizer off your hands, it will not be fully effective.

Gluten-Free Foods and Products

We know that finding gluten-free food is a challenge for many due to panic buying. We are working with our sponsors and vendors to assure a steady supply of direct-to-you and in store products.

Please visit our Gluten-Free Resources for our company list and be sure to check back frequently as more are added.

Gluten-Free Meal Plans and Recipes

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. Our nutritionally-balanced  7-Day Pediatric, Senior, and Diabetic Gluten-Free Meal Plans with simple and delicious recipes can make quarantine a little easier.

Browse our Gluten-Free Meal Plans to determine which is the right fit for you.

Want more delicious gluten-free recipes? Visit Eat! Gluten-Free or download the free app for iPhone or Android.

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

• Stay home.
• 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.

Look for emergency warning signs* for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:

• Trouble breathing
• Persistent pain or pressure in the chest
• New confusion
• Inability to wake or stay awake
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

*This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.

If you must be hospitalized, reference our Healthcare Facility Guide for important questions to ask to assure that you are able to maintain a gluten-free diet in the hospital.

For those living with celiac disease, stress and anxiety can be a part of everyday life, and at this time, the COVID-19 pandemic has added an additional layer of concern. Please review our COVID-19 and Mental Health resources.

If you or someone you care about are feeling overwhelmed with emotions like sadness, depression, anxiety, or feel like you want to harm yourself or others:

• Call 911
• Visit the Disaster Distress Helplineexternal icon or call 1-800-985-5990 and TTY 1-800-846-8517
  • Or text TalkWithUs to 66746
• Visit the National Domestic Violence Hotlineexternal icon or call 1-800-799-7233 and TTY 1-800-787-3224

People with preexisting mental health conditions should continue with their treatment and be aware of new or worsening symptoms. Additional information can be found at the Substance Abuse and Mental Health Services Administration (SAMHSAexternal icon) website.

SECURE-Celiac is a new international patient registry to study coronavirus COVID-19 in people with celiac disease. The Celiac Disease Foundation has partnered with the Celiac Disease Center at Columbia University to encourage celiac patients diagnosed with COVID-19 to ask their doctor to go to covidceliac.org and report their case.

SECURE-Celiac contains only de-identified data which means no one can link reported data to you. Reporting a case should take your doctor no more than five minutes. Only laboratory-confirmed COVID-19 cases should be reported.

With the help of the entire celiac community, we will rapidly be able to define the impact of COVID-19 on patients with celiac disease and how factors such as age, comorbidities, and treatments impact COVID-19 outcomes.

We are committed to providing you with the most up-to-date health information on the COVID-19 outbreak. Steps we’ve taken:

• Joined with the nation’s disease advocacy organizations in lobbying Congress to make sure that protections for patients with chronic conditions remain in place and that nonprofits are included in federal aid so that we may continue to provide services to you.
• Consulted with our Medical Advisory Board to create the COVID-19 and Celiac Disease Resource Center providing you with evidenced-based information from our world experts in celiac disease and resources to keep you and your family healthy and safe during this pandemic.
• Partnered with Columbia University to support SECURE-Celiac, an international registry of celiac patients diagnosed with COVID-19, to rapidly define the impact of COVID-19 on patients with celiac disease and how factors such as age, comorbidities, and treatments impact COVID-19 outcomes.
• Worked with our nation’s celiac disease doctors and dietitians to offer you an ever-growing list of telehealth services.
• Coordinated with our valued sponsors and vendors to provide you with continued access to gluten-free foods and products.
• Collaborate regularly with our counterpart celiac societies worldwide to exchange best practices and information.
• Continue to work with biopharmaceutical companies on patient recruitment for clinical trials so that there will be adjunct treatments to the gluten-free diet in the future.
• Continue to (virtually) meet with Congressional and NIH members and staff to assure celiac disease research funding dollars for FY2022.
• Continue to offer hotline support through telephone, email, and social media.

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