Thursday, March 26, 2020

Dr. Sarah Schafer: Am I at increased risk for COVID-19?

I've mentioned the excellent blog written by Dr. Sarah Schafer a few times, and for good reason. It's a stellar source of information and advocacy for Sjogren's syndrome. 

Dr. Schafer has written another post for Sjogren's Advocate, this one timely given the worldwide attack of COVID-19.

Take time to go to her blog and read it. The information that it contains is of vital importance: 
Am I at increased risk for COVID-19? 
YES.  Sjogren’s patients are at higher risk for infection and serious complications of infection.

My opinion about this is shared by many, but not all, rheumatologists. Because the virus is new, at this time there are no data to analyze that will show how Sjogren’s patients will fare with COVID-19 disease. This could take a year or more to determine.  We don’t have the luxury of waiting to find out. Patients need to know now if they should take extra precautions to prevent serious outcomes, including death.  Fortunately, a lot is known about the impact of Sjogren’s on the lungs and the immune system. The existing facts strongly suggest that  Sjogren’s patients should take extra precautions to avoid COVID-19. 

The UK National Health Service just published a guide for rheumatology care, stating that Sjogren's patients ARE at high risk. Being older (60 +), being on immune-suppressing drugs, or having lung disease will further increase the risk.

Why Sjogren’s patients are likely to be at increased risk for serious complications with COVID-19:
1. Dryness decreases surface immunity, the first line of defense.
The mucus layer is a critical first step to avoiding infection. This moist layer creates both a physical barrier and an immune system barrier from the outside world to the lungs.  Dryness decreases this important surface immunity, making the airways and lung tissue more vulnerable to infection.

2. Lung disease, a common problem, increases risk for complications if infection does occur.
About 10% of patients have interstitial lung disease (ILD) with symptoms. Many more (up to 50% plus) have signs of ILD on high-resolution CT. Moreover, there are many other types of lung disease that Sjogren’s patients have, often undiagnosed. Lung disease is a known risk factor for COVID-19 complications.

3. Dysfunctional immune system
Sjogren’s patients do not have normal immune systems. An overactive immune system does not mean better protection against infection; the overactivity is misdirected.

4. Immune suppressing drugs
Many drugs such as methotrexate, prednisone, Cellcept, Rituxan and others suppress the immune system. These increase the risk of serious infection.

Note: Hydroxychloroquine (HCQ, aka Plaquenil) is not an immune suppressant, but an immune system modulator. Do not assume that taking HCQ will protect you from infection. Despite media reports, this has not been proven with reliable studies! 
Continue reading here.

While you are on the Sjogren's Advocate site, be sure to take a spin around and explore all of Dr. Schafer's information and resources. It will be time well spent.


Anonymous said...

Dr. Schafer is also very active on the online community. I've learned so much more about Sjogrens since I joined the community.


Unknown said...

I just have a wee comment re: risk. The Sjogren's patient is no more at risk for contracting the COVID-19 than a non-Sjogren's individual. It has no preference for one person over another. It is not choosy. However, once infected, the associated complications are likely to be far more severe in the Sjogren's patient. Hence, follow the precautions: stay home, wash your hands frequently with soap and water, cough/sneeze into a tissue or your inner elbow, and keep a safe physical distance.
Stay well!
Please feel free to contact me at

Leslie P. Laing
B.Sc., B.Ed., M.Sc., Ph.D. (Microbiology and Immunology), D.D.S., M.Sc. (Prosthodontics), FRCD(C), FAP
President and Member of Board of Directors and Medical Advisory Board of Sjogren's Society of Canada