What Thyroid Patients Need to Know About COVID-19
Average reading time: 8 minutes
Q&A with Mary Shomon
Have you been wondering how COVID-19 recommendations apply to you as a thyroid patient? Everyone is talking about the Coronavirus outbreak, and let’s face it, the current situation is a little frightening. There’s also a great deal of misinformation and speculation out there, which makes the whole crisis even more difficult. Plus, we have health issues! How do the recommendations apply to us as thyroid patients?
We wanted to put together some of the most reliable information we could find, to help get you up to speed on what you need to know about COVID-19. We turned to our trusted advisor and thyroid health expert, Mary Shomon to ask what we need to be doing right now to protect ourselves and our loved ones. She put together this comprehensive primer for the Thyroid Refresh community.
Please Note: This article was published on March 13, 2020. It was last updated on Friday, March 20, 2020. We will do our best to update it as things change, but for up-to-the-minute information, we recommend visiting the CDC’s Coronavirus page.
What Is COVID-19?
According to the Centers for Disease Control (CDC), the virus itself is called severe acute respiratory syndrome coronavirus 2, abbreviated as SARS-CoV-2. The disease caused by SARS-CoV-2 has been named “coronavirus disease 2019,” abbreviated to COVID-19.
Coronaviruses are a family of viruses that infect both people and animals. You may hear some scientists describe COVID-19 as a “novel coronavirus”, which means that it’s a new virus. In the case of COVID-19, experts believe that it’s an animal virus that first infected people in China in late 2019.
COVID-19 originated in China in December of 2019. Early in the outbreak, infections remained concentrated in the Wuhan area, and the spread was mostly limited to people who had been exposed to those originally infected with COVID-19. As people traveled, the virus spread rapidly to other areas of China. At present, there are more than 81,000 confirmed cases and more than 3,100 deaths from COVID-19 in China alone.
After the initial outbreak in China, travelers who were exposed to the virus went to other countries—including the United States—where they developed infections themselves. As infectious “carriers” of the virus, they also infected some of their close contacts. In the United States in particular, delays in COVID-19 tests have also resulted in many infected carriers unknowingly infecting additional people through community spread.
On March 11, 2020, the WHO declared that COVID-19 is a pandemic, with more than 118,000 cases in 114 countries, and almost 4,300 deaths. A pandemic is defined as “an outbreak of a disease that occurs over a wide geographic area and affects an exceptionally high proportion of the population.”
How Does COVID-19 Spread?
According to the CDC, the main way COVID-19 spreads is from person-to-person, and specifically, between people in close contact, within three to six feet.
This distance is, however, being challenged by findings of a study released on March 10, 2020 by Chinese epidemiologists. They documented the spread of COVID-19 at distances up to 4.5 meters (almost 15 feet).
Experts do agree that COVID-19 is transmitted through respiratory droplets that are produced when an infected person coughs or sneezes. These droplets can then land in the mouths or noses of people in the vicinity, where they can be inhaled into the lungs. One recent report from researchers says that the virus that causes COVID-19 can remain airborne and infectious for as long as three hours.
When someone infected with COVID-19 touches a surface, they can leave behind active virus. Infected droplets can also land on surfaces and survive for an extended period. These surfaces then pose an additional risk of infection if you touch the infected surface, and then touch your mouth, nose, or eyes. This is why diligent and frequent hand washing and use of hand sanitizer—if you can find it—is crucial.
How long the virus survives is a topic for debate. One recent study reports that COVID-19 can survive for up to three days. A study from the March 2020 issue of the Journal of Hospital Infection reported that other human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus and Middle East Respiratory Syndrome (MERS) coronavirus can “persist on inanimate surfaces like metal, glass or plastic for up to nine days”. Several doctors I’ve interviewed said that they are operating on the assumption that the virus that causes COVID-19 lives at least three days, but it’s more likely that it’s closer to nine days. Another reason to make hand hygiene a top priority.
The time between the onset of exposure and the onset of COVID-19 symptoms can range from two to 14 days. According to the CDC, someone with COVID-19 is most contagious when they are also most symptomatic. But COVID-19 can still be spread when someone is infected, but not yet symptomatic.
What Are the Symptoms of COVID-19?
According to the CDC, the primary symptoms of COVID-19—which, as I mentioned above, typically appear from two to 14 days after infection—include:
- Shortness of breath or difficulty breathing
Other commonly reported symptoms include:
When Should You Call Your Doctor?
The CDC is currently recommending that you call your healthcare provider immediately if:
- You develop symptoms and think you have been exposed to COVID-19
- You develop symptoms and you have been in close contact with someone known to have COVID-19
- You have recently returned from an area where there is widespread or ongoing community spread of COVID-19.
What Are the COVID-19 Complications and Mortality Rate?
The complications that can develop from COVID-19 include pneumonia, organ failure, and acute respiratory distress syndrome.
While we don’t currently have accurate information on COVID-19 mortality rates by age for the United States, experts are looking at Chinese data that shows COVID-19 mortality risks by age, as follows:
- People under 50: 0.2 to 0.4 %
- Age 50-59: 1.3%
- Age 60-69: 3.6%
- Age 70-79: 8%
- Over 80: 14.8%
There also appears to be a connection between preparedness and risk of mortality. On March 6, the WHO reported a “crude mortality ratio” (the total number of deaths divided by the number of reported cases—at 3 to 4% globally. But in South Korea, which has implemented an aggressive system of widespread testing and isolation of COVID-19 patients, the rate was 0.7% as of March 9, 2020.
Is there a Vaccine For COVID-19?
At present, there is no vaccine for COVID-19. Under normal circumstances, it can take up to 5 years to identify, run clinical trials, and then get approval for a new vaccine. Given the urgency of the situation, this timeline is likely to be significantly compressed. Still, in numerous media appearances in early March of 2020, Anthony Fauci, MD (the director of the National Institute of Allergy and Infectious Diseases), has said that a vaccine for COVID-19 will not be available to the public “for at least a year to a year and a half”.
The good news, however, is that various vaccines are already development now, and an expedited clinical trial of one vaccine just started in mid-March.
How Is COVID-19 Treated?
There are no specific antiviral medications that are known to be effective against COVID-19, or currently recommended as part of accepted treatment guidelines. Treatment instead focuses on managing the symptoms of COVID-19, and providing supportive therapy, including oxygen, and in some cases, mechanical ventilation.
WARNING: IBUPROFEN IS NOT RECOMMENDED TO TREAT FEVER OR PAIN DURING A COVID-19 INFECTION
IMPORTANT NOTE: The World Health Organization has issued a warning against using ibuprofen (Motrin, Advil) to treat fever, aches, and pains from COVID-19. Instead, it’s recommended that you use acetaminophen (Tylenol) (also known as paracetamol) according to the label recommendations.
While some experts say that there is no proven scientific evidence linking over-the-counter use of ibuprofen to the aggravation of COVID-19, other experts are theorizing that anti-inflammatory drugs like ibuprofen can increase an enzyme that worsens COVID-19 infections. (Lancet: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30116-8/fulltext)
How Can You Protect Yourself Against COVID-19 Infection?
According to the CDC, the best ways to prevent COVID-19 are hand hygiene, and avoiding close contact and exposure to potential infection.
Good hand hygiene involves:
- Washing your hands frequently with soap and water for at least 20 seconds, especially after you have been in a public place, and after blowing your nose, coughing, or sneezing.
- Disinfecting hands using a hand sanitizer that contains at least 60% alcohol, if soap and water aren’t available. To effectively use hand sanitizer, you need to cover all your hand surfaces and then rub them together until your hands feel dry.
- Avoiding touching your eyes, nose, and mouth, especially with unwashed hands.
To avoid exposure to potential infection, you should also:
- Avoid close contact with people who are sick
- Keep a physical distance between yourself and other people of six feet or more, especially if there is COVID-19 spreading in your community. (Note: researchers in China have reported COVID-19 infections at a distance of as much as 15 feet.)
You should also start “social distancing” right away. Social distancing is an infection control technique that involves minimizing or avoiding close contact between people. Even if you have no reason to believe you have COVID-19, you should start practicing voluntary social distancing, by avoiding any areas with large concentrations of people, like meetings, movies, places of worship, sporting events, public transportation, and restaurants. Avoid any non-essential travel. You should also explore options for telework or teleclasses if they are available to you.
We are also starting to see more formalized social distancing approaches being implemented, with official quarantines, travel restrictions, cancellation of large events, and closure of some workplaces, school systems, and universities.
Given projections about how quickly and widely COVID-19 will spread, be prepared for the possibility that some social distancing measures will become mandatory. The main reason? COVID-19 is much more infectious than seasonal flu, and is 10 times more likely than the flu to result in serious complications and the need for hospitalization.
Additionally, no one has any immunity to COVID-19, there are no antiviral drugs that are currently known to be effective against this particular virus, we’re likely months away from any effective antiviral drugs, and at least a year or more away from a vaccine. That means that many millions of Americans are likely to get COVID-19, and a substantial percentage of them will require hospitalization. Social distancing can help “flatten the curve,” so that the surges in demand for acute care in hospitals don’t overwhelm our limited hospital capacity.
How Can You Protect Others from COVID-19 Infection?
Whether or not you’ve been diagnosed with COVID-19, the CDC has sensible recommendations to help you protect others from possible COVID-19 infection.
If you feel sick, stay home—unless you need medical care.
If you feel sick and need to go to a hospital or medical office, call ahead before you go unless it’s a medical emergency. Many HMOs and health care providers are now asking patients to do initial COVID-19 screening with a telephone or televideo appointment first. If in-person medical treatment is needed, they can then arrange in advance for your visit, and to ensure that if you are infectious, you don’t pose a risk to others at the medical office or hospital. (Many hospitals are meeting potential COVID-19 patients to provide them with masks before they enter the building, and some areas now direct non-urgent patients to drive-through locations for COVID-19 testing, to avoid exposing others to potential infection.)
Speaking of masks, you should wear a face mask if you are sick, especially if you’re in close proximity to others or you’re going into a healthcare provider’s office or hospital. (Note: If you do not have a face mask – and they’re largely unavailable currently — public health officials are recommending you use a scarf or bandanna. It’s not as effective as a mask, but better than not covering at all.)
If you are coughing or sneezing, cover your coughs and sneezes with a tissue and then throw it in the trash, or sneeze or cough into the inside of your elbow. After you cough or sneeze, you should wash your hands with soap and water for 20 seconds or use a 60% alcohol hand sanitizer if soap and water is not available.
Daily, you should clean and disinfect common surfaces such as tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, toilets, and sinks. You can kill human coronaviruses in around one minute using any disinfectant or cleaning product that contains 62–71% ethanol (alcohol), 0.5% hydrogen peroxide, or 0.1% sodium hypochlorite (bleach). (Note that other agents such as 0.05–0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate found in some products are far less effective against coronaviruses.)
If you or anyone in your household are suspected or confirmed to have COVID-19, you also need to ramp up cleaning and disinfecting your home or surroundings, especially shared spaces. The CDC has detailed guidelines online.
In schools and workplaces, experts recommend that you specifically avoid handshaking, sharing of food, and physical contact. In addition, postponing large meetings—or holding them via teleconference—is recommended.
According to the WHO, natural ventilation can in some cases reduce the risk of contracting an airborne disease, and poor ventilation can worsen the risk of transmission. To that end, they recommend that homes, schools and workplaces open windows and increase ventilation when possible, and if large meetings are unavoidable, consider holding them in open, well-ventilated spaces.
Are You Considered High Risk Due to Your Thyroid or Autoimmune Condition?
The CDC reports that those who are the highest risk of complications from COVID-19 include:
- Older adults.
- People who have serious chronic medical conditions like:
- Cardiovascular disease/heart disease
- Lung disease
Other health experts have said that people who are immunocompromised and pregnant women should also be considered at higher risk.
Experts know that a strong, functioning, and well-regulated immune system — typically found in children and younger adults — appears to be a major factor that reduces the risk of complications or death from COVID-19. But what about a thyroid condition, or autoimmune disease?
The British Thyroid Association recently issued a statement indicating that “there is currently no reason to believe that people with thyroid problems (autoimmune or otherwise) are at any excess risk from coronavirus.”
I have interviewed a number of experts on infectious diseases in the past several days who disagree with the British Thyroid Association’s position. They have all stated that to be cautious, anyone with a chronic illness or autoimmune disease at any age should, for practical purposes, consider ourselves to be in the high-risk category, and act accordingly. This includes people with chronic thyroid illness like hypothyroidism, as well as autoimmune thyroid issues like Hashimoto’s or Graves’ disease.
In particular, I’d like to share the recommendations of Dean Winslow, MD, a Professor of Medicine at the Stanford University Medical Center, and a specialist in infectious diseases.
He said the cautions should apply to all of us and are especially applicable if your autoimmune disease has affected your lungs, cardiovascular system, or kidneys, or if you are taking a disease-modifying anti-rheumatic drug (DMARD) or receiving any immunosuppressive treatment, including steroid drugs. These drugs and treatments, often prescribed to patients with rheumatoid arthritis and multiple sclerosis, may put you at higher risk of infection and complications from COVID-19.
As you can see, there’s some disagreement, and without specific or official data or research on whether autoimmunity in general — or autoimmune thyroid diseases in particular – are considered high-risk factors for COVID-19, we simply don’t have an answer right now. It’s simply too early in this evolving situation.
But here’s some info on what we do know about autoimmunity:
We still don’t know definitively whether dysregulation in the immune system found in autoimmune disease means a greater risk of complications from COVID-19. If you have an underlying autoimmune disease, how your immune system responds to viral attack can be unpredictable. COVID-19 is a new virus, and we have little information about how the immune system of healthy people responds, much less, people with autoimmunity. But some experts have told me that if your immune system is already dysregulated, and busy fighting off what it thinks is a pathogen — as we see in autoimmune disease — you potentially could be more susceptible to infections, including viral infections like COVID-19. And remember: if you have Hashimoto’s or Graves’ disease, your immune system has already shown that it is dysregulated, by attacking your own thyroid gland.
Keep in mind that autoimmune disease is not the same as being immune deficient or immunocompromised. The immune system of someone who is immunocompromised doesn’t react when it should, making them more susceptible to infection. But in autoimmune disease, the immune system wrongly activates with an outsized immune response against organs, tissues, glands, and in some cases (such as gluten in people with celiac disease) foods or other substances. The immune system is overactive rather than suppressed. But whether that overactivity is a risk factor? Still unknown.
I’d also like to note another statement from the British Thyroid Association, which said that “Thyroid problems are common and the analysis from China would have likely picked up if there was a big problem for thyroid patients already.” Unfortunately, the information to date that has come from China has been severely limited. China is also actively involved in diagnosing and treating a major pandemic in their own country, so epidemiological analysis and disease-specific data simply aren’t available yet.
Personally, I think it’s irresponsible at this point to essentially say “if it were a problem, we’d have heard about it by now,” especially in the midst of a rapidly evolving, worldwide pandemic health crisis where experts are struggling to get a handle on even the basics about COVID-19. While I don’t want to encourage panic, I think it’s responsible to urge caution until we have actual data that looks at specific risks related to thyroid issues in general, and autoimmune thyroid diseases specifically. In the meantime, as someone with Hashimoto’s disease, I am acting as if I am in the high-risk group. I’d rather have an overabundance of caution, than make health decisions based on assumptions of safety that simply aren’t yet backed up by actual science.
My position is that it’s not the time to take chances that put your health at risk. Hand hygiene, maintaining physical distance from others – whether they have COVID-19 or not — and active social distancing are going to be especially important for you until the active pandemic passes. Everyone should act as if you’re infected, and don’t want to pass it to someone else.
“All you folks older than 60 and those who have underlying illnesses, you ought to do personal mitigation starting now.”
– Dr. William Schaffner
Infectious disease specialist at Vanderbilt University
What Should You Do as a Thyroid Patient?
You need to follow the basics: maintain good hand hygiene, avoid touching your face, regularly clean and disinfect common areas, and practice social distancing.
If you are a thyroid patient with any underlying autoimmune disease, the physicians I’ve spoken with all suggest that at this point in time, if you want to be cautious, you should act as if you are in one of the known high-risk groups. This means in addition to all the basics, you should also strongly consider immediately adopting stringent social distancing.
Some other important tips:
- Make sure you have enough medication to last at least a month or more in case you need to self-quarantine, or there are shortages of your medications.
- Note: if you are taking Tirosint, they have posted reassuring information about their status during the COVID-19 pandemic – and their cost-saving mail-order Tirosint Direct program. You can learn more at https://tirosint.com/coronavirus/
- If you can’t get approved refills of medications, through your insurance, consider paying out of pocket for refills.
- You can go to a free service like SingleCare or GoodRx to find the best self-pay price for your medication in your area, or by mail order. You can also get extremely low self-pay prices on generic versions of all thyroid drugs from Honeybee Health.
- Speaking of generic medications, keep in mind that if you can’t get your brand name, a generic drug may be a useful option, and is better than the alternative: running out!
- Find out about home delivery options from your local pharmacy, or mail order prescription options from your HMO or health insurance company.
- Stock up on over-the-counter medicines you may need if you develop coronavirus symptoms.
- Find out your telehealth options. Many doctors and HMOs are quickly ramping up their ability to provide consultations by telephone or video chat/televideo.
- Check with your healthcare provider about whether you should consider postponing any non-urgent hospital procedures, treatments, elective surgeries, or visits to a medical office.
- Have enough household items and groceries on hand so that you will be prepared to stay at home for an extended period of time.
How Can You Support Your Immune System?
A normal, healthy, robust immune system can manage the virus that causes COVID-19. This is why the evidence to date shows that the vast majority of children and young adults who don’t have chronic health conditions and who contract COVID-19 have milder symptoms they can treat at home, and won’t develop serious complications or require hospitalization.
The serious complications and debilitating symptoms of COVID-19 result from a failure of the immune system to keep up with the viral infection. As we get older, immune function normally declines, so the immune system of a middle-aged adult is far more robust than the typical adult over 70, for example. Additionally, heart disease, lung disease, high blood pressure, and diabetes (both type 1 and type 2) can make the immune system less able to fight off infection–at any age.
While we don’t know of any other specific things that can prevent, treat, or cure COVID-19, there are some proven ways you can help support your immune system.
- Prioritize sleep. The immune system works best when you are getting at least seven hours of sleep every night. Now is NOT the time to shortchange yourself when it comes to sleep. Check out the Thyroid Refresh Sleep Bundle for loads of resources to help you optimize your sleep.
- Eat a healthy diet. Even though it’s a stressful time, don’t be tempted to throw healthy eating out the window. And don’t forget to stay well-hydrated. You can browse our collection of thyroid-healthy recipes for delicious high-nutrient meals you can make at home.
- Get some physical activity or exercise every day. Even if you aren’t going to the gym, you can still take a walk, ride your bike, or do some stretching or a workout at home. Thyroid Refresh has dozens of workout videos to choose from.
- Practice some form of stress management daily. This is even more important during this COVID-19 crisis. Whether you do some guided meditation, gentle yoga, breathwork—or sit down to draw, color, or crochet—find something that lets your nervous system calm down, and make sure you devote at least 10 minutes a day. Browse the complete Thyroid Refresh Self-Care archives for ideas.
Are There Any Supplements for COVID-19?
You may wonder whether there are supplements proven to prevent, treat, or cure COVID-19. The answer, unfortunately, is no. But there are supplements that may help support your immune system.
First, an important note: many reliable health experts and nutritional practitioners are issuing a warning about the popular over-the-counter elderberry supplements, including the well-known brand Sambucol (Sambucus nigra L.). While elderberry is a popular natural remedy that’s commonly recommended by some natural practitioners to help with colds and mild flu, research has shown that it may increase cytokine response — and theoretically, may increase the risk of a dysregulated immune response called a cytokine storm. Researchers are reporting that cytokine storm is a cause of serious complications in COVID-19. As a result, it makes sense to avoid Sambucol and elderberry supplements at this time.
Some physicians are recommending that you make sure to supplement daily with vitamin C and vitamin D. This is something I’ve been doing daily since the COVID-19 crisis started. There’s no evidence that it will have a particular benefit related to COVID-19 specifically, but we do know that these supplements may help support the immune system in general, and vitamin D has been shown to help combat respiratory viruses.
One other supplement that may be helpful is zinc, in lozenge form. (Zinc nasal sprays or gels are not recommended, because they can permanently damage your sense of smell.) Again, given that the virus that causes COVID-19 is a new virus, we simply don’t know the effectiveness of zinc against this specific virus. But research does show that zinc lozenges – used according to label recommendations — may have some antiviral effect against the other family of coronaviruses like rhinovirus (the common cold) in general, and suspect that it may also have similar effect against COVID-19, without having any known harmful effects.
And remember, before taking ANY supplement, it’s important to consult with your doctor.
What if You’re One of Those People Who Catches Everything?
I also asked my friend, famed fibromyalgia, chronic fatigue and hormonal health expert Jacob Teitelbaum, MD, to share his best advice to those of you who seem to catch everything, and seem to take forever to recover. Here’s what he had to say:
In my experience, optimizing adrenal function is the way to reverse this. When I give adrenal support to those I treat, the response I routinely hear back is ‘For the first time, everybody else around me was sick this year, but I didn’t catch anything!’ So ,for those who have symptoms of adrenal fatigue—being irritable when hungry (‘hangry’), low blood pressure, or orthostatic intolerance (e.g. POTS/NMH)—I think adrenal support is helpful to support immune function.
– Dr. Jacob Teitelbaum
READ MORE ABOUT HOW YOU CAN SUPPORT YOUR ADRENALS HERE
DOWNLOAD THE EXPANDED 30+ PAGE REPORT – FREE!
To better support our readers, article author Mary Shomon has created an expanded 36-page download, along with 2-page info sheet. She will be regularly updating this guide, and ANYONE can download it FREE.
Copy and paste the link to share: https://maryshomon.podia.com/covid19-thyroid-report
We hope this Q&A has been helpful to you in laying out the basics on what you need to know about COVID-19. On behalf of all of us at Thyroid Refresh, may you stay happy and healthy. (And don’t forget to wash your hands!)
Disclaimer: This page is NOT a substitute for CDC and WHO information on COVID-19, or the advice of your physician. If you have questions or concerns about your health, your travel plans, your medications & supplements, or your level of risk, it’s imperative that you contact your primary care physician, who knows your personal and complete medical profile.