People with Active Celiac Are More Susceptible to Covid-19 and Pneumonia

If you have Celiac, don't get glutened now, because it will make it easier for Coronavirus to harm you. That's the message from a new video posted by Dr. Alessio Fasano, Director of the Massachusetts General Hospital Center for Celiac Research and Treatment.  (Press the arrow/play button to watch.)

If you don't know who he is, he's a bit of a superstar of the Celiac community.  He and fellow researchers, performed a study, over a decade ago, and worldwide, showing that the prevalence of Celiac is much higher than previously thought.  He found local variations in prevalence such as, that North Africa has a lot more of it than we do in the US. Many of his findings were fascinating, surprising, and ultimately led to the provision of safer food for people with Celiac Disease. Since then, he has continued to support the community and performed more studies.

Viruses and Bacteria

So let's talk a bit about viruses and bacteria.  A flu virus burns itself out in a few days, in medical jargon it's "self limiting."  The body figures out how to stop it and rapidly disables it in most cases.  However, doing that takes a lot out of the body.  That means you're running on less interferon and other things your body needs to fight all other infections.  So with the flu (and Covid-19 is a dangerous new flu), the place that ends up most damaged by the virus is the sinuses, lungs and sometimes the gut.

Special case:  If your IgA was low when you got your Celiac test, please remind your doctor of that right away.  IgA (you might remember that from the Celiac blood test) is a sort of alarm system that's present in the lungs and gut of human beings.  In some people with Celiac, IgA is unnaturally low so the alarm doesn't even ring in the first place. However, let's assume your IgA is normal.  If it's not, please consult your MD right away, that situation is beyond my simple explanation powers.   

So now, after the virus is finished with you, your immune system is left limping a bit, and it can give an opportunity for infections to take over your sinuses and lungs.  It can also leave your gut flora in a bit of a mess and make it more likely you'll have indigestion, hence the flu with nausea or loose stools.  The most likely and dangerous attacker after the virus is Pneumonia.

That's why people talk about Pneumonia with any flu and why doctors worry about how your lungs sound.  And that's why people who've had the flu longer than a week are often given antibiotics.  And why people say that antibiotics are not for the flu virus.  They're not, they're for the "secondary infection."  Antibiotics work to kill that *bacterial* infection, even if it's not Pneumonia.

When I say "germs" I am referring to viruses, bacteria, and funguses that can invade the human body.  It's like saying pathogens, but not so fancy. While it's possible to get a fungal infection of the lungs, the secondary infection under discussion today is Pneumonia, usually a bacteria called pneumococcus. 

My Nightmare Scenario

Many hospitals have struggled to provide gluten free food for patients, and even the best pharmacist can sometimes fail to keep gluten out of my drugs.  My nightmare scenario involves being checked into the hospital and then instantly told not to eat any of my own food, and only rely on them.  And then their kitchen serves me gluten free pasta boiled in the same water as wheat pasta.  Or any of a number of ways that people without Celiac can "mean well" but completely mess up my food.  And let's not forget that drugs could contain hidden gluten too.  I'm not allowed to be in the hospital and take my own supply of meds.  Now, in the scenario, I'm more susceptible to the virus and the secondary infection.  So now you see why I felt I had to post about this as soon as I was aware of it.

What's a virus?

Viruses are not alive (cool, huh?) and therefore can't be killed, they can only be deactivated.  The typical virus is an incredibly tiny bubble of protein, with an even more tiny bit of DNA or RNA.  Disinfectats that "kill" viruses damage the protein "envelope" they are in, and often damage the DNA or RNA inside.  Antibiotics have no effect on that. Antivirals are used to stop the biochemical steps that a virus uses to replicate.   Some viruses can linger on surfaces a long time because they need no water or nutrition to survive.  When people say the virus dies after 3 days outside the body, that means, eventually, their protein envelope naturally wears out or breaks down, and they "die."

Remember from the SARS epidemic?  A virus can travel 12 feet from an unprotected sneeze, so cover your coughs and sneezes.

What's replication?

Replication is when a virus makes more of itself.  When a virus enters the body, it floats around until it's next to a cell it can invade, and a series of chemical reactions causes the genes of the virus to take over the cell and force the cell to make more viruses.  Hundreds of thousands, millions of them!  Until the cell bursts open and spills all around, then the new viruses float around until they find more cells....  and that keeps going until the body deactivates it.

When the virus replicates, it might cause a variation of the DNA or RNA to happen.  If so, we call that "mutation" and it may be a more virulent version or a less virulent version.  This happens naturally with all flu viruses and that's why people get a flu shot every year, not just once. 

How does my body normally deactivate a virus?

Your immune system can learn.  It's the original Artificial Intelligence, except it's Natural Intelligence.  And it learns very fast.  The immune system learns to target  the virus with antibodies, then sends out interferon to partly deactivate it, and then finally your body fully recycles or eliminates the bits of virus that are left.  During this process your body uses up a lot of interferon and other materials it needs to win the fight.  So that's why in Cuba, and China, they give people one of the types of interferon which is depleted by the virus.  I don't know if that will be available in the US.

Why are the elderly more at risk?

The thymus. You probably hardly ever think about the thymus gland.  Like the spleen (also involved in fighting infections, and Celiac), it's barely talked about in popular health circles.  But it's vital.  The speed with which you can respond to an infection depends on your lymph node health and your age, because as you age, the thymus ages too and its function drops off.  The slower your response to an infection, the more likely it is that you'll have a more severe form of the infection.  And as I said, the virus depletes your immune system of materials just at the time when a secondary infection like Pneumonia is right there waiting.

As a person ages, it's more and more likely that Celiac genes will become active, so many senior citizens discover late in life that they have Celiac now.  They are often hard pressed to change their life around to avoid gluten entirely.  But even those who do, still have a higher risk of pneumonia and infections.  If the Celiac diagnosis comes in adulthood, then there is a higher risk of all infections, especially pneumonia.  Reference

Can I get Covid-19 twice?

Update:  This section was more confidently written back when I first wrote it.  But that's based on a lot of traditional wisdom that may not be right. Here's what I know about it.  Don't base any anxiety on what I say, I could be wrong. I updated my tone to be more tentative, but I think there are some important questions we should be asking the "experts" in Infectious Disease about Coronaviruses in general and Covid-19 in particular. 

Can you get it twice?  Not exactly.  It's called 19 because there have been others.  Viruses seem to be named for the year they were found,  Covid-19 arrived in 2019.  Confusing the issue, the virus and the disease it causes are named differently.   SARS and MERS are types of Coronavirus too.  But Covid-19 is particularly virulent and has a much higher death rate than any other modern flu virus.  Hence the worldwide precautions.  Here's a fact that may be hard to hear but it's really not as bad as it sounds:  everyone will probably get Covid-19, that's normal.  To explain why, let's take H1N1 as an example.  

And no, it doesn't mean all hope is lost.

Remember the precautions against "Swine flu" several years ago?  Today, most of us have already had it and just like all flu viruses, it keeps mutating into less nasty forms.  Right now, if you get an "ordinary" flu, not Coronavirus, you'll probably be dealing with H1N1, the old Swine flu.  And everyone's been exposed to most of the forms of Swine flu by now, through vaccines --  or just getting sick every year with the new version.  The flu shot each year tries to predict which mutations you'll need to be protected against.

Pro Tip:  Flu viruses get weaker at hurting us over time.  The once deadly Swine flu is now the ordinary flu, and someday the even more deadly Coronavirus will be just another ordinary flu. 

Someday we'll have a flu shot that includes Coronavirus...  I think.  First, we need a shot for Coronavirus itself, that works,  then it will probably be merged with the yearly flu shot.  And so it goes, humanity protecting itself. But that's in the future yet.

Interestingly, the vaccine for SARS was dropped after SARS became more rare in the mid-2000's.  After that press release, the WHO never had another one for SARS, however, some websites claim that a vaccine was developed.  Even stranger, an Infectious Disease expert told NPR that Coronaviruses which cause the common cold are not known to mutate very much, and that immunity to them fades after two or three years.  But in a bizarre twist, they're not part of the yearly flu shot.  Even though that would prevent them from reinfecting us, apparently. The influenza virus, H1N1 also has a "wear off" period of immunity.  So none of what they're saying on this point makes any sense to me. Seem to me, the yearly flu shot should include the four coronaviruses that are common, and now Covid-19 too. 

News:  The first coronavirus vaccine volunteer has already taken the shot.

So the simple answer is, no, you'll never get Covid-19 twice.... probably.   Traditional wisdom says viruses mutate.  So you will probably get its (hopefully weaker) relatives if you don't get your flu shot, after the flu shot contains it.  That's perfectly normal.  You never get the same flu twice...  in the same year.  It's always a variation.  Otherwise you could get one shot and never get a flu again.  Wow this is really turning the traditional wisdom upside down.

But, since both coronaviruses and influenza viruses change over time, and immunity drops off for both, I think we're looking at a major update to the flu vaccine. I certainly have no intention of getting two shots per year!  And while we're at it, how about working on some other viruses that should be included in the flu shot (see note below).  I seem to remember there were people asking why the flu shot was so limited, back in the late 1990s, early 2000's. 

Note:  Technically, Flu is caused by Influenza viruses and "a cold" is caused by Rhinovirus, Coronavirus (old types that are mild), Parainfluenzas and some unidentified viruses.  But this distinction is really techy and functionally they are very much the same, they cause flu like symptoms and then open the door for bacteria.  

You can check my dearly beloved Microbewiki for some very techy details, or this old resource from South Carolina University.  Both of them are out of date, they provide historical background to help you understand where we stand today.  USC has removed that page, so I had to go diving for it in, let me extend a thank you to them for preserving the page.

I could've just left all this confusing stuff out.  But then you would've had a false sense of security and been less informed.  I see my role as giving you what I know, even if it's half baked.  Please don't panic over it.  But at least this way you have some basis for asking the right questions if you get a hold of any Infectious Disease experts.

For example, here's a good question:  Some people think the flu shot is a waste of time, is because they got it and then got sick anyway.  So presumably they got a non-influenza virus that year.  Therefore,  wouldn't confidence improve if more types of viruses were added to the flu shot?  

What is "flattening the curve"?

You might think, well if everyone will have it then why not get it over with?  The reason is that the health care system can't handle that many people having the Coronavirus all at once.  Right now the Coronavirus is as deadly as it knows how to be. I don't want to be scary, but it could mutate into an even more deadly version before it calms down.  However, that's less likely if the spread is slower.

The good news is, flu viruses get less virulent over time. The purpose of slowing the spread is to allow people to access medical care in an orderly way instead of all of us flooding the hospitals at once. Let's be considerate of each other and ride it out together.


Update (3/22/2020):  The NY Times has opened up coronavirus stories to the general public without subscription, so I offer this excerpt from an article about Italy to help demonstrate the seriousness of "flattening the curve."

As new infections have proliferated around the country, they have significantly dropped in Vò, a town of about 3,000 people that was one of the first quarantined and which had the country’s first coronavirus death.

Some government experts attributed that turnaround to the strict quarantine that had been in place for two weeks. But Mr. Zaia had also ordered blanket tests there, in defiance of international scientific guidelines and the national government. The government has argued that testing people without symptoms is a drain on resources.

“At least this slows down the virus’ speed,’’ Mr. Zaia said, arguing that testing helped identify potentially contagious people without symptoms. ‘‘And slowing down the virus’ speed allows the hospitals to breathe.’’ 

What exactly does this have to do with my hands? 

You've heard over and over about not touching your face, and washing your hands a lot, and cleaning a bit more obsessively than usual, etc.  The reason this is important, even if you're self-isolating, and even if you're not ordering anything to be delivered, is not just because of the virus.  It's to keep the other secondary infection germs farther away from your hands and face.

We all live in a world teeming with germs.  That's just normal and we try to keep it sanitary. Keeping fewer of the germs in small areas is how we slow down the germs harming us.  So even if you do get the virus, do not stop hand washing and don't start touching your face, thinking, "Oh, who cares now, I got sick anyway."  It still matters because you don't want to track the very common pneumonia germ to your face with your hands.

I know you're sick of hearing it and you're numb to the advice by now, but I wanted to give you more details about hand washing's importance.   We won't do this every year, but it's not a bad idea to repeat a few of these precautions during flu season from now on. 

When I was a kid, I was the kind who always asked why.  I couldn't follow rules unless I understood.   My mom taught me not to play with matches by showing me how fire worked and told me it could burn everything, maybe even including my teddy bear.  I never played with matches.  😀

So here's something I want to know why about:  Why did the US refuse to use the WHO Covid-19 test, even though 60 countries agreed?  Let's all ask why, shall we?

Update March 30:  a video came out recently from Washington Post showing the timeline of developing a Coronavirus test, and which inefficiencies slowed the process down.  These catch-22 situations are ones that I've experienced myself when talking with my Infectious Disease doctor.  They are routine, not unique. We have to become more responsive and efficient in dealing with infectious disease. It's not always something that happens "elsewhere."


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