Asthma and COVID-19: What to Do
As news of the COVID-19 virus changes daily, the statistics mentioned in this article might not be the most up to date information. We will try to update this article regularly.
Update: March 16, 2020
New symptoms of the novel coronavirus. Added charts on the mortality rate and numbers infected as new reports come out of South Korea and Italy. See below for details.
Update: March 15, 2020
If you or anyone you know thinks they have symptoms of the novel coronavirus, please read Symptoms of Coronavirus in Asthmatics
Update: March 13, 2020
Over the past five days, more information about the coronavirus, or COVID-19, has become known. In Europe, the number of cases has skyrocketed, the number of patients in the US continues to rapidly grow, and the world is in crisis. Many countries have quarantined themselves to contain the virus.
Treatment still has no cure, but doctors are using supportive care techniques. Many of these revolve around anti-inflammatory and antiviral treatments. More extensive treatment for severe cases includes continuous renal replacement therapy (CRRT), invasive mechanical ventilation, and even extracorporeal membrane oxygenation (ECMO). No specific antiviral drugs have been confirmed effective. The development of new medications to combat this are ongoing as you read this. (19)
At home treatment includes treating of the symptoms: fever reducers every 4 hours, cough syrup with a cough suppressant and an expectorant, zinc and vitamin C.
To date, hand washing and social distancing seem to be the most effective at slowing the spread of this virus. Even if someone is young and in good health, practicing social distancing to prevent the contamination of others is still recommended by the CDC and WHO.
Alcohol based sanitizers are effective, but the CDC states that they must be at a 60% level of alcohol in order to kill germs. (20) Dr Elizabeth Scott, a microbiologist at the Simmons Center for Hygiene and Health in Home and Community at Simmons University in Boston, says that homemade or DIY hand sanitizers are not a good substitute in this instance as they won’t contain levels of alcohol at the correct levels to kill germs, particularly the coronavirus. If you can’t find hand sanitizer, don’t worry. Soap and water are proving to be your best defense at eradicating the virus.
To see the numbers in your state in the US, here is a constantly updated spreadsheet of number of people who have the virus, number of people who are negative for the virus, number that is pending for the virus, and number of people who have died. Covid Tracking Project
The CDC in America is also beginning to release numbers of people tested. You can track those numbers on the Testing in the US page here.
According to Helen Chu, an infectious-disease professor at the University of Washington, “People with asthma are not more likely to catch COVID-19, but they are more likely to fare poorly if they do. Asthma and similar health conditions cause the lungs to have trouble exchanging air, a situation that viruses such as the flu and the coronavirus exacerbate by filling the lungs with inflammatory cells.” (21)
What should people with asthma and other chronic lung illnesses do? Consider working from home. Social distance yourself as much as possible. If you have children who are still in school, consider bringing them home for the next 2 weeks. Though children are not as affected by this virus, they can be carriers to those who could be really sick.
The WHO Director-General stated on March 12, 2020 that this is a controllable pandemic. You should not give up with the knowledge that it has reached most countries. Now is the time to double down, dig in, and show off the fighting spirit we have.
Dr John Nicholls, a pathology professor at the University of Hong Kong, says there are three things coronavirus does not like: Sunlight, temperature and humidity.
“Sunlight will cut the virus’s ability to grow in half, so the half-life will be 2.5 minutes, and in the dark it’s about 13 to 20 [minutes]. Sunlight is really good at killing viruses,” Nicholls said. (22) This does not mean that infected persons can spend 10 minutes in the sun and be safe. Rather, it proves that the disease is not unbeatable. We only have to continue to find the cure.
The most important thing to still do is wash your hands, social distance whenever you can, and remain vigilant.
I know it’s scary. Be patient with each other. We will get through this (at a nice safe distance of 6 feet apart). If you are worried, anxious, or scared, those feelings are valid and it is okay for you to feel those things. For support, you can text the National Association of Mental Illness (NAMI) at 741741 anytime.
Original Text as follows
The coronavirus, or COVID-19, targets anyone and everyone. For approximately 80% of people who are infected, there seem to be minimal complications of their health, and experience a sickness like a bad flu. For the remaining 20%, more serious complications can arise. While the media hopes to send comfort to most people, it does little more to address the 20% of people who can be more severely affected.
As a member of that 20% as I live with severe asthma, I find the media’s sense of erasure towards this group both callus and appalling. Therefore, I decided to write this article, research for myself, and share with my fellow asthmatics and chronic lung disease people.
This article will focus on the history of the disease, what current studies are showing in the relation between chronic lung illnesses and the coronavirus, what preventative measures are practical and necessary to take, and how to help others moving forward.
In researching this article, I had the opportunity to speak with Dr. Juanita Mora from the Chicago Allergy Center and who is the national spokesperson for the American Lung Association, who also shared what are steps people with asthma should be taking now.
The point of this article is to make you more aware of what is going on. It isn’t to cause more fear, but to belay fears. I always feel better when I know everything that I can know and prep every way that I can prep.
Final Disclaimer: I am not a medical professional. Please consult your doctor and the World Health Organization for the most up to date information and about what you can do.
Asthma and COVID-19 Summary
There is not much known at this time of the risk for asthmatics specifically as it relates to the coronavirus. The virus causes asthma in other people, so asthmatics are likely to have similar symptoms. Proper hygiene is the most important thing you can do to prevent being sick as the virus is broken down by soap and water. Self-quarantine is important if you do feel you are ill. Make sure your medicines are up to date and that your asthma is well controlled. Take vitamins, eat healthy, exercise (when possible), and ensure that your stress levels are low to maintain a high immune response system. Make sure your home has a week’s supply of food, water, and medicine in the event of illness. Finally, if you suspect that you have contracted the disease, contact your Primary Care Physician for instructions on what to do next.
Want to prep more? Read my 7 Allergy Friendly Pantry Recipes for meals you can make out of what you got.
What is COVID-19?
COVID-19 is the medical term for the disease. CO for Corona, VI for virus, D for disease, and 19 for the year it was discovered, 2019. The virus itself has a sticky outside layer that resembles a crown, which is where it gets its name as the Latin word for crown is “corona”. So no, it isn’t named after a beer.
COVID-19 has symptoms of fever, dry cough, dyspnea (difficulty breathing), fatigue, and lymphopenia (low white blood cell count), with fever being the most common symptom. Some patients also experience gastrointestinal upset. In the most severe cases it can lead to viral pneumonia and/or severe acute respiratory syndrome (SARS), or death. As the virus progresses towards severe, some of the symptoms include a breathing rate of ≥ 30/min, a pulse oximeter oxygen saturation level of ≤ 93% or less at rest, and an oxygenation index of ≤ 300 mm Hg. (1). Statistically, older patients experience more severe cases. (1)
The virus is spread through the water droplets of infected individuals, think things like sneezes, coughs, spit, etc. (2)
The exact incubation period for Covid-19 is still unknown, but scientists estimate between one and 14 days and the outer numbers at 24 days. Most people begin showing symptoms about five days after becoming infected. (2)
Asthma and COVID-19
At this time, there is the one study on COVID-19 from which we can draw scientific information about the affects of the virus on people with asthma. In that study of 140 patients, asthma did not seem to be a risk factor for the virus.
The disease is a respiratory illness and the usual precautions need to be taken for those with asthma and other chronic lung illnesses.
Dr. Juanita Mora of the American Lung Association recommends that as it is a respiratory virus, people with underlying lung disease or asthma might be at greater risk for contracting the coronavirus as well as other respiratory viruses like the flu. (3)
Symptoms of COVID-19
- Fever > 37.5C/99.5F
- Coughing, can be a tickle in the throat or a deep, dry cough
- Shortness of Breath
- Gastrointestinal upset
New reports coming out of China show that the gastrointestinal upset occur days before the respiratory distress. Things like nausea, vomiting, diarrhea, and abdominal discomfort are all early signs of possible infection. Doctors are now using these to distinguish between the flu (an upper respiratory infection and not the stomach flu) and the novel coronavirus. (23)
Additionally, stool samples are testing positive for the SARV-CoV-2. It is important to note that 23% tested positive in a stool sample and negative in a respiratory sample. Endoscopy is showing extensive damage in the GI system. If you are suspicious of having this virus, it is even more important to wash your hands with this new information.
Symptoms of COVID-19 in Asthmatics
Would the symptoms of this virus be more severe in someone with asthma? Again, Dr. Mora says that little is known at this time. The virus is related to other coronaviruses that normally circulate and cause flu and cold symptoms. She goes on to say, “These viruses have been shown to cause asthma episodes or attacks. So, whether COVID-19 can cause asthma episodes or attacks remains to be seen.” (3)
Beyond that, the symptoms will be the same as in those who do not have asthma. Perhaps at a more extreme level more quickly, but again, as this virus is so new, more information is required.
Steroid Use and COVID-19
Will the use of steroids in daily maintenance of asthma be a factor in weakening the immune system and increasing the risk of contracting the virus?
The most important thing is to keep your asthma well controlled. If you use inhaled corticosteroids, there is probably not a risk to having a more weakened immune system. If you use oral corticosteroids, there is a slight increase of a suppressed immune system. (4)
Asthma is a condition with inflamed airways. The more inflammation, the more likely you are to experience asthma attacks. These inflamed cells are caused by immune cells (mainly T-cells and B-cells) that release a chemical known as leukotrienes.
Steroids work by suppressing these inflamed T-cells, reducing the total amount of mucus in the lungs, allowing for less inflammation of the lung tissue, and thereby reducing asthma attacks. (5)
Inhaled steroids are likely to have less of an impact on the immune system overall as they are going directly to the lungs. By rinsing your mouth out well after each use, the chance of the steroids entering your blood system are greatly reduced. Therefore, doctors recommend you rinse your mouth out every time. (15)
Oral steroids work in the same manner of reducing inflamed cells in the body. However, as they are taken orally, they enter the blood stream and work on cells throughout the body, not just in the lungs. (15) However, if they are taken only periodically, say during an infection and for a duration of 7-10 days, long term suppression of the immune system is not likely to occur. (16)
If you use steroids to control your asthma, do not stop taking your medications.
Rescue Inhaler Use and the Immune System
Does the use of a rescue inhaler, such as Albuterol or Ventolin, cause the immune system to become decreased?
No. These medications are bronchodilators, not steroids. You can and should continue to use your rescue inhaler as prescribed by your doctor. (17)
Again, the most important thing is to have your asthma well controlled so that if infection does occur, your lungs are in a better position to ward off the virus. Do not stop any asthma medications at this time in the hopes of having a greater immunity to prevent the virus. Having well controlled asthma is the more important of the two and there are other things to do to improve immunity (addressed further in this article).
You might want to minimize your exposure to public places as much as possible whether or not the outbreak is in your area, so as to decrease your chances of getting the virus.
Age and COVID-19
WHO has shown that people over the age of 60 are one of the more high risk populations for contracting severe COVID-19. (2)
Concerning fatality rate and age, there are two studies to draw from in which to gather information. These articles are the Report of the WHO-China Joint Mission and the paper by the Chinese Center for Disease Control and Prevention (CCDC). (12)
The death rate means that the probability of dying if infected by the virus. They do not represent share of deaths by age group. This table represents for a person in a given age group, the risk of dying if infected with COVID-19.
|AGE||DEATH RATE confirmed cases||DEATH RATE all cases|
|80 + years old||21.9%||14.8%|
|0-9||No fatalities||No fatalities|
However, this data does not break down the percentages of deaths in the given age groups that had pre-existing conditions.
Distribution of Cases by Age Group in Italy and South Korea
This table released over the weekend (3/14/2020) shows that there are varying numbers in age groups regarding who contracts the virus and who does not. Italy they are only testing people with symptoms and South Korea has much broader testing. This shows that many many people can be carrying the virus and show no symptoms, further proof of how important social distancing is at a time like this.
Pre-existing Conditions and COVID-19
The fatality rate by comorbidity provides us with a look into the probability of dying if infected with the virus broken down by the differing pre-existing conditions. The percentages shown below do not represent in any way the share of deaths by pre-existing condition, rather, it represents for a patient with a given pre-existing condition the risk of dying if infected by COVID-19.
|PRE-EXISTING CONDITION||DEATH RATE confirmed cases||DEATH RATE all cases|
|Chronic respiratory disease||8.0%||6.3%|
|No pre-existing conditions||0.9%|
Again, the data does not give us a break down of the death rate of age and pre-existing conditions.
Nor does the data reveal what the chronic respiratory diseases are, as there are several that afflict people. The aforementioned study by the Chinese CCDC did not find a correlation between asthma and mortality rates with COVID-19, however, it is still too early in the study of this disease to state whether the risk factor for well controlled asthma mitigates such risk of death.
Gender and COVID-19
Finally, it is important to note the differences in death rates between men and women. The information here comes primarily from the Chinese CCDC study. The death rate indicated the probability of dying if infected by the virus. When reading these numbers it is important to note that smoking is much more prevalent among males in China. Therefore, smoking can also be a risk factor to be included in the mortality rate of the COVID-19, however, there is no further information that I can discern at this time.
|SEX||DEATH RATE confirmed cases||DEATH RATE all cases|
Prevention of COVID-19 in Asthmatics and Chronic Lung Conditions
The prevention of COVID-19 seems to be our best offense.
The most important thing a person can do is to have proper hygiene. Perform hand hygiene frequently, especially before touching your mouth, nose, or eyes. Always wash your hands before eating, after touching handrails, doorknobs, or when coming home after being in public spaces.
Also, remember to wash your phone. Phones carry germs easily and they are always beside us. A quick wipe with sanitizing wipes a few times a day will make a huge difference.
New Data from Italy on Mortality Rates
New information is coming out of Italy on their first 803 deaths. Two of those people were younger than 60. Zero were younger than 30. The virus is proving more deadly for men than women. For people in their late 80s, the fatality rate is 16.6%. (24)
Why Soap Really Is A Best Defense
COVID-19, and indeed most viruses, are a nanoparticle in which the weakest part of the particle is the outer layer of lipid fatty acids. The soap dissolves the fat membrane and the virus essentially falls apart and “dies”. Disinfectants containing alcohol also have a similar effect but are not quite as good as plain old soap and water. The antibacterial agents in products don’t really affect the structure of the virus as much as soap.
If you are suspicious of having contracted the virus, or any illness, it is important that you take the steps necessary to protect yourself and others. Self-quarantine in your home for two weeks until you are recovered. It is important to not place undue stress on medical facilities in your area.
However, if more severe symptoms do arise, or any difficulty breathing occurs, you need to get in contact with your PCP immediately.
One of the more effective ways to minimize your risk while in public is to practice social distancing. Do not engage in typical cultural greetings, such as kissing, hugging, hand shaking, etc. Maintain a distance of 3 feet / 1 meter around yourself at all times. If someone is coughing or sneezing, maintain a distance of up to 6 ft / 2 meters.
Try to minimize outings. The less you leave your home, the less risk you have of contracting the virus.
When you should begin to remain in your home is a personal choice. If you must go to work, it is important that you continue to do so. If you must go to school, it is important that you continue to do so. Monitor the rates of COVID-19 in your local area to determine when you will feel more comfortable working from home.
Ask for your workplace or school to implement the following as advised by WHO (14)
- Maintain a clean environment.
- Promote regular handwashing by employees, contractors, and customers.
- If any employee, contractor, or customer displays symptoms such as a mild cough or low-grade fever, ask for them to stay at home and work from home.
- Maintain a list of all attendees of events and meetings for at least a month to make it easier for health authorities to trace people who may have become ill after the event.
If it makes you feel more comfortable to have someone else go to the grocery store, bank, etc, who does not have asthma or other chronic lung illnesses, then you need to do what makes you most comfortable.
Finally, pay attention to what your local government is telling you. If there have been restrictions on travel and movement, please follow them.
There are things that you can do to improve your immune system so that if you contract the disease, you are better prepared.
Vitamins and Immune Systems
Creating a healthier immune system requires a whole-body response as the immune system is a whole body system. Harvard Medical School (9) recommends you begin with the following:
- Don’t smoke.
- Eat a diet high in fruits and vegetables.
- Exercise regularly.
- Maintain a healthy weight.
- If you drink alcohol, drink only in moderation.
- Get adequate sleep.
- Try to minimize stress.
Some studies have suggested that a healthy immune system starts in the gut and with your micronutrients. Micronutrients are the vitamins and minerals that are obtained through a varied diet. More specifically, there are some studies that have shown a micronutrient deficiency – specifically of zinc, selenium, iron, copper, folic acid, and vitamins A, B6, C, and E – alter immune responses.
If you suspect you are lacking in some micronutrients, take a daily multivitamin. Taking megadoses of a single vitamin will not protect you. It is the daily use of normal doses that prevents a deficiency.
Foods and Immune Systems
Your gastrointestinal tract houses up to 70% of your immune cells. It is important to improve your gut health to improve the immune system. University of California at Irvine gives this list of things you can do to optimize gut health (10):
- Take a daily probiotic
- Avoid processed foods
- Talk with your doctor about hidden food allergies and food intolerances.
- Eat a balanced diet of whole, unprocessed foods that contain antioxidants.
- Make sure to eat four to five servings of greens (lettuces, mustard and collard greens, and kale) daily.
- Eat garlic daily. When garlic is crushed it releases allicin, a compound that fights infection causing microbes.
Stress and Immune Systems
Stress is one of the most important factors of the immune system. The more stressed a person is, the less responsive their immune system. Reducing stress is one of the most important things you can do to improve your immunity. Prayer and/or daily meditation are simple changes you can make to start reducing your stress levels.
Elderberry and the Immune System
According to the Cleveland Clinic (11), people who drink tea and syrups made from the elderberry plant have a decreased risk of upper respiratory infections and a boosted immune system. They are believed to work by supplying the body with antioxidants and boosting the natural immune response.
In a randomized study, adults who took 15mL of elderberry syrup four times a day saw symptoms clear up on average four days earlier than those who took a placebo syrup.
Preventing Secondary Infections
As important as it is to improve the immune system, there is no reason to forgo taking your annual flu shot.
In the 1918 Influenza outbreak, it was not the flu that caused such a massive loss of human life, but rather, the rise of secondary infections. (13)
If you have not gotten the flu shot, do it now.
If you are a candidate for the pneumonia vaccine, get one today.
While these will not prevent you from getting COVID-19, it will prevent you from getting a secondary infection that will cause further complications.
What to Do If You Have Symptoms
Dr. Mora explains what to do if you have symptoms and are suspicious of having contracted COVID-19:
“If a patient develops fever and cough – they should treat their Asthma as normal. If symptoms become more severe – they should contact their Primary Care Physician (PCP) especially if they have had possible contact with someone with coronavirus.” (3)
The US Center for Disease Control (CDC), where I reside, has put together this list of instructions for what to do when you suspect you have COVID-19. You should check with your local government office for specific instructions on what to do in your area. (18)
First, you should isolate yourself in your home. Limit contact with those in your home, both people and animals. Not much is known about this virus and it is better to be safe and take extra precautions as we learn more about the virus.
Call your PCP or other health care provider and tell them that you suspect you have COVID-19 and ask what their recommendations are for you.
Cover your mouth when coughing and sneezing. Use hand sanitizer and wash your hands frequently. Do not use items in the house that other household members might use, such as the phone or remote control for the TV, without properly sanitizing before and after each use.
Clean all “high touch” items in the house every day. These items include door handles, counters, tabletops, bathroom fixtures, toilets, phones, computers, keyboards, tablets, and bedside tables. Wash the sheets of the bed frequently.
Finally, monitor your symptoms. Check your fever every few hours and keep a log of your temperatures. Seek medical attention if your conditions are worsening, especially if you have asthma or another chronic lung condition.
Caring for Others Who are Sick
If you are caring for others who are sick, the CDC again recommends that you wash your hands and/or sanitize them both before and after interaction with the sick person. Both you and the sick person should wear a face mask. This is to minimize the chances of you catching the virus, and more importantly, for the sick person to not spread the virus via water droplets from coughing, sneezing, or even talking.
The Asthma Sick Kit
There are several things that an asthmatic should put together not just in this time of the coronavirus, but any flu season. This list should not be copied directly by everyone, as everyone has different direct medical needs, and should serve as a guide for the kit that you should put together for you and your family.
- Gatorade / Vitamin Water / Pedialyte x 10 bottles
- Canned Soup and broth x 20 servings
- Popsicles, Noodles, Frozen loaf of bread for when you start to feel a bit better
- Asthma Medicines: inhaler, nebulizer treatments, asthma support medicines (such as Advair or Qvar)
- OTC ibuprofen, Benadryl, Robitussin, etc.
- Elderberry Syrup/Tea
- A Thermometer
- Cough drops
- Toilet Paper
- Sanitizing Wipes
- Sanitizing Spray
To Travel or Not
The topic of traveling is controversial. If you are a person with asthma or other chronic lung disease, I would personally not travel to a high-risk area at this time. If you must travel for work, make sure you take all the precautions discussed in this article.
If you are traveling, it is also important to keep in mind that places might not be open. Businesses have been closing to contain the virus and keep community spread down to as minimal as possible.
You can check the WHO travel guide for the most up to the date information. (5)
What Asthmatics Should Do to Prevent COVID-19
Again, the point of this article was to keep us informed and to not cause panic. Panic causes stress and depletes the immune system, nothing anyone needs right now, and especially those of us with chronic lung illnesses.
To minimize your risk of catching the COVID-19 virus, try to do the things outlined in this article. Wash your hands and use proper hygiene when out in public and especially when you are returning home. Sanitize the outside of shoes, food containers, and door handles. Make sure that your asthma medication is fully stocked and that you are taking your asthma medication as prescribed. If you feel sick, don’t go out in public. If you feel stress and mental duress from this, reach out to a friend or family member to try and keep your stress levels down and your immune system up. Take your vitamins. Travel only if required. Make sure that you have a small kit prepared to stay home for one to two weeks if you do come down with any illness. And finally, contact your primary care physician if you feel you are ill.
Dr. Mora gave a list of the four most important things anyone with asthma should do in this time.
1. Wash your hands with soap and water often.
2. Avoid people who are coughing/sneezing and have cold like symptoms.
3. Make sure you take your medicine and that your asthma is under great control.
4. Get the seasonal influenza vaccine, if you have not.
If you are not at high risk of complications with COVID-19, please reach out to your friends, family, and neighbors who are. See if they need anything and help them to prepare in a way that makes sense for you. There is no need to doomsday prep and every time you do, you are taking away more items for those who are at high risk.
Even if the things they need help with right now seem “over the top”, please realize that people are scared and if things help them feel less vulnerable, that will further help any immune response they might need to make later!
Long story short, take care of each other.
3 Interview with Dr. Mora conducted March 6, 2020
4 https://community.aafa.org/blog/coronavirus-2019-ncov-flu-what-people-with-asthma-need-to-know 5 https://www.webmd.com/asthma/guide/asthma-control-with-anti-inflammatory-drugs#1
Please share this article.
Now is the time to get this information out to the public so we stand the greatest chance of keeping safe and minimizing impacts of this disease. Please share this article with your friends, family, coworkers, and those who have asthma. Thank you.