This article was updated to include information about home testing kits on April 27, 2020.
The symptoms section of this article was updated on May 19, 2020.
Lupus is a chronic autoimmune condition in which the immune system attacks its own tissues. People with lupus are at higher risk of infections, and those with lupus who develop COVID-19 may be at higher risk of developing severe symptoms.
Some treatments for lupus may also increase the risk of infections or severe complications from infections. Prevention is one of the most important tools against COVID-19, and there are some extra steps to consider for people with compromised immune systems.
It is important for people with lupus to work closely with their doctors to find workable treatments for their symptoms in each case.
Keep reading to learn more about how COVID-19 may affect a person with lupus, including what the research says so far, the risks, and some important considerations to help keep them safe.
The FDA have removed the Emergency Use Authorization (EUA) for hydroxychloroquine and chloroquine for the treatment of COVID-19. Based on a review of the latest research, the FDA determined that these drugs are not likely to be an effective treatment for COVID-19 and that the risks of using them for this purpose might outweigh any benefits.
The symptoms of lupus itself can vary widely in each case, from mild to severe or even life threatening. Because of this, the treatments necessary to control the symptoms will also vary widely.
Systemic lupus erythematosus (SLE) is the most common form of lupus. Other types include discoid, drug-induced, and neonatal lupus.
Just as the symptoms of lupus vary, an individual’s reaction to COVID-19 will also vary. SARS-CoV-2 is the respiratory virus that causes COVID-19.
According to the Centers for Disease Control and Prevention (CDC), the symptoms of COVID-19 may appear 2–14 days after exposure to the virus. Symptoms can include:
- a fever
- a dry cough
- shortness of breath
- a sore throat
- a headache
- muscle pain
- new loss of taste or smell
The World Health Organization (WHO) state that other symptoms can include:
- general fatigue
- gastrointestinal symptoms
The infection may have a longer incubation period in some cases. During this time, the person may not notice any symptoms at all. A person can also pass the virus on before any symptoms develop.
Some symptoms of COVID-19 may mimic those of SLE. For instance, fatigue is a common symptom of both COVID-19 and lupus. Also, in people with SLE who struggle with fatigue, a SARS-CoV-2 infection may make fatigue worse.
People with SLE are more at risk of infections and serious complications from these infections. This includes SARS-CoV-2.
Some people with SLE may take immunosuppressant drugs to manage their symptoms. These drugs themselves can also increase a person’s risk of infections.
A person with lupus who also has other risk factors — such as being over 65, living in a long-term care facility, or having another medical condition associated with lupus — may be at a greater risk of severe illness.
People with a greater risk of severe illness may be more likely to experience complications or severe symptoms from a SARS-CoV-2 infection.
It is important for people with SLE to pay attention to the signs and symptoms of COVID-19 so that their doctors can respond quickly.
Some symptoms, such as fatigue, may be difficult to notice. It is therefore important to keep an eye out for other common symptoms of infection, such as a fever, difficulty breathing, or a dry cough.
It is especially important for people with compromised immune systems to keep an eye out for more severe symptoms of COVID-19, such as difficulty breathing, a constant feeling of pressure in the chest, or a change to the color of their face or lips. These symptoms require urgent medical care.
On April 21, the Food and Drug Administration (FDA) approved the use of the first COVID-19 home testing kit. Using the cotton swab provided, people will be able to collect a nasal sample and mail it to a designated laboratory for testing.
The emergency use authorization specifies that the test kit is authorized for use by people who healthcare professionals have identified as having suspected COVID-19.
People with SLE should pay close attention to their triggers at this time and take measures to avoid them.
Individual triggers will vary in each case but may include stress, exposure to sunlight, and some foods or medications. If a person knows their triggers, it can help them prevent flare-ups and keep lupus in remission.
People with SLE should also be certain that they have a supply of any medications they need to take. Having a 90-day supply of any medication they need should ensure that the person has access to treatment, even if they need to go into self-isolation or quarantine.
Anyone who thinks they may have COVID-19 or may have had exposure to SARS-CoV-2 should take steps to help prevent the spread.
A period of self-isolation can help reduce the spread of the illness by reducing the points of contact the virus has. People who experience any form of sickness, including symptoms of common respiratory conditions, should stay home.
There are also a number of other important prevention tips to keep in mind, including:
- getting plenty of rest and staying hydrated
- washing hands regularly with warm water and soap, and lathering for at least 20 seconds
- using an alcohol-based hand sanitizer with at least 60% alcohol when soap and water are not available
- cleaning and disinfecting all household areas that see regular use
- avoiding public transportation
- avoiding public spaces
- staying at least 6 feet (2 meters) away from other people
Additionally, the CDC now recommend that people use cloth face coverings when in public as an additional step in preventing the transmission of SARS-CoV-2.
There is currently no cure for COVID-19. Symptom management suggestions include:
- taking acetaminophen for pain and fever
- drinking plenty of fluids and eating small but frequent nutritious meals
- getting adequate rest and engaging only in activities that do not cause overtiredness
It is important to keep SLE under control by taking any medications a doctor prescribes and avoiding all known triggers.
Lupus medication for treating COVID-19
As one recent study notes, early reports suggest that chloroquine and hydroxychloroquine, which are common treatments for SLE, could have the potential to treat COVID-19.
Research groups are currently investigating these drugs, and more studies are necessary to confirm the results before making any firm claims.
That said, two doctors note that the use of these treatments may impact people with SLE who already use these drugs for treatment, as there may be shortages.
The Lupus Foundation of America have urged manufacturers to increase the supply of these drugs so that people with lupus will continue to have access to them.
A separate study in The Lancet Rheumatology notes that although the Food and Drug Administration (FDA) have approved the drug for off-label use in some cases of COVID-19, the excitement may be premature.
People with lupus who rely on these drugs to treat their symptoms should talk to their doctor or pharmacist about how to ensure that they have access to this medication.
A person with lupus who tests positive for COVID-19 should work closely with their doctor throughout the course of the illness.
They may schedule an appointment via phone or video call to discuss the treatment options. In some cases, the person may need to go to the doctor’s office.
A person should not stop taking any lupus medications unless a doctor advises it. Suddenly stopping a medication may lead to a flare-up of symptoms, which puts additional stress on the body.
Continue to practice prevention measures as much as possible, only leaving the house to seek medical care.
Any time a person who has tested positive for COVID-19 leaves the house, they should wear a protective face mask.
A report from the WHO notes that around 80% of confirmed COVID-19 cases cause mild-to-moderate symptoms. These mild cases may respond well to rest, spending time in the home, and other forms of symptom management.
That said, people with autoimmune conditions such as lupus are at greater risk of infections and serious complications from them.
In more severe cases, a person may require hospitalization. In critical cases, a person may experience life threatening complications, such as respiratory failure or organ failure.
Lupus is an autoimmune condition in which the immune system attacks its own cells. People with compromised immune systems may have a greater risk of infections or serious complications from them. This includes SARS-CoV-2 infections.
People with lupus should be strict with their preventive measures against COVID-19 and may want to take additional steps to stay safe.
Currently, there has been little direct research into lupus and COVID-19. People with lupus should continue taking their medications as usual. Suddenly stopping a medication may lead to an increase in symptoms.
Anyone experiencing severe symptoms of COVID-19 — such as pain or pressure in the chest, difficulty breathing, or a bluish hue in the face or lips — needs emergency medical attention.