Vitiligo and coronavirus

Last Updated on 14th March 2020 by Caroline Haye

COVID-19: an autoimmune risk?

Before I start this topic, I want to make it clear that there is no link between vitiligo and coronavirus (COVID-19). So don’t be too alarmed by the title. There is more than enough speculation and misinformation out there about the current pandemic, without my accidentally adding to it.

Of course, there is a lot of genuinely helpful information doing the rounds too. So I hope that this post will make a small, but welcome, contribution to that. In particular, I hope it will help shed a bit more light on a question that many of us have been wondering about recently… Does having vitiligo, or any other autoimmune condition, increase the health risks posed by this virus?

March is Autoimmune Disease Awareness Month

Since March is designated Autoimmune Disease Awareness Month (ADAM), and COVID-19 is such a hot topic right now, this seems like the right time to consider the implications (if there are any) for autoimmune disease sufferers.

As I am always careful to stress, I have no medical or scientific training. So I can’t offer any cast iron answers myself. But I have been looking through all the credible sources I can find for information that might provide some clarity. And I have come across some interesting facts.

What strikes me is how hard it is to find agreement among medical professionals as to how viruses affect people with autoimmune diseases. Added to which, the limited amount of information I have found is confusing and contradictory in places. So my task in this post is to make some sense of the available information… And, hopefully, draw some common sense conclusions.

COVID-19 and autoimmune disorders: why worry?

Well, there may in fact be no particular need for you to worry at all. But thinking about a few key questions might help you find out one way or the other.

What prompts some people with autoimmune conditions (not just vitiligo, of course) to wonder about our susceptibility to the coronavirus outbreak is this… We have all heard that people with pre-existing conditions and poor immunity are at higher risk. And we also know that, because of our condition, our immune system does not behave normally. (Instead of just protecting us from viruses, bacteria and other harmful infections, it also attacks some of our healthy cells… Which is what causes the symptoms of our particular autoimmune disorder.) So, I think it is only wise to ask what the implications of this might be for us at this worrying time.

Speaking for myself and getting feedback from others online, it turns out that many of us have been pondering these exact same questions…

Am I more likely to catch coronavirus?

The short answer to this question is that no one knows. For one thing, the answer probably depends on which autoimmune disorder you have. And, secondly, one individual may react quite differently from the next, even if they suffer from the same condition.

There is one way each of us might predict how well our immune system will protect us from COVID-19. And that is to consider how we have reacted to other viruses in the past, like flu, for example. However, scientists are observing some significant differences between coronavirus and other flu-like infections.

I once asked my doctor whether having an autoimmune condition like vitiligo meant my immune system was over-active. I wondered if it would therefore be better at protecting me from infections. Or was my immune system not stronger, but simply dysfunctional, in which case I had less protection? But all she could tell me was that there was no real consensus of medical opinion on the subject… A fact borne out by my recent internet searches.

Not having any clear medical guidance either way has led to some conflicting views in various online forums, with some people claiming to have a stronger immune system than the norm, and others the opposite. So some people with autoimmune conditions believe they are less likely to catch the virus while others think the opposite.

In reality, having an over-active immune system can be just as hazardous as having a weakened one, as I will explain later on.

Will my symptoms be worse than other people’s?

The World Health Organization has confirmed that, despite similarities, coronavirus behaves differently from seasonal influenza. In particular, the incubation time is longer, meaning it spreads more slowly… But the ratio of deaths is higher.

The symptoms of COVID-19 are evidently similar to a cold or influenza. So, in the vast majority of cases, these simply pass and you make a full recovery. And, just like colds and flu, some people will report more severe symptoms than others. I’m sure that individual perception and differing tolerance levels for pain and discomfort play a part in this. But there are also important physiological reasons why symptoms may be worse in some cases than others… And why the death rate is higher.

Experts don’t yet know all the reasons why the severity of symptoms in coronavirus varies from one person to the next (as this article in The Scientist explains). But what they do know is that the reduced immunity in old age, and underlying respiratory conditions, pose the greatest risk.

Am I more likely to die from COVID-19?

According to most authorities, mortality is mainly confined to elderly people with weakened immune systems or people with serious underlying health issues that involve the respiratory system. So autoimmune lung disease would likely put you at higher risk and would probably require special medical care. Lupus is another autoimmune condition that can affect the lungs. In fact, any systemic autoimmune condition (one that causes inflammation throughout the body) may affect the respiratory system.

If you are reading this specifically because you have vitiligo, you will be asking the same question at this point as I did… Is vitiligo a systemic autoimmune disease? And, if so, will it make my respiratory system more vulnerable to coronovirus? Again, there is no clear answer to this. On the one hand, most doctors think of vitiligo as a disorder that is localised to the skin. But, on the other, scientists know it can be a sign of other systemic autoimmune diseases. They also know that vitiligo targets the melanocytes in other parts of our body, not just in our skin. And they know that we have melanocytes in our heart and lungs.

Of course, this is not to say that you are more likely to develop serious complications from coronavirus if you have vitiligo. But perhaps it brings us slightly closer to an educated guess. And that guess would be “possibly, to some degree, depending on the medical history of the individual. But, in the majority of cases, probably not”. Not overly helpful, I know. But it does, at least, confirm that the question is one worth taking seriously.

Why is a strong immune system as dangerous as a weak one?

The way the immune system launches its attack on infections is via a process of chemical signalling. And this involves a set of molecules called cytokynes. In an otherwise healthy person the cytokyne activity is appropriate to the risk posed by an invading illness. But if the immune response is too strong it can turn into something known as a cytokine storm. And it is this overproduction of cytokines and immune cells, which can be deadly.

Knowing that the cytokine signalling in autoimmune diseases goes a bit haywire might have you jumping to the conclusion that you are at increased risk of a cytokine storm. But, as I have already said, nothing I have read suggests that having an autoimmune disease necessarily means you have an over-active immune system… Just one that doesn’t know the difference between some of your own healthy cells and infectious invaders.

Interestingly, several of the drugs currently being tested for effectiveness with COVID-19 are immunosuppressants (like chloroquine). So, if you are already taking medication to suppress your autoimmune response, you may actually be at an advantage. Then again, it might mean you are more likely to catch the virus in the first place. So you should probably ask your doctor whether or not you should continue to taking it at the present time. This will ensure you get the best medical advice for your particular case. 

My conclusions

So where does all this leave us? On the main question of vitiligo and coronavirus, should we be worried? I have no definitive answer. And neither do the experts. Even the wider question of COVID-19 risk in relation to autoimmune disease remains unclear.

For what it’s worth though, my investigations have brought me a greater understanding of the subject than I had before I started. And I have come to several conclusions in my own mind, which I list below. They are only my personal opinion, based on everything I have read. So, make of them what you will. I hope they help you form your own opinions.

• Anyone whose general health is less than robust needs to be aware that they may be at greater risk and be prepared for more severe symptoms
• Having a weak immune system increases your risk of infection and complications
• An over-active immune system also increases your risk of complications
• Underlying respiratory conditions (including heart, lungs, etc.) increase risk
• Autoimmune diseases that affect the whole body, including the respiratory system add to your risk
• Autoimmune conditions, like vitiligo, may increase your risk to some extent but probably only if they are a sign of other systemic autoimmune disease
• If you currently take immune-altering medication for your autoimmune disease you may need specific advice from your doctor on whether or not to continue.

Stay well, but stay prepared!