COVID-19 and Hemochromatosis

The World Health Organization has officially declared COVID-19 to be a pandemic. Here at Hemochromatosis Help, we wanted to pass along resources we have found valuable and to share our perspective on coronavirus with a particular emphasis on how it may or may not impact people with iron overload.

I’m writing this article on March 15th, 2020, and at this very early stage in the game, there seem to be more questions than answers about the virus itself, much less its particular impact if you suffer from hemochromatosis. We will do our best to highlight certain areas of interest regarding how high iron impacts the immune system, even though we are unaware of any definitive information specific to hemochromatosis to date.

Should people with hemochromatosis have additional concerns with COVID-19?

Certain groups of individuals are more at-risk for coronavirus, namely older people and/or people with pre-existing medical conditions such as high blood pressure, heart disease, lung disease, cancer, and diabetes.

As of the timing of writing this article, I do not see hemochromatosis listed as a specific risk factor for COVID-19. I would not suspect that we will see an agency like the FDA or World Health Organization list iron overload as a specific risk factor for coronavirus. The number of people with hemochromatosis is small relative to the number of people with lung disease, cardiovascular disease, diabetes, etc. However, if our understanding changes in the future, we will be sure to make any new information known.

So what are the topics with the strongest relationship to hemochromatosis? What concerns should a person with iron overload have with respect to coronavirus?

Immune Function and Age

In general, an iron rich environment may make one more susceptible to coming down with a virus or bacteria. There is no data at this point to know if having hemochromatosis makes a person more susceptible to COVID-19 in particular, however focusing on continuing to take care of both your iron levels and your immune health is more important now than ever.

Sometimes in times of concern, we forget to focus on how to best support our health. During this time period, continue to do your best to keep your iron levels down to reduce the chance for this (or any) virus from being able to thrive in a high-iron environment.

The average age of diagnosis of hemochromatosis is 47 for men and 49 for women. Due to the slow progression iron levels may build up in a person and the fact that a person may go years before receiving a diagnosis of hemochromatosis, many people only find out they have iron overload once they are in their 50s, 60s, or even 70s.

One aspect we do know about COVID-19, is a clear link between age and susceptibility to the disease. Since a large percentage of people with hemochromatosis are in the higher age risk category, it is sensible to take extra precautions if you are older and have high iron.

Phlebotomy

With regards to phlebotomy, we may be facing a balancing act between social distancing and supporting our own health. Phlebotomy is our most powerful tool for reducing iron overload, yet many areas are encouraging a reduction in travel outside your home.

Even prior to COVID-19, individuals are not allowed to undergo phlebotomy or blood donation if they are not feeling healthy and well or if they have a temperature. This is now especially important. And if you are self-isolating with concern that you may have been exposed to coronavirus, the socially responsible decision is to stay home.

According to a new article from the Haemochromatosis Society of the UK (note below: venesection = phlebotomy):

There may be various reasons why you are unable to attend a venesection. These could include your own ill-health with coronavirus, self-isolation resulting from a close relative’s infection or specific UK government or NHS advice.

If you have coronavirus or are self-isolating, venesection is not a priority. Delaying a venesection by a few weeks or months will generally not have any lasting implications for your health. The priority will be to recover from the coronavirus and/or prevent infecting others.

As of March 15th, I have yet to find any specific information from experts or authorities from the US, Canada, Europe, or Australia… so the guidance from the UK is the only info I have seen to date. Essentially, their thinking is that hemochromatosis is a chronic condition, whereas coronavirus is a current and acute condition. As a result, for the time being, our immune system health may need to be prioritized over our iron levels.

We always suggest a person to follow their physician’s advice, so if in doubt, ask your doctor about the pros and cons of phlebotomy.

If you are healthy and able to undergo phlebotomy, the process itself is absolutely safe for you.

On March 11th, 2020 the FDA published an article regarding blood donation. The article states:

The potential for transmission of SARS-CoV-2 by blood and blood components is unknown at this time. However, respiratory viruses, in general, are not known to be transmitted by blood transfusion, and there have been no reported cases of transfusion-transmitted coronavirus.

Routine blood donor screening measures that are already in place should prevent individuals with clinical respiratory infections from donating blood. For example, blood donors must be in good health and have a normal temperature on the day of donation.

As communities are affected, it is imperative that healthy individuals continue to donate blood.

Oftentimes people with hemochromatosis are able to make blood donations that can be used for the community (for more information, see our article on Therapeutic Phlebotomy). Now more than ever, people are encouraged to donate blood because having a healthy blood supply is critical for our overall healthcare system needs.

Vitamin C

As of the time of writing this article, there are no currently officially recommended medications, nutrients, or supplements specific to COVID-19. It is simply too soon to know if any compound or nutrient is safe and effective.

One nutrient that has gotten a lot of attention, nonetheless, for its purported ability to support a person’s health with coronavirus is vitamin C. One unsubstantiated article online suggests that the government in Shanghai is officially recommending vitamin C for COVID-19. The references lead to an article written in Chinese, so I have no way of knowing if this is a legitimate recommendation or not.

However, many patients in our naturopathic practice as well as readers of Hemochromatosis Help have asked our opinion on vitamin C.

While vitamin C has long been held in high regard for its general anti-viral, immune boosting properties, vitamin C is also established to increase iron absorption from meals.

On our Diet for Hemochromatosis page, we caution against vitamin C at mealtimes. There is a nuance, which we reference in our Diet Book for Hemochromatosis as well as our Cooking for Hemochromatosis cookbook.

Namely, the key is to take vitamin C away from meals by at least 1-2 hours. Vitamin C helps to enhance iron absorption from a meal, HOWEVER if it’s taken away from food, it isn’t likely to cause any issues. Iron Overload experts have stated in a textbook on Hemochromatosis that 500 mg of vitamin C daily is unlikely harmful if taken away from meals.

If you choose to take vitamin C for its potential anti-viral benefits, as long as you take it AWAY FROM IRON-RICH MEALS then it will not impact your iron absorption.

Liver function

COVID-19 is primarily a respiratory virus with symptoms of fever, cough, shortness of breath, and breathing difficulties. However, another preliminary finding is for liver enzyme elevation and liver damage.

A study from February 20th, 2020 showed elevated liver enzymes (ALT, AST) in patients with novel coronavirus with pneumonia (NCP):

ALT and AST were abnormally elevated in some patients with novel coronavirus infection, and the rate and extent of ALT and AST elevation in severe NCP patients were higher than those in non-severe patients.

The current COVID-19 virus is different than prior strains of coronavirus and SARS, however a review study from 2005 also showed that SARS coronavirus caused altered liver function and several cases of hepatitis. This 2005 review is the only study I can find that mentions hemochromatosis. So there does seem to be some precedent for this type of virus affecting liver function, and it may give those with iron overload an additional concern.

Hemochromatosis symptoms often affect liver function and liver enzymes, so there does seem to be some rationale for people with iron overload to take even further precautions with COVID-19.

As more information pertinent to hemochromatosis and coronavirus comes up, we will be sure to share what we know with you!

If you would like to follow up with more information on COVID-19, we have listed out a number of resources we have found reliable and valuable below.

Resources for COVID-19

We would like to share a few helpful resources and helpful tips. Even if you’ve heard these suggestions already, it bears repeating. From a public health perspective, we are all in this together!

From the World Health Organization (WHO): https://www.who.int/health-topics/coronavirus

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

COVID-19 is a new strain that has not yet been identified in humans. The concern surrounding this strain of coronavirus is largely due to the fact that we have not seen this virus before, so we do not yet understand how easily it is transmitted, and how pathogenic or deadly it may or may not be.

Symptoms of COVID-19, according to the WHO:

Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

Basic protective measures against the new coronavirus, according to the WHO:

Most people who become infected experience mild illness and recover, but it can be more severe for others. Take care of your health and protect others by doing the following:

Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing.

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Suggestions:

  1. Wash your hands frequently – Regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water.
  2. Maintain social distancing – Maintain at least 1 metre (3 feet) distance between yourself and anyone who is coughing or sneezing.
  3. Avoid touching eyes, nose and mouth – Hands touch many surfaces and can pick up viruses. Once contaminated, hands can transfer the virus to your eyes, nose or mouth. From there, the virus can enter your body and can make you sick.
  4. Practice respiratory hygiene – Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.
  5. If you have fever, cough and difficulty breathing, seek medical care early – Stay home if you feel unwell. If you have a fever, cough and difficulty breathing, seek medical attention and call in advance. Follow the directions of your local health authority.

Further helpful recommendations from the CDC can be found here: https://www.cdc.gov/coronavirus/2019-ncov/protect/index.html

Additionally, here is a list of myth busters per the WHO, as false and inaccurate information may become rampant with coronavirus, along with a thorough Q&A list to answer the most frequently asked questions.

Lastly, here is a link to the article published by the UK Haemochromatosis Society:
https://www.haemochromatosis.org.uk/cornonavirus-update-march-2020

This article has been updated several times already, so I predict they will continue to make revisions as more information comes in.


PS: NOTE: We know that many of you reading this article are drawn to nutrition and natural remedies and it may even be your first choice when it comes to healthcare. We do caution you to be careful of anyone trying to sell you a “cure” for the coronavirus in the form of a vitamin, homeopathic, or other supplement. We do believe that there are likely quite a few natural substances that are and will be helpful in supporting health, but it is irresponsible and untrue for anyone to promise a “treatment” or guarantee that it will work for coronavirus. Unfortunately, as in any crisis, there are those out there trying to capitalize on the panic and make false promises. Please be careful to not fall victim to a scam!

About the Author Dr. Eric Lewis, ND

Dr. Eric is a Naturopathic Doctor who also has a genetic predisposition to hemochromatosis. With his unique perspective of being both a practitioner & patient, he provides a new understanding about the best nutritional strategies to support health with hemochromatosis. He is the author of Holistic Help for Hemochromatosis, a guide to the use of diet and supplements in healing from iron overload.