Coronavirus disease 2019 or COVID-19 pandemic drastically changed our lives in so many ways. The pandemic is affecting millions of people all over the world, causing unprecedented number of deaths, long-term health effects on those that survived the disease, social and economic devastation around the globe. While the disease is highly contagious and can affect anyone, it is particularly dangerous for those over 70 and with underlying medical conditions such as liver disease. What have we learned since February 2020 about how Covid-19 affects people with chronic liver disease and other liver diseases?
While scientists are scrambling to learn from those already affected by the virus, the short period since the beginning of the pandemic is not enough for any definitive conclusions. Nevertheless, several studies offer some possible answers.
One preliminary report shows the high mortality rates for SARS-CoV-2 Infection in people with pre-existing chronic liver disease and cirrhosis. The preliminary findings of another study suggest that the severity of liver disease is in direct correlation with the morbidity and mortality from COVID-19. A retrospective study in China found that patients with NAFLD (Non-alcoholic Fat Liver Disease) had more than six percent higher risk of disease progression, 70 percent higher likelihood of abnormal liver function and longer viral shedding time during the treatment from the virus. The research has found cellular immune dysregulation in COVID-19. As a result, hepatic and systemic immune responses caused by Fatty Liver Disease contribute to the cytokine storm in younger patients with COVID-19. COVID-19 is three times worse in younger patients with NAFLD.
The recently published review on effects of COVID-19 on liver disease found that patients with Covid-19 can have different degrees of abnormal liver function. Tests show that these virus effects are mostly transitory and mild. The evidence indicates that liver damage results directly from the virus, inflammation of the entire system or toxicity from drugs commonly used for treatment. Since the tests show children with Covid-19 show very little or no increase in liver enzymes, the tests that show abnormal liver tests suggest the need for evaluation for pre-existing underlying liver diseases.
While this review suggests that patients with CLD (chronic liver disease) are not at bigger risk for being infected by Covid-19, people with cirrhosis, non-alcoholic fatty liver disease, hepatocellular carcinoma, autoimmune liver diseases or liver transplant do have a greater risk for getting severe COVID-19.
While the scientists are still collecting data and offering conclusions, it is prudent to accept general conclusion that all people with underlying health conditions including liver disease are at risk of adverse outcomes from the virus. If you or your loved one suffers from liver disease, the advice is to adhere to strict social distancing measures to minimise their chance of exposure to COVID-19.
People with certain liver conditions are particularly vulnerable and are advised to follow shielding measures to stay safe.
The extremely vulnerable ‘shielding group’ categories are:
people on immunosuppression for a liver transplant or for autoimmune hepatitis (AIH).
people with liver cancer undergoing chemotherapy, immunotherapy or other antibody treatments.
Liver cancer patients that are offered particular advice here.
Check for welfare and benefits you might be entitled during the COVID-19 pandemic.