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Are people with liver disease at higher risk for severe illness from COVID-19?

Does COVID-19 damage the liver?

As per the Centers for Disease Control and Prevention (CDC) and  our own experience, some patients in hospital for COVID-19 treatment have shown increased levels of liver enzymes, such as AST (aspartate aminotransferase) and ALT (alanine aminotransferase). This means that the patient’s liver is temporarily damaged significant proportion of patients. Hower, Acute liver failure due to COVID is extremely rare in absence of pre-existing liver disease.

Are those with chronic liver disease including Hepatitis B or C at greater risk of severe disease from COVID-19 compared to other normal people?

People with underlying liver conditions particularly cirrhosis whether due to fatty liver, hepatitis B hepatitis C or alcohol are liver at higher risk for severe disease from COVID-19, irrespective of their age. These people are more likely to have a severe illness if their conditions are not well controlled. If you or your friends are diagnosed as liver disease , you should continue the treatment for liver disease unless otherwise advised by the treating doctor.

Can people on medications for chronic liver disease get COVID-19 vaccination?

Yes! COVID vaccine is recommended for all people with pre-existing liver disease, including those who have had liver transplants earlier. COVID-19 vaccination may help protect those with chronic liver disease from getting severely ill from COVID-19. In fact patients with chronic liver disease should be prioritised to receive vaccination.

However, even after getting the COVID-19 vaccination, you should continue to take precautions to protect yourself, by wearing mask, maintaining 6 feet distance from people, avoiding poorly ventilated spaces and crowds, and washing your hands with soap and water. Use hand sanitizer having at least 60 percent alcohol, if soap and water are not available. One must also realise that patients with liver disease particularly if it is severe, may not develop good immunity inspite of vaccination.

What should I do if I have liver disease and get exposed to COVID-19 infection or if I had unknowingly been exposed to COVID-19 patient?

You should call your doctor or healthcare provider immediately if you develop any COVID-19 symptoms or if you have unknowingly been exposed to COVID-19. Covid-19 testing should be carried out at appropriate time..

How can Liver Disease Patients Protect themselves?

Liver patients should take steps to avoid COVID-19. If you or your loved ones is a liver disease patient:

First, stay at home as much as possible. If you are severely sick:

  1. Ask your treating doctor if you can should keep your regular medical appointments or go for online consultations.
  2. Use mobile phone, laptop or desktop with internet for a virtual medical appointment to avoid exposure to the virus
  3. Stock up on your prescription medicines. Preferably, order them online and get them delivered at home

You should also:

  1. Strictly avoid close contact with anyone, especially those who could be sick
  2. Keep at least 6 feet (two arms’ lengths) distance from others. As this is not possible always, wear a mask too.
  3. Disinfect and clean regularly all the surface you often touch, like light/fan switches, TV remotes, phones, faucets and countertops
  4. Wash hands with soap and water often and also use an alcohol-based sanitizer

What else can liver disease patients do to protect themselves from COVID-19?

  1. Continue taking your medicines as prescribed. Talk to your treating doctor before stopping any prescribed medications. Stock up enough prescription and non-prescription drugs at home to avoid or reduce unnecessary visits to medical halls or hospitals.
  2. Talk to your doctor about other routine vaccinations. As per specialists and the CDC, people with chronic liver disease should receive vaccinations against pneumococcal disease, influenza (flu), including Hepatitis A and Hepatitis B.
  3. Continue to eat healthily and get regular exercise
  4. Reduce or avoid alcohol consumption and strictly avoid intoxication. Remember, drinking alcohol does not protect you from COVID-19.
  5. Make sure to maintain a social network remotely, by video chat or by phone call to help you stay socially connected and thus, mentally healthy.
  6. Avoid the use of tobacco in any form. Also, vaping or smoking tobacco, including marijuana, can raise your risk of severe respiratory disease. Quitting smoking or vaping can reduce your chances of developing severe complications from COVID-19.
  7. If case you get sick, make sure you stay in touch with your loved ones via phone or email

Can alcohol or hydroxychloroquine be a solution for the coronavirus?

As per the World Health Organization (WHO), once SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) – the virus that causes COVID-19 (Coronavirus Disease 2019) – has already entered the body, drinking alcohol or spraying it on your body it cannot kill it. In fact, spraying alcohol can be harmful to your body and mucus membranes (eyes and mouth) including your clothes.

However, hand sanitizers, with at least 60% isopropyl alcohol content, can help kill the Coronavirus if used on the hands and on surfaces. Again, it is not meant for drinking internally.

Hydroxychloroquine and chloroquine are very closely related and used to treat malaria and rheumatology conditions respectively. Usually, any form of chloroquine and hydroxychloroquine, along with azithromycin are said to be safe so long as they are given for a specific condition in a controlled manner. 

In China and France, small studies provided some indications of the possible benefits of chloroquine phosphate against pneumonia caused by COVID-19 but need confirmation through randomized trials. However, there is no medical or scientific evidence that proves hydroxychloroquine is indeed the answer to the COVID-19 infection. 

Please do not take these medicines to prevent or treat COVID19 infections without consulting your doctor as they have several side effects. Self-medication can be very dangerous. Some of traditional medicines recommended as home remedies to prevent Covid-19 may be harmful to liver, particularly if taken in large quantity.

Are methamphetamine users more at risk for COVID -19?

Methamphetamine users are at higher risk. Methamphetamine constricts the blood vessels, which can aggravate pulmonary damage and pulmonary hypertension and worsen COVID-19.  Illicit drugs also reduce immune function and increase susceptibility to infections.

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Verified By Dr Mahesh Goenka
MBBS (1981), MD (1987), DM(Gastro, 1987), MNAMS (1995), FACG, FASGE(USA)
  •  SISCO PENTAX ORATION for 2002 awarded by Society of G.I. Endoscopy for contribution in the field of G.I. Endoscopy.
  •  Research fellowship awarded by Indian Assocaition for Study of the Liver (1993) for research contribution in the field of hepatology.
Practicing Gastroenterologist in Kolkata at Apollo Hospital
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