COVID-19 and Gilbert’s Syndrome

So you have lots of bits of information about COVID-19, but what do they add up to if you have Gilbert’s Syndrome? Well, there are a number of things I can tell you which should help join the dots and give you the big picture of where you stand when faced with COVID-19, if you have Gilbert’s Syndrome.

First of all, we have to understand what type of virus COVID-19 is.

It’s a virus similar to the flu and colds. Because it’s new no-one had it before and so no-one is immune and can catch it easily. You can catch it the same way you catch any cold or flu – the virus travels in tiny droplets pushed out from the infected person’s nose and mouth when they cough or sneeze. It either goes straight into your mouth or nose, or sits around for a while waiting to catch a ride on your body. The virus hijacks your cells in your nose, throat and lungs and multiplies. Your body then responds with the usual attack mechanisms, and depending on how healthy your immune system is, and how much of the virus you have been exposed to, you can see it off or have a more severe, possibly fatal reaction. The severe reaction is partly because the body’s immune system response goes into overdrive and the lung tissues become blocked because they become inflamed – which is why people have difficulty breathing. 

Okay, so far, it’s pretty straightforward – but there are differences in how viruses can affect people. This one is pretty different where children are concerned (see below). Others can also affect the liver more – recently the pandemic of 2009, H1N1, was shown to cause liver damage: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4941665/

So far, studies show that COVID-19 doesn’t seem to cause permanent liver damage, although there can be some impact on the liver initially, which doesn’t appear related to the medication given to patients, as this extract from The Hindu, and the Lancet journal text extract below show: 

Liver damage in mild cases of COVID-19 is often temporary and the organ can return to normal without any special treatment. This could be due to the state of direct infection of liver cells or could as well be due to liver cells getting caught up in the immune war between body’s immune system and the virus with chemicals produced by our body, namely cytokines. The Hindu

https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30084-4/fulltext :

‘mild liver test derangement is present at baseline in many patients with COVID-19 before significant medication use. Ie. the liver is impacted before medication is given’

‘It has been proposed that COVID-19 causes direct liver injury via a viral hepatitis, but we believe that there are alternative explanations. First, the derangement of liver function is clearly mild. Second, when liver function tests for patients with different durations of symptoms are examined, there is no evidence that later presentation is associated with greater liver function derangement.’

What’s also great to hear is that: ‘worse outcomes were not seen in the 42 patients with chronic liver disease and COVID-19 who had outcome data’

The greatest problem that people will face when fighting off COVID-19 are underlying health problems which impact the immune system:

https://patient.info/news-and-features/covid-19-coronavirus-what-is-an-underlying-health-condition

In which case you must take special care!

Paracetamol, ibuprofen and COVID-19 – originally it was thought that ibuprofen might cause problems for people with COVID-19, and for those of us with Gilbert’s Syndrome this was bad news. Paracetamol has been shown to impact the liver more in people with Gilbert’s Syndrome (it makes me feel VERY ill),https://www.ncbi.nlm.nih.gov/pubmed/10412886 , so ibuprofen might by your painkiller of choice. Fortunately the WHO and governments have given it the all clear https://www.gov.uk/government/news/commission-on-human-medicines-advice-on-ibuprofen-and-coronavirus-covid-19

So, you should not worry more if you have Gilbert’s Syndrome as COVID-19 doesn’t appear to have an especial impact on the liver. However, just on flu and colds generally – the stress on your body can make you feel really unwell and trigger your Gilbert’s Syndrome symptoms. This is important to tell clinicians if they are treating you so that they can understand what’s happening to your body and why. 

Check out this leaflet from an NHS trust and its recommendations to get the flu vaccine if you have a liver disease, including GIlbert’s Syndrome. https://psnc.org.uk/avon-lpc/wp-content/uploads/sites/23/2015/07/Liver-Disease-and-Flu-Vaccine-Importance.pdf

There may be other questions that we can’t answer such as – is there a link between low white blood cell counts, Gilbert’s Syndrome and fighting infection; what if some of the medication used in the treatment of COVID-19 is processed in the pathways of the liver affected by our enzyme deficiency. As it appears there is a link between high levels of bilirubin and reduced white cell count https://journals.sagepub.com/doi/10.1177/0004563214541969 (topic for another post!), you could potentially hypothesize that this is a good thing – as the overproduction of white cells is part of the excessive inflammatory response I talked about that can actually harm not heal. As mentioned above – do let your clinicians know you have Gilbert’s Syndrome and that some medication, processed in the Phase II pathways, isn’t dealt with as well. 

If you want to know more about how COVID-19 virus works and how the body responds (knowledge is power after all), check out this video from Yale: https://www.youtube.com/watch?v=vvKhT9tAhig

And if you’d just like to feel like you know a bit more about how the liver works check this out: https://www.healthline.com/health/what-does-the-liver-do

But wait – why doesn’t it affect children more, like other flu and colds? How is it different? 

https://time.com/5816239/children-coronavirus/

Why are children less affected when their immune system is still developing? It’s theorized it is BECAUSE their immune system is developing that the life threatening response to COVID doesn’t occur as much in children – the adult body’s immune response includes a ‘cytokine storm’ which results in an inflammatory response in the lungs, making it hard for adults to breathe. Children’s bodies don’t yet respond as aggressively to the virus. 

https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2014.3085

As age advances, the immune system undergoes profound remodelling and decline, with major impact on health and survival [81,82]. This immune senescence predisposes older adults to a higher risk of acute viral and bacterial infections. Moreover, the mortality rates of these infections are three times higher among elderly patients compared with younger adult patients [83]. Infectious diseases are still the fourth most common cause of death among the elderly in the developed world. Furthermore, aberrant immune responses in the aged can exacerbate inflammation, possibly contributing to other scourges of old age: cancer, cardiovascular disease, stroke, Alzheimer’s disease and dementia [84]. During a regular influenza season, about 90% of the excess deaths occur in people aged over 65.

I hope this information helps you live better with Gilbert’s Syndrome!