What is COVID-19?

COVID-19 (coronavirus disease 2019) is a disease caused by a virus named SARS-CoV-2. It can be very contagious and spreads quickly. Over one million people have died from COVID-19 in the United States.
COVID-19 most often causes respiratory symptoms that can feel much like a cold, the flu, or pneumonia. COVID-19 may attack more than your lungs and respiratory system. Other parts of your body may also be affected by the disease. Most people with COVID-19 have mild symptoms, but some people become severely ill.
Some people including those with minor or no symptoms will develop Post-COVID Conditions – also called “Long COVID.”

​What are ways to prevent COVID-19?

• Stay up to date with COVID-19 vaccination – see FDA vaccine guidance https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines-2023-2024
• If you experience side effects of immunization (e.g., pain, swelling, and redness on the arm where the shot was given, tiredness, headache, muscle pain, chills, nausea, fever) you may increase your regular dose of glucocorticoid medication for a day or two.
• Follow basic health and hygiene practices like handwashing
• When individuals with adrenal insufficiency (AI) are not sick and therefore not requiring stress dosing, they should maintain their regular daily dose of glucocorticoid replacement medication (e.g., hydrocortisone, prednisone). They should not be taking higher or lower doses of glucocorticoid hoping it will protect them from getting sick.

​What guidance should be followed if an individual with adrenal insufficiency gets COVID-19?

• Stress dose your glucocorticoid medication. Stress dosing means taking more of your medication than you usually take. This is because your body needs more glucocorticoids to help it respond to the stress of the infection.
  
  The exact amount of stress dosing you need will vary depending on your individual situation. It is important to talk to your doctor about your specific stress dosing plan. However, a general rule of thumb is to double your usual dose of glucocorticoids for 48 hours. If you are not feeling better after 48 hours, you may need to continue stress dosing.
  
  Please see the Adrenal Insufficiency Patient Guide to Management of Illness and Stress-Related Medical Events for adults: Adult stress-dosing guidelines
  and for children: Pediatric stress-dosing guidelines​
• Contact your doctor
• Consider taking Paxlovid, an oral medication from Pfizer;
• If symptoms are severe, administer hydrocortisone
  • Adults – ​100 mg IV (Solu-Cortef® Act-O-Vial) to prevent adrenal crisis
  • Children – 25 mg IV (Solu-Cortef® Act-O-Vial) to prevent adrenal crisis
  • Check into a hospital
  • In Emergency Room
    ​Start IV isotonic saline solution, draw blood for labs and then immediately administer hydrocortisone 25 mg IV for infants and toddlers, 50 mg for school-aged children, 100 mg for adolescents and adults.

References:

• Adrenal Crisis Alert Flyer - https://www.nadf.us/uploads/1/3/0/1/130191972/adrenal_crisis_alert_flyer.pdf

• ENDOCRINOLOGY IN THE TIME OF COVID-19
  Management of Adrenal Insufficiency: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938015/​
  ​Management of Cushing’s syndrome: https://pubmed.ncbi.nlm.nih.gov/32380475/