Reviewed 02/10/2023

Our trustee medics and Clinical Advisory Panel alongside Society for Endocrinology, will continue to review our guidance. We hope you find it useful and it answers some of your questions. 

	Medics - read COVID-19 Adrenal Crisis Information for Endocrinologists
	Unwell with COVID-19? Larger than usual steroid doses are required. Scroll below to read more or visit here for more guidance. Read our Sick Day Rules for advice on appropriate dosing for other illnesses.
	Watch our video on COVID-19 dosing.

Eight COVID-19 (coronavirus) precautions for people who have Addison's Disease or Adrenal Insufficiency.

1. Protecting Yourself & Vaccines

2. Preparing for Emergencies

3. Managing Your Medication

4. Keeping Informed

5. Managing Employment and Finances

6. Getting About Safely

7. Recovering from COVID-19

8. Children and Schools

1. Protecting Yourself & Vaccines

Reduce your risks of serious illness as a result of a COVID infection.

Vaccines & Boosters

The most important way people living with Addison's disease and adrenal insufficiency can lower their risk of becoming seriously ill from coronavirus is to avoid catching the virus in the first place. Vaccines and boosters are effective ways to prevent infection and that’s why we strongly encourage those eligible to get vaccines and boosters when offered. 

Read our guide to Vaccines and Adrenal Insufficiency which explains more about COVID, priority groups as well as flu, Pneumonia and other vaccines. You can also explore personal stories from people in our community who have kindly shared their experiences of receiving the COVID vaccinations and booster jabs.

Vaccines & Adrenal Insufficiency

In the UK and ROI varying levels of guidance are in place to keep the general public safe now that we are living with COVID.

• England Coronavirus Guidance
• Northern Ireland Coronavirus Guidance
• Wales Coronavirus Guidance
• Scotland Coronavirus Guidance
• ROI Coronavirus Guidance

In line with government guidelines, people with Addison's disease and adrenal insufficiency should be particularly stringent in following the local coronavirus guidance.

Please read the sections on this webpage for more detailed information on each point. But here are our top tips for being prepared in case you become unwell with coronavirus:

1. Ensure you have sufficient medication to cover increased doses - Managing Your Medication
2. Get confident about managing emergencies - Preparing for Emergencies
3. Keep yourself up-to-date - Keeping Informed
4. Coronavirus Testing - getting tested is the only way to know if you have the virus. You can order free tests online from the NHS website here. If you test positive and are required to self-isolate, it helps stop the virus spreading. In the UK, home lateral flow tests are available (see the NHS Covid-19 Testing Guide) in addition to those available at test centres.   
5. Visit our sanctuary of support page to help if you feel lost, concerned, puzzled or poorly. 

Managing your mental wellbeing

It’s important to look after your mental health right now, whether you’ve had coronavirus or not. Think about ways to keep your stress levels down, what you can control and how being prepared can be a great help. Talk to someone if you are feeling stressed or anxious.

You can read our advice on coping with psychological stress. If you are an ADSHG member, we have a useful coronavirus thread on our online forum where you can talk about how you feel. Others can then support you, as other members share information and experiences.

For further support in looking after your mental here, here are some useful link to organisations that can help you do that:

Every Mind Matters

Rethink

Mind

Mental Health Foundation

Support for living well

If you meet certain criteria you can access support from volunteer responders. They may be able to help with things like helping you with shopping, getting prescriptions or just checking in to see how you are doing. 

England NHS volunteer responder support online or call 0808 196 3646.

Scotland additional support webpage  or call 0800 111 4000.

Wales support page for vulnerable people phone numbers are listed for each region on the support page.

ROI Community Support helpline or call 0800 915 4604.

Northern Ireland support for vulnerable people

You may be caring for a person in an at-risk group. If you are, take extra care to protect yourself and the person you care for from coronavirus.

2. Preparing for Emergencies

Get your Emergency kit and Emergency Letter ready

Make sure you have an Emergency Injection Kit containing hydrocortisone vials available from your GP or Endocrinologist, syringes, injection instructions, and plastic vial snaps. Make sure it is up-to-date, includes instructions and that you have practiced the self-injection using our videos. Make sure you have a completed Emergency Letter and it is up-to-date.

Keep your NHS Steroid Card handy if you live in England

Keep a copy of both the NHS Steroid Emergency Card and ADSHG charity Adrenal Crisis Emergency wallet card, filled in with your details, in your wallet or purse. 

Learn more about steroid emergency cards

Visit our 'Be Prepared - Resources to help you' page for more support

Prepare in case you need to be admitted to hospital

Put together a hospital folder with your key information in and/or ADSHG leaflets, NHS steroid emergency card, spare medication and a list of your current medication. This can then be picked up and taken there easily by you, your carer or patient advocate.

If living in the UK, register with your local ambulance trust.

Make sure you can stay hydrated

Make sure you have plenty of non-alcoholic drinks, salty snacks and rehydration fluids (available in most chemists) or salts available in your home.

Learn about Self Isolation (different to shielding) in case you are asked to isolate

It's advisable to self isolate if you have COVID symptoms or you have been in contact of someone with confirmed COVID. The following links explain what self isolation is, when to isolate and where to look for advice if isolating impacts your employment or finances.

Familiarise yourself with the the local advice on self isolation so that you are prepared in case you are told to self-isolate:

NHS England advice on self-isolation 

HSE self-isolation and limited social interaction 

Northern Ireland government advice on self isolation

Welsh Government's guidance on self isolation 

Get familiar with how to get medical help in an emergency

If you're based in the UK: If you need to use the NHS 111 service please use the NHS 111 website in the first instance so that the service can handle more urgent cases over the phone. If you need to contact NHS 111 or call 999 in an emergency, be sure to mention 'steroid-dependent' and 'adrenal insufficiency' when explaining your health status. 

Or in ROI: the HSE contact details are: Callsave: 1850 24 1850, Phone: 041 6850300 or Tweet: @HSELive

3. Managing your medication

Unwell with COVID? Larger than usual steroid doses are required. Together with the Society of Endocrinology and our Addison's Clinical Advisory panel, dosing requirements have been advised.

Click to read COVID dosing guidelines.

Keep taking your tablets as normally prescribed unless you are ill. Steroids taken for adrenal insufficiency are replacement doses and increasing the dose during illness is to try and mimic your body's natural physiological response. In the correctly tailored dosages, they should not suppress your immune system or make you more susceptible to infection.

Three months reserve supply of essential steroid medication

Make sure you have a good supply of medication in case you need to increase your dosing suddenly in reaction to COVID, as per our Sick Day Rules. Please read our Sick Day Rules before increasing your dosing and make sure you have extra medication.

3 months provision of essential steroid medication is standard practice and is the advice given by the ADSHG Clinical Advisory Panel, Society for Endocrinology, and on the NHS page for Addison's disease.

If you need to discuss with your GP adjusting your repeat prescription length, please visit our GP page and scroll to our "3 months reserve supply of essential steroid medicine", for resources to support you and your GP. Do not be discouraged if you are initially told this won't be possible by your GP. Please follow the steps on our GP page, and politely ask again.

Please note: The ADSHG cannot become involved in individual disputes, but our resources can be downloaded to raise awareness amongst medics.

Over on our blog we've taken a look at the use of high dose corticosteroids - including hydrocortisone and dexamethasone - in the treatment of COVID-19: Behind the news: Hydrocortisone as a treatment for COVID-19 

4. Keeping Informed

Make sure you have useful ADSHG publications printed, filled in and stored in an easy to find location. Talk to your family about the support and/or treatment you need - make a plan. You could use our Personal Emergency Plan to think everything through together.

Our Sick Day Rules are an excellent set of principles to follow if you become ill. Print them and share them with those who are likely to be looking after you if you become ill.

The Government, NHS and HSE are providing regular updates so follow them online or keep an eye on the media for their latest updates.

UK Department of Health and Social Care

On Facebook
On Twitter 

UK NHS

On Facebook
On Twitter 

ROI HSE
On Facebook 
On Twitter 

Tailored information for people living in Wales, Scotland and Northern Ireland can also be found at:

• Public Health Wales 
• Health Protection Scotland 
• Public Health Agency (NI) 

Tailored information for British Sign Language users

Read the advice from the Society for Endocrinologists regarding adrenal crisis.

Follow the ADSHG on Twitter, Facebook, Instagram, or if you are a member all our updates will also feature on our forum. We'll also include advice on our ADSHG website.

Misinformation can be troubling and misleading. Please review the WHO's Mythbusters to verify the things you are hearing, reading or sharing. 

5. Managing employment and finances

Depending on restrictions in place in the UK or ROI you may receive recommendations to work from home if you're able to. For some, working from home is not possible. You may be concerned about returning to face-to-face working.

If you are employed, talk to your employer about their plans and your needs. As the Citizen's Advice Bureau advises: "Talk to your employer if you think there’s more they could do to keep you safe. Try to be constructive and explain what you need to happen so that you’ll feel safe when working."

Read the your local governments advice for working during the time of COVID-19 and advice if you're worried about working:

UK and Welsh Government Worker Support page

Scottish Government advice for working safely

ROI Citizen's Advice Bureau's Returning to Work Safely page

Northern Ireland's Government advice for workers

You can find the latest advice from the Citizens Advice bureau or in ROI from Citizen's Information, if you are concerned about going to work, sick pay or any benefits you receive. If you are unable to work from home, your workplace is required to meet any COVID secure obligations that apply as set out by your local government. 

You might see measures in place like working times are staggered so people aren’t arriving and leaving at the same time; it's possible to stay socially distant from colleagues in a well ventilated room (keep windows and doors open as much as possible); you can wash your hands or use hand sanitiser frequently or wear a face covering.

In the UK, use GOV.UK’s coronavirus employee risk assessment tool to find out what the risks are for attending your workplace in England and the measures your employer should put in place to reduce those risks. Outside the UK, follow guidance for Scotland, Wales, Ireland and Northern Ireland. 

Please note: The ADSHG cannot become involved in individual disputes, but our resources can be downloaded to raise awareness amongst employers, those in HR or occupational health or healthcare professionals involved in supporting you.

Sick Note. If you get coronavirus symptoms and can’t work, then you shouldn’t need a sick note for the first seven days, but most employers will want to see one after that. In the UK, if you have been told to self-isolate and you need a note for your employer, the NHS can give you a digital isolation note. You can access this service through the NHS 111 website which will be sent via email, or can be sent directly to your employer.

If you’re part of the NHS and public sector, occupational health (OH) services are involved in assessing the risk of people with health conditions going to work. If you’re working in these areas, this information 'Keeping our Workforce Safe’ could be useful.

Unable to Work. If you can’t work and are on a low income or you are self-employed and have been negatively affected by coronavirus, you'll find more information about benefits, allowances, grants and other schemes available from the Citizens Advice bureau or in the ROI from Citizen's Information.

6. Getting out and about safely

Follow the local guidance for outdoor activities and exercise. It might be helpful to think about how much you’d benefit from going somewhere and how much you could potentially be exposed to coronavirus. Always follow the latest guidance from your local government and healthcare providers. 

Generally, outdoor activities should be lower risk than indoor activities as long as the latest government guidance is followed.

Travel. If you are planning to travel, please check the travel advice from your local government about the countries you'll be travelling to and from. 

UK Government Travel Advice

Scottish Government Travel Advice

ROI Travel Advice

We also have advice on our website about managing your Addison's when travelling.

If you have been travelling abroad, and you think you may have been exposed to Coronavirus, the most up-to-date advice on what to do can be found on the NHS, HSE ,Public Health Wales, NHS Inform Scotland, Public Health Agency (NI)  or UK Government websites.

Going to appointments or into hospital. If you have a medical appointment, check the current advice at the medical centre in question and discuss any concerns with them when considering if you will attend or not. It is important to contact the NHS if you have any healthcare concerns. It's important not to put off talking to your GP or endocrinologist. Many GP surgeries now have a website or app that allows you to get help without visiting a surgery so do ask the receptionist for details.

You might find it useful to talk to friends, family or a health care professional about your individual situation, taking into account your Addison's disease or adrenal insufficiency. You can also check out our blog for our hospital and COVID posts:

• Blog: ADSHG member Jennifer shares her experience of having emergency surgery during COVID.
• Preparing for a medical appointment
• Preparing for a hospital admission

7. Long COVID and recovering from COVID

If you have experienced COVID yourself, make an appointment with your GP to discuss how you are recovering since you were ill. Recovery from COVID can sometimes be a long haul so you might benefit from being referred to a COVID follow up clinic if you are having persistent problems. You may also like to see your endocrinologist for an up-to-date assessment. 

Visit the dedicated NHS website for Long Covid

As it is still early days for the medics generally to know how people are going to recover, there will be no 'one size fits all' approach, so contact your healthcare team, who know your circumstances, and find out the best strategy for you.

Long Covid Support Charity

Long Covid Support was formed by a group of people struggling to recover from COVID, who found each other online and have been facilitating international peer support and campaigning in the UK for recognition, rehabilitation and research into treatments since May 2020. Long Covid Support is a charitable company, registered in the UK, but with affiliations in over 100 countries and territories. A group of 50 volunteers, all themselves with lived experience of Long Covid, are involved in our core work streams.

8. Children and schools.

Schools should be following the latest government guidance to help your child when they are at school and encouraging regular hand washing, to prevent the virus from spreading between children and your home.

For the latest information on what parents and carers need to know about schools and education during the coronavirus pandemic visit your local government website.

GOV.UK pages about school and education

Scottish government pages about school and education

Welsh government pages about school and education

Northern Irish government pages about school and education

If you are worried about the safety of your child returning to school if they have Addison’s or adrenal insufficiency, speak to the school and to your child’s endocrine team about your concerns.

There are also some key things you can do to before your child returns to school:

Medication - Resupply the school with an in-date hydrocortisone emergency injection kit and medications as prescribed and following your child’s Individual Healthcare Plan (IHP).

An Individual Health Care Plan - Individual Health Care Plans (IHPs), are called different things depending on the nation you live in. But these plans are used to make sure your child’s Addison’s or adrenal insufficiency is managed properly during school time. Make sure your child’s IHP is up-to-date and includes a copy of the latest letter from the medical professional coordinating your child’s care. A sample IHP template is included in our booklet "When a student has Addison's: a guide for schools and parents."

Be Prepared - If your child is old enough, you can support them in making sure they know how to use their emergency injection kit. Read more about kits on our website and watch our Emergency Injection videos on YouTube about how to correctly use an emergency injection kit.

Visit our Children & Young Adults page

For more information on the COVID advice for schools for the four nations, please follow the links below: 

Schools guidance in England

Schools guidance in Northern Ireland

Schools guidance in Scotland

Schools guidance in Wales

Schools guidance in Ireland

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