Reviewed 23/11/2020: This page is currently up-to-date, based on the most recent guidance available and is the best advice we have for people with Addison's and Adrenal Insufficiency at this time. This advice is for people living in the UK and ROI. 

Our trustee medics and Clinical Advisory Panel alongside Society for Endocrinology, have been keeping an eye on the emerging situation and the current view is as follows. We hope you find it useful and it answers some of your questions. 

Healthcare professionals managing a patient with COVID-19 and Adrenal Insufficiency - please view the  latest guidance from the European Society of Endocrinology.

As the coronavirus outbreak is a rapidly developing situation, please also the NHS website, NHS Wales website, NHS Scotland website or HSE in Ireland for the latest health related information for people living in the UK and ROI. 

Here are our eight COVID-19 (coronavirus) precautions for people who have Addison's Disease or Adrenal Insufficiency.

1. Protecting Yourself

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

In the UK and ROI guidance is in place to keep the general public safe during the time of COVID-19

England Coronavirus Guidance

Northern Ireland Coronavirus Guidance

Wales Coronavirus Guidance

Scotland Coronavirus Guidance

ROI Coronavirus Guidance

According to guidance published in the EJE journal in April: "Patients with adrenal insufficiency are at increased risk of COVID-19; they are at an increased risk of catching this infection and they have a higher risk of complications due to the potential for an adrenal crisis to be triggered by the infection. There is currently no evidence, however, suggestive of a higher likelihood of a severe course of disease in patients with AI falling ill with COVID-19.

According to the Summary Advice Statement released by Society for Endocrinology, you should be particularly stringent in following social distancing measures and work from home, where possible.

Please see section 6. Getting About Safely  below for more information.

Shielding advice

You may hear from your local government, NHS (or HSE in ROI) directly about updates on pausing or resuming shielding as appropriate.

When shielding is paused:

You should follow the coronavirus advice provided by your local government for the rest of the population (see section 1 above). To check if any other conditions you have would mean that you would be recommended to shield. Please look at the latest definition from your local government:

The UK Government definition of 'clinically extremely vulnerable'

The Welsh Government definition of 'extremely vulnerable people'

The Scottish Government definition of 'the highest risk group'

The Northern Irish Government definition of vulnerable people

The ROI Government definition of 'people at higher risk

When shielding is in place: Use the above links to check if your health conditions are featured on the lists of conditions that would require you to shield. Where they do not, you can follow the guidelines being provided to the rest of the population. 

If you think you or a loved one are in this highest risk category and have not received a letter from the NHS (or HSE in ROI), the government or your GP, get in touch with your GP or hospital-based healthcare professional by phone or online to find out what's right for you. It’s important to remember that the need for shielding is dependant on your personal health and any combination of health conditions you may have, so we encourage anyone with concerns to speak to their GP, Endocrine nurse or hospital consultant to know what is right for you

For some, the current measures may have taken a huge toll on both their physical and mental health. 

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

Clear Your Head (Scotland)

Rethink

Mind

Mental Health Foundation

The World Health Organisation has also published advice here about managing your mental wellbeing during the coronavirus outbreak.

Support for living well

Even if you're not in the shielding group, if you meet certain criteria you can access support from volunteer responders. They can do 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

Other ways to protect yourself

It is recommended that you get a flu jab to protect yourself from influenza. Read our flu jab guide to find out why this will help you have a healthy winter.

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.

Make sure your vaccinations are up to date. Note that our medics have confirmed that the pneumonia vaccine protects against pneumococcal bacterium and would not protect against the type of Pneumonia caused by COVID-19. This is confirmed on the WHO website on their coronavirus myth-busters page.

We welcome the news of great progress on a Covid-19 vaccine. Visit the World Health Organisation for all the latest Covid-19 vaccine updates. Our medics continue to track the plans for ensuring the vaccine is safe and how it will be distributed. We will keep you informed if there are any specific implications for people with adrenal insufficiency.

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, that you have the instructions and practice a 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. It is hoped that the steroid emergency card will be adopted in Wales, Scotland and Northern Ireland in the future. The steroid emergency card is not available in the ROI. It might still be helpful to carry it as the advice could still be a lifesaver!

Prepare in case you need to be admitted to hospital:

Read our four tips for preparing for hospital admission

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:

You may be required to self isolate after travelling, if you have COVID-19 symptoms or a found to be a contact of someone with confirmed COVID-19. Self Isolation is different to shielding. 

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 

NHS Scotland advice on self-isolation

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

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.

Make sure you have a good supply of medication that cover you, in the event, you have to self isolate and fall ill enough to increase your dosing as per our Sick Day Rules.  Please read our Sick Day Rules before increasing your dosing and make sure you have an extra month's worth of medication

If your UK or ROI based GP or Endocrinologist does not wish to provide additional prescriptions to provide the above cover, please print and provide them with the below documents as a guide and politely ask again:

EJE Clinical Guidance: Managing Adrenal Insufficiency in the time of COVID-19 

The advice from the Society for Endocrinologists for people with adrenal insufficiency.

The ADSHG Caring For the Addison's Patient leaflet

The Pituitary Foundations's Letter to GPs - Digital Template

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 for people with adrenal insufficiency.

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

Please familiarise yourself with the NHS advice on self-isolation in case you are asked to self-isolate. 

Follow the ADSHG on Twitter, Facebook 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 local restrictions in place in the UK or ROI you may be asked to work from home if you're able to. For some, working from home is not possible.

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, you should only be going back to work if your workplace is 'COVID-secure'. 

COVID-secure should mean that working times are staggered so people aren’t arriving and leaving at the same time; you’re able 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 and wear a face covering if possible.

Use GOV.UK’s coronavirus employee risk assessment tool to find out if you should be going back to work in England or get more information for ScotlandWales, 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. They can offer advice to employers about the deployment of staff during the pandemic. 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 may be able to access a grant through your local government. 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 guidance for outdoor activities and exercise. Taking into account local guidance, deciding whether or not to do something within those guidelines is down to your attitude to risk. 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 and be sure to follow stringent social distancing measures. 

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

Find out how many cases are in your area. If lots of people in your area are infected with coronavirus, it’s more likely that you will be exposed to the virus. Find official coronavirus statistics for your area in the UK  or in IrelandFind out the current R number in the UK, as well as separate ones for England, Northern Ireland, Scotland and Wales. View ROI updates on the R number

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

Welsh 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, Health Protection ScotlandPublic 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-19 posts:

  • Q&A with Dr Helen Simpson (Consultant Endocrinologist) and Professor John Wass about going into hospital during COVID-19 - read read about the Q&A..
  • ADSHG member Jennifer shares her experience of having emergency surgery during COVID-19 - read about it in our blog.

7. Long COVID and recovering from COVID-19

If you have experienced COVID-19 yourself, make an appointment with your GP to discuss how you are recovering since your were ill. It seems to be that recovery from COVID-19 can sometimes be a long haul so you might benefit from being referred to a COVID-19 follow up clinic if you are having persistent problems.

It might well be worth your seeing your endocrinologist for an up to date assessment. 

Visit the dedicated NHS website for Long Covid support.

As it is still very 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.

8. Children and schools.

Schools should be practising social distancing for your child when they are back 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 outbreak 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 Injectionvideos on YouTube about how to correctly use an emergency injection kit.

For more information on the COVID-19 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