COVID-19 and Lymphedema: What You Need to Know

It would be an understatement to suggest that the current global crisis is merely unprecedented. Unparalleled, unheard-of…adjectives fail to convey the astounding nature of our situation. By now it’s hard to imagine anyone remains who is not aware of the threat of the novel coronavirus. But what is COVID-19, and how can you prevent coronavirus infection? And who is at risk for coronavirus?

What Is COVID-19?

The coronaviruses are a family of viruses that have previously been associated with dangerous respiratory infections, such as Severe Acute Respiratory syndrome (SARS), which first emerged nearly two decades ago. These viruses are known to circulate among certain animal species, such as bats or even reptiles, and they are notoriously prone to genetic mutations that may or may not render them more transmissible to, and infectious, among humans. 

Coronavirus Disease 2019, or COVID-19, emerged in 2019, presumably in or near Wuhan, China. Estimated to be even more infectious than seasonal influenza, COVID-19 quickly spread throughout the local population and eventually throughout the world. Emerging evidence suggests that anywhere from 25% to 50% of infected individuals may contract the disease but experience few if any symptoms.

Others become severely ill, with symptoms ranging from muscle aches, to cough, fever, and even digestive tract upset and diarrhea. More recently, anecdotal evidence has emerged that some patients, especially young people, may develop skin manifestations. Found primarily on the finger or toes, these discolored lesions, known as “COVID toes,” are often the only symptom present in such cases. Another possible, emerging sign of infection includes “pink eye,” also known as conjunctivitis. 

Unfortunately, a relatively small, but significant, number of patients will experience acute respiratory distress, requiring hospitalization and even life support. 

At-Risk Populations 

According to the United States Centers for Disease Control and Prevention (CDC), certain populations should take special care to avoid exposure to COVID-19. We are all encouraged to practice social distancing, of course, but for people with underlying health conditions, this practice is especially crucial. 

• Older adults (65+) are already considered at higher risk.
• People with underlying health conditions, such as diabetes and heart disease, are also in this extreme risk category.
• People living in nursing homes and retirement homes are also at special risk, due to advanced age and close living quarters.
• Those who may have compromised immune systems, due to medications for the treatment of autoimmune diseases, or HIV, for example, are also at elevated risk.
• People with chronic lung disease or moderate to severe asthma.
• Severe obesity (BMI or body mass index) 40 or greater.
• People with chronic kidney disease requiring dialysis. 

While there is no specific guidance regarding the risk of COVID-19 among people with lymphedema, it’s safe to assume that all possible precautions against contracting the disease should be observed by lymphedema patients. That’s because many such patients already suffer from elevated inflammation in the body. Some may also have certain of the conditions listed above. According to a guidance memo issued by the Lymphedema Support Network, lymphedema alone does not make you more susceptible to the virus. 

The same, extensive detailed precautions regarding avoiding exposure to the virus apply to lymphedema patients. Care should be taken to avoid contact with any individual not already sharing your living space. Hands should be washed regularly, and thoroughly, whenever you touch any item that may have harbored the virus. Data has recently emerged suggesting the virus can remain infective on various surfaces for up to three days.

How Long Can the Virus Survive on Common Surfaces? 

Many common surfaces we may encounter, such as metal, cardboard, glass, or plastic, may support the virus for days after landing or being transferred there. It may survive on fabrics, for instance, anywhere from 3 to 48 hours, or longer. Some guidelines suggest the virus may linger and remain infective on certain surfaces for up to five days. Only bare copper is known to inactivate the virus within four hours. But other common metallic surfaces may allow the virus to remain infective for days.

Wearing a mask in public may help remind you to avoid touching your nose or mouth. If you happen to own a N-95 mask, you can rely on it to protect you from inhaling the virus if it happens to be in the air. While this route of transmission is theoretically possible, especially if someone sneezes or coughs in your general area, it’s somewhat more likely that you may be exposed by touching a surface coated with the invisible pathogen and transferring it to the vulnerable tissues of your nose, mouth, or eyes, through touch.

If you have had contact with a known or suspected patient, even if you were wearing gloves and an appropriate mask, you should remove any clothing and launder it immediately. Ordinary laundry detergent will inactivate the virus. Sunlight almost certainly helps inactivate the virus too, due to the damaging effects of ultraviolet radiation from the sun. Some people who happen to own masks are using sunlight to sterilize them between uses. 

Special Recommendations for Lymphedema Patients

As always, it’s important to keep your skin moisturized to avoid developing cracks that might allow disease-causing organisms (pathogens) to enter the body. Avoid shaking hands, or getting within six feet of others. Wear a mask if you can obtain one, and wash hands frequently. Stay hydrated, too. While this is always good advice, new guidelines suggest it may be helpful to take at least a drink of warm water all day, every day, at 15-minute intervals. This may help wash any viral particles you may have inhaled down into the stomach, where they will be inactivated and prevent the virus from taking hold in your respiratory tract. Gargling with warm saltwater to help flush the mouth and upper throat is also recommended. 

Wash your compression garments even more frequently, especially if you must venture out during shelter-in-place. If you have access to disposable gloves, feel free to wear them on your hands and/or lymphedema compression gloves or gauntlets. Remove and discard them frequently. Simply roll the glove off, inside out, and discard without touching the outer surface.

Finally, if you happen to take any form of a steroid drug, such as a corticosteroid, you should discuss this with your doctor. Emerging information suggests that steroids, which strongly affect immune system function (through suppression), may alter the course of the disease. In most instances, this may result in negative outcomes. Never, ever stop taking prescribed medication, such as a corticosteroid, unless under the direct supervision and advice of your physician. The use of these drugs typically must be tapered off slowly and carefully to avoid causing serious problems.