COVID-19 and Herpes Zoster

The medical community has focused in recent months on the virus at the core of the coronavirus disease 2019 (COVID-19) pandemic, but now its broader impact is beginning to come under scrutiny. 

One area of concern is the effect of coronavirus-related stress on the human body. Common stressors include fear of contracting the virus or losing loved ones to it, sheltering at home, sudden job loss, caring for children who would normally be in daycare or school, and overall uncertainty about the future. Will this stress contribute to a spike in other health issues, including herpes zoster (HZ)?

The CDC acknowledges that the COVID-19 outbreak may be stressful for individuals, and that “fear and anxiety about a disease can be overwhelming and cause strong emotions in adults and children.”¹  

While noting that people react differently to stressful situations based on their personalities, backgrounds, and communities, the CDC identifies populations that are most vulnerable. “People at higher risk for severe illness, such as older adults, and people with underlying health conditions are also at increased risk of stress due to COVID-19,” it states.¹

In fact, the elderly, individuals with chronic health conditions like diabetes and inflammatory bowel disease, and the immunocompromised have long been known to be at greater risk for developing shingles. Psychological distress, sleep disturbance, and depression-all states associated with COVID-19- are among acknowledged triggers that cause the varicella zoster virus to reactivate into shingles. 

Research into the psychological antecedents of HZ published in the journal Innovations in Clinical Neuroscience concluded that stress, stressful life events, and depression may partially contribute to outbreaks of shingles.²

“When psychological influences are present, they are likely to exert their deleterious impact through effects on immunity,” report coauthors Randy A. Sansone, MD, and Lori A. Sansone, MD.² “For example, studies have found that age, nutrition, and depressive symptoms can lower an individual’s immunity.”

CNN recently reported that dermatologists it contacted said that they have received an increasing number of telehealth calls on several stress-related skin conditions, including shingles, since the pandemic was announced. Stress can also prolong a patient’s discomfort, lead to lingering complications like postherpetic neuralgia and postherpetic itch, weaken the immune system, and delay full recovery.³

Besides suggesting stress management techniques, health care providers can counsel patients on ways to lessen their chances of developing shingles beyond the pandemic. The best option they can recommend is vaccination. Although there is no effective COVID-19 vaccine yet, there is effective vaccination against shingles. 

References:

1. CDC. Coronavirus Disease 2019 (COVID-19). Coping with Stress. Page last reviewed: April 30, 2020. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html.

2. Sansone RA, Sansone LA. Herpes zoster and postherpetic neuralgia: an examination of psychological antecedents. Innovations in Clinical Neuroscience. 2014.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140624/pdf/icns_11_5-6_31.pdf

3. LaMotte S. From migraines to asthma to shingles: The physical toll coronavirus-related stress takes on your body and how to combat it. CNN; May 14, 2020. https://www.cnn.com/2020/05/14/health/stress-coronavirus-physical-impact-wellness/index.html.