Early stage liver disease has been mostly ignored by the medical community leading to diagnosis too late to be helpful even in normal times.  In the age of COVID it can be deadly. When you look at what conditions the CDC lists as increasing your risk of serious illness you see the list below.

(NOTE, no liver disease mentioned)

(Might the fact that no one bothers to track most liver disease effectively have anything to do with that?)

• Cancer
• Chronic kidney disease
• COPD (chronic obstructive pulmonary disease)
• Heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
• Immunocompromised state (weakened immune system) from solid organ transplant
• Obesity (body mass index [BMI] of 30 kg/m² or higher but < 40 kg/m²)
• Severe Obesity (BMI ≥ 40 kg/m²)
• Pregnancy
• Sickle cell disease
• Smoking
• Type 2 diabetes mellitus

A recent study looked at 61.4 million medical records from 1999-2020 and identified patients with liver disease or metabolic syndrome. They then matched those records to 8,885 documented cases of COVID. They showed for the first time a significant risk for people suffering from NASH.  This has not previously been addressed in the literature. This hidden risk probably results from the fact that NASH is co-morbid with so many other conditions and is commonly undiagnosed so that its significance is largely masked.

Here is a link to the study if you would like to dig into it.

The incidence of COVID-19 in patients with metabolic syndrome and non-alcoholic steatohepatitis: A population-based study

The reason this is not clear to the CDC, or medicine in general, is that we do not screen for asymptomatic liver disease. We ignore it until symptoms arise and by then it is a dangerous situation. An estimated 5 million people have NASH and don't know it.  That puts them at a much higher risk in this pandemic than they think they are and likely results in more risky behavior, illness, and death.

We support screening for liver disease as part of a general wellness program. This is not the current standard of care and we seek to change that. Fortunately research is beginning to give us tools we can use for early detection.

A recent study comparing various blood tests for identifying possible liver disease was presented by Fibronostics at the AASLD meeting which compared many of the current screening options and measured their effectiveness as diagnostic tools.

Recent research has shown that the combination of multiple tests, such as FIB-4 and VCTE greatly improve diagnostic accuracy. Tests like these do not provide a definitive diagnosis but can be useful for assessing risk and guiding next steps.

We believe that recent research shows that we now have the ability to identify NASH before it becomes serious. The Foundation intends to press for early diagnosis and intervention in liver disease. This will be particularly important as decisions are made about when different groups are offered COVID vaccine. If you have NASH you may want to be very high on the list for vaccination.