What to Know About Down Syndrome and COVID-19

Down syndrome is listed by the Centers for Disease Control and Prevention (CDC) as one of the conditions that increase the risk of severe illness from COVID-19.

This means that if you or someone who you spend time with has Down syndrome, you need to take precautions to try to avoid exposure to the virus. Down syndrome is considered one of the conditions that put a person at higher risk of severe COVID-19.

If you develop COVID-19 or have been exposed to the condition, you should contact your healthcare provider. Getting medical attention can help prevent complications of the infection.

But keep in mind that even with Down syndrome, becoming infected with the virus does not necessarily mean that you will develop complications—you might not develop symptoms at all. You can have a good recovery after becoming sick from the virus.

Down Syndrome and COVID-19 Risk 

According to the CDC, having Down syndrome has not been associated with an increased risk of exposure to COVID-19. However, if you are exposed to the virus, Down syndrome increases your risk of severe illness and hospitalization.

Down syndrome puts you at risk of developing severe COVID-19 symptoms at a younger age—an average of 10 years younger than the general population.

Some factors that increase the risk of becoming sick after exposure to the virus include: 

Facial and neck structures: Down syndrome is associated with certain structural features, including a large tongue, enlarged adenoids, a short neck, and diminished muscle tone in the throat muscles. These physical effects of Down syndrome often predispose to respiratory infections.

It can be difficult to adequately cough and clear your throat to clear infectious organisms in the respiratory system. This has been noted with respiratory infections in general, as well as with COVID-19. 

Reduced immunity: Down syndrome is associated with diminished immunity. This can predispose a person with Down syndrome to becoming sick with an infection after the type of exposure that might not necessarily make other people sick.

Genetic factors: The chromosomal defect in Down syndrome, a third copy of chromosome 21, leads to an excess of the gene that codes for TMPRSS2, a protein that promotes entry of the virus that causes COVID-19 into the body’s cells—increasing the amount of infectious virus in the body.

Congenital heart defects: Structural heart defects can occur in association with Down syndrome. Heart defects can increase a person’s susceptibility to developing severe cardiac effects due to respiratory problems.

Complications of Down Syndrome and COVID-19

The most common symptoms of COVID-19 infection among people who have Down syndrome are fever, cough, and shortness of breath.

It has been found that Down syndrome raises the risk of severe illness and hospitalization and raises the risk of being placed on a ventilator approximately six-fold.

Complications of COVID-19 infection with Down syndrome include:

• Respiratory problems: You may have trouble breathing, feel short of breath, or gasp for air. These issues require medical interventions. 
• Pneumonia: The infection can affect your lungs, causing widespread inflammation and/or fluid accumulation.
• Heart problems: Lung infections can interfere with underlying heart problems, potentially requiring treatment for heart dysfunction.
• Sepsis: This severe response to infection affects the whole body and can be life-threatening. Effects of sepsis include very low or very high blood pressure, rapid heart rate, and confusion.

The risk of death from COVID-19 is significantly elevated among people who have Down syndrome after age 40.

Down Syndrome Treatments and COVID-19

In general, the treatments used to manage Down syndrome are symptomatic, and they do not have an impact on COVID-19. For example, if you have high blood sugar or high cholesterol, which can occur more commonly with Down syndrome, you would need medication to manage these conditions.

If you are hospitalized with a COVID-19 infection, you might be treated with medications, including Veklury (remdesivir) and Olumiant (baricitinib), which are used for reducing the impact of the infection.

Additionally, you might need one or more of the following:

• Supplemental oxygen: You may need to have oxygen supplementation as you continue to breathe on your own. This would likely involve a small plastic tube or a mask placed over your mouth. You can still talk and move around if you have supplemental oxygen, and you can remove it for a few minutes, such as while you are eating.
• Respiratory therapy: This may include breathing exercises to help you move air in and out of your lungs.
• Intubation: Severe impairment of breathing can occur due to the viral infection. You might need to have a tube placed in your throat so that a machine can help you to breathe until you recover.
• Extracorporeal membrane oxygenation (ECMO): This is an intervention that would be needed if your lungs and heart both need support due to severe illness.

Frequently Asked Questions 

Can I receive the COVID-19 vaccine if I have Down syndrome?

Yes, you can safely be vaccinated for COVID-19 if you have Down syndrome. Down syndrome is not associated with any contraindications or risks of complications with the vaccine.

The COVID-19 vaccine is available to everyone 6 months of age and older. In addition, booster shots are available to people over the age of 5.

The FDA recently granted EUAs for updated bivalent boosters of the Moderna and Pfizer COVID-19 vaccines.

The CDC recommends one bivalent booster shot for all people over the age of 5, no matter the type of vaccine series initially received. A bivalent booster shot is recommended two months after receiving a primary COVID-19 vaccination series or after the last booster dose.

Children ages 5 years are only eligible to receive the bivalent Pfizer booster. Everyone ages 6 years and older can choose to get the Pfizer or Moderna bivalent booster.

In limited situations, a monovalent Novavax booster dose may be used in people ages 18 and older who are unable to receive an mRNA vaccine.

Should I go to a healthcare provider if I feel sick?

If you start to develop symptoms of COVID-19, you should contact your healthcare provider’s office. They will direct you regarding the next steps, including a telehealth visit, an in-person visit, at-home medication, or admission to the hospital.

Can I go to work?

If you have a job, you might be able to go in person if your workplace has opened and is taking appropriate precautions. If there is a risk of exposure, it could be unsafe for you. Discuss the situation with your healthcare provider and your supervisors at work. And you might be able to do some or all of your work remotely until the risk of infection is reduced.

How to Stay Safe 

If you have Down syndrome, it is important that you avoid exposure to people who might be carrying the virus since you are at extra risk of severe complications if you are exposed. Other preventative actions include:

• Staying up to date with COVID-19 vaccinations and boosters 
• Wearing a well-fitting mask indoors in public
• Avoiding crowds and limiting close contact with other people in public
• Washing your hands with soap and water frequently, or using an alcohol-based hand sanitizer to clean your hands

Many people who have Down syndrome live in assisted care homes or get help from professional caregivers who come to the family’s home. Exposure to more people could increase the risk of exposure to COVID-19.

This means that you might have had a major change in your routine since the pandemic started—such as not being able to have visitors or not getting in-person help in your own family home from your medical caregiver. These issues can pose challenges. 

Some considerations:

• Getting help at home: If your caregiver can’t come to your home due to COVID-19 precautions, your family who you live with might need to learn how to do things—like give you your medication or measure your blood pressure. See if you can videoconference with your regular caregiver so they can teach you and your family how to do these things.
• Telehealth: You should not skip your regular healthcare provider’s appointments, and you should also see your healthcare provider if you feel sick. Ask your healthcare provider’s office if they want to see you using telehealth or in person for your appointments.
• Loneliness: If you live in a group home or with your family, you might feel lonely. Try to meet with your friends and loved ones through videoconferences. You can have a nice conversation, share stories, and catch up with loved ones even if you can’t be together in person.

A Word From Verywell

Children and adults who have Down syndrome are able to have many enjoyable experiences and achieve many of their goals. If you or your loved one has Down syndrome, you have already been making adjustments to optimize your health throughout your whole life.

The COVID-19 pandemic adds more considerations to your usual routine. Staying safe during the pandemic can help you avoid long-lasting health complications of the virus, including the potentially life-threatening effects of the infection.

Learn everything you can about staying safe. Don’t forget that you have a priority when it comes to getting the vaccine and getting help for any health concerns you have.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.