Hindsight

Coronavirus

To my Patients and Friends,

Here are some of the latest COVID-19 news items.

More About blood

More patients have been inquiring lately about their blood types.  Although blood types are not typically included as part of a routine blood panel, there is renewed interest as a result of a small study from Italy and Spain recently published in the New England Journal of Medicine, which found that patients with blood type A were at 45% greater risk for respiratory complications from COVID-19 than other blood groups.  Blood group O was associated with a 35% lower risk relative to other types.  Prior to this more recent study, researchers from China had found that there was a higher COVID-19 infection rate in people with type A blood.  And the commercial DNA testing company 23AndMe has found a similar disease distribution by blood type.  We don’t yet understand the basis for this phenomenon but we will keep our eyes open for more answers.  Meanwhile, simmer down all of your type-Os out there… it’s too soon to start ripping off those masks and clinking glasses!

More on medication safety

Yet another report has confirmed that two very common categories of blood pressure medications-  ACE-inhibitors and Angiotensin Receptor Blockers (ARBs)- pose no increased risk for more severe COVID -19 disease.  Earlier in the course of the pandemic, it was theorized that these agents may pose risk for more severe disease because of their impact on the ACE-2 receptor, which is used by the coronavirus to gain entry into our tissues.  This latest report is more good news for the many millions of Americans who rely on these medications.

Movin’ on up

According to the World Health Organization’s COVID-19 daily situation report, the global daily incidence of COVID-19 continues to increase and at an accelerated rate.  Twenty states are reporting major increases as a result of Memorial Festivities, premature reopening in many states, and reductions in social distancing and mask use.  In Florida, for example, at least 12 hospitals have reported no current ICU bed availability as the disease incidence climbs in that state.  Incidence is climbing dramatically as well in sections of California, Texas, Georgia, North Carolina Louisiana, Alabama, Arizona, Arkansas, Iowa, South Dakota, and Oklahoma (expect a major spike there in the coming 2-3 weeks).  According to former FDA Commissioner Dr. Scott Gottleib, some of these states are “on the cusp of losing control.”  I’m happy to say that we have been doing quite well in most of Connecticut, although the virus is still here– so it remains important that we wear masks, keep our hands clean and comply with physical distancing guidelines.

Notably, we have not seen significant increases thus far as related to nationwide outdoor protests.  However, prepare for more spikes in areas where states continue to disregard the White House task force’s guidelines for staged reopening (see Florida) and where large indoor events are taking place.

A fishy plan

You may recall that Sweden adopted a unique, somewhat cavalier approach when the COVID-19 pandemic struck.  While other parts of Europe implemented distancing measures as per the recommendations of most epidemiologists and the World Health Organization (WHO), Swedish authorities chose to limit the degree to which businesses, schools, restaurants, and bars were closed as the pandemic struck.  The rationale was that, if enough people become exposed to the virus, herd immunity might develop, which could then slow the spread of the virus. Herd immunity– now a household term- refers to the phenomenon in which, when a large enough percentage of a population are exposed to (or vaccinated against) a particular infection, the resulting rise in germ-specific antibodies renders the infection less able to spread.  Although they were questioned at the time by many in the epidemiology community, we watched the Swedes with interest.  Unfortunately, the country has seen one of the higher European COVID-19 death rates, and the number of citizens with COVID-19 antibodies is only around 6.1%, which is far lower than they had hoped and is well below the 60-80% threshold for herd immunity.  Some in the U.S had speculated early on that perhaps we should adopt a similar approach as a means of getting businesses up and running more quickly; I’m glad we didn’t.

A life span for COVID-19 antibodies?

A recent study from China has found that COVID-19 antibodies that develop after an infection may not remain in the bloodstream for more than a few months.  This was found to be especially true for those who had asymptomatic illness.  The study was small and will need to be replicated on a much larger scale in order for us to better understand the role of protective antibodies.  However, these results serve to emphasize that, based on what we currently know, a positive antibody test may not guarantee protection from a repeat COVID-19 infection.  It also adds to the uncertainty as to when a proven vaccine will become available.

Time to shed those winter coats

Check out this interesting article about a COVID-19 breakout spread by minks on a Dutch fur farm.  We still have much to learn about how this virus affects other animal species.

Finally, a belated happy Juneteenth to everyone!  Be safe, be optimistic but patient, be kind, and be part of the solution!  I hope you have a nice weekend, and I’ll see you soon.

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