COVID-19 research yields new details, theories
June 1, 2020
COVID-19 may affect men differently than women
The COVID-19 pandemic is continuing to perplex researchers and is leaving millions of people struggling. It is still not clear why some individuals are more severely affected by the virus than others. So far, adults age 60 and older and those with certain pre-existing conditions appear to be at greater risk. However, a new study in the journal Frontiers in Public Health suggests that men are significantly more likely to suffer severe effects of the disease and die. The results suggest that additional care may be required for older men or those with underlying conditions.
While most people with COVID-19 experience mild symptoms, identifying the factors that predispose people to severe disease and death could help society to protect and treat those most at risk. So far, researchers have confirmed that older COVID-19 patients and those with certain underlying conditions, such as heart disease and respiratory conditions, are at greater risk of severe disease and death. However, Dr. Jin-Kui Yang, a physician at Beijing Tongren Hospital in China, noticed a trend among COVID-19 patients who died. “Early in January, we noticed that the number of men dying from COVID-19 appeared to be higher than the number of women,” said Dr. Yang. “This raised a question: are men more susceptible to getting or dying from COVID-19? We found that no one had measured gender differences in COVID-19 patients, and so began investigating.”
Dr. Yang and a group of colleagues analyzed several patient datasets to see if there were differences in how men and women respond to COVID-19. This included data on 43 patients who the doctors had treated themselves and a publicly available dataset on 1,056 COVID-19 patients. The virus responsible for COVID-19 is similar to the virus behind the 2003 SARS outbreak, and it attaches to the same protein (ACE2) on cells it attacks. Given this similarity, the doctors also analyzed a dataset of 524 SARS patients from 2003.
Among the COVID-19 patients, the researchers confirmed that older adults and those with specific underlying conditions tended to have more severe disease and were more likely to die. The age and numbers of infected men and women were similar, but men tended to have more severe disease. In the largest COVID-19 dataset, more than 70% of the patients who died were men, meaning that men had almost 2.5 times the death rate of women.
In the SARS dataset from 2003, the researchers found a similar trend, with a significantly higher mortality rate amongst males compared with females. Interestingly, levels of ACE2, the protein involved in the viral attack in both SARS and COVID-19, tends to be present in higher levels in men, and also in patients with cardiovascular disease and diabetes. The study may have important implications for patient care.
“We recommend that additional supportive care and prompt access to the intensive care unit may be necessary for older male patients,” said Dr. Yang.
Blood clotting associated with COVID-19
A new study has found that Irish patients admitted to the hospital with severe COVID-19 infection are experiencing abnormal blood clotting that contributes to death in some patients. The study, which was carried out by the Irish Centre for Vascular Biology, RCSI and St James’s Hospital, Dublin, was published in the British Journal of Haematology.
The authors found that abnormal blood clotting occurs in Irish patients with severe COVID-19 infection, causing micro-clots within the lungs. They also found that Irish patients with higher levels of blood clotting activity had a significantly worse prognosis and were more likely to require ICU admission.
“Our novel findings demonstrate that COVID-19 is associated with a unique type of blood clotting disorder that is primarily focused within the lungs and which undoubtedly contributes to the high levels of mortality being seen in patients with COVID-19,” said Professor James O’Donnell, who is Director of the Irish Centre for Vascular Biology, RCSI and Consultant Hematologist in the National Coagulation Centre in St James’s Hospital, Dublin. “In addition to pneumonia affecting the small air sacs within the lungs, we are also finding hundreds of small blood clots throughout the lungs.” He said this scenario is not seen with other types of lung infection, and explains why blood oxygen levels fall dramatically in severe COVID-19 infection.
“Understanding how these micro-clots are being formed within the lung is critical so that we can develop more effective treatments for our patients, particularly those in high risk groups,” said O’Donnell. “Further studies will be required to investigate whether different blood thinning treatments may have a role in selected high risk patients in order to reduce the risk of clot formation.”
Can antibody products help protect individuals?
A clinical trial now is underway looking at whether blood plasma donated by people recovered from COVID-19 could be used to treat other people. Led by researchers from NYU Grossman School of Medicine, Montefiore Health System, and Albert Einstein College of Medicine, the trial will seek to determine whether “convalescent plasma,” if injected into patients’ blood, can keep them from developing the most severe forms of respiratory distress.
Plasma treatments contain antibody blood proteins, which are part of the immune system. Shaped such that they can attach to viruses, antibodies glom onto and tag them for removal from the body. Vaccines work by triggering such reactions, but “passive” treatments like plasma inject antibodies pre-trained to attack the virus in question.
“Infections like the new coronavirus that jump into humans from animals are dangerous because we have no antibodies against them, so we hope to learn if supplying them can save lives,” said co-lead study investigator, Dr. Mila Ortigoza, who is an instructor in the Departments of Medicine and Microbiology at NYU Langone Health. “Vaccines may not be available for more than a year. In the meantime, and given the lack of natural immunity and available vaccines, plasma therapy may help to provide the body what it needs to fight the infection.”
Beyond emergency care, there are no proven treatment options for COVID-19, the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Convalescent plasma becomes a more viable treatment option as the numbers of recovered people continue to grow, said Dr. Ortigoza. While researchers do not know exactly how much antibody is needed, the theory is that plasma taken from one patient may be enough to treat one to three patients. Such plasma treatments were shown to be useful against SARS-CoV-1, the 2003 “SARS” epidemic that caused nearly 800 deaths, and against Ebola during in the 2013 African epidemic, according to the researchers.
The current, randomized phase I (safety) trial seeks to enroll 300 hospitalized patients aged 18 years or more across seven hospital centers. The trial is designed to focus on patients within a tight time window (three to seven days after symptom onset), during which they are sick enough to be hospitalized, but before the onset of overwhelming respiratory distress driven by systemic inflammation. The goal of the trial is to see whether plasma from people who have recovered from COVID-19 can improve oxygenation and reduce the requirement for mechanical ventilation, intensive care unit (ICU) admission, and death.
John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at email@example.com.