Genetics, Alzheimer's, cancer factor into COVID vulnerability

Everyone has been impacted by the COVID-19 pandemic, but a new study by researchers at the University of Groningen, Netherlands has found that some individuals weathered the stress of the pandemic better than others, in part, due to their genetics.

How a person perceives their quality of life depends on a combination of factors that include the genes they inherited from their parents and their environment (a mix of nature and nurture). Studying genes related to quality of life can be complicated, but the COVID-19 pandemic allowed the researchers to investigate how this stressful, worldwide event interacted with a person’s genetics to affect their overall wellbeing.

The team screened the genomes of more than 27,000 participants in the Netherlands who had donated genetic material to a biobank. They looked for connections between genetic variants and the participants’ responses to a series of questionnaires about lifestyle and mental and physical health given over 10 months starting in March 2020.

The researchers found that some individuals had a genetic tendency toward better well-being than others during the pandemic. As the pandemic wore on, they found that genetic tendency had an increasingly powerful influence on how those people perceived their quality of life, potentially due to the social isolation required by strict COVID-19 containment measures. The findings are published in the journal PLOS Genetics and they demonstrate that the contribution of genetics to complex traits like wellbeing can change over time.

Breakthrough COVID-19

Breakthrough COVID-19 cases resulting in infections, hospitalizations and deaths are significantly more likely in patients with cancer and Alzheimer’s patients, according to two new studies from researchers at the Case Western Reserve University School of Medicine.

Individuals with these diseases are more susceptible to infections in general and are among the population’s most vulnerable to severe health outcomes from COVID-19 infections as well. The studies come as the U.S. total of COVID-19 deaths since the pandemic surpassed 1 million.

The first study, published recently in Journal of the American Medical Association (JAMA) Oncology, analyzed electronic health records to track the number of breakthrough COVID infections, hospitalizations and mortality rates among vaccinated patients with cancer. A “breakthrough infection” is when a fully vaccinated person contracts COVID.

The research team counted people diagnosed with the 12 most common types of cancer: lung, breast, colorectal, bladder, liver, endometrial, skin, prostate, thyroid and blood cancers. These participants received COVID-19 vaccinations between December 2020 and November 2021 and had not previously been infected. The control group consisted of vaccinated participants without cancer.

The researchers compared breakthrough COVID-19 infections between cancer and non-cancer participants, matching for comorbidities, social determinants of health, age and gender, and other demographics. The team analyzed the records of more than 636,000 vaccinated patients, including more than 45,000 vaccinated people with cancer.

“This study showed significantly increased risks for COVID-19 breakthrough infection in vaccinated patients with cancer, especially those undergoing active cancer care, with marked variations among specific cancer types,” said study co-author Rong Xu, professor of biomedical informatics at the Case School of Medicine, Cleveland, Ohio.

The overall risk of breakthrough COVID infections in vaccinated people with cancer was 13.6%, compared to 4.9% for vaccinated people without cancer. The highest risk of breakthrough infections was in people with pancreatic cancer at 24.7%, liver cancer 22.8%, lung cancer 20.4% and colorectal cancer 17.5%.

Cancers with lower risk of breakthrough infections included thyroid 10.3%, endometrial 11.9%, and breast 11.9%. The overall risk for hospitalization following a breakthrough infection occurred 31.6% in those with cancer compared to a rate of 3.9% in those without cancer.

The risk of death was 6.7% following a breakthrough infection, compared to 1.3% in patients without cancer.

Breakthrough infections in patients with cancer were associated with significant and substantial risks for hospitalizations and mortality. These results emphasize the need for patients with cancer to maintain mitigation practice, especially with the emergence of different virus variants and the waning immunity of vaccines, according to the researchers.

In a second study, researchers analyzed electronic health data to examine the incidence rate of breakthrough COVID-19 infections in those diagnosed with some subtypes of dementia. The study was published in the journal, Alzheimer’s & Dementia, and the findings were striking.

The researchers examined data on breakthrough COVID-19 cases in those with dementia. They assessed anonymous electronic health data from more than 262,847 adults 65 or older vaccinated between December 2020 and August 2021, and who didn’t have the infection before being vaccinated. Of that number, 2,764 people were diagnosed with Alzheimer’s disease; 1,244 with vascular dementia, 259 with Lewy body dementia, 229 with frontotemporal dementia and 4,385 with mild cognitive impairment.

The researchers compared the overall risks of breakthrough infections in vaccinated patients with dementia to those without any cognitive impairment. Vaccinated patients with dementia had an overall risk for breakthrough infections ranging from 10.3% for Alzheimer’s disease to 14.3% for Lewy body dementia, significantly higher than the 5.6% in the vaccinated older adults without dementia.

“Patients with dementia have a significantly higher rate of breakthrough COVID infections after vaccination than patients of the same age and risk factors other than dementia,” said Pamela Davis, a Research Professor at Case School of Medicine. “Therefore, continued vigilance is needed, even after vaccination, to protect this vulnerable population. Caregivers should consider ongoing masking and social distancing, as well as booster vaccines to protect these individuals.”

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