Understanding How Covid-19 Affects People with Rare Immunological Disorders Can Help Scientists Uncover What Protects Us Against It
Studying how immunocompromised patients react to the coronavirus may offer valuable insights into combating severe Covid-19 infections.
A Retrospective Study
Researchers called for global medical and scientific communities to provide case studies of Covid-19 patients with rare inborn errors of immunity (IEI). Data from 94 IEI patients who battled the disease was gathered.
Contrary to expectations, the patients were not elderly. Their median age ranged from 25 to 34 years (including children), with just over half suffering from primary antibody deficiencies. Other disorders included immune dysregulation syndromes, phagocyte defects, autoinflammatory disorders, and bone marrow failure.
Among the 94 individuals, 10 were asymptomatic, 25 were treated on an outpatient basis, 28 required hospitalization without intensive care or ventilation, 13 needed non-invasive ventilation or oxygen administration, and 18 were admitted to the ICU.
Among those in intensive care, 12 required invasive ventilation, and three received extracorporeal membrane oxygenation.
The most common symptoms were fever, cough, runny nose/sneezing, and shortness of breath. Some patients also experienced gastrointestinal issues, muscle pain, fatigue, sore throat, loss of smell and taste, and anemia.
Comorbidities Remain the Primary Factor
Over 30% of the patients experienced only mild Covid-19, but risk factors and mortality rates for those with severe infection were similar to the rest of the population without immunological disorders.
Some of these risk factors included comorbidities such as hypertension, obesity, diabetes, lung and heart diseases, age, and sex. This means that having an IEI is not necessarily a predominant risk factor for Covid-19.
The treatment strategies for the entire cohort included antibiotics, immunoglobulin replacement, hydroxychloroquine/chloroquine, steroids, antivirals, monoclonal antibodies, and an anticoagulant. Five patients received convalescent plasma therapy along with other treatments – and only one of them died.
Specific Immune System Characteristics
Through the study, researchers also identified specific immune system characteristics that potentially lead to asymptomatic/mild and severe cases.
Those with a defect in the adaptive immune system recovered and did not suffer from severe Covid-19.
Thus, certain components of adaptive immunity do not appear to be essential in controlling SARS-CoV-2 infection. Instead, these adaptive immune deficiencies may even contribute to a milder course by reducing immune-mediated sequelae.
Research on patients with IEI during the pandemic could prove beneficial not only for treatment but also for the general population. Understanding how genes and autoantibodies may contribute to Covid-19 outcomes could lead to more effective interventions and strategies for managing the virus.