There are several articles out today on the evolving finding that coronavirus infection appears to result in a binary outcome in otherwise healthy young people; you are either well with minimal symptoms or (in a minority) you get life-threatening disease.
I’ve written about this topic before, but articles from Science Magazine and on CNN reinforce this remarkable conundrum. Even Dr. Fauci has remarked about the unique pathogenesis of this virus can kill some young people.
The article in Science entitled “How sick will the coronavirus make you? The answer may be in your genes,” by Jocelyn Kaiser reinforces many of the themes I have argued. It indicates that there is a focus on young, healthy individuals who have died and she says that “researchers are now gearing up to scour the patients’ genomes for DNA variations that explain this mystery.”
She quotes geneticist Andrea Ganna of the University of Helsinki’s Institute for Molecular Medicine Finland (FIMM) who says “We see huge differences in clinical outcomes and across countries. How much of that is explained by genetic susceptibility is a very open question.” The FIMM group has set up a website to examine these genetic influences.
There are also quotes form Dr. Phillip Murphy at NIH who wonders if differences in the ACE2 protein, which acts as the target for the virus, might play a part. I have argued for a project to examine immunity defining genes in particularly from young people who died from COVID-19 infection. Many of these patients die from their immune response to the virus and not the infection itself.
I also think that it will be important to examine the body fluids and lung tissue of these individuals. We can look in these samples for the evidence of inflammatory markers that correlate with bad outcomes. This is an especially important area to investigate since drugs that block inflammatory cytokines (antibodies to IL-6) appear to help treat these patients.
On a final note, I wish to thank everyone in this country for the remarkable job they been doing with social distancing. The numbers are really beginning to turn in many areas. There’s hope that after a peak this week even hard-hit areas like New York and Detroit will begin to taper off.
So hang in there and keep chill. We may yet make it to the beach this summer!
Pandemic Pondering 
Excellent piece, as usual, Dr. Baker. Thanks very much for sharing your wisdom.
A few things:
1) What’s the status of an antibody test, particularly for folks in SE Mich, like Germany and Italy will be using (when ready) as an indicator of safe return-to-work?
2) For those who need donors who have recovered from COVID-19 for convalescent plasma, where would folks in SE Mich donate? (NB: while a couple links appear broken on link below, the one for American Red Cross works 🙂 https://ccpp19.org/donors/index.html
3) What do you think about COVID-19 being airborne vs droplet (safe as long as you’re 6′ away) — and are you wearing a mask when you go out?
I like what you say: We may yet make it to the beach this summer!
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Antibody testing is difficult to obtain right now. I am trying to get tests from China at the present time.
I have no insights for plasma donations, but several Universities, Johns Hopkins and Mt. Sinai in NYC, are collecting.
I wear a mask if I am going anywhere near people-even 6 feet (have not been to the store in over a week, but was in work). Think if you are running or walking alone it is not necessary.
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I am going to ask this question like I do not know anything about immunology (but I do, so please respond as if I am able to understand more than my question suggests I do).
1) Do asymptomatic carriers create antibodies to clear an infection, 2) is there an alternative to antibody response to resolving the infection, in asymptomatic carriers, 3) will the asymptomatic carrier silently tolerates the infection indefinitely?
Thank you.
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