Chapel Scientists Discuss Covid-19

Posted on April 25, 2020 by Julian Smith

To Richard Malaure & Alex Gordon

Dear In-house Phd Microbiologist & MSt Epidemiologist

I hope this finds you both well.

Got your date for next year Richard, and keep-up the good work Alex in supporting two of your family’s households / temporary lodgings.

Could I please ask for your comments on the link below …

https://www.bbc.co.uk/news/health-52243605

All the very best

Julian

Richard Responds

The scientists are trying to see if there is a genetic element to the impact of Covid. The answer is obviously yes – there are always some people who catch and have no symptoms and some that die, and everything in between. That is why there are always survivors from a plague etc.
The exit for this is so complicated and is important as Covid is so easily transmissable.

My take on exit will be: (1) need for an antibody test that shows if someone has had covid and is now immune – this lot can then go back to work, if the whole household is immune!) All gone quiet on this at the  moment; (2) if there is a genetic element, to identify the ones least impacted, so undertake a genetic test – this lot can then go back to work and catch-it – tricky morally! (3) need a vaccine – this would be combined with the antibody test, if negative to the antibody, vaccinate them – health and care workers first in the queue and then the old, unwell and genetically vulnerable

Unknowns: (1) are there different versions of covid now, mutated?. Need a range of tests? (2) can you catch it twice, because it mutates. Common cold is an example of this issue.

So, I think we have a very difficult exit which will be based on how the NHS is coping.

We’re only half way through round 1 of this match.

All very troubling

Richard

Alex Responds

Thank you for sending me the link about the UK Biobank, which I found
interesting.  It is exactly the sort of thing that appeals to my inner
epidemiologist.  (This is not to diminish the severity of the problem,
however interesting the research questions are.)

The first thing that I’d note is that the biobank can be used in to
determine risk factors (eg, if a number of people have a particular
gene marker Y, this appears to indicate a heightened risk of outcome
X).  This is a simplified relationship being characterised between X
and Y (a link, but not necessarily a causal one), controlling for a
range of other factors.

My second note:  Those other factors are, as you might imagine, not
limited to other gene markers.  Other factors can be behavioural or
lifestyle-specific or even exogenous interventions, and these other
factors along with the genetic ones combine to shape outcomes.
Identifying those other factors and hypothesising their relationship,
is the work of many dissertations and papers.

So when they mention ACE2, for instance, this gene may in itself go
some distance to explain severity of response to coronavirus; it may
have strong explanatory power, or it may be that when considered in
conjunction with other factors there are strong interactive effects
(which themselves could compound/aggravate the effects, or could be
countervailing).  What hypotheses they develop to account for other
factors will perhaps yield the most useful results, since no one lives
in a vacuum, people are different, and they live their lives very
differently indeed.

They closed with a reference to the parallel study at Rockefeller,
which reminded me that New York has many cases (more than any country apart from its own, in fact).  Which made me think:  what do they do about people otherwise described as healthy who are exposed to high
levels of pollutions for a long period of time ?  If living in NYC is
akin to smoking several cigarettes a day, does this rule out many of
their potential data points ?

I’ll close with a last question, which takes perhaps steps back a bit.
The broader evidence suggests that severe cases, particularly those
resulting in death, are disproportionately in men.  Will this research
examine the hypothesis that a number of genes that relate to immunity
are on the X chromosome, causing the women do rather better ?

I hope that you are keeping yourselves safe and comfortable.

Alex