COVID-19 scientific review

Susceptibility to emerging infections such as COVID-19

(under preparation)

List of authors

  • Tomer Illouz, Bar-Ilan University, Israel
  • Arya Biragyn, Laboratory of Molecular Biology and Immunology, NIA, NIH
  • Orly Weissberg, Bar-Ilan University, Israel
  • Alessandro Gorohovski, Bar-Ilan University, Israel
  • Milana Frenkel-Morgenstern, Bar-Ilan University, Israel
  • Eugene Merzon, Tel Aviv University, Israel
  • Ilan Green, Tel Aviv University, Israel
  • Florencia lulita, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  • Lisi Flores-Aguilar, McGill University, Canada
  • Maria del Mar Dierssen Sotos, Centre for Genomic Regulation (CRG), Spain
  • Ilario De Toma, Centre for Genomic Regulation (CRG), Spain
  • Hefziba Lifshitz, Bar-Ilan University, Israel
  • Ayelet Gur, Bar-Ilan University, Israel
  • Sigal Eden, Bar-Ilan University, Israel
  • Stylianos antonarakis, University of Geneva, Switzerland
  • Eugene Yu, Roswell Park Comprehensive Cancer Center, USA
  • Yann Herault, Institut de Génétique Biologie Moléculaire et Cellulaire, IGBMC, France
  • Marie-Claude Potier, Paris Brain Institute (ICM), France
  • Randall Roper, University Indianapolis Benjamin Sredni, USA
  • Ronit Sarid, Bar-Ilan University, Israel
  • Jacqueline London, Université de Paris, France
  • William Mobley, University of California, San Diego, USA
  • Andre Strydom, King’s College London, UK
  • Eitan Okun, Bar-Ilan University, Israel

The recent SARS-CoV-2 outbreak, which causes COVID-19, has proven to be particularly devastating for elderly individuals (>60 years old), especially for those with chronic medical conditions (i.e., hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer). As of now, the SARS-CoV-2 virus infection has been confirmed in at least 1,904,566 persons worldwide and is responsible for at least 118,459 deaths, numbers that are expected to continue to rise in the coming weeks.

The fast spread of SARS-Cov-2 has outpaced the development of drugs with demonstrated ability to prevent infection or lessen its effects. Therefore, no drug therapy has been officially approved thus far. Small clinical studies and anecdotal accounts from clinicians have provided some preliminary evidence, but the evidence base is still in an embryonic phase, and much remains before it is shown which treatments are effective.

Nevertheless, the U.S. based Food and Drug Administration (FDA) issued an emergency investigational new drug (eIND) use authorization for remdesivir (an anti-viral treatment originally used for Ebola infections) and for hydroxychloroquine (an old anti-malaria treatment) so that physicians can prescribe them. In addition, the FDA has issued an eIND protocol in which plasma collected from individuals who have recovered from COVID-19 can be delivered into critically ill patients in the hope that the antibodies to the virus will lessen disease severity. In Europe, many hospitals are combining hydroxychloroquine with azithromycin (an antibiotic with anti-inflammatory and possibly antiviral action). They have also used ivermectin, an FDA-approved anti-parasitic with anti-viral activity in vitro against SARS-CoV-2, and Tocilizumab, an anti-IL6 treatment used for reducing the virus-induced cytokine storm and deterioration of lung function in SARS-CoV2 severe pneumonitis. Many of these experimental treatments are associated with significant side effects.  Decisions regarding initiation of treatment should always be balanced against potential risks. Very recently, several clinical trials, which are essential for defining safety and efficacy of anti-viral treatments, have been initiated (see https://clinicaltrials.gov/). The European Medicines Agency (EMA) has created a special task force to take quick and coordinated action for the development and authorization of safe therapeutics and vaccines against COVID-19.

  • Testing for SARS-Cov-2 positivity in symptomatic and asymptomatic at-risk individuals may be an efficient way to reduce mortality and the spreading of COVID-19 (http://www.uni-goettingen.de/en/606540.html). Nasopharyngeal samples and sputum are typically used to detect viral genome using RT-QPCR with a sensitivity of around 500 RNA copies. These tests can potentially be widely used in individuals with Down syndrome (DS). Just as in the general population, priority should be given to those presenting with any symptom related to COVID-19, such as fever, tiredness, dry cough, shortness of breath, aches and pains, sore throat, diarrhea, nausea, runny nose, loss of smell and/or taste. However, there have been difficulties in developing sufficient testing capacity in many countries. In addition, the false negative rate of these tests may also be an issue.
  • At T21RS, we are concerned about the potential impact of SARS-CoV-2 infection in individuals with DS. Our concern for those with DS is based on their higher prevalence for respiratory tract infections and immune complications, including increased incidence of periodontal disease, infectious, and autoimmune disease. The extent of immune impairment in DS can be substantial, including functional anomalies in a variety of immune cells (i.e., T- and B-cells, monocytes and neutrophils) that are of importance to both immune response and suboptimal antibody responses to vaccination.
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