Dr. Al-Hajj Club *
The world has reached a critical stage in its efforts to combat the emerging corona virus, which causes the “Covid-19” disease, at the time of writing this report, more than a million people have died as a result of their infection with the virus.
People are affected in different ways after infection with the Coronavirus (whose scientific name is SARS-CoV-2), with a subset of severe illnesses and respiratory failure.
Despite the ongoing efforts to develop a vaccine, supplies will be limited at first, with Coronavirus vaccines not being widely available until at least mid-2021.
The question that arises, then, is: Who should get the vaccine first? Most of us agree that frontline health care workers and people at risk of serious illness should be vaccinated first.
According to data issued by the Centers for Disease Control and Prevention, the admission rates of patients with “Covid-19” virus between the ages of 75 and 84 years to receive treatment increase by 8 times, and their death rate increases by 220 times compared to people between the ages of 18 and 29 years old. The hospitalization rate for treatment rises 13 times, and the death rate to 630 times for patients over the age of 85.
This was not always the case with other epidemics. The swine flu virus that spread in 2009 posed a great danger to children aged 5-18 years, and people between the ages of 25 and 49 years in particular.
Likewise, the severity of the Spanish flu that spread in 1918 was noted due to the high death rate among adults aged 20 to 40 years.
And when a virus spreads, it is important to quickly identify the most vulnerable group in the population and give priority to treatment and protection.
Therefore, it is imperative to find strategies to identify subgroups of the population that are at high risk and to develop rapid approaches to diagnosis and treatment.
Precision medicine is a new approach to treating and preventing diseases based on each person’s genetic makeup, lifestyle, and environment in which they live. This approach is being promoted as the future of healthcare where appropriate treatment methods are designed for the patient – each one – and is the opposite of the idea of a one-size-fits-all approach currently used in healthcare facilities.
Precision medicine approaches have entered the mainstream clinical practice of oncology, where treatment modalities are chosen and designed specifically to target genetic mutations in cancer.
In precision oncology, biomarker-guided trials are currently developing as a new approach to cancer research. Genetic information is a hallmark of precision medicine due to its ability to explain individual differences in disease risk and response to treatment.
The risk of developing certain infectious diseases can be known by knowing the changes in a person’s DNA. A famous example of this is the “CCR5 – Delta 32” mutation known to give immunity against the acquired human immunodeficiency virus (AIDS). Some scientists even indicated that this mutation may have provided protection against the plague, which explains its high frequency among Europeans due to Positive checks.
Currently ongoing research has provided valuable insights into the genetic susceptibility to infection and severe diseases caused by the “Covid-19” virus.
Genetic defects have been discovered that affect the interferon response to infection in some critically ill patients. Type 1 interferons are known to play a major role in the immune response to viruses during the first stage of infection.
Likewise, a genome-linked study in France and Spain revealed the presence of interfering link signals in a region on chromosome 3, as well as at the blood group site in HIV-infected patients with respiratory failure.
This research has confirmed the results of non-genetic studies that showed lower risks in individuals who have blood type “or” (O), with the possibility of diseases who have blood type “A” (A) infection with the virus to a small degree.
Likewise, recent results of a large study conducted by the giant “23 & Me” company for direct consumer genetic examinations show a strong association between blood type and symptoms of infection with “Covid-19”.
This study also confirmed the existence of a link between a gene on chromosome 3, the gene “SLC6A20” (SLC6A20), and an increased risk of severe disease.
Moreover, the researchers noted many risk factors that require hospitalization for treatment for Covid-19 infection, including advanced age, gender, obesity, socio-economic status, in addition to pre-existing respiratory diseases and heart metabolism.
The role is still limited
Despite the increasing importance of precision medicine in predicting, preventing and treating diseases, its role in combating the “Covid-19” virus has been limited.
This is not surprising given that big data is essential to developing a PM-based approach, and collecting such a large amount of data may not be possible during a rapid response to a pandemic.
23 & Me was able to conduct the extensive analysis that we referred to before after contacting more than 6 million individuals from the company’s customer base to participate in the analysis, with only 1 million people participating in this study.
Just imagine the results that would have happened if the genetic and clinical data and information from the wearable devices of an entire population were already integrated into electronic health records so that AI and machine learning techniques could be applied quickly to understand disease risks.
This can provide us with valuable insights on how to identify, prevent and protect people at high risk during the early stages of a pandemic. This could also have allowed the development of an ethical framework for prioritizing resource allocation when health resources are limited.
After years of careful investment and planning, Qatar is among the countries well positioned to implement such a strategy for facing future epidemics.
These countries have established genome projects to monitor DNA sequences of the entire population. However, the ability to quickly access relevant health data and analyze it in real time is vital during rapid response times.
Therefore, there is an urgent need to develop a strategy to accelerate the incorporation of genomic data into EHRs. Patient data from these central repositories can be quickly published to determine disease risk in epidemics. This will help us anticipate the most vulnerable among us and those who need ongoing care and support.
There is no doubt that there will be privacy concerns and difficulties in obtaining informed consent when implementing such methods. Governments, international organizations and regulatory bodies have a responsibility to develop innovative ways to overcome such challenges while preserving our genetic and clinical data. The spread of the “Covid-19” virus has shown us that access to accurate and timely data is more important than ever.
We must always remember that we must be prepared to deal with the spread of any pandemic in the future instead of just making assumptions and perceptions to deal with it in the event it does occur, and that our comprehensive response to the “Covid-19” pandemic must be useful in our preparation to deal with any future pandemic.
Digitizing health care services, applying accurate diagnostic procedures, and rapidly assessing risks at large scale can help ease the burden when the worst happens.
* Dr. Nadi Al-Hajj holds the position of Assistant Professor in the Department of Genomics and Precision Medicine at the College of Health and Life Sciences at Hamad Bin Khalifa University in Qatar.