In the latest episode of Impetus Digital‘s Fireside Chat, I sat down with Dr. Farah Fourcand, Author of Pandemic Manifesto, as she shared her experience working on the frontlines of the COVID-19 pandemic. She also dived into the psychological impact of COVID-19, lessons learned from the pandemic so far, the unanswered questions surrounding this novel virus, and much more.
Here is a preview of our conversation:
Q: Are we ready to start talking about “population management”? Do we have enough trends, bucketing and segmenting patients by characteristics and health factors, that we can start to do that in order for us to be able to unleash some of the issues around closing down the economy?
A: I do agree that there are genetic differences and then there are epigenetic differences. We’ll separate those. The genetic differences I will talk about are the blood types and also some of the immunoglobulin types that people have. We’ll get into that, it sounds gooey but it makes sense. Then, the epidemiology, meaning certain populations that have a higher incidence and prevalence of certain chronic diseases that in and of themselves make them a higher risk for developing COVID-19.
With regards to blood type, there is Type A, Type B, Type AB, and Type O. Now, there have been studies with SARS, which is one of the viruses that preceded SARS-CoV-2 or COVID-19. SARS and MERS are two coronaviruses that affect humans more severely than the others, like the common cold. There’s been research on this for many years, and now there are studies looking at blood type in COVID-19 as well. It seems that Type O people, who are universal donors but can’t accept anything, but in this case, it’s a positive, they have an anti-A antibody in the plasma that seems to lessen their likelihood of getting SARS-CoV-2 or COVID-19 disease. On the other end, Type A, they don’t have anti-A antibodies because they are Type A, what they have are anti-B antibodies. There have been studies showing that they’re more susceptible to getting SARS-CoV-2 or coronaviruses in general because most coronaviruses do work with the ACE receptor. The Type O, because of their anti-A antibody in the plasma, has less likelihood of attracting the ACE that is largely responsible as a gatekeeper for SARS-Cov-2.
Then, there’s something else that’s not actually discussed much but it’s the immunoglobulins. Those are the antibodies that we have, the IgG, IgM, IgA, and there are IgE and IgD, but we don’t need to worry about that. Ig stands for immunoglobulin, another word for antibody. We all have antibodies. IgM is the antibody that rises up right away and fights an infection very early on. IgGs are antibodies that take a while to develop but stay with you. IgM and IgG are measured usually in antibody testing and sometimes they are not specified nor separated but they’re measured, IgA is not. IgA is an antibody that’s found in all secretions such as in the nasal passages, oropharynx, GI tract, tears, everywhere.
Different people have different amounts of IgA and there are actually genetic diseases where people that have an IgA deficiency are very prone to all sorts of infections, but even people who are healthy have varying levels of IgA. There is some evidence that people with high IgA levels are less likely to be able to contract certain viruses including SARS-CoV-2. I think the blood type and then the IgA scientifically make sense and at least as far as the blood type goes, there is evidence and studies that have been done way before COVID-19 with SARS and now in SARS-CoV-2 that show that there is pathophysiology that makes sense, but clinically, it makes sense as well.
Then there are the populations that are more at risk. The CDC has a list of risk factors that make one more likely to develop severe COVID-19. All of the risk factors that contribute to metabolic syndrome such as diabetes, hypertension, hyperlipidemia, obesity, smoking, asthma, COPD. These risk factors are not specific to COVID-19. These kinds of patients are the ones who come into the hospital for whatever reason, much more often than people who are otherwise healthy. These risk factors increase the risks of stroke, heart disease, and kidney disease. These people are already at a precipice and having this infection just throws them off of there. They’re more likely to get a severe course of the disease.
There are different populations that have a higher prevalence of smoking and obesity, and I think targeting those populations makes sense. As far as education, health literacy education, patients can come to the doctor or the hospital and you really need to talk with them, educate, and empower them. Health literacy is everything, and that’s what they take with them when they leave the doctor’s office. Trying to provide that on a community level or community intervention level makes sense.
Not only health literacy but making sure that there are resources for them to maintain social distancing and all of these factors that we implemented. We say “maintain social distancing, wash your hands, wear a mask,” but we need to make sure that with certain populations, it’s logistically possible for them to maintain some sort of distance. Do they have access to gloves and masks and all of these? What we say may not be practical for certain people and we have to understand that and provide those resources if you truly want to make a difference in that regard. These people also need more access to vaccinations and the secondary things that we’re doing now…
For more of our discussion, you can watch the whole Fireside Chat with Dr. Farah Fourcand, or listen to the podcast version, below.
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