PREPRINT: Increased risk from COVI-19 in apoe4s

[Fiver]

https://www.medrxiv.org/content/10.1101 ... 20094409v1

Full text: https://www.medrxiv.org/content/10.1101 ... l.pdf+html

APOE E4 GENOTYPE PREDICTS SEVERE COVID-19 IN THE UK BIOBANK COMMUNITY COHORT
View ORCID ProfileChia-Ling Kuo, View ORCID ProfileLuke C Pilling, View ORCID ProfileJanice L Atkins, Jane AH Masoli, Joao Delgado, George A Kuchel, David Melzer
doi: https://doi.org/10.1101/2020.05.07.20094409
This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

Abstract

The novel respiratory disease COVID-19 produces varying symptoms, with fever, cough, and shortness of breath being common. In older adults, we found that pre-existing dementia is a major risk factor (OR = 3.07, 95% CI: 1.71 to 5.50) for COVID-19 hospitalization in the UK Biobank (UKB). In another UK study of 16,749 patients hospitalized for COVID-19, dementia was among the common comorbidities and was associated with higher mortality. Additionally, impaired consciousness, including delirium, is common in severe cases. The ApoE e4 genotype is associated with both dementia and delirium, with the e4e4 (homozygous) genotype associated with high risk of dementia. We therefore aimed to test associations between ApoE e4 alleles and COVID-19 severity, using the UKB data.

[Tincup]

Not surprising, given 4's propensity for inflammation. OR ~2.3-2.4. My own strategy is to maximally avoid all comorbidities. Plus being sure I'm sufficient in 25OHD. That avoids a lot of risk right there. This is just partial, plus consistently testing a bunch of biomarkers at home for a potential early warning.

[Fiver]

Yep. I agree. I expected it too. Still, it seems like piling on.

[FitFoodie]

I hope the researchers analyze the role of long term care facilities in this data.

In NJ 1/3 of deaths are estimated to be in LTC residents,
https://www.npr.org/sections/coronaviru ... fatalities

And I believe that once they double the NJ death toll, adding "probable" cases, that ratio will lean even higher toward LTC residents.
https://www.nytimes.com/interactive/202 ... ll-us.html

My mom died of probable covid last month. She was 88, in late stage of alz/dementia and in a memory care unit. She passed within 3 days of starting a fever. It's unclear how many people in her unit died/are dying of covid, but the number is not small. I could see her roommate's emptied-out side of the room via Skype. I believe the greater vulnerability to Covid is in the communal setting many people with alz/dementia find themselves in, not so much their pre-existing condition. (I don't know what my mom's apoe status was.)

[SusanJ]

My mom died of probable covid last month.

So sorry to hear about your mom, and sending some virtual hugs your way.

There are so many challenges to keeping LTC folks safe. My SIL's father, age 92 in a LTC facility, died 2 weeks ago of Covid-19 (he was tested when he got symptoms). Seemed to be getting better, but then took the sudden turn. Her mother, who has dementia and also in her 90s, just had a mild case and is doing fine now.

So many variables to know exactly who will get a bad case and who won't, but I think we're all agreed on minimizing inflammation is very important.

[NF52]

I hope the researchers analyze the role of long term care facilities in this data.
...
My mom died of probable covid last month. She was 88, in late stage of alz/dementia and in a memory care unit. She passed within 3 days of starting a fever. It's unclear how many people in her unit died/are dying of covid, but the number is not small. I could see her roommate's emptied-out side of the room via Skype. I believe the greater vulnerability to Covid is in the communal setting many people with alz/dementia find themselves in, not so much their pre-existing condition. (I don't know what my mom's apoe status was.)

Please accept my deep condolences for the loss of your mother last month, in circumstances in which I doubt you were able to be with her. My aunt (and godmother) also died last month in a nursing home within days of having what was assumed to be aspiration pneumonia, but tested as COVID-19. My understanding from taking a course to be a COVID-19 Case investigator and Contact Tracer, is that it appears to be the "congregate housing" of many people who share communal sleeping, eating and socializing areas, and who often require personal assistance in feeding, toileting, dressing and other daily living skills, which increases the likelihood of viral particles entering the nose, mouth or eyes. Once they have the virus, their underlying risk factor of age (the immune system may not respond as effectively) and high likelihood of other risk factors (underlying heart disease, reduced strength and mobility, reduced ability to recognize and alert staff to symptoms) make these wonderful loved ones more susceptible.

I know that my cousins felt comforted by the love and care their mother received from the staff, who stayed with their mother while she passed, and asked that any donations go to a relief fund set up especially for those front-line LTC employees. They mentioned that the day before she died, my aunt was laughing (she had a sweet laugh), so I like to think that these oldest-old are spared some of the worry and pain experienced by those in hospitals.

May your mother's life and love be a blessing for you and your family.

[Julie G]

So sorry, (((FitFoodie))). Not being able to be with her must have been so hard. Sending good energy your way. -xo

[roxanne]

So Sorry for your loss FitFoodie, SusanJ and NF52. Let's hope that all this suffering soon comes to an end. SusanJ, it's comforting to know that your SIL's mother is well now. Sending positive energy your way.

[circular]

My heart goes out to all those losing loved ones to Covid, perhaps especially when they are in a facility or the hospital and can't have family with them.

We need to not leave out the huge role that facility protocols and staff diligence play in reducing a communal resident's environmental susceptibility. One nursing home facility I'm familiar with had a large outbreak among both staff and residents, with new cases being reported daily for some time. With extraordinarily hard work and extreme social distancing of the other residents (much to their own suffering and decline -- a story not being reported in the news), they've now gone almost a month without any new presumptive positive or positive cases.

Given the enemy, the past isn't prologue. Once a facility is doing an excellent job containing an outbreak, then there's still the uncertainty of staff going home and being around other family members with their own potential exposures, and/or participating in the 'open up the economy' process, and then asymptomatically reintroducing the virus to the facility.

I hope that assisted living and memory care facilities have incorporated 3-4x/day temperature, BP, and O2 checks, even though normally only skilled nursing facilities do this. They shouldn't be relying on residents to self report. Even a normally competent one, once infected, may not be so reliable. If you have a loved one in such a facility, you might advocate for rigorous screening or see if there's a licensing restriction that prevents it. The nurses who normally hand out medication should be able to do this, although they may have to hire more.

[Fc1345linville]

Circular makes excellent points:
"I hope that assisted living and memory care facilities have incorporated 3-4x/day temperature, BP, and O2 checks, even though normally only skilled nursing facilities do this. They shouldn't be relying on residents to self report. Even a normally competent one, once infected, may not be so reliable. If you have a loved one in such a facility, you might advocate for rigorous screening or see if there's a licensing restriction that prevents it. The nurses who normally hand out medication should be able to do this, although they may have to hire more."

I was a Volunteer Ombudsman in Fairfax County, VA for seven years. Our job was, and still is, to ensure that the Assisted Living and Nursing home facilities are respecting the Federal and State laws governing their operation. Unfortunately those laws do not limit the ratio of first-line staff to residents.
There are many excellent facilities out there, but there are also poor performers which risk the health of their residents, and staff, and in conditions like we have now make all of them potential petri dishes. Another under-regulated industry.