Future of COVID care could lie in human genetics
Why does a seemingly healthy 30-year-old infected with COVID-19 become critically ill and die, while a 95-year-old with the virus experience only mild symptoms? And why does one person at a gathering become infected with the virus while another person with the same exposure remains unaffected?
Those questions have persisted throughout the COVID-19 pandemic, but a new study reveals a source of potential answers: our genetic code. The study, published recently in the prestigious journal Nature, shows that 13 genes are associated with susceptibility to COVID-19 infection or severity of the disease once a person is infected. That means that the genes we were born with may put us at higher risk of catching COVID-19 and becoming critically ill, regardless of what safety precautions we may be taking or our overall health status.
While COVID-19 remains a critical threat to society, this study is an exciting step toward better prevention and treatment. It also represents unparalleled collaboration between genetics researchers around the world. The study spanned 46 different study cohorts in 19 countries and nearly 50,000 COVID-19 patients whose genetic data was already known.
Human genetics is truly the future of medicine because, in the case of COVID-19, it can help us to identify people who would be at higher risk of becoming critically ill. For example, we know that people who are older and obese face a higher risk for severe disease with COVID-19, but those risk factors alone do not explain why people have had vastly different experiences with the virus. Scientists in this study have discovered that genetic factors were driving the clinical outcomes in a subgroup of people who had developed severe, life-threatening illness due to COVID-19. If a person’s genes can tell us who faces a higher risk, we have a better chance of protecting them.
By conducting massive comparisons of the genomes of nearly 50,000 people, researchers were able to identify the 13 genes for their association with COVID-19. Several of the genes are known for the role they play in respiratory conditions, lung diseases and autoimmune diseases. Researchers will no doubt discover additional genes and the roles they play in COVID-19 infection, as more genomes of additional COVID-19 patients are studied and compared.
Interestingly, the study used genetics to link both smoking and body mass index to susceptibility to COVID-19 and more severe disease and death after infection. We already know that smoking and obesity make it more difficult for the body to fight the virus, but the interaction of predisposing gene variants with smoking and obesity makes it more complicated. Researchers continue the work of untangling the cause and effect, but it’s likely that genetic predisposition was involved in worsening symptoms and death.
We still have much to learn from this pandemic. Tragically, minority communities have been among the hardest hit by the virus — a sad reality in which genetics also plays a role. Minorities tend to be genetically predisposed to obesity, diabetes and conditions like heart disease. When the genetic predisposition is taken into account along with social and economic barriers, minorities are significantly more at risk of becoming infected and dying of COVID-19. We must be moved to action by the health disparities that have been laid bare by this pandemic.
Human genomics is an amazing tool in health care. The human genome has about 20,000 genes, and each gene has some 2,000 variants. That represents millions of pieces of information about how each of us will fare when faced with disease and how our bodies would respond to certain medications. Although the COVID-19 genetics study is exciting, we are still far away from using that information to guide patient care. But it is representative of the future. One day, doctors will have our genetic makeup at their fingertips, along with our lab results and imaging data from X-rays or MRI scans. By evaluating them together, doctors will be able to tailor treatments based on the patient’s overall risk assessment.
Until then, we must fight COVID-19 with the tools currently at our disposal. Vaccination remains the most important step a person can take to avoid COVID-19 infection and serious disease. Because Oklahoma faces some of the worst health outcomes in the nation, we must be especially diligent about increasing our vaccination rate. The vaccine is a marvelous advancement that we can use today, while we also work toward harnessing our genetic makeup for more precise disease prevention and treatment.