Bacon's Rebellion

Democracy Thrives in Sunlight

Autoimmune Response and Unequal Impacts

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by

James A. Bacon
in

by Carol J. Bova

When I first read of the racial differences in Virginia’s COVID-19 statistics, I wondered how reliable the numbers were. After exploring details from multiple sources, medical and popular, I no longer doubt there is a serious demographic divide in the impact of COVID-19. The disparities are is not limited by race but tie into genetics and early life experience. Socioeconomic status, especially early in life, is too often the foundation for adult impacts of health conditions that increase the risk of severe COVID-19.

Diabetes, chronic lung disease (including moderate to severe asthma, heart disease, obesity, and other chronic diseases are the top four comorbidities for COVID-19, according to an April 3 CDC report. Others include an immunocompromised condition, kidney disease requiring dialysis, pregnancy, being a current or former smoker, neurologic disorders, and liver disease.(1) The report broke down 7,162 COVID-19 cases with “data on the presence or absence of underlying health conditions and other recognized risk factors for severe outcomes from respiratory infections.”(2) Although the results were preliminary and limited by the amount of data collected by health departments, they seem to echo more recent reports.

In that first study of 7,162 COVID-19 cases with completed information on one or more underlying conditions, the CDC found:

On April 17, CDC issued advice to groups at higher risk for severe illness on why each type of comorbidity puts them at higher risk and what actions they should take.(3)

“The Lancet” published a report on March 16, “COVID-19: consider cytokine storm syndromes and immunosuppression.”(4) The article discussed screening for patients with severe COVID-19 “to identify the subgroup of patients for whom immunosuppression could improve mortality.” This screening advice seems to have been overlooked in the rush to try immunosuppressants like chloroquine and other rheumatoid arthritis drugs. Fortunately, chloroquine is becoming available again for with RA and lupus who depend upon it for relief of their conditions.

“Physicians Weekly” posted an article on April 8, “Cytokine Storm: The Sudden Crash in Patients with COVID-19” that describes the “overproduction of immune cells and their activation compounds–cytokines….” which “can lead to respiratory distress and increases the risk of mortality in patients.” (5)

There has been a flurry of articles recently on cytokine storm. One article today (April 21) in The Atlantic, (6) covers the topic in clear English and goes on to explore the CDC report that found significantly higher death rate for Latinos and African Americans than for white Americans. “Rates of death and severe disease are several times higher among racial minorities and people of low socioeconomic status.”

For now, the screening and treatment described in “The Lancet” article must be applied to those COVID-19 patients at high risk to improve their chances of survival.

But there is no instant formula for improving early life experiences. Current medical and educational attempts cannot do all that is needed. Long-term change in lifestyle and attitudes must come from within a culture, not imposed from outside. Perhaps the best hope is for  community organizations, churches, or fraternal groups to be part of the change in developing leaders who are respected and can influence those in their community to guide their children to better lifestyle choices that will reduce their long term health risks.

  1. https://www.cdc.gov/coronavirus/2019-ncov/hcp/underlying-conditions.html
  2. https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm
  3. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html
  4. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30628-0/fulltext
  5. https://www.physiciansweekly.com/cytokine-storm-the-sudden-crash-in-patients-with-covid-19/
  6. https://www.theatlantic.com/health/archive/2020/04/coronavirus-immune-response/610228/

Carol J. Bova is a writer in Mathews County and on the staff of

Chesapeake Style magazine.

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32 responses to “Autoimmune Response and Unequal Impacts”

  1. Steve Haner Avatar
    Steve Haner

    I too ran across the Atlantic article today, on Real Clear Politics/Science and it’s very useful. While I cringe at “race” being blamed as a contributing factor, no question about poverty’s impact. But the lesson there for the taking (but nobody will want to run with it) is that smoking and obesity are deadly mistakes. The heart disease, diabetes and even some of the asthma flow from those. Urban air pollution issues add to the asthma. Some people without the conditions also go into immunity overload and die, but having these issues at the start greatly change the odds.

    https://www.theatlantic.com/health/archive/2020/04/coronavirus-immune-response/610228/

    1. DeptOfTyranny Avatar
      DeptOfTyranny

      and mass transportation

      1. djrippert Avatar
        djrippert

        Yeah – no kidding. How does population density fit in? By and large in America it seems that the hotspots are in densely populated areas. And that population density goes below the “city” level. Staten Island has a density of about 8,000 per sq mi with 11.7% of the residents categorized as black or African-American. Brooklyn has a density of 35,367 per sq mi with 34.1% black or African-American.

        Right now there are approximately 1.0 COVID-19 deaths per 100,000 in Staten Island and 1.2 deaths per 100,000 in Brooklyn

        I’m sure that poverty plays a role in both comorbidity and quality of medical care and black Americans are more likely to be poor than white Americans. However, any true analysis will have to get down to the zip code level before the consequences of living in a higher density area can be taken out of the equation.

        1. Reed Fawell 3rd Avatar
          Reed Fawell 3rd

          Without denying the poverty harms health, I suggest the central problem is culture, the habits and attitudes formed early in particular geographic places that drives each us and whole communities into problematic futures. This of course applies to all skin colors, and classes.

          This is huge subject, pregnant with heretofore possibilities because it gets into preventative measures that can save our society big time in almost endless ways. Problem is we have to monetize it someway.

        2. Dick Hall-Sizemore Avatar
          Dick Hall-Sizemore

          Don, density is certainly a factor in ease of transmission, but it seems to me that the studies were looking at mortality rates of those with COVID-19 without regard to the location of contraction. It would seem that the chances of dying would be more dependent on factors related to the individual and his health, rather than where he lived.

          1. Reed Fawell 3rd Avatar
            Reed Fawell 3rd

            I suspect that is right, if quality of health care is equal.

        3. LarrytheG Avatar
          LarrytheG

          need to define “density”. Most of the time, it’s used to talk about how many people per acre or square mile – not how many people are in a church (for instance).

          You can have a church in a very sparse rural area – with very minimal density but if that church has 300 people in it – it’s no different than a church in a place like Fairfax.

          You can have a very popular restaurant in a rural area but if it has 100 people in it – it’s no different than a restaurant in Fairfax with 100 people in it.

    2. LarrytheG Avatar
      LarrytheG

      Yes… and a couple of things:

      1. – rural folks have their share of these bad habits… black and white

      2.- A lot of human bodies when they get to age 50 are not in the best condition. A substantial percent of the population is obese – even kids, and folks in their 20s and 30s. Ditto with diabetes…

      What would you do about this in terms of a pandemic?

      just write them off and tell them all to shelter in place?

      if they have to see a doctor – and that doctor’s office has infected
      people in the waiting room – what happens?

      1. Nancy_Naive Avatar
        Nancy_Naive

        Meth… don’t forget those rural folks do like their meth and meth labs

        1. LarrytheG Avatar
          LarrytheG

          an oxy-contin and cigarettes and moonshine…

          but it sounds like if you have bad habits or bad genes – you deserve to die or some such, right?

    3. LarrytheG Avatar
      LarrytheG

      re: ” But the lesson there for the taking (but nobody will want to run with it) is that smoking and obesity are deadly mistakes. ”

      yep – but as they say – the REST of the story………

      If one receives regular medical care – a primary care physician, he/she will advise you and help you quit smoking, lose weight, and start exercising, take blood pressure pills and statins, etc.

      If you do not have regular medical care and a primary care physician, you do not benefit from such intervention, you typically quite often just roll downhill to an earlier death. A map of Virginia, showing life expectancy by county will show dramatic differences.

      It can’t be that everyone in the low life-expectancy counties has bad habits and everyone in the higher-life-expectancy counties have good habits. It has more to do with access to health care which, in turn, is related to income.

  2. Peter Galuszka Avatar
    Peter Galuszka

    Huh? So minorities are that way and nothing can be done about it. You don’t make your case. Btw, are you a doctor or researcher with credentials?

  3. Nancy_Naive Avatar
    Nancy_Naive

    What was the racial breakdown in Italy?

    1. Steve Haner Avatar
      Steve Haner

      Or Belgium. It leads in per capita deaths.

      1. Nancy_Naive Avatar
        Nancy_Naive

        Sweden ain’t doing bad either. I’ll bet the blondes fare better.

  4. cjbova Avatar
    cjbova

    Peter, I don’t need to be a doctor to read and share resources or an opinion.
    Do you disagree with what I said, that there is a divide in impacts? Or that it “is not limited by race, but ties into genetics and early life experience. Socioeconomic status, especially early in life, is too often the foundation for adult impacts of health conditions that increase the risk of severe COVID-19.”

    I point out there is something that can be done now about the COVID-19 by using the screening and if indicated, use of immunosuppressants described in”The Lancet” article.

    NN, did you miss the impact divide “is not limited by race?”

  5. Dick Hall-Sizemore Avatar
    Dick Hall-Sizemore

    Thanks for a reasoned discussion of these issues.

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      I agree with Dick’s assessment.

  6. Peter Galuszka Avatar
    Peter Galuszka

    Strikes me as racist as hell.

  7. TBill Avatar
    TBill

    I am very interested in this stuff, but I am going to take a wait-and-see attitude to let the hypotheses mature more into accepted theories. No doubt we have apparent differing effects in cohort groups (but the Virginia racial data was less complete and less helpful at first).

  8. Fred Costello Avatar
    Fred Costello

    Can we determine how the various models incorporate these hypotheses?

  9. Fred Costello Avatar
    Fred Costello

    CJBova’s data (population density, Coronavirus cases, Hospitalizations, Median income, and poverty level):
    Alexandria City 10,221 474 65 $96,733 10.10%
    Arlington County 8,309 663 116 $112,138 6.30%
    Fairfax County 3,786 2,256 405 $98,514 6.13%
    Henrico County 1,300 684 96 $68,438 10.40%
    Prince William 1,200 924 101 $98,514 6.95%
    shows that areas of higher density has fewer infections (correlation coefficient = -0.3), areas of higher poverty has fewer cases (cc = -0.6), and areas of higher income have more cases (cc = +0.1) . Counterintuitive?

    1. Reed Fawell 3rd Avatar
      Reed Fawell 3rd

      Great comment. Travel likely is key here?

    2. idiocracy Avatar
      idiocracy

      Well, I suppose you could draw a useful conclusion from that data if counties were exactly the same size.

  10. cjbova Avatar
    cjbova

    Thank you, Fred. I gave up on trying to get it to post in correct alignment. I think it shows only that we can’t use widescale conditions to predict the outcome of the virus.

    As Reed points out, travel was a major factor early on.
    A quick search of news reports shows 2 passengers from Fairfax were on the Egyptian Nile cruise where 2 others from Virginia Beach were also infected. That cruise and others in late February and early March were linked to 15 cases in Florida, 1 in Hawaii, 15 in Iowa, 6 in Maryland, 2 in Ohio, 2 in Pennsylvania, and 12 in Texas.
    Two of the Maryland passengers who got sick had visited large groups after their return, but before they fell ill, one in Philadelphia, the other in Rockville, Md.

  11. LarrytheG Avatar
    LarrytheG

    I’d offer my views as usual for what it’s worth (or not).

    I think there are two parts here:
    1. – how disease migrates through a population and

    2. – the effect of the disease on people, regardless of race or culture but more with respect to having health conditions that are managed and treated or not.

    travel – or movement from one population to another – really irregardless of where they came from – near or far – if where they came from had infection disease problems.

    Whether it’s someone from Europe to the US or someone from NY to Myrtle Beach – it’s the same basis issue if someone brought disease with them.

    And no great shock – more than a few communities in the US don’t want people from outside their community coming in – even if they own a second home!

    And this is why social distancing is so important even in mostly isolated communities if ANYONE – even people in those communities had traveled outside that area then returned.

    If you truly cannot fully lock down a community and stop all “travel” – then it’s imperative that you practice social distancing.

    The second part here is whether or not someone who has existing health conditions are actively managing them or not. It’s not that some cultures or races have more/worse bad lifestyle habits as much as it is whether or not they have continuous access to a primary care doctor who knows their medical history and has been treating them and managing their health over that time.

    In Virginia – and other places, if you did not receive a good education and/or go to college – as many in the black community did experience over time, the chances are that your job is a low-income job and does not provide health insurance so ergo, you don’t really have continuous relationship with a primary care doctor.

    People who DO have a better job and health coverage ALSO develop health conditions like obesity, heart disease, diabetes but their conditions are monitored and managed.

    The primary difference is not race or culture – it’s access to medical care.

    And you can see this on county-level maps for states like Virginia. Poor counties that do not have good access to medical care how lower life expectancies – no matter their race or culture.

    If you are low income without health insurance, the chances are you’re going to fare much worse than someone who does have health insurance and a regular doctor.

  12. cjbova Avatar
    cjbova

    Larry, the side note about travel was just that–a side note to look at population density and socioeconomic levels in serious outbreak areas.

    You are missing the main point though. This virus can trigger an autoimmune response that can be life-threatening and sudden. With COVD-19, it is not a matter of managing pre-existing conditions, or even how they have been managed. It’s about increasing survival chances in severe cases of COVID-19 now.

    It is about knowing which conditions increase the possibility of the virus causing the body to react to its own tissues in fatal ways, testing for hyperinflammation, and responding promptly with immunosuppressants and other treatments if it’s found.

    1. LarrytheG Avatar
      LarrytheG

      Boy did I miss that! I thought I had gone back up and read the post!

      In terms of those conditions – don’t you think this is ongoing and not yet really fully understood?

      This particular aspect of how to treat – is not only important but could be exceptionally important if a vaccine cannot be developed. We do not even have vaccines for some existing viruses.

      There is no universal flu vaccine. There are no vaccines with long-lasting protection against malaria or tuberculosis.

      None for parasites like Chagas, elephantiasis, hookworm or liver flukes. None for some viral threats that could become pandemic, like Nipah, Lassa and Middle East Respiratory Syndrome.

      None for some that already have, including Lyme, West Nile, Zika and hepatitis C.

      None for respiratory syncytial virus, which kills infants, nor even for the dozens of causes of common colds.

      but a lack of access to health care in the first place, pretty much trumps all disease and leads to death for those who have treatable diseases but fail to get diagnosed and treated.

      This is common in 3rd world countries but it’s also a problem in the US between those who have good access to health care and those that do not.

  13. James Wyatt Whitehead V Avatar
    James Wyatt Whitehead V

    120 years ago Virginia addressed the crippling disease of TB by building 3 sanitoriums like this one in Charlottesville.
    http://www.asylumprojects.org/index.php?title=Blue_Ridge_Sanatorium

  14. LarrytheG Avatar
    LarrytheG

    yep – and it’s STILL with us:

    In 2017, Virginia reported 204 cases of tuberculosis (TB), a 0.5% increase from the 203cases reported in 2016. Nationally, the CDC reported 9,093 TB cases for 2017, a 1.8%decrease from 2016. Virginia ranked 12th in the United States by number of cases and20th by rate, with a rate of 2.4 per 100,000 population in 2017. Virginia’s TB case ratehas stayed below the national rate, but has seen a slight increase in recent years fromthe state’s lowest rate in 2013 of 2.2 per 100,000.

    And contact tracing is the standard procedure when a person is discovered to be infected.

    Every infection disease has different characteristics in terms of how it is transmitted and so the procedure for contact tracing varies accordingly.

  15. James Wyatt Whitehead V Avatar
    James Wyatt Whitehead V

    I thought the story of the Piedmont Sanitorium was interesting. Ivor and Lynchburg did not want a black sanitorium. It was finally built in Burkittsville against the wishes of the locals. It looks to be the most modern and well made sanitorium of the three Virginia had. The patients end up merging with Blue Ridge in 1965. Apparently it was a smooth integration. I wonder what will be done with this place in the future. Are there any good lessons to draw from the TB sanitorium era? They might be useful today.

    http://www.asylumprojects.org/index.php/Piedmont_Sanatorium

    1. LarrytheG Avatar
      LarrytheG

      buildings this old are usually not remodleable cheaper than if you built new. We have an old high school built in the 1940s or 1950s and they
      had engineering study done and all the pipes and electric would have
      to be redone.. they’d have to gut the inside completely …

      But what happens to people today who have TB? Do they still have to go to a sanitorium , for how long, etc?

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