The Looming Disaster of Underestimating Covid Autoimmunity

Summary

Dr. Philip McMillan emphasizes the underestimation of autoimmunity in the context of severe COVID-19, which he describes as a viral-mediated autoimmune disease. He discusses a significant German study that found a 42.63% higher likelihood of developing autoimmunity in patients with a history of COVID-19, particularly those with more severe cases. The study, which analyzed healthcare data of millions, identified conditions like Hashimoto thyroiditis, Graves disease, psoriasis, and rheumatoid arthritis as being associated with post-COVID autoimmunity. Dr. McMillan stresses the importance of understanding autoimmunity for proper treatment and future health implications, comparing it to a 'silent disease' like hypertension. He calls for more research and a targeted approach to treatment, especially considering the potential long-term risks of the pandemic.

Takeaways

• 🧬 Autoimmunity is a critical aspect of severe COVID-19, which is considered a viral-mediated autoimmune disease.
• 🔬 The immune system in autoimmunity mistakenly targets normal proteins in the body, similar to friendly fire in a war.
• 📉 The risk of autoimmunity is linked to the body's response to the spike protein of the SARS-CoV-2 virus, particularly its receptor binding domain.
• 📚 A study out of Germany found a 42.63% higher likelihood of acquiring autoimmunity in patients who had COVID-19, with more severe cases at greater risk.
• 📈 The study highlighted an increased incidence of autoimmune diseases such as Hashimoto thyroiditis, Graves disease, psoriasis, and rheumatoid arthritis post-COVID-19.
• 👥 The research involved a large cohort, examining over 38 million insured individuals to identify 641,000 COVID-19 cases.
• 📊 The excess risk for any newly diagnosed autoimmune disease was 4.5 per 1,000 person-years, a significant figure across a large population.
• 🧐 Autoimmunity often goes undetected unless actively sought, making it a 'silent disease' similar to hypertension.
• ⚠️ The long-term implications of underestimating autoimmunity in the context of COVID-19 are severe and not easily resolved.
• 🧐 There are significant questions regarding the treatment of COVID-19 in the context of autoimmunity that need further research.
• 🌟 The scientific community is beginning to recognize the importance of autoimmunity in the pathogenesis of COVID-19, although this recognition has been slow.

Q & A

What is Dr. Philip McMillan's primary focus regarding autoimmunity and COVID-19?

Dr. Philip McMillan's primary focus is on the concept that severe COVID-19 is a viral-mediated autoimmune disease, which has implications for treatment and the types of diseases to look out for post-COVID-19 infection.

Why is autoimmunity in the context of COVID-19 considered critical?

Autoimmunity is critical because it affects how the immune system targets normal proteins in the body, which can lead to complex, difficult-to-treat conditions and needs to be actively sought out and understood to prevent long-term health impacts.

What is the main point of the paper discussed by Dr. McMillan?

The paper discusses the association between SARS-CoV-2 infection and the incidence of autoimmune diseases, highlighting a higher likelihood of autoimmunity post-COVID-19 infection, especially in patients with more severe cases.

What is the significance of the spike protein in the context of autoimmunity?

The spike protein is significant because it is what the virus uses to enter cells. The immune system may mistakenly recognize parts of the spike protein as foreign, leading to the production of autoantibodies and potentially triggering an autoimmune response.

What was the study design of the paper published in Clinical Rheumatology?

The study was a matched cohort study that analyzed routine health care data from Germany, comparing individuals with a positive PCR-confirmed COVID-19 diagnosis to a control group, and followed them up to June 30, 2021.

What did the study find regarding the risk of autoimmune diseases post-COVID-19 infection?

The study found a 42.63% higher likelihood of acquiring autoimmunity for patients who had suffered from COVID-19, with patients who had a more severe course of the disease being at greater risk for incident autoimmune disease.

What are some of the autoimmune diseases that were found to be associated with COVID-19 in the study?

Some of the autoimmune diseases associated with COVID-19 in the study include Hashimoto thyroiditis, Graves disease, psoriasis, and rheumatoid arthritis.

How does the size of the study cohort impact the relevance of the findings?

The size of the study cohort, which included millions of individuals, makes the findings extremely relevant from a scientific point of view, as it provides a broad and significant dataset for understanding the potential autoimmune implications of COVID-19.

What is the excess risk for any newly diagnosed autoimmune disease found in the study?

The excess risk for any newly diagnosed autoimmune disease was 4.5 per 1,000 person-years in the study.

Why is it important to actively seek out autoimmunity in clinical work?

Autoimmunity is important to actively seek out because it is often silent and can have a significant impact on health over time if undetected. It requires specific autoantibodies to be targeted for diagnosis, and without this proactive approach, the condition may go unnoticed.

What does Dr. McMillan suggest is the responsibility of the scientific community regarding autoimmunity and COVID-19?

Dr. McMillan suggests that the scientific community has a responsibility to study autoimmunity in the context of COVID-19 thoroughly, understand its implications, and focus on mitigation strategies based on a good understanding of the disease's pathophysiology.