Why COVID-19 impacts some more than others? Integrating Precision Health, Genomics & AI
GLOBAL TESTING AND DATA ANALYSIS:
The European Center for Disease Prevention and Control (ECDC) publishes daily statistics on the COVID-19 pandemic, not just for Europe, but for the entire world. The European CDC data gives a global perspective on this evolving pandemic. While we now know that COVID-19 is everywhere and is causing deaths especially in the most vulnerable population segments of our society, let’s first understand how is the data being captured and reported, and are we using it intelligently?
THE PANDEMIC AND SIGNIFICANCE OF INTELLIGENT TESTING:
All countries have been struggling to test a large number of cases, which also means that not every person that should have been tested, has in fact been tested. Since an understanding of testing for COVID-19 is crucial for an interpretation of the reported numbers of confirmed cases, let’s analyze where do countries stand so far in terms of testing.
The US has performed over 5 million COVID-19 tests. While the stats indicate how many tests a country may have conducted, does it reflect the population covered? This distinction is important – people may be tested many times, and the number of tests a person has is likely to vary across countries. The chart below shows many tests a country may have conducted per 1000 people.
WHICH UNDERLYING CONDITIONS DO COVID-19 PATIENTS HAVE?
According to data published by the CDC, hypertension is the most common underlying medical condition in adults hospitalized for COVID-19. Almost 60 percent of hospitalized COVID-19 patients had the condition as of April 18, as opposed to 25 percent in the U.S. adult population who said they were diagnosed with it and 45 percent who are suspected to have it – diagnosed or not.
DECODING THE DATA:
COVID-19 seems to have different effects on different age groups and people, with different manifestations. This has also given rise to certain theories ranging from climate and environmental factors to immunity status of certain populations and their past vaccination history. The reasons for a wide variation in severity of coronavirus disease 2019 (COVID-19) across the affected countries of the world are not known. Two recent studies have suggested a link between the BCG vaccination policy and the morbidity and mortality due to COVID-19. India and Pakistan are reporting fewer cases as compared to what was initially predicted keeping in mind the trends in China, Italy, Spain and other countries. While COVID-19 testing in India and Pakistan remains low, Pakistan as an example has now switched to a “ smart lock-down ” recently, with targeted tracking and tracing of cases while allowing some industrial and commercial activities to resume under safety guidelines.
THE NEED FOR MOLECULAR INTELLIGENCE:
The unprecedented challenge COVID-19 has posed our health systems, which was already under strain, now burdened with the wide variety of clinical manifestations of this pandemic, amplifies the role of genetics and molecular intelligence, and how we are evaluating the COVID-19 pandemic within the framework of precision health
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The question that the available data is not answering so far is why COVID-19 kills some people more than the others? Do we know enough about the genetic code of the coronavirus that we are able to predict if the virus gets inside a host/human, and if it finds x,y,z criteria, it would trigger an x,y,z specific response, for example in certain cases leading to death? The resulting wide variation of host response, ranging from acute respiratory failure, pneumonia, ARDS, liver failure, acute kidney failure, acute cardiac injury, septic shock, DIC (common in patients who died) and complications like blood clots begin to trigger a certain thought process.
The wide variation of COVID-19 clinical manifestations, different mechanisms and patterns of spread and severity of this viral infection calls to immediate action the need to study and analyze the genetics of the local population to design a predictive and intelligent strategy in precisely understanding this pandemic. The human population has been susceptible to this novel virus as it lacks immunity. Currently, there have been no studies reported that explore why there’s wide variation in terms of host response based on the genetics of both, the host and the viral genome. What triggers the virus to cause a certain clinical presentation or complication in a particular individual?
PATH TOWARDS PRECISION HEALTH INTELLIGENCE
The exact definition of precision medicine is a moving target; however, the National Institutes of Health currently states that precision medicine “is an emerging approach for disease treatment and prevention that takes into account individual variability in environment, lifestyle and genes for each person. The goal needs to shift from providing better medicine or vaccines, to predicting what population sample could be predisposed to certain diseases, or even specific complications related to a particular disease.
In the UK, NHS embarked on the 100,000 Genomes Project, a bold multiyear initiative to transform UK biomedical research and clinical care to a precision health–oriented model. The initiative is funded by the National Institute for Health Research and NHS England, The Wellcome Trust, Cancer Research UK and the Medical Research Council. Across the globe, China, Iceland, and Japan have similar initiatives. In the US, 21st Century Cures Act was signed into a law in 2016, and is designed to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently.
Precision Health should not simply be about creating new drugs or solutions for each and every patient. The recommended path forward would be the aggregation of data from diverse population samples, identify cohorts of population based on their genetic make up and their susceptibility to certain diseases or lack of, and eventually plan the delivery of proactive and intelligent care. That should be the goal of Precision Health, and COVID-19 challenge gives us the opportunity to bring data science, genetics, machine learning and artificial intelligence (clinical data, radiology and medical imaging diagnostics) on an Enterprise Imaging platform by creating harmony in health systems within an integrated framework.
The link between human genetics and the virus genome needs to be studied at the molecular level, and it’s time to evaluate and integrate molecular intelligence on the path towards precision health.