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Sunday, February 6, 2022

Never COVID Cohort

In 2021, I wished everyone good luck with my new-found phrase Catch a Cold! (March 2021). There, I described the view of some that the body may react to exposure to some coronavirus with production and retention of T-cells that may be providing them with ongoing resistance to other coronaviruses like SARS-CoV-2, and the COVID-19 infections.

It is possible that humans may be "genetically predisposed" to disease. As Medlineplus explains and cautions, "genetic variations can have large or small effects on the likelihood of developing a particular disease." It seems that "particular variations in other genes," which might also be called "mutations," have been identified as increasing patient risk for diseases like cancer. Just as the virus can evolve, so perhaps does our DNA? As living organisms, we are all very similar, but our individual genetic codes may include distinctions and challenges.

This came to mind recently when MSN.com published Why do some People get COVID when others don't? It is an intriguing look into the virus that has dictated much of our existence over the last 24 months, deeply impacted the world of work generally, and influenced much in the community of workers' compensation. There have been impacts on the ability to attend doctor appointments, the rapidity of surgical interventions, process changes for mediations and hearings, and much more.

So, why is it that some people seem to just not be susceptible to this virus? I know a lady who refers to her husband as "Superman" because despite multiple exposures he has not contracted COVID-19. MSN refers to these people as the "never COVID cohort."

I know four young people who sat around a card table yelling out while playing Uno one evening. The next day one of the four had symptoms and a positive test; the other three tested negative. I know a lady whose family all tested positive and she cared for them for days, but she consistently tested negative. It seems implausible, but these anecdotal instances are similar to stories that have been related to me by others.

MSN parrots that by noting that:
"there are multiple anecdotes of COVID cases being discovered among couples, families or groups of colleagues who have mixed closely, but where not everyone has become infected." 
The medical community is "keen to understand why." To find out, a small-scale recent study intentionally put the virus directly into 36 test subject's noses. Only 50% of them contracted COVID-19.

The MSN article characterizes this variation on susceptibility as "one of the great mysteries that has emerged from the Covid-19 pandemic." Why does this virus seem so fickle? The good news is that scientists are researching and experimenting. Recent research "published by Imperial College London" is supportive of the earlier theories regarding "T cells" that may have been created or stimulated by some previous "common cold coronaviruses," to which the "never COVID cohort" was exposed.

There is clear evidence that "high levels of pre-existing T cells" from "other human coronaviruses" have in some instances been effective in protecting "against COVID-19 infection." Thus, there is some clear evidence and a conclusion. However, the researchers are not satisfied that this tells the whole story. They are quick to advocate for being "fully vaccinated, including getting your booster dose."

The MSN article provides ample discussion of vaccinations, and benefits of reduced disease severity, and diminished transmissibility. There is candid admission that Omicron and other variants are successfully infecting even the "fully vaccinated," but blessedly causing far less severe symptomatology overall. Thus, the vaccines are admittedly "not 100% effective in preventing infection and the immunity they provide wanes over time."

However, the sentiment in favor of vaccination is clear in the MSN discussion. While multiple experts in the article include vaccination in their potential explanations for the "never COVID cohort," the year that most of us spent waiting for a vaccination, a year in which many did not contract COVID-19 despite exposures and risk, must certainly support that vaccination cannot alone explain the overall "never COVID cohort" phenomenon.

Part of the mystery, or perhaps merely curiosity, of the "never COVID cohort" is that we have all likely been the victim of a "common cold." Many of those are caused by coronaviruses. Thus, one might expect that we would all carry T-cells to combat infection of SARS-CoV-2 (COVID-19). However, a molecular oncologist quoted in the MSN article notes that "some individuals maintain levels of cross-reactive immunity," and by implication, he seems to suggest that not all of us "maintain" so well for some reason(s).

The conclusion is that further research will be needed regarding the "so-called never COVID individuals." The point of investigating their immune response will hopefully be a "better understanding of the immune response" and specifically "what facets of the cross-reactive response (prior T-cell reaction and retention) are most important." There is hope that such knowledge may enable scientists to better formulate future vaccinations, with broader capabilities and less susceptibility to the challenges of virus variants and mutations.

That said, there is also a suggestion that some portion of the "never COVID cohort" is instead blessed with individual genetic makeup. This may have import both in whether one becomes infected and in the extent or nature of resulting symptoms. One expert is quoted claiming "variations between people's immune systems 'makes a difference, at least to whether or not you get symptomatic disease.'" Some current focus is on the human leukocyte antigen genes and the potential they have to impact a human immune response. Thus, there are perhaps innate advantages some enjoy in the COVID battle.

A side note to the study in which people were purposely exposed but only 50% contracted COVID-19, is the detection of infection. The researchers noted that the virus tends to be detectable "first in the throat," rather than the nose. While the "peak levels" were higher in the nose, detecting the virus there was possible only about 18 hours after it was detected in the throat. This may explain some of the challenges that people have cited regarding negative tests. MSN notes that testing only nostrils presents some risk of "missing infectious virus early in the course of infection."

The end result is likely that more research will be pursued. There will be an exploration of the ability to retain T-cells and thus be better prepared for any coronavirus. There will likely be an exploration of the process of vaccination composition and administration. There will be studies regarding DNA and the potential for some viral insusceptibility based on genes. There will undoubtedly be further advocacy for vaccination and boosters. There seems fairly broad agreement regarding both efficacy and advisability. 

For my part, I do sincerely hope you will catch a cold, just in case.