Alpha-1 coronavirus (COVID-19) update as of the 8th April 2020:
Further to the previous guidance relating to the risks of COVID-19 that was posted on this website, there continues to be a complete lack of information that relates specifically to the risks for patients with alpha-1 antitrypsin deficiency. Following a discussion with other alpha-1 experts, I can confirm that we are not yet aware of any alpha-1 patients becoming ill with COVID-19 and, therefore, no clinical experience or objective clinical information is yet available to support any evidence-based guidance or advice. Nevertheless, the informal expert consensus view remains, at the current time, the following:
- There is no reason, at the present time, to suspect that alpha-1 antitrypsin deficiency (AATD) poses an increased risk of contracting infection with COVID-19.
- In the event of infection with COVID-19, AATD patients with lung disease (emphysema / ‘COPD’ / bronchiectasis) are likely to have the same risks of developing worsening symptoms and respiratory failure as non-deficient patients with a comparable severity of lung disease. It is, currently, not possible to say whether an acute illness would be worse in these AATD patients than in the comparator patients with normal alpha-1 antitrypsin levels.
- In the event of infection with COVID-19, AATD patients who develop a pneumonia may be more likely to experience worse long-term lung damage than people with normal levels of alpha-1 antitrypsin.
- COVID-19 infection is, in some cases, associated with abnormalities in the blood tests that are used to assess liver function. There are no reports that indicate these abnormalities are caused by a clinically significant hepatitis and, to our knowledge, no deaths have been attributed to liver failure arising from viral hepatitis caused by COVID-19.
I have contacted Mark Pawsey MP and Matt Western MP (both of whom have previously demonstrated their support for patients with AATD) to raise their awareness that government guidance in the UK on ‘shielding’ does not currently address the concerns of AATD patients. I am awaiting their responses. In the meantime, further information can be obtained at:
Patients who consider that they fall into the UK Government’s ‘extremely vulnerable’ category should also visit the website www.gov.uk/coronavirus-extremely-vulnerable and complete the form (or call 0800 028 8327). AATD patients who are concerned they may fall into the ‘extremely vulnerable’ category, but are unsure, should contact their NHS consultant for advice.
This information should only be considered up to date at the current time, since the landscape is changing rapidly. The web links included in the previous posting direct you to live updates relating to the government’s general advice.
Professor David Parr, University Hospital Coventry & Warwickshire