Alpha-1 coronavirus (COVID-19) update as of the 27th April 2020:
Further to the previous guidance relating to the risks of COVID-19 that was posted on the 8th April, there is little new that I have to report on the potential repercussions of infection with COVID-19 in patients with alpha-1 antitrypsin deficiency (AATD). Whilst there have been a few isolated reports of patients with AATD having been infected with the virus, the information remains insufficient to draw general conclusions with any degree of confidence. In order to address this current lack of information on COVID-19 in Alphas, it has been agreed following discussion with the EARCO joint chairs, Dr Marc Miravitlles and Dr Timm Greulich, that EARCO members across Europe will provide any information and experience they gain of COVID-19 infection in their patients to me as the central contact who is leading this initiative. This information can be then used to build a picture of the effects of COVID-19 on Alphas as quickly as possible. Until then, the informal expert consensus view remains unchanged from the summarised points in the previous update dated the 8th April 2020, namely:
- 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 not yet received any answers in response to the emails I sent to Mark Pawsey MP and Matt Western MP to raise their awareness that government guidance in the UK on ‘shielding’ does not currently address the concerns of AATD patients. However, I anticipate that the information arising from the above EARCO initiative will provide some evidence-based guidance to politicians that can be used to lobby on behalf of the AATD community.
Alphas who either know or believe they have been infected with COVID-19 can contact me directly by email (firstname.lastname@example.org). Please note that, on account of the exceptional pressure of clinical work during this crisis, requests for advice on matters relating to personal clinical issues cannot be addressed by email: patients are advised to either arrange a referral to the Coventry AATD service or, if they already attend the Coventry AATD Service, to book a virtual clinic appointment through my secretary (Jennifer.ChesterMorgan@uhcw.nhs.uk Tel No. 02476 966205).
Please note that the information in this posting should only be considered up to date at the current time. I will continue to provide regular updates on this website of any significant changes to the current COVID-19 situation.
Professor David Parr, University Hospital Coventry & Warwickshire