Recent articles look at COVID-19 risk by blood type, ethical lessons, prone positioning

The risk for severe COVID-19 infection may vary among different blood types, a recent study found. The genomewide association study, published by the New England Journal of Medicine on June 17, involved 835 severely ill COVID-19 patients and 1,255 control participants from Italy and 775 and 950, respectively, from Spain. It found genes that were associated with severe COVID-19, some of which coincided with the ABO blood type. A blood-group-specific analysis found increased risk with type A (odds ratio, 1.45; 95% CI, 1.20 to 1.75) and a protective effect with type O (odds ratio, 0.65; 95% CI, 0.53 to 0.79). “Our genetic data confirm that blood group O is associated with a risk of acquiring Covid-19 that was lower than that in non-O blood groups, whereas blood group A was associated with a higher risk than non-A blood groups. The biologic mechanisms undergirding these findings may have to do with the ABO group per se … or with other biologic effects of the identified variant,” the authors said.

Hydroxychloroquine was the focus of several recent statements. On June 15, the FDA warned that co-administration of remdesivir and chloroquine phosphate or hydroxychloroquine sulfate is not recommended as it may result in reduced antiviral activity of remdesivir and revoked the emergency use authorization that allowed for chloroquine phosphate and hydroxychloroquine sulfate to be used to treat hospitalized patients with COVID-19 outside of clinical trials. The decision was based on emerging scientific data showing that the drugs are unlikely to be effective in treating COVID-19, as well as evidence of serious cardiac adverse events and other side effects, a press release said. ACP updated its practice points about use of chloroquine or hydroxychloroquine alone or in combination with azithromycin for prophylaxis or treatment of COVID-19 in a June 17 letter in Annals of Internal Medicine. Six new studies were found; they added support to the College's previous conclusions but resulted in no conceptual changes to the practice points released on May 13.

ACP also published a joint op-ed with the American Medical Association (AMA) on ethical lessons learned from COVID-19. ACP President Jacqueline W. Fincher, MD, MACP, and AMA Immediate Past President Patrice A. Harris, MD, MA, discussed inequities in the health care system in “A Wake-Up Call for American Health Care: Emerging Ethical Lessons from Covid-19,” published June 16 by Modern Healthcare. The op-ed focuses on how the COVID-19 pandemic brought attention to inequities, including distribution of limited health care resources and the disproportionate health impact on communities that have suffered decades of neglect, disinvestment, and marginalization.

Finally, a study published as a research letter by JAMA Internal Medicine on June 17 found that prone positioning improved oxygenation in patients with respiratory failure who weren't yet intubated. It included 25 patients who spent at least an hour in a prone position; four eligible patients declined and were intubated immediately. An hour after initiation of the position, the patients' oxygen saturation (SpO₂) had increased (range, 1% to 34%; median, 7%) with no change in the level of supplemental oxygen, and 19 patients had SpO₂ of 95% or higher. “In this small single-center cohort study, we found that the use of the prone position for awake, spontaneously breathing patients with COVID-19 severe hypoxemic respiratory failure was associated with improved oxygenation,” the authors said. They called for randomized trials. An editorial agreed about the need for trials but cautioned that a potential concern with this intervention is that it could delay intubation and mechanical ventilation.