ALL of us with CLL are immune compromised, so what does it mean to be immunocompromised? Why does this increase our risk of coronavirus?

[AussieNeil]

ALL of us with CLL are immune compromised to some extent, more so during treatment. CLL adversely impacts our immunity in many ways, not only by reducing our ability to make antibodies and through infiltration of our bone marrow, reducing our ability to make infection fighting white blood cells, but by various other inhibiting effects on the effectiveness of our immune system.

"Because immunocompromised people’s immune systems are defective or ineffective, they’re unable to stop invasion and colonisation by foreign intruders, including the SARS-CoV-2 virus, which causes COVID-19.

An under-performing immune response leaves people susceptible to infection, but the severe symptoms in some people are actually caused by a huge immune response sweeping over the whole body.

The reasons for this are varied, and can be complex and intertwined.

So what does the research say so far?

There are a few early reports emerging from heavily hit areas on how COVID-19 differs in prevalence and severity among immunocompromised people.

The world has been primed to worry about these people contracting COVID-19 because they’re more susceptible to severe illness when infected with the range of viruses that usually cause respiratory illness, including common colds.

However, because the severe illness in COVID-19 is actually a result of excessive immune responses, immunocompromised people don’t seem to be presenting with more severe disease than the general population.

It’s worth exploring each case, though, and reviewing our understanding as the evidence emerges."

From Monash University, Melbourne, Sarah Jones, Research Fellow, Centre for Inflammatory Disease and Fabien B. Vincent, Research Fellow; Rheumatology Research Group, Centre for Inflammatory Diseases: theconversation.com/what-do...

Tips from Australia's Leukaemia Foundation on preventing infection and illness

leukaemia.org.au/disease-in...

This is an unlocked post.

Neil

[AKAICUsurvivor]

Very interesting - it would be neat if there was some advantage to having CLL ( beyond finding all you guys) - Unbreakable styly

[Psmithuk]

Wouldn’t it be nice to at last have something that gives us an advantage?😁

[HopeME]

No one knows for sure but it is nice to read an optimistic story first thing this morning. Thank you Neil.

[AdrianUK]

It’s interesting how prevalent this view that we may even be at an advantage is becoming in some circles. Not convinced that there is much data to support it at this point, however. As much as we might hope it is true the opposite could equally well be true.

An alternative theory is that since we are less able to fight off the virus it will be allowed to replicate more causing more damage and that damage might at some point trigger an over reaction in our sluggish but poorly regulated immune systems. Remember CLL is also associated with an increase in incidence of auto immune problems. And remember we are susceptible to sepsis in other infections which is believed to also be caused by the immune system over reacting to the stimulus.

As I understand it the best actual data on this whole issue remains the Chinese study of 1500 or so patients. There a HR of 3.5 was associated with malignancy. Broadly speaking patients with malignancy were approx 3.5 times more likely to have a severe outcome.

So for me, unless clear data emerges to counter the suggestion we are at higher risk from COVID19 than the general population I think we are well advised to ensure we are strictly self isolating to avoid exposure. Not getting COVID19 remains the surest way to avoid getting any complications of it. Hibernation is my preferred term for what so many of us are doing right now. We will emerge when this threat has eased and/or is better understood.

Here is the study from the Chinese in case anyone hasn’t seen it yet:

ncbi.nlm.nih.gov/pmc/articl...

[johnl]

I remember Dr. Terry Hamblin suggested this possibility years ago in regards to the bird flu at the time.

john

[Ernest2]

Many thanks for that Neil.

Good to see scientific studies are now starting to emerge, even if insufficient data do far (must be lots on the pipeline).

Hope you are getting on ok.

Best wishes,

Ernest

[Sushibruno]

Wow very interesting, it would be amazing if one pill (just one) would do the same with cll one day.

[scarletnoir]

That is a very interesting post. AdrianUK has reacted sceptically, which is fair enough.

I think we can all agree that the data are not there yet for a definitive answer, but it's certainly a fascinating question/hypothesis! We'll have to 'watch this space' whilst continuing to be very careful...

[Jonquiljo]

Sorry, I would be skeptical of any data coming out of China - unless some country like the US or UK were reporting it.

The article mentioned above is suspect simply because the reported smoking instances are quite low. This is awfully inconsistent with a country that has a 40%+ smoking rate!

[AussieNeil Partner Administrator in reply to Jonquiljo]

Which article reported smoking instances?

Coincidentally, I just came across this article concerning the risks associated with smoke and respiratory diseases, which includes a few references to recent studies on tobacco smoking and coronavirus.

theconversation.com/the-smo...

[Jonquiljo in reply to AussieNeil]

No coronavirus article. Just look up % of smokers in China. It's almost 50% for men. Doctors smoke around 40%. It's strange, but apparently true.

[AussieNeil Partner Administrator in reply to Jonquiljo]

I made that observation early on, including the interesting supportive statistics from South Korea, where the smoking ratio of men to women is about 10:1 and there was a much higher fatality rate in men from the coronavirus.

[Jonquiljo in reply to AussieNeil]

Italy apparently has a high smoking rate. Not as high as China, but high.

Italy supposedly has enormously terrible levels of pollution - that have prompted local shutdowns in the past. I gather the air there is very bad, and could contribute to covid-19 outcomes as well.

[Kwenda in reply to Jonquiljo]

I confirm that in the valley of the river Po, in Northern Italy, that the air pollution is completely off the top of the scale.

As you drive down South from Switzerland you can see the pollution and taste it.

Dick

[Kwenda in reply to AussieNeil]

See also for the research

Here projects.iq.harvard.edu/cov...

Here vitals.lifehacker.com/how-p...

Here bbc.co.uk/news/health-52351290

Dick

[Jonquiljo]

Also, granted that they aren't giving placebos to patients to be "scientifically precise", the preliminary data on Remdesivir is very hopeful. statnews.com/2020/04/16/ear...

Then again, would you hand out placebos to people who had an 80% mortality rate?

Hopefully we will have the results of a multi-center trial soon. Again the problem is the medical community taking "do no harm" a bit too literally. I still maintain that anti-virals should be best given before the later disease states. You stop the virus in its tracks before it becomes a severe infection. Those trials are in progress and the results of those will be seen soon.

The biggest obstacle to widespread use of Remdesivir is that it takes a long time to make - and it is very expensive. Not insurmountable, however.

[Yuck in reply to Jonquiljo]

Great post.

Statnews is free and excellent. We subscribe and found yesterday’s article about the U of Chicago study with Remdesivir extremely hopeful as you wrote. Readers, consider subscribing.

I liked your comment about early treatment with antivirals. Some in treatment already take one daily.

I hope people on this site will share information and opinions about antivirals and weigh in on Jonquiljo’s comments about giving them early in the course of the disease.

Hope J that you will soon be posting those studies when they become available!

Thanks!

Stay safe!

~Yuck

[virdieblue]

Thank you! I've been wondering how it all fit together.

Virginia