COVID-19 Update: Blood Types, MMR Vaccine, and Your Questions

Dr. Steven Bishop returned to Facebook Live on Wednesday, June 24, to provide another update on COVID-19. He discussed whether blood types affect the risk for severe COVID cases and some data from a recent study regarding the MMR vaccine. He also answered several questions from the audience. 

Watch the full 30-minute video below and read on for a full recap. 

Do Different Blood Types Have a Higher Risk for Worse COVID-19 Outcomes?

A couple months ago, the initial association data out of China showed there might be a higher risk for people who had A-Type blood. That was a small study related to the Chinese study. The New England Journal of Medicine recently dived further into the question with a much more genome-wide analysis. 

They did confirm the association between the A-Type blood and having a higher risk for a more severe case of COVID-19, as well as the association between O-Type blood and a lower risk. Read the study here.

The thing to keep in mind with all association studies is they don't prove causality. Yes, there is an association. But it doesn't actually tell us that A-Type blood causes people to have a harder time with COVID-19, because there could be confounding factors involved with people who have A-Type blood. 

MMR (Measles, Mumps, Rubella) Vaccine Update

The MMR Vaccine and whether it is effective against COVID-19 has been in the news recently again. It would be incredibly convenient, given it is already a vaccine and we know it is safe. However, the idea is completely theoretical at this point. The idea is that live virus vaccines, which are injected as weakened but active virus, can stimulate the innate immune system. 

The innate immune system is considered a more "ancient" immune system, which recognizes generalized threats as a virus, a bacteria, a fungus, an allergen, etc. It essentially says this shouldn't be here. The other part of the immune system is the acquired immune system, which is more specific to each individual and the exposures they've had. This is the part of the immune system that develops antibodies that can identify a virus as COVID-19 or the measles or whatever it may be. 

So it's thought that live virus vaccines can boost the innate immune system a little better. There is some evidence that the MMR vaccine gives some protection against a variety of known viruses, but there are no studies yet that indicate it specifically helps against COVID-19. 

You Asked. He Answered. 

• Do you have a sense of whether the accelerated spread in states like Arizona, Texas, and Florida could seed renewed infection in our area? It's going to be interesting to see. There probably has been renewed travel from state to state, so we will need to wait to see if it has an effect. The number of cases is definitely going up. The hospitalizations in certain areas are going up, but the death rates are not. So, it's been a little tough to tell how much of the accelerated spread is new cases, if more people are sick, if we're just doing more testing, etc.
  
  
• Have you looked at the small (under 80 participants) study published in China this week whose results suggest that iGg antibodies decline steeply over a few months in both symptomatic and asymptomatic patient? Are there any new insights about immunity or just many unanswered questions? I have not seen that specific study, but that would not surprise me. What we've been seeing clinically here is that people who do not get very sick with the virus or who are asymptomatic are not getting challenged in a strong enough way in terms of their immune system, so whatever antibodies those people develop will probably not persist.
  
  It makes sense, because the body is not seeing the virus in those people as a serious threat, so it's not invested in fighting it off and putting in the effort to making the long-lasting antibodies. I would expect the antibodies to last longer in people who are sicker.
   
• What is causing the lower prevalence rate? We've declined steadily and are now at 6% positive test rate, what are the reasons? And, is there a target for positive test rate where we don't feel the virus is an issue anymore? One part of it is that we are testing so many people, so most of the tests indicate people do not have it. Which is great. Social distancing and wearing masks and all that continues to help. The target positive test rate should be as close to 0% as we can get. There isn't a point we can stop worrying about the virus until then.
  
  However, below 5% is a fantastic milestone, because at that point, you get to a point where it might not make sense to test asymptomatic people anymore because you are more likely to get a false positive versus a true positive. 
  
  
• I’m seeing lots of chatter online about combining face shields and face masks. Do you know whether there is data about whether this combination is better than masks alone either at protecting yourself or protecting others? There is some data on this. In some of the studies, its showing face shields might be better than masks. Especially as schools open up, we may see a higher use of face shield for teachers and students and others. We've seen that in other countries. They are easier to use, easier to wear, and aren't as constrictive to wear as far as breathing. And they are cheap and easy to produce as well.
  
  If you have a choice between a face shield and a mask, there is some data that says a shield alone is better than a mask alone. A shield and a mask is even better. 
• How do you feel about the kids going back to school? Is it safe for everyone? It's probably safe for most people to go back to school, assuming we continue to move through the phases as planned and the prevalence rates continue to drop. I'm definitely going to feel comfortable if the rates are at 5% or below. We are going to have to be more conscious about hand washing, social distancing, and minimizing large gatherings. But at low prevalence rates and low mortality rates for the young, I think it's wrong to deprive kids of an education for a virus with a low mortality rate for their age group. Of course, this is assuming things keep improving between now and the Fall.
   
• Dr. Fauci said he's hopeful for a vaccine by the end of the year/early next year, what's your take on the earliest timing for a viable vaccine? I'm hopeful, and I share his optimism. There are a number in the pipeline and two in Phase III. What they are actually doing with a number of these vaccines that are in the warp speed program is going ahead a producing millions of doses of each.
  
  So, when the time comes that one is deemed safe and effective, they will be able to just release the stockpile. They aren't waiting until the studies are done to produce the vaccines, which means things should move quickly once the data is in. End of the year is probably the earliest timeline, but next Spring is probably more realistic. We'll know more definitely by the Fall. 
  
  
• If I go to see my doctor for what I think is a cold or sinus infection, will I automatically be getting a coronavirus test? Depends on your doctor, but right now, I think that is probably going to be the case at most places. I know it is the case for us at PartnerMD. We would consider you a symptomatic person at that point and test you for COVID-19. Now, if someone has a history of sinus infections and its a classic story, we may not test you at that point and then later on down the line, when getting routine blood work, we'd check for antibodies. 
• How risky or safe are dentist offices? I think most are pretty safe. They are doing a great job with distancing and cleaning and keeping the appointments controlled. I think it's more of a risk for the dentists than the patients, because they are getting exposed to the patients. I've scheduled my routine cleaning for July. I think July or August is going to be the sweet spot for getting routine stuff done, before the flu and likely a second wave picks back up in the Fall.