To figure out what makes some people more vulnerable to severe cases of covid-19, we need to rethink what we know about infection



Health



6 May 2020

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THE new coronavirus has already infected millions of people, but we are still learning about who is most vulnerable to its attacks. It quickly became clear that older people and those with certain underlying health conditions such as diabetes and cancer were at higher risk. But there have now also been many reports of the disease killing young, otherwise healthy individuals. And even among the high-risk groups, the threat that covid-19 poses varies dramatically.

What’s more, information from several countries now indicates that people from some ethnic minorities are more likely to die. So are men and people who are obese.

Meanwhile, because covid-19 attacks the lungs, we predicted that people with asthma would be among the most vulnerable. But so far, they don’t seem to be in greater danger.

Around the world, efforts to quickly identify risk factors have already helped shape public health advice and direct resources. But to understand why these factors make such a difference, we will need to look more closely – not just at the virus, but also ourselves.

“The disease is actually just our response to the pathogen,” says Priya Duggal, an epidemiologist at Johns Hopkins University in Maryland. To work out who gets sick and why, we need to understand what happens once the virus is inside us, and the role our genes play in our body’s response. As well as helping us to better protect the most vulnerable, doing so could guide the development of treatments that ultimately let us live with covid-19.

We tend to think of the SARS-CoV-2 virus – the spiky 85-nanometre parcel of protein and nucleic …



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