Illouz T, Biragyn A, Frenkel-Morgenstern M, et al.

Abstract
The current SARS-CoV-2 outbreak, which causes COVID-19, is particularly devastating for individuals with chronic medical conditions, in particular those with Down Syndrome (DS) who often exhibit a higher prevalence of respiratory tract infections, immune dysregulation and potential complications. The incidence of Alzheimer’s disease (AD) is much higher in DS than in the general population, possibly increasing further the risk of COVID-19 infection and its complications. Here we provide a biological overview with regard to specific susceptibility of individuals with DS to SARS-CoV-2 infection as well as data from a recent survey on the prevalence of COVID-19 among them. We see an urgent need to protect people with DS, especially those with AD, from COVID-19 and future pandemics and focus on developing protective measures, which also include interventions by health systems worldwide for reducing the negative social effects of long-term isolation and increased periods of hospitalization.

Summary: One of the H&Ps I presents was a 16 year old patients with Down’s Syndrome (DS) who complained of shortness of breath and wheezing, almost every patient we saw in the ED was tested for COVID-19 and I wanted to find an article that discussed COVID-19 and patients with DS. This article is an overview of the factors that make patients with DS more susceptible to COVID-19. Individuals with DS have higher risk of severe symptoms from COVID-19 due to a number of reasons that make them more susceptible to infection. Chromosome 21, which is triplicated in patients with DS, is directly involved with entry of SARS-CoV-2 into cells. Anatomical features such as short stature, flat wide face, flat nasal ridge, slanted eyes, short neck, impact the airway tract and enhance airway related infections. Other comorbidities associated with DS and severe COVID-19 include obesity, male sex, hypertension, diabetes, obstructive sleep apnea, congenital heart disease. Compared to the general population patients with DS have increased susceptibility to bacterial and viral infections at a younger age leading to worse outcomes, higher rates of hospitalization, longer length of stay in hospital, and higher mortality rates. The average age of patient with DS requiring hospitalization was 10 years younger than those without DS. In general, patients with DS, elderly patients, type II diabetics, and morbidly obese patients are poor responders to vaccines. The article concludes by determining that future pandemics could pose similar or greater risk to this population and determine a need for preparedness plans for at risk populations such as those with DS. They suggest a multidisciplinary effort including immunology, epidemiology, neurology, and sociology to develop this plan. The authors formulate a framework for factors that need to be considered including but not limited to a database for monitoring symptoms and treatment response, virtual network for social welfare, lifestyle changes and reduction in obesity, studying treatment and clinical outcomes in individuals with DS and long term sequelae, establishing vaccine response in this population.

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