In the future, billions of COVID-19 nasal swab tests could not only tell if you have contracted COVID-19, but maybe even foretell if you are in danger of a serious infection.

In a new study, researchers from University of Copenhagen (Copenhagen, Denmark) have shown that the phenomenon cell fitness could predict the host immune response to a COVID-19-infection. The study has shown that analysis of a particular protein on the cell surface is likely to predict who is in danger of a serious infection caused by the virus. The discovery could prove to be important for pandemic management.

“Cells have a so-called fitness status, and by analyzing it we could predict hospitalization or death in COVID-19 patients, potentially making such a biomarker an earlier prediction tool, especially because it can be detected from the common nasal swab COVID-19-tests,” said Rajan Gogna from the Won Group at the Biotech Research & Innovation Centre.

If the cell fitness status is poor, it indicates that the cell does not develop well, either because the cell is aged, lacks reliability, has an ill-functioning metabolism or is disease prone etc. Earlier in 2021, the research team discovered that fitness status is expressed in proteins called flower proteins. These flower proteins are on the surface of the cell, and they are expressed in two forms, explained Gogna. Especially helpful in cases of the early phase of COVID-19 illness, the flower protein expression could accurately predict hospitalization or death as well predict who would have a less serious infection.

Cell fitness is relative to many things in our bodies and does not necessarily alter with age. Age has an impact, but the researchers have seen many cases from their database where people who are 80 years of age have a very good fitness profile of lungs, which is the main area where cell fitness is measured to predict COVID-19 infection outcome, explained Gogna. The researchers performed a post-mortem examination of the infected lung tissue in deceased COVID-19 patients to determine the flower proteins biological role in acute lung injury, which is the main cause of death from the disease. By using nasal swab samples, they also performed an observational study to evaluate whether the protein expression could accurately predict hospitalization or death.

“The method could predict who needed hospitalization with an accuracy of was 78.7%. With COVID-19 patients who would not have a serious infection, the prediction was accurate at 93.9%,” said Associate Professor and Group Leader Kyoung Jae Won, who analyzed the data using machine learning.

As parts of the Western world is slowly returning to normal, many countries in the low- and middle-income countries are still fighting and fearing new outbreaks of COVID-19. And for most it feels almost unbearable to endure another new wave of the virus, which could end in more deaths and long-term persistent symptoms from COVID-19 infection. The researchers hope their discovery is timely, because of the persistency of COVID-19 and rising cases and deaths in various nations outside the Western world despite vaccines.

“The cell fitness, expressed by the flower protein, could help explain why some people respond poorly to COVID-19 and provide opportunity for pre-identification of high-risk individuals. This discovery has the potential to help save their lives by severely alerting them to be extra protective of themselves, or until they are fortunate enough to get their hands on a vaccine. In some other nations, the population in general has great hesitancy against vaccination. But people are not hesitant about a test, and we hope this will improve outcomes,” added Gogna. 

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