Medical hypotheses
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The context of the COVID-19 pandemic has highlighted the structural inequalities and vulnerabilities experienced by black communities in the world, and in Brazil it is no different. The data generated in Brazil demonstrate that Brazilian inequality is alarming. Underreporting, non-prioritization of data that consider the variable race and color, and social groups in social vulnerability, help the unequal instrumentalization of epidemiological surveillance; many deaths from the black population are not being accounted for. ⋯ There is emerging evidence that COVID-19 may disproportionately affect black people, who in addition to the vulnerability resulting from socio-spatial conditions, appear to be more susceptible to contamination with a more serious and lethal outcome. Finally, biological differences, such as impaired functioning of the immune response, can be increased by structural racism. In this sense, we reinforce that possible relationships between social and biological vulnerabilities of black communities and the SARS-CoV-2 infection pandemic need to be considered and investigated.
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No definitive treatment for COVID-19 exists although promising results have been reported with remdesivir and glucocorticoids. Short of a truly effective preventive or curative vaccine against SARS-CoV-2, it is becoming increasingly clear that multiple pathophysiologic processes seen with COVID-19 as well as SARS-CoV-2 itself should be targeted. Because alpha-1-antitrypsin (AAT) embraces a panoply of biologic activities that may antagonize several pathophysiologic mechanisms induced by SARS-CoV-2, we hypothesize that this naturally occurring molecule is a promising agent to ameliorate COVID-19. ⋯ Furthermore, because both NETs formation and the presence of anti-phospholipid antibodies are increased in both COVID-19 and non-COVID pre-eclampsia, it suggests a similar vascular pathogenesis in both disorders. As a final point, AAT has an excellent safety profile when administered to patients with AAT deficiency and is dosed intravenously once weekly but also comes in an inhaled preparation. Thus, AAT is an appealing drug candidate to treat COVID-19 and should be studied.