Thread by @__ice9

More autoimmune exacerbation in COVID-19:

Fatal cases have higher levels of autoantibodies to Annexin A2, vs. non-fatal severe cases and non-severe cases.

Inhibiting Annexin A2 promotes thrombosis and pulmonary edema.

Similar to Abs against β2GPI in antiphospholipid syndrome.

https://twitter.com/DaveLeeERMD/status/1346084568185581578

Interestingly, antibodies to SARS-CoV-2 S2 are also somewhat cross-reactive to Annexin A2.

Not relevant to vaccines using stabilized Spike.

Relevance unclear for natural infection.

May matter during the exaggerated antibody response in severe COVID-19.

https://twitter.com/DaveLeeERMD/status/1275792603829723136?s=19

Anti-S2 antibodies do not appear to be neutralizing either. Overall, this is arguably a form of ADE.

stm.sciencemag.org/content/12/550…

Note again this can only arise during a COVID-19 case, 'natural infection'.

All leading vaccines use stabilized Spike, so the vaccines cannot do this.

For a medical audience, the main conclusion from this is more evidence in favor of APS as a contributing factor in severe COVID-19 thrombosis and pulmonary edema.

For a non-medical audience, the main conclusion is to try to get a COVID-19 vaccine ASAP.

In the meantime, keep in mind there is extensive clinical evidence that early antiviral treatment (including prophylaxis) reduces risk of progression to moderate or severe COVID-19.

Most effective options:

https://twitter.com/__ice9/status/1345622297051353088?s=19

High risk: also consider dipyridamole-aspirin.