Risk factors for severe disease

This page collects observations, interpretations, and consequences for action about Risk Factors of SARS-CoV2. Please observe the structure of the page, when you add your content. Please use references where possible. Remember to find the relevant page. For example, if your observation is about Sources, please use that page, instead of posting your content here.

What is already known

• Recent studies suggest that ACE2 expression is increased in diabetes and treatment with ACE inhibitors and ARBs increases ACE2 expression. Consequently, the increased expression of ACE2 would facilitate infection with COVID-19. This observation makes some researchers hypothesize that diabetes and hypertension treatment with ACE2-stimulating drugs increases the risk of developing severe and fatal COVID-19.
• ibuprofen should not be used for managing symptoms, say doctors and scientists.

Rumours about interaction with medicines

Observations

• The publication by Fang et al. suggests that ACE-inhibitors may increase the risk of Coronavirus infection and severe outcomes. . This is so far, the only publication that we know of.
• In the Netherlands, rumors circulate (and are even discussed at National Television) that Ibuprofen and NSAID in general increase the rik of severe COVID19 disease outcome.
• In Greece, the same rumors have led to a shortage of paracetamol in the pharmacies. The representative of the Ministry of Health said that there is not enough evidence thus it would be good when people have symptoms to prefer paracetamol.

Analysis and interpretation

• The study of Fang et al. is relevant and credible. However, the study alone does not (yet) constitute convincing evidence that ACE2-inhibitors are risk factors for COVID19 and severe outcome. The association is plausible, yet requires more study to generate supporting evidence.
• Notwithstanding the above, it is important to take note of the study of Fang et al. The observation deserves consideration, especially by clinicians treating patients who are in known risk groups for severe COVID19
• The news item in the BMJ by Michael Day on Ibuprofen, seems to support the rumors that are observed in some countries. This is still at the level of case reports and observations, without explanatory study results.
• After the news item in BMJ by Michael Day, the WHO places an announcement that they have no indication to recommend against ibuprofen.

Consequences for action

• Additional studies to find supporting evidence (or refuting) are needed for both topics (ACE-inhibitors and Ibuprofen)
• Clinicians should take note of the study of Fang et al., and make decisions on a case by case basis

Images

WHO announcement Ibuprofen (18 March 2020)

News item BMJ 17 March on Ibuprofen and Covid19