Risk factors for severe disease

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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. [1]

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. [1]. This is so far, the only publication that we know of.
  • In the Netherlands, rumours 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 rumours have lead 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 symoptoms 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
  • Rumours on NSAID are currently unsubstantiated.

Consequences for action

  • Additional studies to find supporting evidence (or refuting) are needed
  • Clinicians should take note of the study of Fang et al., and make decisions on a case by case basis
  • In absence of evidence supporting NSAID as risk factor, experts need to very clearly explain that such rumours are unsubstantiated

References

  1. ↑ 1.0 1.1 Fang, Lei, George Karakiulakis, and Michael Roth. "Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?." The Lancet Respiratory Medicine (2020).
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