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Current Affairs

Why COVID-19 has killed more elderly patients?

Date: 26 March 2020 Tags: Miscellaneous

Issue

Across the world, the novel coronavirus has killed elderly people the most, especially those with pre-existing medical conditions such as heart disease.

 

Background

 Immunological and molecular observations support the clinical observations of infrequent COVID-19 infections in children compared to more frequent COVID-19 infections in elderly patients, especially those with comorbid conditions.

 

Details

  • Researchers have hypothesised that the reason could lie in the victims’ medications, when they suffer from comorbidities such as cardiovascular diseases, hypertension, diabetes and chronic kidney disease.

  • For patients with cardiovascular diseases such as refractory hypertension, coronary artery disease and heart failure, some highly recommended medications are angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).

  • These medications are also recommended for the management of cardiovascular disease in elderly patients and in those with diabetes and renal insufficiency.

  • It was found that the administration of intravenous injections of ACEIs and ARBs increases the ACE2 receptors in their cardiopulmonary circulations.

  • The ACE2 receptors bind with the proteins present on the exterior of coronaviruses such as SARS CoV and SARS-CoV-2. Significantly, the presence of “S” proteins on the exterior of the SARS-CoV-2 binds with the ACE2 receptors in the lower respiratory tract of COVID-19 patients.

  • When the virus is able to bind with the ACE2 receptors, it can make its way to the patient’s lungs more easily, leading to the possibility of the patient developing pneumonia and potential respiratory failure.

  • All the patients with the aforementioned diagnoses were using ACEIs and ARBs, which may mean that these medications are a possible risk factor for severe disease outcomes in the case of COVID-19.

  • Elderly patients with such comorbidities are more likely to be taking these medications, and therefore, are at greater risk of facing fatal outcomes.

  • One reason that children may be better protected against developing severe symptoms could be that they have fewer ACE2 receptors in their lower respiratory tracts, making it more difficult for the coronavirus proteins to bind and find their way to the lungs.