ACE polymorphisms and COVID-19-related mortality in Europe
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COMMENTARY
ACE polymorphisms and COVID-19-related mortality in Europe Matteo Bellone 1
&
Stefania Laura Calvisi 1
Received: 15 July 2020 / Revised: 2 September 2020 / Accepted: 11 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
The severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has emerged in China at the end of 2019 and has rapidly spread to Asia, Oceania, Europe, and America causing the coronavirus disease-19 (COVID-19) pandemic [1] and more than 700,000 deaths worldwide as of August 6, 2020. Epidemiology analyses have been showing higher mortality due to COVID-19 in Europe than in China [2]. In Table 1, we report the number of fatalities due to COVID-19 both in relation to the number of total cases (i.e., mortality) and the entire population of the indicated country (i.e., death/1 million population) as of August 5, 2020. The two parameters are differently influenced by several variables (e.g., the number and type of tests each country has used to confirm the clinical diagnosis, the access to hospitalization, or the parameters used to ascribe death to COVID-19). Considering that the mortality parameter strictly depends on the number of test performed in each country, and that testing has neither been homogeneously performed in the different countries [3] nor the entire populations of these countries have been screened, we focused on the death/1 million population. As reported in Table 1, COVID19-related deaths are much less in China than in Europe. Furthermore, deaths related to COVID-19 are not equally distributed in Europe. Northern European countries, for example, Denmark, Germany, and Norway, have experienced rates of COVID-19-related deaths closer to China than Southern European countries like Italy, Spain, or France. There are several exceptions to this apparent rule. For example, the Belgian National Health Institute has been counting even suspected cases of COVID-19-related deaths, regardless of whether the deceased person was tested. Northern European countries like the UK and Sweden did not impose a lockdown, thus diverging from the politics of social containment to face the pandemic The work has not been previously presented. * Matteo Bellone [email protected] 1
I.R.C.C.S. Ospedale San Raffaele, Via Olgettina 60, 20132 Milan, Italy
adopted by several other European nations. These considerations may apply to other countries worldwide. Median age of the population (Table 1), social behaviors that are more distinctive of Southern European countries (e.g., intense social life in crowded places, warm greetings, apartments shared by youngsters and elders), or even air pollution [4–6] are additional factors that have been implicated in COVID-19-related mortality. As for the European countries analyzed in Table 1, median age of inhabitants does not appear to have a relevant impact on COVID-19-related mortality (Fig. 1a). The renin-angiotensin-aldosterone system (RAAS) is under scrutiny in the coronavirus COVID-19 pandemic [7] because the angiotensin-converti
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