Possible link between obesity and severe COVID-19

Why Is COVID-19 More Severe in Patients With Diabetes? The Role of Angiotensin-Converting Enzyme 2, Endothelial Dysfunction and the Immunoinflammatory System

Meta-analyses have indicated that individuals with type 1 or type 2 diabetes are at increased risk of suffering a severe form of COVID-19 and have a higher mortality rate than the non-diabetic population. Patients with diabetes have chronic, low-level systemic inflammation, which results in global cellular dysfunction underlying the wide variety of symptoms associated with the disease, including an increased risk of respiratory infection. While the increased severity of COVID-19 amongst patients with diabetes is not yet fully understood, the common features associated with both diseases are dysregulated immune and inflammatory responses. An additional key player in COVID-19 is the enzyme, angiotensin-converting enzyme 2 (ACE2), which is essential for adhesion and uptake of virus into cells prior to replication. Changes to the expression of ACE2 in diabetes have been documented, but they vary across different organs and the importance of such changes on COVID-19 severity are still under investigation. This review will examine and summarise existing data on how immune and inflammatory processes interplay with the pathogenesis of COVID-19, with a particular focus on the impacts that diabetes, endothelial dysfunction and the expression dynamics of ACE2 have on the disease severity.

COVID-19 Australia: Epidemiology Report 26: Fortnightly reporting period ending 27 September 2020

Cumulatively to 27 September there have been 27,095 case notifications and 835 deaths. The number of new cases reported nationally this fortnight was 278, a 67% decrease from the previous fortnight (841). On average, this represented 20 cases notified each day over the reporting period, a decrease from an average of 60 cases per day over the previous reporting period. 82% of all COVID-19 cases for the period (229/278) were reported in Victoria, with smaller numbers of cases reported from New South Wales (32), Western Australia (9), Queensland (6) and South Australia (2). In Victoria, 92% of cases (210/229) were locally acquired with known source, 7% (15/229) were locally acquired with unknown source, and 2% (4/229) were reported as under investigation. Excluding Victoria, there were 49 cases in other jurisdictions. Of these, 69% (34/49) were overseas acquired, 18% (9/49) were locally acquired, and 12% (10/49) were under investigation at this time. The continued decrease in new cases observed this fortnight in Victoria was the result of the public health interventions to minimise transmission. A total of 8 deaths were reported from cases diagnosed in this reporting period, all of whom were >75 years old, and all from Victoria. Although testing rates declined over the past month, they remain high at 10.4 tests per 1,000 population per week. There is variability in the testing rate by jurisdiction; the rate depends on the epidemic context. The overall positivity rate for the reporting period was 0.08%. Victoria reported a positivity rate of 0.18% for this reporting period, while in all other jurisdictions the positivity rate was 0.05% or lower.