SARS-CoV-2 uses ACE2, an inhibitor of the Renin-Angiotensin-Aldosterone System (RAAS), for cellular entry. Studies indicate that RAAS imbalance worsens the prognosis in COVID-19. We present a consecutive retrospective COVID-19 cohort with findings of frequent pulmonary thromboembolism (17%), high pulmonary artery pressure (60%) and lung MRI perfusion disturbances. We demonstrate, in swine, that infusing angiotensin II or blocking ACE2 induces increased pulmonary artery pressure, reduces blood oxygenation, increases coagulation, disturbs lung perfusion, induces diffuse alveolar damage, and acute tubular necrosis compared to control animals. We further demonstrate that this imbalanced state can be ameliorated by infusion of an angiotensin receptor blocker and low-molecular-weight heparin. In this work, we show that a pathophysiological state in swine induced by RAAS imbalance shares several features with the clinical COVID-19 presentation. Therefore, we propose that severe COVID-19 could partially be driven by a RAAS imbalance.

BACKGROUNDMany of the dramatic changes in family formation and dissolution observed in wealthy countries over the past 60 years are tracked through vital statistics or censuses. The signature change in family behavior -non-marital cohabitation -is not, however, registered in most settings. OBJECTIVEWe evaluate the quality of new register-based estimates of parents‗ union status at birth and of separation during the childrearing years. METHODSParents of a common child are identified through the Multi-Generation Register that links each child to each parent and therefore each parent to each other. The Total Population Register identifies the property at which each parent is registered at the end of each year. We use the five-year censuses 1960-1990 as one standard of comparison because the censuses identify the dwelling unit for each parent on the census date. RESULTSProperty-based estimates of parents‗ coresidence compare very well to census reports. Register-based estimates are virtually identical with those produced from the 1992 Swedish Fertility and Family Survey; differences between register estimates and those produced from the 1991 and 2000 Level of Living Survey can be explained by differences in measurement of marriage and cohabitation.1 Stockholm University Demography Unit, Department of Sociology, Sweden. E-Mail: elizabeth.thomson@sociology.su.se. 2 Stockholm University Demography Unit, Department of Sociology, Sweden. E-Mail: helen.eriksson@sociology.su.se. Thomson & Eriksson:Register-based estimates of parents' coresidence in Sweden, 1969Sweden, -2007Sweden, 1154 http://www.demographic-research.org CONCLUSIONSEstimates of parents‗ cohabitation based on annual, property-level registration are of sufficient quality for their use in substantive analyses of union status at birth and parents‗ separation in Sweden. COMMENTSAlthough register-based estimates of parents‗ coresidence at a child‗s birth or afterwards can be generated only for a select group of countries, their use can be fruitful for understanding more general processes of family change. Centralized administrative registers exist in many countries but have not been made fully available for research therefore losing much of the potential value.

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Interview and observational studies document that dual-caring is characterized by temporality. Two ‘ideal-typical’ trajectories are identified: ‘halving it all’ in which couples divide care equally on a daily or weekly basis and ‘taking turns’ in which parents take month- or year-long turns in serving as primary caregivers to the child. This study utilizes a new source of couple-level longitudinal information on parental leave to investigate dual-caring trajectories in contemporary Sweden. Results show that while care trajectories in which only one parent serves as the primary caregiver can be captured without longitudinal information, the dominant dual-caring trajectory cannot. In fact, despite a uniquely flexible parental leave system that allows egalitarian couples to share care on a daily basis, most couples do not share care in every point in time, but ‘take turns’ in serving as the primary caregiver to the child, with the mother’s ‘turn’ preceding the father’s. The results demonstrate that cross-sectional and aggregate measures of child care may fail to detect emerging trends in dual-caring.

SARS-CoV-2 enters the cell through the ACE2 receptor, which is considered one of the main inhibitors in the Renin-Angiotensin-Aldosterone System (RAAS).1​ ,2 The virus has been shown to downregulate the ACE2 receptor, leading to a subsequent increase in the vasopressoragentangiotensinII.3​ Evidently,criticalcoronavirusdisease2019(COVID-19)is thought to be due to a dysregulated immune response, causing a cytokine-release syndrome eventually leading to acute respiratory distress syndrome (ARDS).4​ ,5 ​However, several reports on clinical laboratory features and case-descriptions of critically ill patients with COVID-19 show discrepancies compared to typical ARDS. Here, we show that infusing swines with angiotensin II induces a pathophysiological syndrome closely resembling that of patients with RT-PCR-positive COVID-19. By using multimodal clinical imaging of patients, comparing laboratory data and translational histological features, we show that it is highly likely that an increase in RAAS is one, if not the main, pathogenic feature in critical COVID-19. Furthermore, it is plausible that this large animal model can be used to screen for potential new treatments for patients with severe COVID-19 and that MRI lung perfusion can be used to evaluate the outcome of potential treatments targeting the pathophysiological syndrome.