The many estimates of the COVID-19 case fatality rate

Rajgor, Dimple; Lee, Meng Har; Archuleta, Sophia; Bagdasarian, Natasha; Quek, Swee Chye

doi:10.1016/s1473-3099(20)30244-9

Cited by 485 publications

(497 citation statements)

References 6 publications

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“…However, the expression of AT 2 receptor is low in healthy adults. [45] As such, Ang II's effects in adults are modulated and balanced indirectly by angiotensin II converting enzyme (ACE2), which converts Ang II into lung-protective Angiotensin-(1-7) (Ang- [1][2][3][4][5][6][7]), similar to effects seen from AT 2 receptor stimulation. [41,46] Conceptually grouping pathways into an Ang II/AT 1 receptor and its opposing pathway ACE2/Ang-(1-7) helps with understanding the countering forces and the sequelae when an imbalance occurs.…”

Section: Angiotensin II / At 1 Receptor Relationshipmentioning

confidence: 99%

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Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review

et al. 2020

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ImportanceCoronavirus disease 2019 (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared a global pandemic with significant morbidity and mortality since first appearing in Wuhan, China, in late 2019. As many countries are grappling with the onset of their epidemics, pharmacotherapeutics remain lacking. The window of opportunity to mitigate downstream morbidity and mortality is narrow but remains open. The renin–angiotensin–aldosterone system (RAAS) is crucial to the homeostasis of both the cardiovascular and respiratory systems. Importantly, SARS-CoV-2 utilises and interrupts this pathway directly, which could be described as the renin–angiotensin–aldosterone–SARS-CoV (RAAS–SCoV) axis. There exists significant controversy and confusion surrounding how anti-hypertensive agents might function along this pathway. This review explores the current state of knowledge regarding the RAAS–SCoV axis (informed by prior studies of SARS-CoV), how this relates to our currently evolving pandemic, and how these insights might guide our next steps in an evidence-based manner.ObservationsThis review discusses the role of the RAAS–SCoV axis in acute lung injury and the effects, risks and benefits of pharmacological modification of this axis. There may be an opportunity to leverage the different aspects of RAAS inhibitors to mitigate indirect viral-induced lung injury. Concerns have been raised that such modulation might exacerbate the disease. While relevant preclinical, experimental models to date favour a protective effect of RAAS–SCoV axis inhibition on both lung injury and survival, clinical data related to the role of RAAS modulation in the setting of SARS-CoV-2 remain limited.ConclusionProposed interventions for SARS-CoV-2 predominantly focus on viral microbiology and aim to inhibit viral cellular injury. While these therapies are promising, immediate use may not be feasible, and the time window of their efficacy remains a major unanswered question. An alternative approach is the modulation of the specific downstream pathophysiological effects caused by the virus that lead to morbidity and mortality. We propose a preponderance of evidence that supports clinical equipoise regarding the efficacy of RAAS-based interventions, and the imminent need for a multisite randomised controlled clinical trial to evaluate the inhibition of the RAAS–SCoV axis on acute lung injury in COVID-19.

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Section: Angiotensin II / At 1 Receptor Relationshipmentioning

confidence: 99%

“…[1][2][3] (At time of article submission). While early estimates vary and true values remain uncertain, mortality is estimated between 0.4 to 3.4% [4,5] with initial morbidity and mortality disproportionally affecting older patients. [6] Infectivity (R 0 ) is estimated at 2.24 to 3.58.…”

Section: Introductionmentioning

confidence: 99%

Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review

et al. 2020

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“…Mortality estimates are influenced by the transmissibility rate (basic reproduction number), availability of diagnostic tools, notification policies, asymptomatic presentations of the disease, resources for disease prevention and control and treatment facilities. Even with more than 1,359,398 people infected as of April 7, 2020 [4], variability in the mortality rate fits the pattern of emerging infectious diseases [38]. Furthermore, the reported cases do not consider asymptomatic cases, mild cases where individuals have not sought medical treatment, and the fact that many countries have limited access to diagnostic tests or have implemented testing policies only very recently [39].…”

Section: Discussionmentioning

confidence: 99%

Coronavirus Disease (COVID-19) Pandemic: An Overview of Systematic Reviews

Nascimento

O’Mathúna

Groote

et al. 2020

Preprint

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Background: Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging and ongoing critical appraisal of this output is essential.We aimed to collate and summarize all published systematic reviews on the coronavirus disease .Methods: Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO's Global Research, LILACS and Epistemonikos) were searched from December 1, 2019 to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory and radiological findings) and quality assessment (AMSTAR 2). Meta-analysis on prevalence of clinical outcomes was performed.Results: Eighteen systematic reviews were included; one was empty. Using AMSTAR 2, confidence in the results of 13 reviews was rated as "critically low", one as "low", one as "moderate" and two as "high". Symptoms of COVID-19 were (range values of point estimates): fever (82-95%), cough with or without sputum (58-72%), dyspnea (26-59%), myalgia or muscle fatigue (29-51%), sore throat (10-13%), headache (8-12%) and gastrointestinal complaints (5-9%). Severe symptoms were more common in men. Elevated C-reactive protein (associated with lymphocytopenia) and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. Chest imaging described a frequent pattern of uni-or bilateral multilobar ground-glass opacity. Only one review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3% to 14%. Conclusions:Confidence in the results of most reviews was "critically low". Future studies and systematic reviews should adhere to established methodologies. The majority of included systematic reviews were hampered by imprecise search strategy and no previous protocol submission.All-cause mortality was 0.3% (95% CI 0.0%-1.0%). Epidemiological studies showed that mortality was higher in males and elderly patients. Clinical SymptomsThe incidence of symptoms were shown as following: Fever 82%, (CI) 56%-99%; Cough 61%, 95% CI 39%-81%; Muscle aches and/or fatigue 36%, 95% CI 18%-55%; Dyspnea 26%, 95% CI 12%-41%; Headache 12%, 95% CI 4%-23%; Sore throat 10%, 95% CI 5%-17% and gastrointestinal symptoms 9%,95% CI 3%-17%.

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“…patient from day 5 recovered or dead on day 19 and so on. Case fatality rate (F) values of COVID-19 is differed in different studies (29)(30)(31), however to avoid the regional confinement, here in this study WHO reported COVID-19 case fatality rate (F) 3.4% (3) was used. This pointed that the death from the cases day 0 is 0.034 (1×3.4%) on day 14, as opposed to be recovered 0.966 people.…”

Section: Adjust the Values Of Different Parameters From Epidemiologicmentioning

confidence: 99%

Predict the next moves of COVID-19: reveal the temperate and tropical countries scenario

Hasan¹,

Haque²

2020

Preprint

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The spread of COVID-19 engulfs almost all the countries and territories of the planet, and infections and fatality are increasing rapidly. The first epi-center of its' massive spread was in Wuhan, Hubei province, China having a temperate weather, but the spread has got an unprecedented momentum in European temperate countries mainly in Italy and Spain (as of March 30, 2020). However, Malaysia and Singapore and the neighboring tropical countries of China got relatively low spread and fatality that created a research interest on whether there are potential impacts of weather condition on COVID-19 spread. Adopting the SIR (Susceptible Infected Removed) deviated model to predict potential cases and death in the coming days from COVID-19 was done using the secondary and official sources of data. This study shows that COVID-19 spread and fatality tend to be high across the world but compared to tropical countries, it is going to be incredibly high in the temperate countries having lower temperature (7-16°C) and humidity (80-90%) in last March. However, some literature predicted that this might not to be true, rather irrespective of weather conditions there might be a continuous spread and death. Moreover, a large number of asymptotic COVID-19 carrier in both temperate and tropical countries may re-outbreak in the coming winter. Therefore, a comprehensive global program with the leadership of WHO for testing of entire population of the world is required, which will be very useful for the individual states to take proper political action, social movement and medical services.

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The many estimates of the COVID-19 case fatality rate

Abstract: WHO. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Feb 16-24, 2020. https://www.who.int/ publications-detail/report-of-the-who-chinajoint-mission-on-coronavirus-disease-2019-(covid-19) (accessed March 22, 2020).

Cited by 485 publications

References 6 publications

Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review

Understanding the renin–angiotensin–aldosterone–SARS-CoV axis: a comprehensive review

Coronavirus Disease (COVID-19) Pandemic: An Overview of Systematic Reviews

Predict the next moves of COVID-19: reveal the temperate and tropical countries scenario

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