May 11, 2020

COVID-19: Global death toll soars past 280,000

ECDC case count update

According to the European Centre for Disease Prevention and Control (ECDC), since 31 December 2019 and as of 11 May 2020, 4 063 525 cases of COVID-19 have been reported, including 282 244 deaths.

Cases have been reported from:

Africa: 63 413 cases; the five countries reporting most cases are South Africa (10 015), Egypt (9 400), Morocco (6 063), Algeria (5 723) and Nigeria (4 399).
Asia: 662 285 cases; the five countries reporting most cases are Turkey (138 657), Iran (107 603), China (84 010), India (67 152) and Saudi Arabia (39 048).
America: 1 772 622 cases; the five countries reporting most cases are United States (1 329 799), Brazil (162 699), Canada (68 848), Peru (67 307) and Mexico (35 022).
Europe: 1 556 150 cases; the five countries reporting most cases are Spain (224 390), United Kingdom (219 183), Italy (219 070), Russia (209 688) and Germany (169 575).
Oceania: 8 359 cases; the five countries reporting most cases are Australia (6 941), New Zealand (1 147), Guam (151), French Polynesia (60) and Fiji (18).
Other: 696 cases have been reported from an international conveyance in Japan.

Deaths have been reported from:
Africa: 2 290 deaths; the five countries reporting most deaths are Egypt (525), Algeria (502), South Africa (194), Morocco (188) and Nigeria (143).
Asia: 22 087 deaths; the five countries reporting most deaths are Iran (6 640), China (4 637), Turkey (3 786), India (2 206) and Indonesia (973).
America: 105 317 deaths; the five countries reporting most deaths are United States (79 528), Brazil (11 123), Canada (4 871), Mexico (3 465) and Ecuador (2 127).
Europe: 152 418 deaths; the five countries reporting most deaths are United Kingdom (31 855), Italy (30 560), Spain (26 621), France (26 380) and Belgium (8 656).
Oceania: 125 deaths; the four countries reporting deaths are Australia (97), New Zealand (21), Guam (5) and Northern Mariana Islands (2).

Other: 7 deaths have been reported from an international conveyance in Japan.

COVID-19 and the use of ACE inhibitors and ARBs

On 7 May, WHO published on its site a Scientific Brief which concluded that "there is low-certainty evidence that patients on long-term therapy with [angiotensin-converting enzyme] ACE inhibitors or [angiotensin receptor blockers] ARBs are not at higher risk of poor outcomes from COVID-19".

According to the report, concerns exist that ACE inhibitors and ARBs increase susceptibility to coronavirus SARS CoV-2 and the likelihood of severe COVID-19 illness. It added that these concerns are based on considerations of biological plausibility, and the observation that there is an overrepresentation of patients with hypertension and other cardiovascular comorbidities among patients with COVID-19 who have poor outcomes.

"Speculation about worse outcomes among patients on these medications during the COVID-19 pandemic has caused widespread anxiety among patients and their care providers", the Scientific Brief noted. It added that there is also widespread speculation about the potential benefits of ACE inhibitors and ARBs, based on biological plausibility arguments and animal data and small clinical studies on patients with other viral respiratory infections.

A rapid review was carried out using Ovid MEDLINE and the Cochrane Database of Systematic Reviews from 1 January 2003 to 24 April 2020 as well as the WHO database of COVID-19 publications, clinicaltrials.gov, and medRxiv.org from inception to 17 April 2020. Additional citations were identified from hand-searching reference lists. "Studies in all languages were included. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale", the Scientific Brief stated.

The rapid review identified 11 observational studies, eight of which were conducted in China, along with single studies from Italy, the United Kingdom, and the United States. Nearly all studies included only patients with lab-confirmed COVID-19.

"No studies were found that were designed to directly assess whether ACE inhibitors or ARBs increase the risk of acquiring COVID-19. After adjustment for confounders, history of ACE inhibitor or ARB use was not found to be associated with increased severity of COVID-19 illness. There were no studies that address the potential benefits and harms of initiating ACE inhibitors or ARBs as treatment for patients with COVID-19", the Scientific Brief concluded.

SOURCE: ECDC; WHO