Horm Metab Res 2020; 52(07): 540-546
DOI: 10.1055/a-1182-2016
Hypothesis

Is There a Role for Environmental and Metabolic Factors Predisposing to Severe COVID-19?

Stefan R. Bornstein
1  Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
2  Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
3  Department of Diabetes, School of Life Course Science and Medicine, Kingʼs College London, London, UK
4  Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, University Hospital, Zürich, Switzerland
,
Karin Voit-Bak
5  Zentrum für Apherese- und Hämofiltration am INUS Tagesklinikum-Cham, Cham, Germany
,
Dieter Schmidt
5  Zentrum für Apherese- und Hämofiltration am INUS Tagesklinikum-Cham, Cham, Germany
,
Henning Morawietz
6  Division of Vascular Endothelium and Microcirculation, Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
,
Alexander Benjamin Bornstein
2  Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
,
Waldimir Balanzew
2  Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
,
Ulrich Julius
2  Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
,
Roman N. Rodionov
2  Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
,
Anne Maria Biener
2  Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
,
Jun Wang
2  Department of Medicine III, University Hospital Carl Gustav Carus at the Technische Universität, Dresden, Germany
,
Klaus-Martin Schulte
7  Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, London, UK
8  ACRF Department of Cancer, John Curtin School of Medical Research, The Australian National University, Canberra, Australia
,
Peter Krebs
9  Institute of Urban and Industrial Water Management, Technische Universität Dresden, Dresden, Germany
,
Günter Vollmer
10  Institute of Zoology, Molecular Cell Physiology and Endocrinology, Technische Universität Dresden, Dresden, Germany
,
R. Straube
5  Zentrum für Apherese- und Hämofiltration am INUS Tagesklinikum-Cham, Cham, Germany
› Author Affiliations
Funding Information This work was supported by the Deutsche Forschungsgemeinschaft (DFG) (grant numbers MO 1695/5-1 and -2) and the Excellence Initiative by the German Federal State Governments (Institutional Strategy, measure “support the best”, grant number 3-2, F03661- 553-41B-1250000). Klaus-Martin Schulte is supported by the Max Lindemann Memorial Fund.

Abstract

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic affects people around the world. However, there have been striking differences in the number of infected individuals and deaths in different countries. Particularly, within Central Europe in countries that are similar in ethnicity, age, and medical standards and have performed similar steps of containment, such differences in mortality rates remain inexplicable. We suggest to consider and explore environmental factors to explain these intriguing variations. Countries like Northern Italy, France, Spain, and UK have suffered from 5 times more deaths from the corona virus infection than neighboring countries like Germany, Switzerland, Austria, and Denmark related to the size of their respective populations. There is a striking correlation between the level of environmental pollutants including pesticides, dioxins, and air pollution such as NO2 known to affect immune function and healthy metabolism with the rate of mortality in COVID-19 pandemic in these European countries. There is also a correlation with the use of chlorination of drinking water in these regions. In addition to the improvement of environmental protective programs, there are possibilities to lower the blood levels of these pollutants by therapeutic apheresis. Furthermore, therapeutic apheresis might be an effective method to improve metabolic inflammation, altered vascular perfusion, and neurodegeneration observed as long-term complications of COVID-19 disease.



Publication History

Received: 08 May 2020

Accepted: 15 May 2020

Publication Date:
29 June 2020 (online)

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