Objective: To study the effect of COVID-19 on pregnancy, neonatal outcomes; and the use of PPE amongst clinicians caring for COVID-19 patients. Design: Prospective cohort study Setting: A large tertiary maternity unit within a university hospital with an average annual >10,000 births. Population: A cohort of 23 pregnant women including singleton and multiple pregnancies tested positive for COVID-19 between February 2020 and April 2020 inclusive. Methods: Analysis of prospectively collected data to assess the effect of COVID-19 on pregnancy, neonatal outcomes; and staff use of PPE. Main outcome Measures Maternal and neonatal morbidity and mortality, and the use of PPE when interacting with COVID-19 patients Results: 23 pregnant women tested positive for COVID-19, delivering 20 babies. 16/23 (70%) were women from Asian background. Nearly fifth of the patients (4/23) developed severe respiratory complications requiring ICU support, one of which was complicated by maternal death (4.3%). (48%) of the patients had pre-existing co-morbidities, with diabetes being the most prevalent (17.4%). (36.4%) of COVID-19 pregnancies had preterm deliveries, (10.5%) respiratory distress, and pre-eclampsia. 16/23 (68%) of patients delivered by C-section. Out of the 20 new-borns, there were no cases of vertical transmission. FFP3 masks were not used by staff in (28.8%) of cases with confirmed COVID-19 infection. Conclusion: COVID-19 is associated with high prevalence of preterm birth, preeclampsia, and caesarean section compared to non-COVID pregnancies. There was no clinical evidence of vertical transmission to the new-borns. PPE use was compliant with WHO recommendations. Funding N/A Keywords COVID-19; maternal morbidity/mortality; neonatal morbidity/mortality; PPE

Objectives: The clinical characteristics and outcomes of COVID-19 pneumonia in children are different with adults. We evaluated the clinic characteristics and communicable period of COVID-19 pneumonia in pediatric patients of Changsha, capital of Hunan province. Methods: This is a retrospective study. We enrolled all 12 COVID-19 pneumonia pediatric patients and 134 adult patients in the Public Healthy Medical Center of Changsha from 29th Jan. to 20th Feb. Final date of follow-up was 10th Mar. We analyzed the characteristics and communicable period communicable period of pediatric patients, compared the differences between the pediatric and adult patients. Results: Of the pediatric patients enrolled, the median age was 8.5 years old. Four (33.3%) children were asymptomatic, but one had image changes. Fever 5(41.67%) and cough 4(33.33%) were the most common symptoms at onset of illness. Leukopenia, ALT/AST, LDH, CRP and PCT elevation were significantly less than adults. Only six children (50%) showed chest CT images changes. All patients were given antiviral drugs and supportive treatment. The estimated median communicable period was 15(8–17.75) days, which was significantly longer than adult patients 10 (8-12) days (P=0.044). However, the clinic cause of adult patients was much severe than pediatric patients, including Leukopenia, CRP elevation, typical radiological changes, clinic classification, and supporting therapy. Conclusion: In summary, majority of pediatric patients have a mild clinic cause and longer communicable period than adult, so they may need a longer quarantine period likely to be a supper source of infection.

Many Western countries have been affected by the outbreak of COVID-19. Italy has been particularly hit at the beginning of the pandemic, immediately after China. In Italy and elsewhere women seem to be less affected then men by severe/fatal COVID-19 infection, regardless of their age. Despite the evidence that women and men are different fort this infection, very few studies consider different therapeutic approaches for the two sexes. Undoubtedly, understanding the mechanisms at the bases of these differences may help to find appropriate and sex specific therapies. Here we consider that other mechanisms but estrogen protection are involved. Several X-linked genes (such as ACE2) and Y-linked genes (SRY, SOX9) may explain sex differences. Cardiovascular comorbidities are among the major enhancers of virus lethality. In addition, the number of sex-independent non-genetic factors that can change susceptibility and mortality is enormous, and many other factors are likely to be considered, including gender and cultural habits in different countries.

In SARS-CoV2 infections causing coronavirus disease-2019 (COVID-19) metabolic co-morbidities portend worse disease outcomes. We aimed at understanding the pathogenetic mechanisms underlying this phenomenon that may differentiate SARS-CoV2 infection from few other respiratory viruses that caused more limited pandemics in the recent past. A meta-analysis, of publicly available gene expression studies on human lung epithelial cells (HLEC) infected with different respiratory viruses, revealed both shared and exclusive transcriptional regulations. In addition, a few key metabolic pathways were found to be exclusively enriched in SARS-CoV2 infection. Systemic metabolic disorders are known to cause similar dysregulations in HLECs, which possibly underlie the predisposition of diabetic individuals to chronic lung diseases. We further performed an integrated analysis of the transcriptome from SARS-CoV2-infected HLECs, COVID-19 bronchoalveolar lavage and autopsied lung transcriptome as well as lung transcriptome from preclinical models of diet-induced obesity, revealing significant overlaps among these key pathways in these discreet contexts. This led us to hypothesize that with underlying metabolic co-morbidities this metabolic dysregulation of the HLECs on SARS-CoV2 infection is aggravated promoting widespread disruption of lung epithelial integrity, driving the worse prognosis. We envisage that any therapeutic agent that can target these key featured pathways, viz. metformin, should be of interest in SARS-CoV2 infection and warrants further studies.

At date, research is moving for a direct SARS-CoV-2 antiviral, which will be, probably, the ideal solution to defeat the virus. In the meantime, evidences have shown that effective improvements for health status of infected patients can be found in the decrease or stop of the hyper inflammatory state. Experts have divided the SARS-CoV-2 infection in three phases. In the last one, phase 3, the most severe, the immune system goes an overdrive status and, as consequence, it launches a large-scale assault versus all the tissues. This phenomenon is known as “cytokine storm” and it can lead to a damage of organs and, in some cases to death. Several studies showed that blocking the cytokine storm or acting advance with a prevention of the phenomenon, can be effective; studies are ongoing to evaluate agents that can be able to reduce this hyperinflammatory state, as, for example, IL-6 or IL-1 inhibitors. However, other drugs that are able to block the cytokine cascade can also be considered. In this article is reported the scientific and molecular motivation related to the use of colchicine as monotherapy or in association in all three phases of infection by SARS-CoV-2 modulating the inflammatory state. Colchicine can be considered safe and effective for the treatment and prevention of Cytokine Storm in patients affected by SARS-CoV-2 infection, in particular as a remedy added to other therapeutical agents. In fact, colchicine, probably, provides a bigger benefit to all current agents and its safety profile is superior to the one provided by other drugs, such as corticosteroids and immunosuppressive drugs.

Objective Olfactory Findings in Hospitalized Severe COVID-19 Patients.Jerome R. Lechien, MD, PhD, MS1-4, Morgane Ducarme, MD5, Sammy Place, MD6, Carlos M. Chiesa-Estomba, MD, MS1,7, Mohamad Khalife, MD1,8, Giacomo De Riu, MD9, Luigi Angelo Vaira, MD9, Christophe de Terwangne, MD10, Shahram Machayekhi, MD10, Arnaud Marchant, MD, PhD11, Fabrice Journe, PhD2*, Sven Saussez, MD, PhD1,2,4*

Beckgroung: The global pandemic Sars-Cov-2 (COVID-19) is causing thousands of deaths worldwide, and is one of the greatest health challenges ever faced in human history. Sars-Cov-2 infection can cause fatal lung injuries caused by a generalized inflammatory state associated with multi-organ dysfunction. Objective: In this context, it is essential to recognize the factors that increase the risk of viral infection. People with pre-existing conditions, such as diabetes, are at greater risk of complications and death caused by COVID-19. Materials and Method: Old age, possible chronic drug therapies, kidney failure, hyperglycemia, heart disease, are predictive factors of a bad outcome for the diabetic patient. The regulation of glycaemia and the adoption of appropriate measures are critical aspects to be taken into consideration for the diabetic patient in this pandemic period, especially in the patient with ongoing infection. Results: In the latter, the use of drugs used to fight COVID-19 infection, such as antivirals or immunomodulants, must be well controlled to avoid possible drug interactions and major complications. People with diabetes fall into the category of fragile and at-risk population, and if a COVID-19 infection is also ongoing the patient must be managed optimally, trying to fight the virus but also without neglecting homeostasis and glycemic control. Conclusion: This analysis highlights current knowledge and challenges for the prevention and management of patients with diabetes and COVID-19 infection.

Background and Objective: Compared with adult patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), children have a higher proportion of re-detectable positive (RP) in the recovery period.The underlying risk factors remain unknown.We aimed to identify the early risk factors for RP, and to provide a basis for early clinical prediction and risk stratification. Methods: A retrospective analysis was performed on all pediatric cases diagnosed with coronavirus disease 2019 (COVID-19). Results: 14 of 38 (36.8%) pediatric patients were RP.Children have a significantly higher percentage of RP (OR[95%CI] 4.84[2.21-10.59];P=.000).Compared with control group (n=24),RP group (n=14) had more family cluster infections (1.59[1.1-2.3];P=.030),while age ([7.2±4.8] vs [7.6±5.1]),and percentage of male gender (35.7% vs 45.8%), fever (21.4% vs 45.8%),respiratory or digestive symptoms (71.4% vs 50%), asymptom (28.6% vs 33.3%), computed tomography positive findings (85.7% vs 83.3%) and co-infection (7.1% vs 8.3%) were statistically nonsignificant.The laboratory data of RP group had a relatively higher white blood cell count (WBC) (7.5[5.1-9.8] vs 4.8[4.4-7.5];P=.009) and longer plasma prothrombin time (PT) ([12.6±0.7] vs [12.1±0.5];P=.023),while neutrophil percentage and count, lymphocyte percentage and count, hemoglobin, platelets,erythrocyte sedimentation rate,high sensitivity C-reactive protein, interleukin 6,procalcitonin, activated partial thromboplastin time ([37.5±4.6] vs [34.2±5.1]; P=.057),fibrinogen,antithrombin III and D-dimer showed no statistical difference. Conclusions:Family cluster infection,higher WBC and longer PT are the main risk factors for RP in the recovered COVID-19 children.Early activation of coagulation and WBC may be involved in SARS-CoV-2 clearance.

Title: COVID-19: Precautions with children in home mechanical ventilation.Authors: Luis Vasconcello-Castillo1, Rodrigo Torres-Castro MSc1, Roberto Vera-Uribe MSc1, Rebeca Paiva MD2.1Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile2Ministerio de Salud, Programa de Asistencia Ventilatoria No Invasiva Domiciliaria, Santiago, Chile

Background: During COVID-19 pandemic, a metered-dose inhaler (MDI) with a valved holding chamber (VHC) is a preferred route of bronchodilator delivery. We have developed a new homemade VHC, made of a paper coffee cup and a drinking water bottle. This study was conducted to compare the bronchodilator response in children with airway hyperresponsiveness after the use of our homemade VHC and that of a standard commercial one. Methods: In a randomized, two-period, two-sequence crossover design, we recruited 20 children, aged 6-15 years, who had greater than 12% increase in FEV1 after inhaled salbutamol. They were randomized into Group A and B. Group A used our VHC on the first day and Aerochamber® on the second day. Group B used the same VHCs but in alternate sequence. Spirometries were performed before and after 400 microgram of salbutamol MDI was administered via those VHCs. Results: Baseline demographic data and spirometric values did not have statistically significant differences between group A and B and between the first and second day (P > 0.05). After giving salbutamol MDI, both VHCs produced significant increases in FVC, FEV1 and FEF25-75% (P < 0.005). The improvement in FEV1 did not significantly differ between our homemade VHC and Aerochamber® (P > 0.05). Conclusion: Our homemade VHC is effective for an MDI bronchodilator delivery. Since it is very cheap and easy to make, it may be used as a disposable device to minimize airborne transmission especially when commercial VHC are not available.

Background Coronavirus disease 2019(Covid-19) Personal Protective Equipment (PPE) has been reported to effect communication in healthcare settings. We sought to identify those challenges experimentally. Method Bamford-Kowal-Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for speech intelligibility with and without PPE both at normal speech and raised voice. Results There was a significant difference in speech discrimination scores between normal and PPE wearing subjects in theatre simulated background noise levels (70dB). Conclusion PPE wearing can impact communication and efforts should be made to remind staff about this burden and seek alternative communication paradigms, particularly in theatre environments.

The coronavirus disease 2019 (COVID-19) pandemic has become a major public health crisis. The diagnostic and containment efforts for the disease have presented significant challenges for the global healthcare community. In this brief report, we provide perspective on the potential use of salivary specimens for detection and serial monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), based on current literature. Oral healthcare providers are at an elevated risk of exposure to COVID-19 due to their proximity to nasopharynx of patients, and the practice involving the use of aerosol-generating equipment. Here we summarize the general guidelines for oral healthcare specialists for prevention of nosocomial transmission of COVID-19, and provide specific recommendations for clinical care management.

Background: The relative resistance of children to severe course of novel coronavirus infection remains unclear. We hypothesized that there might be a link between this phenomenon and observation from our previous studies, concerning an inhibitory or cytotoxic effect of children exhaled breath condensate (EBC) on endothelial cell cultures. Since we could not find any data on similar effect caused by EBC from adults, the aim of our study was to evaluate and compare the biological activity of EBC from adults and children in an experimental in vitro model. Furthermore, in order to identify a putative agent responsible for these properties of children EBC, we attempted to analyse the composition of selected EBC samples. Methods: The influence of EBC samples on metabolic activity of endothelial cell line C-166 was assessed using colorimetric tetrazolium salt reduction assay (MTT assay). Selected EBC samples were fractionated using size exclusion chromatography and subjected to mass spectrometry analysis. Results: Exhaled breath condensates from healthy children, but not from adults, revealed a cytotoxic effect on in vitro cell cultures. This effect was most significant in condensate fraction, which contained a prominent 4.8 kDa peak in the mass spectra. Conclusion: Breath condensates from healthy children contain the factor, which reveals inhibitory/cytotoxic effect on endothelial cell cultures. Although physiological role of this agent remains unclear, its identification may potentially be useful in ongoing research on SARS-CoV-2/COVID-19.

A document by Cristina Quecchia, written on Authorea.

In late December 2019, a novel coronavirus disease (COVID-19) emerged and rapidly spread in China. Some of the pets were abandoned due to the poor economic situation, being quarantined in exotic areas or the death of their owners; these were usually adopted by an animal sanctuary. However, an extreme phenomenon of abandoning pets during the outbreak of the COVID-19. We analyzed the reasons and serious consequences of this improper behavior and gave our suggestions. We appeal for the careful protection of the pets. These innocent animals should be taken care of.

Emerging or re-emerging zoonotic diseases are the main issue in global health and affect the well-being of nations. COVVID-19 originated from a wet market where wild animals are sold and rapidly outbreak across worldwide. Analysis outlined bats are key host, so COVID-19 is a zoonotic disease and crossed from animals into humans. Wildlife migration among world protected areas and disease transmission has caused an increased risk of emerging or re-emerging of zoonotic diseases such as COVID-19. Transboundary animal diseases (TDAs) make the health approach more crucial as these diseases cause many problems. Hence, the prevention and control of zoonotic diseases are critical. In this paper, we addressed world protect areas management, wildlife migration, and preventive and control measures aspects on zoonotic diseases such as COVID-19 that have already been globally recommended. South American and African countries due to higher coverage of protected areas in human development regions; and Asian and South American countries due to lack of protected area management assessment are more prone to transmit COVID-19 by wildlife migrations. World Health Organization should pay attention to the determined countries for more practical health care plans in protected area communities and settlement especially in facing with wildlife species.

The health crisis due to coronavirus disease 2019 (COVID-19) shocks the world with more than million infections and casualties. COVID-19 could present from mild illness to multi-organ involvement, especially acute respiratory distress syndrome. Cardiac injury and arrhythmias including atrial fibrillation (AF) are not uncommon in COVID-19. COVID-19 is highly contagious, and the therapy against the virus remains premature and largely unknown. These make the management of AF patients during pandemic particularly challenging. We here describe possible pathophysiology link between COVID-19 and AF, and therapeutic considerations for AF patients during this pandemic.

Background: Little is known about whether coinfection of other respiratory tract viruses contributes to severity of COVID-19 pneumonia. Methods: We retrospectively studied 128 hospitalized patients with COVID-19 pneumonia (64 cases co-infected with influenza A/B vs 64 negative influenza cases via pair-matching on age, sex, and days from onset of symptom). Results: Among 64 co-infected patients, 54 patients (84.4%) had co-infected with influenza A, and 10 (15.6%) with influenza B. The percentages for the severity of pneumonia on admission of the two groups, i.e., with influenza infection and without, were similar (P=0.945). The median duration (days) of viral shedding time from admission was longer for patients with influenza infection (17.0 day) than those without influenza infection (12.0 day) (P<0.001). However, the progression of lung CT in four weeks after onset of symptom were similar in both groups. The multivariable Cox proportional hazards model showed that the HR of pneumonia resolution on CT scans was 0.869 (P=0.612) for patients with influenza (95% CI 0.505, 1.495) compared with patients without influenza, while the HR of resolution in lung involvement was 1.878 (P=0.020) for patients with lopinavir/ritonavir, compared with patients without lopinavir/ritonavir (95% CI 1.103, 3.196). Patients who were treated with lopinavir/ritonavir presented with faster pneumonia resolution in two weeks after symptom onset both in the whole cohort (32.4% vs 13.8%, P=0.036) and in influenza co-infected group (37% vs 1%, P=0.001). Conclusions: Lopinavir/ritonavir eliminated the difference of lung involvement between influenza co-infected and non-infected groups, indicating lopinavir/ritonavir is associated with pneumonia resolution in COVID-19.

Abstract Background: Considering the lack of definitive drug or vaccine, the non-pharmaceutical interventions need to be implemented to control the current coronavirus disease (COVID-19) outbreak, notably in countries with limited resources like Bangladesh. So, the study targeted the university students of Bangladesh as the representatives of the millennials to determine their level of awareness regarding COVID-19. Methods: A cross-sectional study was designed to determine the knowledge, attitude and practices with a co-produced perception section regarding COVID-19 among university students in Bangladesh. The survey was conducted from 16 to 23rd March, 2020. Descriptive and inferential analyses were performed with statistical significance defined as p < 0.05. Result: Among 1393 students participated in the study, about one-third of them had a positive attitude towards COVID-19 issues, although only 6.9% had good knowledge. While the majority of the participants followed sneezing/ coughing etiquette, frequent hand washing/sanitizing, limited body contact and public transport, etc., both good knowledge and positive attitude were significantly associated with respondents’ good practices. But despite the satisfactory hand hygiene behaviors, awareness is required about the type of sanitizers and the importance of washing hands for 20seconds. Promoting health educative activities through Facebook might be considered to improve the knowledge level, especially to raise awareness about rare symptoms and asymptomatic transmission. However, bazaars might be the potential point of the outbreak that needs to be controlled. Conclusion: The study supports the concerning lack of knowledge among the students along with suggesting the issues to be addressed for successful containment of COVID-19.

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the global pandemic and caused hundreds of thousands of people died in the world, which is in urgent need to develop new drug therapy and pathogen progressive information. Although abundant anti-viral drugs has been directly practiced in some patients, there are no specific drug treatment due to the new SARS-CoV-2 virus, which cause great disaster and panic all over the world. Remdesivir has been recently a strong candidate for the treatment of COVID-19. Recently, due to the support of antiviral experiments in vitro and a case report by compassionate use of the drug, remdesivir has been a promising candidate treatment for the treatment of COVID-19. As a broad-spectrum anti-viral compound targeting the viral RNA dependent RNA polymerase, remdesivir has been shown to suppress the coronavirus, such as SARS-CoV and MERS-CoV. However, is remdesivir really a magic bullet for COVID-19, also a coronavirus? In this article, we first overview the general information about SARS-CoV-2 and its potential suppressing drug remdesivir. Then, we carefully discussed the limitation with the remdesivir antiviral study, including the case report by compassionate use of remdesivir. Finally, from the pharmaceutical perspective we explored the anti-virus capability of remdesivir against different viruses to see whether it’s a magic bullet for COVID-19. Therefore, this paper provides crucial evidence and objective theoretical basis on remdesivir to cure COVID-19 infections.

Combined use of hydroxychloroquine and azithromycin was globally adopted, in part due to paucity and high cost of alternative therapies. However the utility of these medications has been questioned; and thus safety becomes a major concern given clinical equipoise regarding efficacy. Both hydroxychloroquine and azithromycin continue to be administered in US clinical trials examining their potential role in prevention of infection, treatment of mild infection in ambulatory patients, and in combination with other medical regimens in treatment of patients with severe disease. These drugs also continue to be clinically utilized in hospitalized patients around the globe, often without continuous telemetry due to lack of resources. Concern regarding use of hydroxychloroquine without adequate rhythm monitoring in clinical trials has been recently expressed.1 A review of clinicaltrials.gov at the time of submission of this correspondence reveals actively recruiting trials of combined hydroxychloroquine/azithromycin with or without additional COVID-19 therapies, for both ambulatory and hospitalized patients within and outside the US. The potential for hydroxychloroquine and azithromycin to cause QT prolongation is counterbalanced by very low risk of pro-arrhythmia in the general population, and emerging evidence of relatively low risk of Torsades de Pointes (TdP) in COVID-19 patients.2,3,4,5 Thus delineation of the determinants of significant QTc prolongation and pro-arrhythmic risk for hydroxychloroquine/azithromycin is very important, especially given mounting evidence of inefficacy in COVID-19 treatment.

Background: The Covid-19 pandemic is characterized by extreme variability in the outcome distribution and mortality rates across different countries. Some recent studies suggested an inverse correlation with BCG vaccination at population level, while others denied this hypothesis. In order to address this controversial issue, we performed a strict epidemiological study collecting data available on a global scale, considering additional variables such as cultural-political factors and adherence to other vaccination coverages. Methods: Data on 121 countries, accounting for about 99% of Covid-19 cases and deaths globally, were from John’s Hopkins Coronavirus Resource Center, World Bank, International Monetary Fund, United Nations, Human Freedom Report, BCG Atlas. Statistical models were Ordinary Least Squares, Tobit and Fractional Probit, implemented on Stata/MP16 software. Results: Countries where BCG vaccination is or has been mandated in the last decades have seen a drastic reduction in Covid-19 diffusion (-80% on average) and mortality (-50% on average), even controlling for relative wealth of countries and their governmental health expenditure. A significant contribution to this reduction (respectively -50% and -13% on average) was also associated to the outbreak onset during summer, suggesting a possible influence of seasonality. Other variables turned out to be associated, though to a lesser extent. Conclusions: Relying on a very large dataset and a wide array of control variables, our study confirms a strong and robust association between Covid-19 diffusion and mortality with BCG vaccination and a set socio-economic factors, opening new perspectives for clinical speculations, experimental studies and public health policies.

Background The aim of the present theoretical essay is to evaluate evidence published on the characteristics of the transcription of SARS-CoV-2 and explain the mechanism of action of ivermectin that may justify its therapeutic use in clinical practice for the treatment of COVID-19. Methods Laboratory studies, narratives, editorials and expert opinions on the subject were identified through a systematic search of the literature in the Medline/PubMed, Cochrane Library, Web of Science and Embase databases. Two blinded, independent reviewers selected studies published up to May 17, 2020 based on the eligibility criteria. Results The search of the databases led to the retrieval of 25 articles. After the different phases of the selection process, eight articles were included in the present review for the extraction of relevant data. The results suggest that ivermectin inhibits the viral replication of SARS-CoV-2 through the action of the hypoxia-inducible factor (HIF-1α) and consequent destabilization of importin α/β1 proteins. Conclusions Ivermectin inhibits the viral replication of SARS-CoV-2. Laboratory and clinical studies are needed to provide more evidence in terms of the best posology and possible associations with other drugs for combatting COVID-19.

COVID-19 has been the biggest global health threat since world war II. Up to now, the novel coronavirus pneumonia epidemic has resulted in over 300 thousand deaths. Angiotensin-converting enzyme 2 (ACE2), the receptor of SARS-CoV-2, is also the key modulator of renin-angiotensin-aldosterone system (RAAS) axes, which regulates the inflammatory response to maintain internal environment balance. On the contrary, RAAS axes can also regulate the expression of ACE2 which may influence on the susceptibility of SARS-CoV-2. Furthermore, SARS-CoV-2 binds with ACE2 and subsequently down-regulates ACE2 expression, which may exacerbate the inflammatory response due to RAAS imbalance. In this review, we summarized pathogenesis and clinical characteristics of COVID-19 patients, and discussed the potential link between the RAAS axes imbalance and the susceptibility/progression of organ injury in COVID-19. Therefore, we speculate that rebalance of the RAAS axes is the preventive and therapeutic strategy of COVID-19.