Potential insights into COVID-19 disparities from the science of cancer health disparities
Authors: John M. Carethers
Journal: Clinical Cancer Research (2020)

Older age as well as health comorbidities that include metabolic syndrome, cardiovascular disease, hypertension, asthma, and chronic kidney disease are listed by the Centers for Diseases Control and Prevention (CDC) as strongrisk factors for severe disease and mortality from COVID-19  Since the outbreak began throughout the world and theUnited States, both gender and race/ethnicity have additionally become associated with infection and severeCOVID-10 disease and mortality  While all humans lacked immunity at its onset to the new SARS-CoV-2 virus, thecause of COVID-19, older-age individuals are likely more susceptible due to age-weakened immune systems, thepresence of health comorbidities, and are the most likely group to be housed within skilled nursing facilities (SNFs)where outbreaks and death from COVID-19 have been frequent  SNFs often lacked isolation protocols, initial viraltesting, and lacked personalized protection equipment (PPE) that was prioritized to hospitals  People with healthcomorbidities regardless of age are more susceptible to severe COVID-19 likely because of weakened health andimmunity  Indeed, patients on immunosuppression for medical conditions were among the first susceptible to severeinfection when the outbreak began  The association of severe COVID-19 and race/ethnicity shows the strongestrationale with socioeconomic inequalities  Those from minority-population backgrounds are often in more urbancrowded areas where mitigating factors of social distancing and opportunities to avoid virus exposure are lessrealized  Many minority populations, as a result of socioeconomic inequality, have more difficult access to healthcare, hold lower-paying jobs, reside in lower-income neighborhoods with grocery store deserts, have higher use oftobacco and alcohol and demonstrate lower physical activity, and have lower use of preventive medicine  This inturn has the physiologic consequences of alteration of the gut microbiome, increased localized inflammation, andcompromised immunity, leading to higher frequencies of health comorbidities, the exact conditions that have beenshown to place an individual at much higher risk for mortality from COVID-19  Other COVID-19 risk factors such asblood group type A and the use of angiotensin-converting enzyme (ACE) inhibitors for the high prevalence ofessential hypertension and cardiovascular disease in racial populations appear not to play a role  Specific spikeprotein variants that have proved to be more virulent have not been evaluated among racial groups  The use ofhydroxychloroquine might play a role in sudden death if used for treatment or prophylaxis of COVID-19 in someAfrican Americans because of the common presence of a cardiac sodium channel polymorphism  The higher risk formen over women for severe COVID-19 disease is intriguing;the SARS-CoV-2 virus requires the use of cell ACE2receptors and the cell serine protease TMPRSS2, both regulated by androgens for expression  Differences inexpression levels as well as trials of antiandrogen therapy are both being explored to assess if these permissive cellfactors are the cause for gender differences