Halting Progression to Acute Respiratory Distress Syndrome in COVID19 using Angiotensin Converting Enzyme II Receptor Antagonists

Abstract

The global COVID19 outbreak has reached pandemic levels with catastrophic consequences. A key health challenge has been absence of evidenced treatment options and of course an approved vaccine. Late disease manifests with severe pneumonia associated with Acute Respiratory Distress Syndrome (ARDS). Extracorporeal ventilation support ultimately becomes necessary, even when many countries especially within Africa are under equipped. Here, we argue that basing on the infection biology of the SARS-CoV2, where by target cell attachment and entry is mediated via Angiotensin Converting Enzyme type II (ACE2) Receptors (AAR) on Alveolar Epithelia, Existing ACE2 receptor antagonists presently approved for treating hypertension and left heart failure can be repurposed as a prophylactic treatment for COVID19 associated ARDS among patients with no prior history of longstanding drug-use. Despite earlier warning against the sustainance of ACE inhibitors (ACEi) and ARR, a recent observational cohort study involving 564 patients revealed benefits towards halting progression to ARDS. Management of the issuing hypotension might be a more amenable ‘sideeffect’ relative to the requirement for ventilation.