Are Asians More Prone to Get the Covid-19?

Posted on Mar 06, 2020

by Jesse Santiano, M.D.

The vast majority of the cases and deaths (76,776 and 2,247)  of the Covid-19 pandemic is in China.  Covid-19, previously known as the 2019-novel coronavirus, can lead to severe pneumonia, especially among the elderly with many other medical problems.

The Covid-19 virus is known to stick to the cells of the lungs. The way they attach is by a receptor in the cells. That receptor is known as the angiotensin-converting enzyme 2  (ACE2) receptors. Thus, it seems logical to say that the more ACE2 receptors, the more Covid-10 viruses can stick to the lungs, and the more severe the disease.

Looking around the internet and twitter, there is a table that shows that Asian males are more prone to Covid-19 than other whites and Africans because they have more angiotensin-converting enzyme 2  (ACE2) receptors.

That table circulating on the internet is shown below.

I searched for the original source of the table above using my journal sources and found nothing. Google Scholar came up with none. I scanned thru all the published journals of the 1,000 Genome project and found zero. I also reversed look-upped the table, and it showed nothing. There are no studies to back the table that shows Asians have more ACE2 receptors.

What I found out is that I am not the only one searching for it. A discussion about the same topic at elicited a response from Claire, also known as greendoc. Greendoc also looked for the source of the table. In the following screenshot, this is what greendoc said.

That is only a part of her comment. More can be read here.  I have reason to believe greendoc. She provided credible references for her arguments as she went on. I use the female gender for greendoc since she signed her response as Claire.

The question now is, Is there a study that shows racial differences in ACE2 receptors?

None so far. However, here are

Two studies that showed NO Differences in ACE21 receptors among races.

In a preprint study done Feb 17, 2020, Asians and Other Races Express Similar Levels of and Share the Same Genetic Polymorphisms of the SARS-CoV-2 Cell-Entry Receptor, the authors did not find any differences in the number of ACE2 receptors among races.

The expression of ACE2 increases with age, but is not associated with sex. Asians show a similar ACE2 expression to other races.

Furthermore, the frequencies of ACE2 alleles in Asians are not significantly deviated from those in other races.

Could there be an explanation of why more males die from the Covid-19? The answer may be in smoking.

Smoking Increases the Number of ACE2 Receptors

In another preprint study, Feb 12, 2020, Tobacco-Use Disparity in Gene Expression of ACE2, the receptor of 2019-nCov, from the University of South Carolina, what they found is that smokers have a higher number of ACE2 receptors in their lungs. To wit,

No significant disparities in ACE2 gene expression were found between racial groups (Asian vs Caucasian), age groups (>60 vs <60) or gender groups (male vs female).

However, we observed significantly higher ACE2 gene expression in smoker samples compared to nonsmoker samples. This indicates the smokers may be more susceptible to 2019-nCov and thus smoking history should be considered in identifying susceptible population and standardizing treatment regimen.

A preprint is a study that is not formally published in a scientific journal. They are not yet peer-reviewed. Peer review is a process where other scientists of the same specialty read and verify the facts written in the paper. In the current situation of a new virus rapidly spreading, there may not be enough time to wait for rigorous scientific debate. More studies need to be done to fully understand this new coronavirus.

Noteworthy is that even if there is no formal peer-review, the papers are open to comments from different scientists around the world.

What is the significance of the absence of difference in ACE2 among races?

To avoid complacency. If a particular group of people thinks that they are not prone to this infection, they can get deadly wrong soon.

Knowing that the current coronavirus pandemic is an equal opportunity infection will hopefully make everybody institute proper precautions to avoid getting sick or spreading it to someone more vulnerable than they are.

The studies above are also mentioned in my recent article, 3 Reasons Why Smokers Have Worse Covid-19 Outcomes

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Don’t Get Sick!



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