Despite recent controversy suggesting that popular medications prescribed to lower blood pressure may increase the risk of infection by the novel coronavirus and lead to more severe outcomes in COVID-19, a retrospective study by Cleveland Clinic, Ohio, US, has supported the view that there is no foundation to these claims, although the researchers called for larger studies as the pandemic develops.
The medications in question are Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs), both of which dilate blood vessels to increase the amount of blood pumped by the heart. The result is lowered blood pressure and increased blood flow, which helps to lower the heart’s workload and reduce the risk of heart failure. The medications are commonly prescribed in cases of coronary artery disease, heart failure, diabetes and hypertension (high blood pressure).
“Our analysis found no association between ACEI or ARB use and COVID-19 test positivity,” says Cleveland Clinic cardiologist Ankur Kalra, MD, the study’s corresponding author.
“These medications are important tools in the management of coronary artery disease, heart failure, diabetes and hypertension. As there may be a risk to withdrawing these agents, our findings support current professional society guidelines to not discontinue ACEI or ARB therapy in the context of the COVID-19 pandemic,” he added.
The Cleveland Clinic study looked at 18,472 individuals tested for COVID-19 at its locations in Florida and Ohio, with a mean age of 49 (± 21 years), and who were predominantly female (60%) and white (69%). Testing for COVID-19 was positive in 1,735 patients, or 9.4% of the total sample.
First study author Neil Mehta, MD of the Department of Medicine at the Cleveland Clinic Lerner College of Medicine, says: “Our findings with regard to clinical outcomes and measures of COVID-19 severity while on ACEI or ARB therapy give some reassurance. However, they must be interpreted with caution, due to the small sample size and the limitations of observational studies. They require replication and reanalysis in larger patient samples later in the course of the ongoing COVID-19 pandemic.”
A secondary analysis among COVID-19-positive patients showed no association between use of these medications and risk for mechanical ventilation.

Using laser light techniques, University of Amsterdam physicists and medical researchers have found that small cough droplets, potentially containing virus particles, can float in the air in a room for many minutes, especially when the room is poorly ventilated. Good ventilation in public spaces (e.g. public transport, nursing homes) is therefore crucial to slow down the spread of the coronavirus. The results were published in The Lancet Respiratory Medicine on 28 May 2020.
The research was carried out by physicists Daniel Bonn, Stefan Kooij and Cees van Rijn from the UvA Institute of Physics, together with medical researchers Aernout Somsen (Cardiology Centers of the Netherlands) and Reinout Bem (Amsterdam University Medical Centers).
The researchers asked healthy test persons to speak and to cough, and used laser light to analyse the droplets that were produced. Both during speech and coughing, large amounts of small droplets (between roughly 1 and 10 micrometres in size) were observed. During coughing, larger droplets (up to 1 millimeter in size) are also produced. Those droplets fall to the ground within one second, however, and therefore have a much smaller probability of transmitting viruses.
The small droplets only move very slowly to the ground due to the large amount of air drag they experience. The researchers found that such droplets can stay in the air for several minutes. After a single cough, it takes about five minutes for the number of small droplets in the air to be halved. These tiny droplets are therefore much more dangerous when it comes to possible transmission of the coronavirus.
Ventilation
When the same measurements were repeated in a well-ventilated room, the results improved dramatically. With only mechanical ventilation turned on, half of the droplets disappeared within 2.5 minutes, but in a room that also had a door and window open, the number of droplets was halved after 30 seconds – ten times faster than in the unventilated room.
The result is important for making better policies to slow down the spread of the coronavirus. Despite physical distancing, spaces like public transportation and nursing homes can still be centres for spreading the virus if insufficiently ventilated. When droplets remain in the air for a long time, proximity tracing via smartphone apps is also an insufficient precaution. The researchers therefore recommend healthcare authorities consider recommendations to ensure adequate ventilation wherever possible in public spaces
Small droplet aerosols in poorly ventilated spaces and SARS-CoV-2 transmission – The Lancet Respiratory Medicine https://doi.org/10.1016/S2213-2600(20)30245-9 Indoor environments
Meanwhile, in a similar study, scientists from Surrey’s Global Centre for Clean Air Research (GCARE), with partners from Australia’s Queensland University and Technology, argue that the lack of adequate ventilation in many indoor environments – from the workplace to the home – increases the risk of airborne transmission of Covid-19.
They note that Covid-19, like many viruses, is less than 100mn in size but expiratory droplets (from people who have coughed or sneezed) contain water, salts and other organic material, along with the virus itself. However, as the water content from the droplets evaporate, the microscopic matter becomes small and light enough to stay suspended in the air and over time the concentration of the virus will build up, increasing the risk of infection – particularly if the air is stagnant like in many indoor environments.
The study highlights improving building ventilation as a possible route to tackling indoor transmission of Covid-19.
Could fighting airborne transmission be the next line of defence against COVID-19 spread? www.sciencedirect.com/science/article/pii/S2590252020300143 Modelling
Additionally, a study carried out in March this year by four Finnish research organisations modelled the transport and spread of coronavirus through the air. They note that preliminary results indicate that aerosol particles carrying the virus can remain in the air longer than was originally thought, so it is important to avoid busy public indoor spaces. This also reduces the risk of droplet infection, which remains the main path of transmission for coronavirus.
The research has been has been submitted for peer-review and published on https://arxiv.org/abs/2005.12612. The paper details how they have modelled the airborne transport of different-sized droplets. These are emitted through coughing, so the study evaluated the quantities of particles that someone could come into contact with upon entering a supermarket or any other indoor public space.
Assistant professor at Aalto University, and project coordinator, Ville Vuorinen, says that both previous related research, and a number of well-known infection spikes, indicate a substantial risk of coronavirus through inhalation of aerosol particles, as well as direct droplet transmission and transmission from surfaces. The 3D flow simulations and analyses carried out in the project also support these ideas.
The 3D simulation shows how droplets of varying size travel in an indoor airflow https://youtu.be/f7I0O0C_eqg credit: Aalto University / Finnish Meteorological Institute / VTT / University of Helsinki / IT Center for Science CSC. Animation: Jyrki Hokkanen, CSC – IT Center for Science Ltd.

Cytel has launched an open-access global COVID-19 Clinical Trial Tracker to help facilitate greater collaboration between researchers, policymakers, clinicians, journalists, philanthropists, and other critical stakeholders who need to understand the complex dynamics of the global response to finding a solution to the COVID-19 outbreak.
The tracker will enable them to make more informed and pragmatic decisions on how to channel scarce resources. Clinicians and local government need to know what trials are taking place in their community to ensure that the right patients receive the right exploratory treatment, while philanthropists and policymakers deserve a one-stop shop to determine which are the most promising early phase treatment results.
Funded in part by The Bill and Melinda Gates Foundation, this live dashboard offers an overview of all the trials taking place in the international effort to tackle the pandemic.
Joshua Schultz, Chief Executive Officer at Cytel, explained, "While much of the world is isolating, the scientific and clinical communities are coming together to fight the COVID-19 virus. United by an unprecedented sense of urgency, there is a level of collaboration that we’ve not seen before, and, despite the current pressures on the healthcare system, hundreds of hospitals are still committed to working on clinical trials. At Cytel, we have been supporting numerous clients in developing statistically rigorous models for fast data analysis and addressing the various challenges the pandemic presents in the current clinical environment. We are committed to supporting the global effort – and launching the COVID-19 Clinical Trial Tracker offered an additional way to do that."
To access Cytel’s Covid-19 Clinical Trial Tracker, visit: www.covid19-trials.com

Frontline clinicians treating coronavirus patients can now gain access to the latest advice from a panel of human physiology experts. Frontline medics can ask anything about how the body might function in response to the disease.
The aim is to provide clinicians with an evolving understanding of the physiological and pathophysiological mechanisms that both underpin this disease and determine its outcome and mitigation.
The initiative is a joint venture between The Physiological Society and the Intensive Care Society, which is being co-ordinated by Mike Tipton, Professor of Human and Applied Physiology at the University of Portsmouth and David Paterson, Professor of Cardiovascular Physiology at the University of Oxford,.
Questions, comments and data from frontline clinicians dealing with patients are responded to by a Covid-19 advisory panel consisting of 24 specialists with diverse physiological expertise.
Professor Tipton said: “Following a discussion with Hugh Montgomery, a professor of intensive care medicine, it was clear that our clinical colleagues were working flat out whilst most of our academic colleagues were not able to deploy their expertise, sitting at home isolating.
Anyone can access the website to read the questions and responses, but only clinicians can register to ask questions or comment.
Questions from the frontline: https://www.physoc.org/covid19/questions

ForaCare Suisse AG has launched its FORA Autonomous Temperature Measuring Station. The station allows for accurate and precise temperature readings without the need for human operation of the thermometer.
“ForaCare understands the challenges of making temperature measurements in the Covid-19 environment. We observed workers in public health, government, education, and corporations manually taking temperature measurements, and saw the need to develop a system that would provide safe distance in performing and monitoring temperature checks. We also realized the need for an almost instant reading that is accurate, and connected to a device that could capture the data,” said Ty-Minh Tan, CEO of ForaCare Suisse AG. “Our goal was to put all of those needs together in a system that could allow for monitoring from a mobile measurement station. A single person can simultaneously monitor multiple temperature station results from a remote location, thereby providing increased efficiency and reduced possibilities of cross-infection.”
The FORA Autonomous Temperature Measuring Station includes three components: a FORA IR41 non-contact forehead thermometer that uses infrared sensors to take measurements, an iPad with a customized software displaying the measured temperature, and a medical-grade wheeled station to provide easy mobility of the system.
The Temperature Station’s thermometer, FORA IR41, provides quick measurement with results in just two seconds and records data using Bluetooth connectivity. The thermometer is clinically validated with ± 0.2 ̊C accuracy, and complies with ASTM E1965-98 and EN ISO 80601-2-56 standard requirements for clinical thermometer and body temperature measurement.
For more information visit: www.foracare.ch/news-fcs-fight-covid-19