COVID-19 DEATHS IS LOW IN CHILDREN BUT HIGH IN THE ELDERLY POPULATION. THIS IS DUE TO A PROGRESSIVE INCREASE IN ACE2 EXPRESSION IN THE TISSUES.

1. EVIDENCE THAT LOW ACE2 EXPRESSION
IN THE CHILDREN
ACCOUNTS FOR THEIR LOW MORTALITY
OF COVID-19
By
Kevin KF Ng, MD, PhD.
Former associate Professor of Medicine
Division of Clinical Pharmacology
University of Miami, Miami FL. U.S.A.
Email: kevinng68@gmail.com
A slide presentation for HealthCare Professionals Nov 2020

2. Percentage of people who died from COVID-19 in the
United States from January 22 to May 30, 2020, by age
https://www.statista.com/statistics/1127639/covid-19-mortality-by-age-us/
Coronavirus deaths in the United States% of COVID-19 deaths by age in U.S.
https://www.nbcnews.com/health/health-news/coronavirus-deaths-
u-s-map-shows-number-fatalities-compared-confirmed-n1166966

3. COVID-19 fatality rates by age in
South Korea, Spain, China & Italy. (2020)
https://ourworldindata.org/mortality-risk-covid

4. What causes low mortality in young COVID-19 patients?WHAT CONTRIBUTES TO THE
LOW MORTALITY IN YOUNG
COVID-19 PATIENTS?

5. Pathogenesis of coronavirus (CoV-2) infection
leading to COVID-19
virus receptor COVID - 19

6. Does lack of ACE2 enzyme account for low mortality in
young COVID-19 patients ?
?
transmembrane protease serine 2 (TMPRSS2
https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.120.046941

7. SCIENTIFIC EVIDENCE

8. Developmental expression of angiotensin converting enzyme 2
(ACE 2) in the mouse
https://www.nature.com/articles/pr20117/figures/1
E, day of embryonic life;
P, day of postnatal life.

9. Human ACE2 (angiotensin-converting enzyme 2) is expressed
throughout the body (B) schematic of ACE2 primary domains
https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.317015
Major sites
ACE2

10. Method to study Nasal Gene Expression of
Angiotensin-Converting Enzyme 2 (ACE2) in Children and Adults
https://jamanetwork.com/journals/jama/fullarticle/2766524

11. Nasal Gene Expression of (ACE2) Angiotensin-Converting Enzyme 2
increases from Children to Adults (2020)
JAMA. 2020;323(23):2427-2429. doi:10.1001/jama.2020.8707 https://health.ucdavis.edu/coronavirus/coronavirus-testing.html

12. Correlation of ACE2 protein expression with age (2020)
https://onlinelibrary.wiley.com/doi/10.1111/all.14522

13. Conclusion
▪ COVOD-19 mortality increases from
▪ 0.1% (9 years and younger) to
▪ 28.4% (80 years and older)
▪ The low mortality (0.1%) in children is
associated with low expression of ACE2
which is the portal of entry for the
virus.
▪ The 280 fold increase in mortality in
elderly patients is associated with an
increase in ACE2 (angiotensin
converting enzyme 2) expression in the
tissues.