Endotheliitis after COVID-19 Infection Requires Optimization of Chronic Disease Prevention

The outbreak of a new coronavirus–infection (2019-nCoV, so-called COVID-19) started in Wuhan, China1 and shortly became a pandemic to create an enormous burden on the global health care and economic system.2,3 In August 2021, the cumulative infected cases and the cumulative death, per world health organization (WHO) reporting, were over 266 million and almost 4.4 million worldwide, respectively.2 In Thailand, the number of polymerase chain reaction (PCR) confirmed COVID -19 cases increased beyond one million cases in August 2021.4 Although the majority of cases had only mild symptoms, critical cases developed severe pneumonia with respiratory failure, and many died.5,6 Most of the deaths occurred in elderly patients who had chronic illness (non-communicable disease (NCD)) including diabetes mellitus (DM), hypertension (HT), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD).6-8 Studies revealed that the endothelial and epithelial cells that express angiotensin-converting enzyme 2 (ACE-2) receptor are the entry site for COVID -19 viral invasion. The subsequent inflammation, so-called endotheliitis, induces micro thrombi generation in capillary beds of lungs, kidneys, and myocardium, and contributes to cardiovascular morbidity and mortality.8-11 This review summarizes the link between COVID -19 virus induced endotheliitis and poor prognosis in those with prior endothelial dysfunction. This relationship urges improvements in strategies to control and prevent these chronic conditions.