The coronavirus disease 2019, referred to as COVID-19 by the World Health Organization (WHO), is an ongoing viral pandemic caused by the influenza-like virus strain SARS-CoV-2 (1). According to WHO (2020), SARS-CoV-2 infection has been responsible for approximately 10,185,374 confirmed cases of COVID-19 and more than 500,000 deaths worldwide (2). In Brazil, 1,368,195 cases have been confirmed, and 58,314 deaths have occurred as of June 30, 2020 (3).
The coronaviruses are one of the primary pathogens that target the human respiratory system. These viruses often cause pneumonia-like symptoms that can develop into Severe Acute Respiratory Syndrome (SARS), causing higher leukocyte production, abnormal respiratory findings, and increased levels of plasma pro-inflammatory cytokines (4). COVID-19 may manifest either as an asymptomatic infection or as a mild to severe pneumonia (5). The most common initial symptoms at the onset of COVID-19 are fever, cough, and fatigue, while sputum production, headache, hemoptysis, diarrhea, dyspnea, and lymphopenia are less frequent (6).
The severity of the COVID-19 infection varies among individuals and may relate to several reported risk factors, such as aging, diabetes mellitus, cardiovascular risk (including hypertension), and respiratory or kidney disease. Moreover, an increasing number of studies have linked obesity to more severe COVID-19 symptoms and, ultimately, increased mortality (7-9).
Recently, a retrospective analysis of 3,615 patients with COVID-19 at the New York academic hospital system reported that approximately 38% of these patients were obese (Body Mass Index, BMI >30 kg/m2). Moreover, obese patients under 60 years of age had twofold susceptibility to being admitted in critical care compared to non-obese individuals (8).
Obesity-related conditions worsen the impact of COVID-19 symptoms due to complications associated with excessive body weight, metabolic dysfunction, cardiovascular risk, sleep apnea, vitamin D deficiency, dysregulation of the renin-angiotensin-aldosterone system, and sarcopenia (10). Furthermore, obese patients have altered levels of circulating cytokines. Notably, these individuals exhibit higher concentrations of TNF-alpha, MCP-1, and IL-6, which are generated by visceral and subcutaneous adipose tissue (11). This alteration in inflammatory profile appears to predict the severity and prognosis of obese patients and COVID-19 (11,12). Thus, special attention should be considered for this population.
In the absence of efficient pharmacotherapy, and due to the public health emergency, a significant number of potential drugs was proposed, such as antiviral agents, chloroquine and hydroxychloroquine, and corticosteroids (13,14).