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males [Meng 2020]). All these issues present important limitations and only a few studies have addressed all of them. Third, co-morbidity papers have led to an information overload. Yes, virtually every medical discipline and every specialist has to cope with the current pandemic. And yes, everybody has to be alert these days, psychiatrists as well as esthetic surgeons. Hundreds of guidelines or position papers have been published, trying to thoughtfully balance fear of COVID-19 against the dire consequences of not treating other diseases than COVID-19 in an effective or timely manner – and all this in the absence of data. On May 15, a PubMed search yielded 530 guidelines or considerations about specific diseases in the context of COVID-19, among them those for grade IV glioma (Bernhardt 2020, bottom line: do not delay treatment), but also for dysphonia and voice rehabilitation (Mattei 2020: can be postponed), infantile hemangiomas (Frieden 2020: use telehealth), ocular allergy (Leonardi 2020: very controversial), high resolution anoscopy (Mistrangelo 2020: also controversial), migraine management (Szperka 2020: use telehealth) and breast reconstruction (Salgarello 2020: defer “whenever possible”), to name just a few. These recommendations are usually not helpful. They apply for a few weeks, during acute health crisis scenarios as seen in overwhelmed health care systems in Wuhan, Bergamo, Madrid or New York. In other cities or even a few weeks later, proposed algorithms are already outdated. Nobody needs a 60-page recommendation, concluding that “clinical judgment and decision making should be exercised on a case-by-case basis”. However, some important papers have been published over the last months, a couple of them with very helpful data, supporting the management of patients with co-morbidities. In the following, we will briefly go through these.
Hypertension and cardiovascular co-morbidities From the beginning of the pandemic, hypertension and/or cardiovascular disease (CVD) have been identified as potential risk factors for severe disease and death (Table 1). However, all studies were retrospective, included only hospitalized patients and did not distinguish between uncontrolled and controlled hypertension or used different definitions for CVD. Multivariate analyses adjusting for confounders were performed in only a few studies. Moreover, different outcomes and patient groups were analyzed. According to some experts, current data do not necessarily imply a causal relationship between hypertension and severity of COVID-19. There is no study that demonstrates the independent predictive value of hypertension. It is “unclear whether uncontrolled blood pressure is a risk factor for acquiring COVID-19, or whether controlled blood pressure among patients with hypertension is or is not less Kamps – Hoffmann
