Underlying mechanisms for increased mortality with age and frailty with COVID-19 may include endothelial dysfunction leading to vasoconstriction and organ dysfunction (25, 26), heightened inflammation (27) and pro-coagulant state (25, 26, 28), dysregulated angiotensin-converting enzyme 2 activity promoting viral uptake (28–30) and immunesenescence (28). This evidence concerns the gene ACE2 and endothelial dysfunction.