Distinctive features of severe SARS-CoV-2 pneumonia

J Clin Invest. 2021 Jul 15;131(14):e149412. doi: 10.1172/JCI149412.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic is among the most important public health crises of our generation. Despite the promise of prevention offered by effective vaccines, patients with severe COVID-19 will continue to populate hospitals and intensive care units for the foreseeable future. The most common clinical presentation of severe COVID-19 is hypoxemia and respiratory failure, typical of the acute respiratory distress syndrome (ARDS). Whether the clinical features and pathobiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia differ from those of pneumonia secondary to other pathogens is unclear. This uncertainty has created variability in the application of historically proven therapies for ARDS to patients with COVID-19. We review the available literature and find many similarities between patients with ARDS from pneumonia attributable to SARS-CoV-2 versus other respiratory pathogens. A notable exception is the long duration of illness among patients with COVID-19, which could result from its unique pathobiology. Available data support the use of care pathways and therapies proven effective for patients with ARDS, while pointing to unique features that might be therapeutically targeted for patients with severe SARS-CoV-2 pneumonia.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Angiotensin-Converting Enzyme 2 / physiology
  • Autopsy
  • COVID-19 / epidemiology
  • COVID-19 / etiology*
  • COVID-19 / pathology
  • Cytokines / biosynthesis
  • Humans
  • Lung / immunology
  • Lung / pathology
  • Lung / virology
  • Macrophages, Alveolar / immunology
  • Macrophages, Alveolar / virology
  • Models, Biological
  • Pandemics
  • Pneumonia, Viral / etiology*
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / pathology
  • Receptors, Virus / physiology
  • Respiratory Distress Syndrome / etiology*
  • Respiratory Distress Syndrome / immunology
  • Respiratory Distress Syndrome / pathology
  • SARS-CoV-2* / immunology
  • SARS-CoV-2* / pathogenicity
  • SARS-CoV-2* / physiology
  • Severity of Illness Index

Substances

  • Cytokines
  • Receptors, Virus
  • ACE2 protein, human
  • Angiotensin-Converting Enzyme 2