A thorough review of what we know about COVID-19 and how it works suggests that the virus has a unique infectious profile, which explains why it can be so difficult to treat and why some people experience the so-called “long COVID”. with major health problems months after infection.
There is growing evidence that the virus infects both the upper and lower respiratory tract, unlike the “pathogenic low” human coronavirus subspecies, which usually settle in the upper respiratory tract and cause cold-like symptoms or viruses. “highly pathogenic” such as those caused by SARS and ARDS, which usually settle in the lower respiratory tract.
In addition, the more frequent impacts of multiple blood organs and clots and an unusual immune-inflammatory response that is not commonly associated with other similar viruses means that COVID-19 has developed a set of uniquely difficult features.
Although animal and experimental models involve an immune response to overly aggressive inflammation is a key factor, it seems that things work differently in humans: although inflammation is a factor, it is a unique deregulation of immune response that causes our bodies to mismanage the way we fight. the virus.
This may explain why some people experience “long COVID” and suffer severe lung damage after infection.
Ignacio Martin-Loeches, a clinical professor in the Faculty of Medicine at Trinity College Dublin and a consultant in intensive care medicine at St James’s Hospital, is the co-author of the journal he has just published in the leading medical journal, The Lancet.
The appearance of coronavirus two of the severe acute respiratory syndrome (SARS-CoV-2), which causes COVID-19, has caused a health crisis that has not been seen since the Spanish flu pandemic of 1918. Tragically, millions of people all over the world they are already dead.
Despite the international concentration on the virus, we are only beginning to understand its complexities. Based on growing evidence, we propose that COVID-19 should be perceived as a new entity with a hitherto unknown infectious profile. It has its own characteristics and a different pathophysiology and we must be aware of it when treating people.
This does not mean that we should abandon existing good practice treatments that are based on the knowledge of other humans. coronavirus, but a gradual and impartial assembly of the key pieces of the COVID-19 puzzle for different cohorts of patients (according to sex, age, ethnicity, pre-existing comorbidities) is what needs to be modified to existing treatment guidelines, subsequently providing the most appropriate care to COVID-19 patients.
Ignacio Martin-Loeches, Professor of Clinic, Faculty of Medicine, Trinity College Dublin
The review article has been produced by the European Sepsis Immunology Group (EGIS), where Professor Martin-Loeches is one of the members of the funding. EGIS is a multidisciplinary group of scientists and doctors with a special interest in severe infection in patients admitted to the ICU.
Osuchowski, MF, et al. (2021) The COVID-19 puzzle: deciphering the pathophysiology and phenotypes of a new disease entity. The Lancet. doi.org/10.1016/S2213-2600(21)00218-6.