Why Is COVID-19 So Hard to Treat? A Comprehensive Review of What We Know

Growing evidence points to a unique infection profile

A comprehensive review of what we know about COVID-19 and the way it works suggests the virus has a unique infectious profile, which explains why it can be so difficult to treat and why some people suffer from so-called ‘long-lasting COVID’ , struggling with significant health problems for months after infection.

There is growing evidence that the virus infects both the upper and lower respiratory tracts – unlike ‘low pathogenic’ subspecies of the human coronavirus, which typically lodge in the upper respiratory tract and cause cold-like symptoms, or ‘highly pathogenic’ viruses such as those that SARS and ARDS cause, which usually settle in the lower respiratory tract.

In addition, more frequent effects of multiple organs and blood clots, and an unusual immune-inflammatory response not often associated with other similar viruses, mean that COVID-19 has evolved a uniquely challenging set of features.

While animal and experimental models imply that an overly aggressive immune inflammatory response is a key driver, things seem to work differently in humans: While inflammation is a factor, it’s a unique dysregulation of the immune response that causes our bodies to behave the way they fight mismanaged. the virus.

This may explain why some people experience “long-term COVID” and suffer severe lung damage after infection.

Ignacio Martin-Loeches, Clinical Professor at Trinity College Dublin School of Medicine, and Consultant in Intensive Care Medicine at St James’s Hospital, co-authored the review just published in the leading medical journal The Lancet.

He said:

“The emergence of the severe acute respiratory syndrome coronavirus two (SARS-CoV-2), which causes COVID-19, has resulted in a health crisis that has not occurred since the 1918 Spanish flu pandemic. Tragically, millions have already died worldwide.

“Despite the international focus on the virus, we are only just beginning to understand its intricacies. Based on growing evidence, we propose that COVID-19 should be viewed as a new entity with a previously unknown infectious profile. It has its own characteristics and different pathophysiology and we should be aware of this when treating people.

“That doesn’t mean abandoning existing best-practice treatments based on our knowledge of other human coronaviruses, but an unbiased, gradual collection of the key COVID-19 puzzle pieces for different patient cohorts – based on gender, age, ethnicity. , pre-existing co-morbidity – is what is needed to adapt existing treatment guidelines and then provide the most adequate care for COVID-19 patients. “

Reference: “The COVID-19 Puzzle: Deciphering Pathophysiology and Phenotypes of a New Disease Entity” by Marcin F. Osuchowski, DVM; Martin S. Winkler, MD; Tomasz Skirecki, MD; Sara Cajander, MD; Prof Manu Shankar-Hari, PhD; Gunnar Lachmann, MD; Prof Guillaume Monneret, PhD; Prof Fabienne Venet, PhD; Prof Michael Bauer, MD; Prof Frank M Brunkhorst, MD; Sebastian Weis, MD; Alberto Garcia-Salido, MD; Matthijs Kox, PhD; Prof Jean-Marc Cavaillon, DrSc; Florian Uhle, PhD; Prof Markus A Weigand, MD; Stefanie B Flohé, PhD; Prof. W. Joost Wiersinga, MD; Raquel Almansa, PhD; Amanda de la Fuente, MSc; Prof Ignacio Martin-Loeches, MD; Christian Meisel, MD; Thibaud Spinetti, PhD; Joerg C Schefold, MD; Catia Cilloniz, PhD; Prof Antoni Torres, MD; Prof Evangelos J Giamarellos-Bourboulis, MD; Ricard Ferrer, MD; Massimo Girardis, MD; Prof Andrea Cossarizza, MD; Prof Mihai G Netea, MD; Prof Tom van der Poll, MD; Jesús F Bermejo-Martín, MD and Ignacio Rubio, PhD, May 6, 2021, The Lancet: Respiratory Medicine.
DOI: 10.1016 / S2213-2600 (21) 00218-6

The review article has been produced by the European Group on Immunology of Sepsis (EGIS), in which Professor Martin-Loeches is one of the funding members. EGIS is a multidisciplinary group of scientists and physicians with a special interest in serious infections in ICU patients.