SARS-CoV-2 and viral sepsis: observations and hypotheses

• Published in: The Lancet Vol. 395; no. 10235; pp. 1517 - 1520
• Main Authors: Li, Hui, Liu, Liang, Zhang, Dingyu, Xu, Jiuyang, Dai, Huaping, Tang, Nan, Su, Xiao, Cao, Bin
• Format: Journal Article Web Resource
• Language: English
• Published: England Elsevier Ltd 09.05.2020; Elsevier B.V; Elsevier BV; Elsevier Limited
• Subjects: Apoptosis; Autopsies; Autopsy; Bacterial infections; Betacoronavirus - pathogenicity; Blood Coagulation Disorders - virology; Chemokines; Cold shock; Coronaviridae; Coronavirus Infections - complications; Coronaviruses; COVID-19; Critical Illness; Cytokines; Cytokines - metabolism; Endothelium; Epithelium; Extremities; Fatalities; Health aspects; Humans; Hypotension; Hypotheses; Infections; Inflammation; Influenza; Investigations; Ligands; Lung - immunology; Lung - pathology; Lung diseases; Lymphocytes; Macrophages; Medical colleges; Medical research; Medicine, Experimental; Pandemics; Pathogenesis; Pneumonia, Viral - complications; Respiratory agents; Respiratory diseases; SARS-CoV-2; Sepsis; Sepsis - virology; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Shock - etiology; Tumor necrosis factor-TNF; Viral diseases; Viral infections; China
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(20)30920-X

Since the outbreak of coronavirus disease 2019 (COVID-19), clinicians have tried every effort to understand the disease, and a brief portrait of its clinical features have been identified. In clinical practice, we noticed that many severe or critically ill COVID-19 patients developed typical clinical manifestations of shock, including cold extremities and weak peripheral pulses, even in the absence of overt hypotension. Understanding the mechanism of viral sepsis in COVID-19 is warranted for exploring better clinical care for these patients. With evidence collected from autopsy studies on COVID-19 and basic science research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV, we have put forward several hypotheses about SARS-CoV-2 pathogenesis after multiple rounds of discussion among basic science researchers, pathologists, and clinicians working on COVID-19. We hypothesise that a process called viral sepsis is crucial to the disease mechanism of COVID-19. Although these ideas might be proven imperfect or even wrong later, we believe they can provide inputs and guide directions for basic research at this moment.