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SARS-CoV-2: a storm is raging
Open accessAbstract
A rapidly expanding pandemicIn early December 2019, several local health facilities first reported pneumonia cases of unknown origin in Wuhan, China.This new coronavirus infectious disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 1, 2020 and identified as a previously unknown betacoronavirus (1, 2).Since then, studies have increasingly demonstrated that SARS-CoV-2 can be transmitted effectively among humans through aerosol or fomites (3-5).With transmission capabilities even before symptom onset (6, 7), this pandemic is rapidly evolving and expanding.As of April 2, 2020, a total of 962,977 confirmed cases of COVID-19 and 49,180 deaths have been reported across 180 countries and regions.Recent models indicated that as much as 86% of all infections early in the spread were undocumented, suggesting the real number of infections is likely much greater (8).As a public health emergency of international concern, COVID-19 was declared a pandemic by the World Health Organization.Public health authorities around the globe are now racing to contain the spread.
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“Patients infected with SARS-CoV-2 present elevated levels of IL-6, IL-10, IL-1β, INF-γ, CCL2, TNF-α, CXCL10, CCL7, IL-1 receptor antagonist and IL-2 receptor, supposedly associated with disease severity [9, 98–105].”
From Hyperactivation of P2X7 receptors as a culprit of COVID-19 neuropathology (2021) · cites this paper as [100]
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“The reduction in CD4+ T cell counts in HIV patients correlates with the severity of SARS-CoV-2 infection [80].”
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“Unlike HIV-1 infection, cytokine dysregulation in SARS-CoV-2 infection induces cytokine release syndrome (or cytokine storm), an acute systemic inflammatory syndrome that involves multiorgan dysfunction [16,17].”
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“Based on inflammatory origin, the cytokines’ storm involves mainly IL-1, IL-6, IFNγ, and IL-16.”
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“Overproduction of inflammatory cytokines such as interleukin (IL)-2, IL-6 and tumor necrosis factor (TNF)-a has been implicated in the deterioration of patients with COVID-19 [8,9].”
Tocilizumab for severe COVID-19 related illness – A community academic medical center experience
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“That is to say, the infection has been proven to cause an immune dysregulation with overproduction of pro-inflammatory cytokines (IL-1, IL-6, IL-2R, IL-10, and TNF-alpha) in severe cases (Chen et al., 2020; Ong et al., 2020; Pedersen and Ho, 2020).”
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Long-Term Health Consequences of SARS-CoV-2: Assumptions Based on SARS-CoV-1 and MERS-CoV Infections
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BackgroundInflammatory-Metal Profile as a Hallmark for COVID-19 Severity During Pregnancy
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Markers of NETosis and DAMPs are altered in critically ill COVID-19 patientsPreprint
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“List Of Abbreviations ACEi/ARB – angiotensin converting enzyme inhibitors/angiotensin-receptor blockers; ADAM – a disintegrin and metalloproteinase; ALI - acute lung injury; ALT – alanine transaminase; APTT - activated partial thromboplastin time; ARDS – acute respiratory distress syndrome; AST – aspartate aminotransf…”
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Clinical Relevance of Elevated Soluble ST2, HSP27 and 20S Proteasome in Patients with COVID-19Preprint
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“This finding supported the hypothesis that patients with severe COVID-19 exhibited strong inflammatory activation [5], [6], [8], and it confirmed previous findings that identified sST2 as a marker that clearly distinguished between patients with increased risk and patients with low risk of mortality [5], [6], [8], [38…”
ResultSpectrum of COVID-19 induced liver injury: A review report
Singh, L., Kumar, A., Rai, M., Basnet, B., Rai, N., Khanal, P., Lai, K., Cheng, W.-H., Asaad, A. M., & Ansari, S. (2024) · World Journal of Hepatology · doi:10.4254/wjh.v16.i4.517 · Cited by 5
Functional and structural investigation of a broadly neutralizing SARS-CoV-2 antibody
Chang, Y.-H., Hsu, M., Chen, W.-N., Wu, M., Kong, W., Lu, M. J., Huang, C.-H., Chang, F.-J., Chang, L., Tsai, H.-Y., et al. (2024) · JCI Insight · doi:10.1172/jci.insight.179726 · Cited by 5
Symmetrical peripheral gangrene: potential mechanisms and therapeutic approaches in severe COVID-19
Wang, M., Sun, T., Dong, L., Huang, S., & Liu, J. (2023) · Frontiers in Cardiovascular Medicine · doi:10.3389/fcvm.2023.1280625 · Cited by 5
“Lymphopenia impairs the function of the immune system to produce antibodies against virus-speci fi c antigens, as well as reducing the generation of interferon gamma (IFN-γ ) by the CD4+ T cells (43).”
BackgroundZinc Deficiency And sTNF-RII Are Associated With Worse COVID-19 Outcomes
Mouchati, C., Durieux, J., Zisis, S. N., Tribout, H., Scott, S., Smith, B. A., Labbato, D. E., & McComsey, G. A. (2023) · Journal of Nutrition · doi:10.1016/j.tjnut.2023.11.026 · Cited by 6
Hitti, E., Muazzen, Z., Moghrabi, W. N., Al‐Yahya, S., & Khabar, K. S. A. (2024) · Immunology · doi:10.1111/imm.13835 · Cited by 5
“Mortality in COVID-19 infections was often associated with excess inflammation and cytokine storm [6].”
Paolino, G., Mercuri, S. R., Bearzi, P., & Mattozzi, C. (2020) · Dermatologic Therapy · doi:10.1111/dth.13537 · Cited by 4
“The immunologic response to SARS-CoV-2 infection, like many other viruses, is characterized by the robust production of proinflammatory cytokines.(3) Several cytokines are involved in the immune response against viral infections, such as interleukin (IL)-1β, IL-2, IL-7, IL-8, IL-9, IL-10, IL-17, G-CSF, granulocyte mac…”
BackgroundFelix, J. C., Sheinin, Y. M., Suster, D. I., Ronen, N., Ratiani, M., Heuvel, T. V., Winge, E., Patton, M. D., Rau, M. J., Ge, L., et al. (2021) · Annals of Diagnostic Pathology · doi:10.1016/j.anndiagpath.2021.151744 · Cited by 5
“It has been postulated that high levels of cytokines, such as IL6, IL10, and TNFα may be mediated by alveolar macrophages in these patients [11].”
BackgroundCytokine-Induced Modulation of SARS-CoV2 Receptor Expression in Primary Human Nasal Epithelial Cells
Ramezanpour, M., Bolt, H., Hon, K., Bouras, G. S., Psaltis, A. J., Wormald, P., & Vreugde, S. (2021) · Pathogens · doi:10.3390/pathogens10070848 · Cited by 5
“However, a delayed and dysregulated response can evolve in some cases resulting in a cytokine storm which can be catastrophic to the patient [9].”
BackgroundCOVID-19: well-known drugs, new opportunities
Uzbekistan’s Public Healthcare Ministry, 2. S. S., Хамидович, А. А., Мавлянов, И. Р., Искандарович, М. З., & Жарылкасынова, Г. Ж. (2020) · Health Risk Analysis · doi:10.21668/health.risk/2020.4.19 · Cited by 4
“Patients who are in critical state suffer from a drastic increase in contents of these factors, and IL-6 concentrations correlate with an increased in mortality [13, 14].”
BackgroundNičkčović, V. P., Nikolić, G. R., Nedeljković, B. M., Mitić, N. R., Filipović-Danić, S., Mitić, J., Marčetić, Z., Sokolovic, D. T., & Veselinović, A. M. (2022) · Chemical Papers · doi:10.1007/s11696-022-02170-8 · Cited by 5
Psychiatric Manifestations of COVID-19: A Literature Review
Khatun, A., Tamilanban, T., & Chitra, V. (2022) · CNS & Neurological Disorders - Drug Targets · doi:10.2174/1871527321666220701152821 · Cited by 5
Wang, Z., & Gao, H. (2023) · Arabian Journal of Chemistry · doi:10.1016/j.arabjc.2023.104663 · Cited by 5
Intrauterine activation of the fetal immune system in response to maternal COVID-19
Gashimova, N. R., Pankratyeva, L. L., Bitsadze, V. O., Khizroeva, J. K., Makatsariya, N. А., Tretyakova, M. V., Shkoda, A. S., Grigoreva, K. N., Tsibizova, V. I., Gris, J., et al. (2023) · Obstetrics Gynecology and Reproduction · doi:10.17749/2313-7347/ob.gyn.rep.2023.404 · Cited by 5
Kaneko, T., Ezra, S., Abdo, R., Voss, C., Zhong, S., liu, X., Hovey, O. F. J., Martin, C. M., Slessarev, M., Nynatten, L. R. V., et al. (2024) · Clinical Proteomics · doi:10.1186/s12014-024-09457-w · Cited by 5
“The cytokine release syndrome (CRS) or cytokine storm is a major cause of acute lung damage associated with log2 ratio between the patient group and HC patient mortality [47–52].”
BackgroundEl-Sekaily, A., Helal, M., & Saad, A. A. (2020) · International Journal of Cancer and Biomedical Research · doi:10.21608/jcbr.2020.28938.1033 · Cited by 5
Seguridad y eficacia de ivermectina en tiempos de COVID-19
Universidad de San Martín de Porres, F. D. M., Cruz, A. P., Espino, J. C. L., & Universidad de San Martín de Porres, F. D. M. (2020) · Horizonte Médico (Lima) · doi:10.24265/horizmed.2021.v21n1.10 · Cited by 5
Laboratory tests for the detection of SARS-CoV-2 infection: basic principles and examples
Alkharsah, K. R. (2021) · PubMed Central · doi:10.3205/000293 · Cited by 5
“Lymphocytes may also be killed by apoptosis induced by several proinflammatory cytokines produced during the course of the disease such as tumor necrosis factor-alpha [18], [19].”
BackgroundTrujillo‐Rodríguez, M., Muñoz‐Muela, E., Serna‐Gallego, A., Praena‐Fernández, J. M., Pérez‐Gómez, A., Gasca‐Capote, C., Vitallé, J., Peraire, J., Palacios-Baena, Z. R., Cabrera, J. J., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0269875 · Cited by 5
Host genetic variants associated with COVID-19 reconsidered in a Slovak cohort
Škereňová, M., Cibulka, M., Daňková, Z., Holubeková, V., Kolková, Z., Lučanský, V., Dvorská, D., Kapinová, A., Krivosova, M., Petráš, M., et al. (2024) · Advances in Medical Sciences · doi:10.1016/j.advms.2024.03.007 · Cited by 5
Mental illnesses among COVID-19 patients: Possible immunological underpinnings
Kar, S. K., Verma, P., Verma, S., & Saxena, S. K. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.102376 · Cited by 5
Papathanasiou, G. S. (2020) · Clinical Research Open Access · doi:10.16966/2469-6714.156 · Cited by 5
Ooi, S. T., Parthasarathy, P., Lin, Y., Nallakaruppan, V. D. O., Ng, S. J. H., Tan, T. C., Low, S. K., & Tang, T. (2020) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofaa486 · Cited by 5
“Severe COVID-19 is typically marked by rapid clinical deterioration with features of hyperinflammation [4, 5, 6].”
BackgroundGiuliani, C., Bucci, I., & Napolitano, G. (2020) · Medical Hypotheses · doi:10.1016/j.mehy.2020.110473 · Cited by 5
Kumar, A., Kumar, S., Narayan, R. K., Kumari, C., Pareek, V., & Prasoon, P. (2021) · Viral Immunology · doi:10.1089/vim.2020.0277 · Cited by 5
“The COVID-19 severity is also characterized by differential response of immune cells: reflected by increased counts of neutrophils and macrophages, however, reduced counts of eosinophil and lymphocytes (specifically of CD4 + and CD8 + T cells) (12,13,19).”
Prabhu, S., & Patil, N. (2021) · International Journal of Advances in Medicine · doi:10.18203/2349-3933.ijam20210264 · Cited by 5
Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19
Fath, A. R., Aglan, A. D., Varkoly, K., Eldaly, A. S., Beladi, R. N., Forlemu, A. N., Mihyawi, N., Solsi, A., Israr, S., & Lucas, A. R. (2021) · Journal of Investigative Medicine High Impact Case Reports · doi:10.1177/23247096211019559 · Cited by 5
Estebanez, E. B., Lavín-Alconero, L., Fernández, B. J., Marguello, M. G., Caro, J. C. L., Díez-Vallejo, J., Sampedro, M. F., Muñoz, P., Espiga, C. R., & García-Saiz, M. D. M. (2021) · Trials · doi:10.1186/s13063-021-05544-7 · Cited by 5
“Secondarily, the release of cytokines conditions the injury of the capillary alveolar membrane giving rise to respiratory distress [30] and favors a procoagulant state and hyperfibrinolysis characterized by an increase in D-dimer [32, 33].”
Bouwman, W., Verhaegh, W., Holtzer, L., & van de Stolpe, A. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.05.13.092759 · Cited by 6
Kovalchuk, A., Rodriguez‐Juarez, R., Ilnytskyy, S., Li, D., Wang, B., Kovalchuk, I., & Kovalchuk, O. (2020) · doi:10.21203/rs.3.rs-30927/v1 · Cited by 5
LOX-1 + immature neutrophils predict severe COVID-19 patients at risk of thrombotic complicationsPreprint
Combadière, B., Adam, L., Quentric, P., Rosenbaum, P., Dorgham, K., Bonduelle, O., Parizot, C., Sauce, D., Mayaux, J., Luyt, C. E., et al. (2020) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2020.09.15.293100 · Cited by 5
Heart failure and COVID-19: synergism of two inflammatory conditions?
Khan, E. (2020) · British Journal of Community Nursing · doi:10.12968/bjcn.2021.26.1.18 · Cited by 4
Potencial Rol de la Periodontitis en la Severidad de COVID-19. Revisión
Hernández-Vigueras, S., & Aquino-Martinez, R. (2021) · International journal of odontostomatology · doi:10.4067/s0718-381x2021000200335 · Cited by 2
Gümüşyayla, Ş., Durmaz, Ş. E., & Kaya, B. U. (2022) · Nöro Psikiyatri Arşivi · doi:10.29399/npa.27855 · Cited by 4
Molecular mechanisms implicated in SARS-CoV-2 liver tropism
Quarleri, J. F., & Delpino, M. V. (2022) · World Journal of Gastroenterology · doi:10.3748/wjg.v28.i48.6875 · Cited by 4
Cui, X., Zhang, X. F., & Jagota, A. (2023) · The Journal of Physical Chemistry B · doi:10.1021/acs.jpcb.2c06662 · Cited by 4
2-Deoxy-d-Glucose: A Repurposed Drug for COVID-19 Treatment
Chopra, S., Dahiya, A., Nair, A., Sharma, N., & Sharma, R. K. (2023) · Springer eBooks · doi:10.1007/978-981-19-5399-6_20 · Cited by 4
Severe COVID-19: Drugs and Clinical Trials
Ceja-Gálvez, H. R., Renteria-Flores, F. I., Nicoletti, F., Hernández‐Bello, J., Ojeda, G. M., & Muñóz-Valle, J. F. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12082893 · Cited by 5
“Dysregulation of T-cell functions precedes the cytokine storm (uncontrolled immune response) and neutrophil expansion in alveolar tissues, leading to tissue damage [162].”
BackgroundIzhari, M. A., Hadadi, M. A. A., Alharbi, R., Gosady, A. R. A., Sindi, A. A. A., Dardari, D. M. M., Alotaibi, F. E., Klufah, F., Albanghali, M. A., & Alharbi, T. H. (2024) · Healthcare · doi:10.3390/healthcare12070729 · Cited by 4
“Cytokine response storm with elevated inflammatory serological biomarkers and coagulopathy worsen outcomes in COVID-19-infected individuals [6,7].”
BackgroundElevated levels of pro-thrombotic eNOS-negative platelets in COVID-19 patients
Asgari, A., Franczak, A., Herchen, A., Jickling, G. C., & Jurasz, P. (2024) · Thrombosis Research · doi:10.1016/j.thromres.2024.109178 · Cited by 4
Sadowski, J., Ostrowska, S. A., Klaudel, T., Zaborska, M., Chruszcz, M., Sztangreciak-Lehun, A., & Bułdak, R. J. (2025) · Journal of NeuroVirology · doi:10.1007/s13365-025-01242-1 · Cited by 4
“The main cells involved in the response to infection are T lymphocytes, B lymphocytes, neutrophils, and other antigen-presenting cells, of which macrophages play the main role (Kempuraj et al. 2020a; Pedersen and Ho 2020).”
Kang, K., Gao, Y., Zhao, M., Fei, D., Ye, M., Gao, Y., Yang, W. Z., Wang, C., Liu, H., Chang, G.-P., et al. (2021) · Chinese Medical Journal · doi:10.1097/cm9.0000000000001540 · Cited by 4
Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis
de Araújo, L. J. T., Gonzalez, L. L., Buss, L., Guerra, J. M., Gomez, D. S., Ferreira, C. S. D. S., Cirqueira, C. D. S., Ghillardi, F., Witkin, S. S., & Sabino, É. C. (2021) · Revista de Saúde Pública · doi:10.11606/s1518-8787.2021055003068 · Cited by 4
“Dengue, (1034) 968 (94) 730 (71) 334 (32) 555 (54) 352 (34) 112 (11) 46 (4) 21 (2) Leptospirosis, (633) 572 (90) 606 (96) 258 (41) 415 (66) 262 (41) 79 (12) 32 (5) 9 (1) Yellow fever, (398) 250 (63) 249 (63) 374 (94) 228 (57) 154 (39) 37 (9) 37 (9) 16 (4) Rickettsia, (382) 348 (91) 342 (90) 194 (51) 349 (91) 193 (51)…”
Irfan, A., & Jean, D. T. S. (2021) · Annals of Global Health · doi:10.5334/aogh.3358 · Cited by 7
Does COVID-19 Affect Adult Neurogenesis? A Neurochemical Perspective
Saikarthik, J., Saraswathi, I., & Al-Atram, A. A. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.101179 · Cited by 4
“Increased levels of IL-6 correlate with mortality and the need for ventilator support [105, 106].”
BackgroundTNF-α Levels in Respiratory Samples Are Associated with SARS-CoV-2 Infection
Pereson, M. J., Badano, M. N., Aloisi, N., Chuit, R., de Bracco, M. M. E., & Baré, P. (2022) · Microbiology Spectrum · doi:10.1128/spectrum.01411-21 · Cited by 4
Metadata
- Authors
- Pedersen, S. F., & Ho, Y.-C.
- Affiliations
- Yale University (US)
- Corresponding author
- Ho, Ya-Chi
- ORCID
- Ho, Ya-Chi
- Venue
- Journal of Clinical Investigation
- Published
- 2020-04-13
- Volume
- 130
- Issue
- 5
- Pages
- 2202-2205
- ISSN
- 0021-9738 (ISSN-L)
- 1558-8238
- PMC
- PMC7190904
- OpenAlex
- W3014001472
- Cited by
- 1,137
- References
- 23
- Citations by year
- 2026: 11 · 2025: 34 · 2024: 60 · 2023: 113 · 2022: 183 · 2021: 341 · 2020: 395
- FWCI
- 33.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Investigation (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- amfAR, The Foundation for AIDS Research
- Yale University
- Gilead Sciences
- National Institutes of Health (AI150464, DA047037, UL1TR001863)
- National Institute on Drug Abuse (R61DA047037)
- National Institute of Allergy and Infectious Diseases (UM1AI126620, P50AI150464, R01AI047868, R01AI141009, R37AI147868)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- SARS-CoV-2, COVID-19 pandemic, pandemic, Betacoronavirus, airborne transmission, fomite transmission, pre-symptomatic transmission, undetected infections, WHO pandemic declaration
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Age Factors, Humans, Lymphocytes, Pneumonia, Viral, Respiratory Distress Syndrome, Severity of Illness Index, Cytokines, Coronavirus Infections, Disease Progression, Pandemics
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