Pathobiology of COVID-19
Our results suggest that the descriptor cytokine storm does not appropriately describe the milieu in COVID-19-induced organ dysfunction. Autopsy reports consistently note widespread dissemination of SARS-CoV-2 throughout diverse tissues. 47
Lymphopenia is common, as we report here, and prognostic, as others have reported. 1
T lymphocytes are directly susceptible to SARS-CoV-2 infection, 49
and are depleted in clinical COVID-19. 22
In this context, it is worth considering that the less pronounced cytokine elevations in COVID-19 could reflect a regulated, or even inadequate, inflammatory response to overwhelming viral infection. A predominantly hypoimmune state with subsequent (directly) virus-mediated tissue damage and dysregulated inflammation is consistent with both the apparent clinical and pathological abnormalities in COVID-19 and the high concentrations of circulating acute-phase reactants reported
Confucius: the man who broke the mountain was the same man who started ...