SARS-CoV-2/COVID-19: Evolving Reality, Global Response, Knowledge Gaps, and Opportunities

Abstract

Approximately 3 billion people around the world have gone into some form of social separation to mitigate the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The uncontrolled influx of patients in need of emergency care has rapidly brought several national health systems to near-collapse with deadly consequences to those afflicted by Coronavirus Disease 2019 (COVID-19) and other critical diseases associated with COVID-19. Solid scientific evidence regarding SARS-CoV-2/COVID-19 remains scarce; there is an urgent need to expand our understanding of the SARS-CoV-2 pathophysiology to facilitate precise and targeted treatments. The capacity for rapid information dissemination has emerged as a double-edged sword; the existing gap of high-quality data is frequently filled by anecdotal reports, contradictory statements, and misinformation. This review addresses several important aspects unique to the SARS-CoV-2/COVID-19 pandemic highlighting the most relevant knowledge gaps and existing windows-of-opportunity. Specifically, focus is given on SARS-CoV-2 immunopathogenesis in the context of experimental therapies and preclinical evidence and their applicability in supporting efficacious clinical trial planning. The review discusses the existing challenges of SARS-CoV-2 diagnostics and the potential application of translational technology for epidemiological predictions, patient monitoring, and treatment decision-making in COVID-19. Furthermore, solutions for enhancing international strategies in translational research, cooperative networks, and regulatory partnerships are contemplated.

Fig. 1

Phylogeny, evolutionary relationships, global propagation pathways, and timeline of SARS-CoV-2 viruses from the ongoing COVID-19 pandemic.

Fig. 2

A pulmonary presentation of SARS-CoV-2 infection in a severely ill, intubated, and mechanically ventilated COVID-19 patient by computed tomography (CT; panel A) and plain chest x-ray imaging (panel B).

Fig. 3

Summary of potentially protective and harmful host responses during the SARS-CoV2 infection based on the currently available data.

Fig. 4

Global clinical research activities on SARS-CoV2/COVID-19 based upon trial registration data.

Fig. 5

Example of a fully automated assessment of the total and lobar disease burden in COVID-19 pneumonia based upon an AI algorithm.