Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Oct 1;100(4):1455-1466.
doi: 10.1152/physrev.00020.2020. Epub 2020 Jun 4.

SARS-CoV-2 and COVID-19: From the Bench to the Bedside

Stefano Romagnoli  1 , Adriano Peris  1 , A Raffaele De Gaudio  1 , Pierangelo Geppetti  1
Affiliations
Review

SARS-CoV-2 and COVID-19: From the Bench to the Bedside

Stefano Romagnoli et al. Physiol Rev. .

Abstract

First isolated in China in early 2020, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the novel coronavirus responsible for the ongoing pandemic of Coronavirus Disease 2019 (COVID-19). The disease has been spreading rapidly across the globe, with the largest burden falling on China, Europe, and the United States. COVID-19 is a new clinical syndrome, characterized by respiratory symptoms with varying degrees of severity, from mild upper respiratory illness to severe interstitial pneumonia and acute respiratory distress syndrome, aggravated by thrombosis in the pulmonary microcirculation. Three main phases of disease progression have been proposed for COVID-19: an early infection phase, a pulmonary phase, and a hyperinflammation phase. Although current understanding of COVID-19 treatment is mainly derived from small uncontrolled trials that are affected by a number of biases, strong background noise, and a litany of confounding factors, emerging awareness suggests that drugs currently used to treat COVID-19 (antiviral drugs, antimalarial drugs, immunomodulators, anticoagulants, and antibodies) should be evaluated in relation to the pathophysiology of disease progression. Drawing upon the dramatic experiences taking place in Italy and around the world, here we review the changes in the evolution of the disease and focus on current treatment uncertainties and promising new therapies.

Keywords: COVID-19; SARS; SARS-CoV-2; coronavirus.

PubMed Disclaimer

Conflict of interest statement

No conflicts of interest, financial or otherwise, are declared by the authors.

Figures

None
Graphical abstract
FIGURE 1.
FIGURE 1.
Schematic representation of the symptoms that characterize the three different phases of COVID-19 progression and corresponding possible treatments. ARDS, acute respiratory distress syndrome; IL, interleukin; rt-PA, recombinant tissue plasminogen activator.
FIGURE 2.
FIGURE 2.
Schematic representation of the SARS-CoV-2 cycle in airway epithelial cells and inflammatory consequences of viral infection. Some of the mechanisms related to the possible therapeutic action of drugs used or proposed to treat COVID-19 are reported. ACE2, angiotensin converting enzyme 2; IL-6, interleukin-6; MCP1, monocyte chemoattractant protein-1; MIP1α, macrophage inflammatory protein 1α; TMPRSS2, type 2 transmembrane serine protease; TNF, tumor necrosis factor; tPA, tissue plasminogen activator.
FIGURE 3.
FIGURE 3.
The highly varied impact of the COVID-19 outbreak in the respective Italian regions. [Data from Onder et al. (51).]
See this image and copyright information in PMC

References

    1. Ahmed SF, Quadeer AA, McKay MR. Preliminary identification of potential vaccine targets for the COVID-19 coronavirus (SARS-CoV-2) based on SARS-CoV immunological studies. Viruses 12: 254, 2020. doi: 10.3390/v12030254. - DOI - PMC - PubMed
    1. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Berlin: Springer, 2020. - PMC - PubMed
    1. Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, Taylor J, Spicer K, Bardossy AC, Oakley LP, Tanwar S, Dyal JW, Harney J, Chisty Z, Bell JM, Methner M, Paul P, Carlson CM, McLaughlin HP, Thornburg N, Tong S, Tamin A, Tao Y, Uehara A, Harcourt J, Clark S, Brostrom-Smith C, Page LC, Kay M, Lewis J, Montgomery P, Stone ND, Clark TA, Honein MA, Duchin JS, Jernigan JA; Public Health–Seattle and King County and CDC COVID-19 Investigation Team . Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med 382: 2081–2090, 2020. doi: 10.1056/NEJMoa2008457. - DOI - PMC - PubMed
    1. Barker AB, Wagener BM. An ounce of prevention may prevent hospitalization. Physiol Rev 100: 1347–1348, 2020. doi: 10.1152/physrev.00017.2020. - DOI - PMC - PubMed
    1. Bhimraj A, Morgan R, Shumaker A, Lavergne V, Baden L, Chi-Chung Cheng V, Edwards K, Gandhi R, Muller W, O’Horo J, Shoham S, Murad M, Mustafa R, Sultan S, Falck-Ytter Y.. Infectious diseases society of america guidelines on the treatment and management of patients with COVID-19 (Online). https://www.idsociety.org/globalassets/idsa/practice-guidelines/covid-19.... - PMC - PubMed

LinkOut - more resources