Severe COVID-19: A Review of Recent Progress With a Look Toward the Future

Abstract

The novel coronavirus disease 2019 (COVID-19) is an acute infectious disease caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, the World Health Organization has confirmed that COVID-19 is a global infectious disease pandemic. This is the third acute infectious disease caused by coronavirus infection in this century, after sudden acute respirator syndrome and Middle East respiratory syndrome. The damage mechanism of SARS-CoV-2 is still unclear. It is possible that protein S binds to angiotensin-converting enzyme 2 receptors and invades alveolar epithelial cells, causing direct toxic effects and an excessive immune response. This stimulates a systemic inflammatory response, thus forming a cytokine storm, which leads to lung tissue injury. In severe cases, the disease can lead to acute respiratory distress syndrome, septic shock, metabolic acidosis, coagulation dysfunction, and multiple organ dysfunction syndromes. Patients with severe COVID-19 have a relatively high mortality rate. Currently, there are no specific antiviral drugs for the treatment of COVID-19. Most patients need to be admitted to the intensive care unit for intensive monitoring and supportive organ function treatments. This article reviews the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment methods of severe COVID-19 and puts forward some tentative ideas, aiming to provide some guidance for the diagnosis and treatment of severe COVID-19.

Keywords: COVID-19; diagnosis; epidemiology; pathogenesis; treatment.

Figure 1

Chest CT showing changes in 3 patients with severe COVID-19. Compared to the first transferred to ICU, chest CT showing significant absorption of exudative lesions in patient of the day before they were discharged from the ICU. (A) Chest CT images of the patients when they were first transferred to ICU. (B) Chest CT images of the patients on the day before they were discharged from the ICU showing absorption of the exudative lesions. Intensive care unit: ICU.