Coronavirus Historical Perspective, Disease Mechanisms, and Clinical Outcomes

The emergence of a new coronavirus disease (coronavirus disease 2019 [COVID-19]) has raised global concerns regarding the health and safety of a vulnerable population. Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incites a profound inflammatory response leading to tissue injury and organ failure. COVID-19 is characterized by the bidirectional relationship between inflammation and thrombosis. The clinical syndrome is propelled by inflammation producing acute lung injury, large-vessel thrombosis, and in situ microthrombi that may contribute to organ failure. Myocardial injury is common, but true myocarditis is rare. Elderly patients, those with established cardiovascular disease, and mechanically ventilated patients face the highest mortality risk. Therapies for COVID-19 are evolving. The antiviral drug remdesivir, dexamethasone, transfusion of convalescent plasma, and use of antithrombotic therapy are promising. Most require additional prospective studies. Although most patients recover, those who survive severe illness may experience persistent physical and psychological disabilities.
Central Illustration
Highlights • Severe acute respiratory syndrome coronavirus 2 infection (COVID-19) is a global pandemic affecting millions of people worldwide. • Clinical sequelae result largely from an intense inflammatory response triggering large-vessel and microvascular thrombosis. • No therapy has been universally effective for COVID-19, but systemic anticoagulation, remdesivir, and corticosteroids hold promise. • Long-term sequelae of COVID-19 are variable and incompletely defined, but physical and psychological disabilities can persist.