Scientist suggests COVID-19 should be treated as acute inflammatory disease

The novel coronavirus (COVID-19) should be treated as an acute inflammatory disease and the severity of infection is associated with the dysregulation of inflammatory immune responses and subsequent inability to develop protective immunity from the virus, according to new research by scientists at the Virginia Commonwealth University (VCU) and published in the Journal of Immunology.

Most people infected with COVID-19 show flu-like symptoms and survive the disease. However, individuals with susceptibility factors, including age, sex, and underlying health complications, such as cancer, heart disease, diabetes, or asthma, are significantly more vulnerable to infection because their immune response is in disarray. Manjili said that men are more susceptible to infection than women because of an expression of sex-associated genes coded by the X chromosome that play a key role in the immune response.

As viral loads are similar in symptomatic and asymptomatic patients with COVID-19, the researchers said it appears that a dysregulated immune response is the primary cause of death as opposed to viral load. The most serious consequences of COVID-19 are sepsis-like cytokine storm or a severe overreaction of the immune system, blood clots, and respiratory or cardiovascular complications.

In response to injury or infection, the immune system will normally react with an immediate inflammatory response to limit the infection and help to develop a long-lasting, protective immunity against the virus within seven to 10 days following infection.

Masoud Manjili, DVM, PhD, lead author of the study and researcher at the VCU cancer Center, said that antiviral therapies such as chloroquine, hydroxychloroquine, and remdesevir might be effective as preventive strategies or in very early stages of infection but could prevent patients from gaining protective immunity. Efforts to develop novel treatment options for COVID-19 should be primarily focused on the transference of plasma from immune individuals to those with severe symptoms of the disease as well as a vaccine that prevents infection.

Specifically, Manjili determined that the highly tailored anti-inflammatory treatments should be considered as viable options for treating COVID-19.

"When inflammation is not modulated or resolved after serving its purpose, it turns into hyperinflammation or becomes chronic and results in the inhibition of adaptive immune responses, tissue damage or organ failure, as evidenced in many cases of the novel coronavirus," Manjili said in a statement. "Therefore, understanding and successfully controlling inflammation would be a promising approach for the management of COVID-19."

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