What happens to people's lungs when they get coronavirus disease 2019?

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Annalisa Frizzelli
Domenico Tuttolomondo
Marina Aiello
Maria Majori
Giuseppina Bertorelli
Alfredo Chetta


SARS-CoV-2, Pneumonia, Respiratory failure, ARDS


The novel coronavirus SARS-CoV-2 was first identified in Wuhan in December 2019 as cause of the consequent novel coronavirus disease 2019 (COVID-19). The virus has since spread worldwide. The clinical presentation following human infection ranges from a mild upper respiratory tract infection to severe acute respiratory distress syndrome and sepsis. We reviewed literature using Pubmed to identify relevant English-language articles published until April 15, 2020. Search terms include novel coronavirus pneumonia, severe acute respiratory syndrome coronavirus 2, coronavirus and ventilation. We summarized what SARS-CoV-2 infection means for the lungs.


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1. Zhu N., Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020 Feb 20; 382 (8):727-33.
2. Lu R, Zhao X, Li J, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implication for virus origins and receptor binding. Lancet. 2020 Feb 22; 395(10224): 565-74.
3. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet. 2020 Feb 15;395(10223):497-506.
4. Zhou P, Yang XL, Wang XG, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579: 270–273.
5. Harmer D, Gilbert M, Borman R, Clark KL, Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett 2002; 532: 107–10.
6. Imai Y, Kuba K, Rao S, et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature 2005; 436:112–6.
7. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. Jama. 2020 Feb7;323(11):1061-9.
8. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020 Apr; 8(4):420-2
9. Wu C, Chen X, Cai Y, et al., Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China, JAMA Intern Med. (2020) 1-10.
10. Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China, N. Engl. J. Med. (2020) 1–13.
11. Yang X, Yu Y, Xu J, et al., Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study, Lancet Respir. Med. (2020) 1–7.
12. Hallgren R, Samuelsson T, Laurent TC, Modig J. Accumulation of hyaluronan (hyaluronic acid) in the lung in adult respiratory distress syndrome. Am Rev Respir Dis. 1989 Mar;139:682–7).
13. Bell TJ, Brand OJ, Morgan DJ, et al. Defective lung function following influenza virus is due to prolonged, reversible hyaluronan synthesis. Matrix Biol. 2019 Jul;80:14–28.
14. Shi Y, Wang Y, Shao C. et al. COVID-19 infection: the perspectives on immune responses. Cell Death Differ (2020).
15. Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19) Jama Cardiol. March 27, 2020.
16. Tavazzi G, Pellegrini C, Maurelli M, et al. Myocardial Localization of Coronavirus in COVID-19 Cardiogenic Shock. J Heart Fail. 2020 Apr 10.
17. Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017; 377:1119–1131.
18. Zhonghua Liu Xing Bing Xue Za Zhi. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus disease (COVID-19) in China. 2020 Feb 17; 41 (2): 145-51.
19. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020 Feb 15; 395 (10223): 507 -13.
20. Jin Y-H, Cai L, Cheng Z-S, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Med Res 7, 4 (2020).
21. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet 2020; Published: March 13, 2020; 395 (10231): 1225-1228, April 11, 2020.
22. Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med. 2020 Apr 6.
23. Gattinoni L, Coppola S, Cressoni M, et al. Covid-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome [published online ahead of print, 2020 Mar 30]. Am J Respir Crit Care Med. 2020;10.1164/rccm.202003-0817LE.

24. World Health Organization (WHO). Clinical management of severe acute respiratory infection when Novel ronavirus (nCoV) infection is suspected: Interim Guidance [EB / OL].
25. Hui DS. Severe acute respiratory syndrome (SARS): lessons learnt in Hong Kong[J].J Thorac Dis, 2013,5(Suppl 2):S122-S126.
26. Wang K, Zhao W, Li J, shu W, Duan J. The experience of high-flow nasal cannula in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of Chongqing, China. Ann. Intensive Care 10,37 (2020).
27. Ding L, Wang L, Ma W, He H. Efficacy and safety of early prone positioning combined with HFNC or NIV in moderate to severe ARDS: a multi-center prospective cohort study. Crit Care. 2020 Jan 30;24(1):28.

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