Hypothesis for potential pathogenesis of SARS-CoV-2 infection–a review of immune changes in patients with viral pneumonia

Abstract

Coronavirus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with droplets and contact as the main means of transmission. Since the first case appeared in Wuhan, China, in December 2019, the outbreak has gradually spread nationwide. Up to now, according to official data released by the Chinese health commission, the number of newly diagnosed patients has been declining, and the epidemic is gradually being controlled. Although most patients have mild symptoms and good prognosis after infection, some patients developed severe and die from multiple organ complications. The pathogenesis of SARS-CoV-2 infection in humans remains unclear. Immune function is a strong defense against invasive pathogens and there is currently no specific antiviral drug against the virus. This article reviews the immunological changes of coronaviruses like SARS, MERS and other viral pneumonia similar to SARS-CoV-2. Combined with the published literature, the potential pathogenesis of COVID-19 is inferred, and the treatment recommendations for giving high-doses intravenous immunoglobulin and low-molecular-weight heparin anticoagulant therapy to severe type patients are proposed.

Clinical observation and management of COVID-19 patients

“…It is believed that COVID-2019 can activate coagulation cascade through various mechanisms, leading to severe hypercoagulability. Early anticoagulation may block clotting formation and reduce microthrombus, thereby reducing the risk of major organ damages [5,6].…”

COVID-19, Low-Molecular-Weight Heparin, and Hemodialysis

“…LMWH has some antiviral properties in vitro and it is routinely used in COVID-19 patients to prevent or circumvent the activation of the coagulation cascade induced by inflammation [23]. This is a particularly severe and lethal complication, leading to disseminated intravascular coagulation and venous thromboembolism.…”

Recomendaciones de «hacer» y «no hacer» en el tratamiento de los pacientes críticos ante la pandemia por coronavirus causante de COVID-19 de los Grupos de Trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)

“…cuando existe un deterioro brusco del estado hemodinámico o respiratorio. recomienda realizar eco-doppler de extremidades inferiores y ecocardiografía.Se sugiere anticoagular a pacientes con niveles crecientes de dímero-D superiores a 4 veces el valor alto de la normalidad siempre que no existan contraindicaciones(130). Se recomienda utilizar enoxaparina o heparina no fraccionada.…”