JACC Focus Seminar: Coronavirus Disease 2019 in 2020
JACC Focus Seminar
Coronavirus Historical Perspective, Disease Mechanisms, and Clinical Outcomes: JACC Focus Seminar

https://doi.org/10.1016/j.jacc.2020.08.058Get rights and content
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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.

Abstract

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.

Key Words

cardiovascular disease
COVID-19
inflammation
SARS-CoV-2
thrombosis

Abbreviations and Acronyms

ARDS
acute respiratory distress syndrome
BMI
body mass index
COVID-19
coronavirus disease 2019
CS
cytokine storm
HCQ
hydroxychloroquine
IL
interleukin
MERS
Middle East respiratory syndrome
NIH
National Institutes of Health
RNA
ribonucleic acid
SARS
severe acute respiratory syndrome
SARS-CoV-2
severe acute respiratory syndrome coronavirus 2
TLR
toll-like receptor
TNF
tumor necrosis factor
TRIF
Toll/interleukin-1 receptor domain–containing adaptor-inducing interferon-β

Cited by (0)

Dr. Pinney has received consulting fees from Abbott, CareDx, Medtronic, and Procyrion. Dr. Giustino has received consulting fees from Bristol Myers Squibb and Pfizer. Dr. Halperin has received consulting fees from Bayer AG HealthCare, Boehringer Ingelheim, Johnson & Johnson, and Ortho-McNeil-Janssen Pharmaceuticals; and served as a member of the Executive Steering Committee for the MARINER trial comparing anticoagulant strategies. Dr. Mechanick has received honoraria for lectures and program development from Abbott Nutrition. Dr. Olin is an Advisory Board member for Janssen Pharmaceuticals; and is on the Steering Committee for TRA2°P-TIMI 50. Dr. Rosenson has received research support from Akcea, Amgen, The Medicines Company, Novartis, and Regeneron; has received consulting fees from Amgen, C5, CVS Caremark, Corvidia, and The Medicines Company; has received honoraria for nonpromotional speaking from Amgen, Kowa, Pfizer, and Regeneron; has received royalties from UpToDate, Inc.; and has stock ownership in MediMergent, LLC. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Muthiah Vaduganathan, MD, served as Guest Associate Editor for this paper. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.