How Could This Happen?
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How Could This Happen? Narrowing Down the Contagion of COVID-19 and Preventing Acute Respiratory Distress Syndrome (ARDS) Wilfried Allaerts1 Received: 26 March 2020 / Accepted: 10 April 2020 © Springer Nature B.V. 2020
Abstract In this rapid commentary, a mini-review is given of the present state-of-knowledge regarding the etiology and epidemiology of the new coronavirus 2019-nCoV and the risks for developing Acute respiratory distress syndrome (ARDS). The available knowledge on the viral genomics, molecular biology and pathogenicity of viruses of the Coronaviridae family and other Nidovirales, forms a helpful template for understanding the present pandemic outbreak. However, important questions remain unanswered about the underlying mechanism causing the very high case fatality ratios (CFR) and mechanisms regarding severe reactions like ARDS, fatal cardiac and renal failures, associated with a number of important comorbidity factors. Immunological reactions to lung alveoles in particular (involving lung macrophages and alveolar epithelial cell damage) in late phase ARDS in SARS-like CoV diseases, so far may not have received enough attention. Finally a shortlist of questions for high priority further research is suggested. Keywords COVID-19 (2019-nCoV) · SARS · MERS · Acute respiratory distress syndrome · Angiotensin converting enzyme 2 · Lung immunopathology
1 Introduction Since the outbreak of the 2019 novel coronavirus (named 2019-nCoV by the World Health Organization) (Wu et al. 2020), also named coronavirus disease 2019 (Covid19) or SARS-CoV-2, the disease has spread to a global pandemic. The effects of this pandemic not only on public health and health care institutions, but also on nearly every aspect of social life and worldwide economy is unprecedented in postmodern history. The speed of its distribution, since the discovery on 30 December 2019 * Wilfried Allaerts 1
Biological Publishing A&O and Immunology Department, Erasmus MC, Rotterdam, The Netherlands
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of a new virus in the bronchioalveolar lavage (BAL) (samples taken from the lung content) of a patient at Wuhan Jinyingtan Hospital (Hubei province, China) (WHO 2020) until today—which is less than 3 months—has caused a shockwave in a number of severely struck countries. Unfortunately, it may have caused a lot of confusion in the public media too. Especially the high rate of fatalities, following the incidence of acute respiratory distress syndrome (ARDS) has raised the stakes of national health authorities up to the highest levels of vigilance and promulgation of the most extreme measures. This paper aims at summarizing the information already available concerning the etiology, genomic background and epidemiology of COVID-19. In particular, similarities and differences observed in related species of the Coronaviridae (order Nidovirales), especially of the genus Betacoronavirus, and most predominantly the SARS-related Rhinolophus bat coronavirus (SARSr BaCoV HKU3) and SARSrelated human coronavirus (SARS CoV U
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