COVID-19

Charles S. Dela Cruz, MD, PhD

Charles Feldman,MBBCh,DSc, PhD

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) emerged 3 years ago and has caused an epic global pandemic of acute respiratory disease, named “coronavirus disease 2019 (COVID-19).” This has resulted in almost 6.6 million deaths, a total of 635 million cases globally, and an ever increasing number of patients suffering from post-COVID conditions. Since the start of the pandemic, there have been continued multiple waves of viral variants causing infection and disease, disease and currently the virus may be transitioning into an endemic state. There has been an unprecedented speed and degree of discovery in learning how the virus evolves, becomes transmitted, and causes disease. Equally, there have been major advances in the detection, treatment, and preventative measures in efforts to contain the virus and limit human disease. In this issue of Seminars in Respiratory and Critical Care Medicine on “COVID-19,” we have invited a group of dedicated authors from around the globe to provide cutting edge and insightful reviews on important aspects of COVID-19, many of whom have had first-hand experience and contribution in their respective responses to the viral infection crisis.

The articles in this issue encompass the major issues that frequently arose during the pandemic. This issue starts off with a discussion on the discovery and investigation of the origins of SARS-CoV-2 and the genomic approaches to identify the virus. COVID-19 has highlighted the importance of pulmonary infection in causing significant morbidity and mortality to previously unforeseen degrees in recent history. We have learned how COVID-19 pneumonia is similar to community-acquired pneumonia in some regards, but also different with features that are unique to COVID-19. Respiratory infections have been known to cause extrapulmonary manifestations, but COVID-19 has underscored how viral lung infections can have a profound impact on many organs including the cardiovascular systems. More data have emerging to implicate the role of endothelial injury, inflammation, immune dysregulation, and microthrombosis.

COVID-19 has impacted specific vulnerable populations including children, pregnant women, and patients living with HIV. The pandemic has allowed for the evaluation of COVID-19-specific models using clinical scores and/or biomarkers to predict disease outcomes. This potentially allows for the identification of higher risk patient populations which is important in medical triage. Given the influx of patients requiring higher levels of clinical care, the management of severe COVID-19 patients has taught us the use of high-flow nasal oxygen, awake proning, mechanical ventilation strategies, and extracorporeal membrane oxygen (ECMO).

The pandemic has also changed the landscape of many diseases including sepsis, increasing its rates, and challenged previous care management. Similar significant advances in the development of antiviral therapeutics have through the use of new and repurposed drugs to treat COVID-19. There is, however, a continued need for more affordable and effective therapies, particularly for variably resourced countries. We learned the therapeutic impact of immune modulators, given the importance of the hyperinflammatory response to the viral infection in the pathogenesis of pneumonia with a discussion focused on the beneficial role of corticosteroids.

Unfortunately, a significant number of infected patients suffer from persistent post-COVID-19 health problems that span from cardiopulmonary to neuropsychiatric symptoms. Ongoing efforts to better understand these post-COVID-19 conditions will hopefully identify viable treatment and management approaches to help these patients recover. Lastly, the collective global response allowed for the development, production, and dissemination of safe and effective vaccines against SARS-CoV-2. This work highlighted continued challenges relating to evolving viral variants, immune evasion, waning immunity, and disparate global access to the vaccines.

The guest editors sincerely thank all of the authors for their important and thoughtful contributions to this issue of the journal. They have worked tirelessly during these past years in their personal and collective response to this global pandemic. While much progress has been made with lessons learned, more needs to be done as we witness the transition of this current pandemic into an endemic phase and be better prepared for future respiratory viral crises.

Publication History

Article published online:
16 January 2023