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SARS-CoV-2 pandemic: clinical picture of COVID-19 and implications for research
  1. Marc Lipman1,
  2. Rachel C Chambers1,
  3. Mervyn Singer2,
  4. Jeremy Stuart Brown1
  1. 1 Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
  2. 2 Bloomsbury Institute for Intensive Care Medicine, University College London, London, UK
  1. Correspondence to Professor Jeremy Stuart Brown; jeremy.brown{at}

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represents an extraordinary medical challenge that has already had massive economic and societal impacts. In contrast to the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus outbreaks, every respiratory physician and intensivist are likely to encounter patients infected with SARS-CoV-2 and need a good understanding of the management of the associated disease, COVID-19. We are facing the first wave of the SARS-CoV-2 pandemic, but the infectivity of the virus and the lack of population immunity suggest future waves are possible. For this article (summarised in table 1), we have used our recent clinical experience of COVID-19 combined with the limited published data to discuss how the clinical presentation relates to pathogenesis, key research questions and particular issues relevant to respiratory medicine.

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Table 1

Summary of COVID-19 disease features, the research questions these raise, and potential therapeutic relevance

Most infections with SARS-CoV-2 are mild, but a minority of patients develop COVID-19 pneumonia. The main differential diagnosis for COVID-19 is community-acquired pneumonia (CAP), which is also commonly caused by infection with respiratory viruses. However, COVID-19 has several clinical features distinct to CAP, which both indicate the diagnosis and suggest it has distinct mechanisms of pathogenesis. For patients with CAP, symptoms, signs and alveolar consolidation usually develop rapidly after infection, whereas for patients with COVID-19, a 6+-day lag between the start of infective symptoms and admission with pneumonia is usual.1 2 COVID-19 also often causes marked malaise and extrapulmonary symptoms, such as anosmia, headache, myalgia and myocarditis.3 4 The leading cause of death in COVID-19 is respiratory failure from extensive lung injury. This usually presents with …

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  • Contributors All authors contributed to the writing of the editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.