SARS-CoV-2 infection is often associated with a hyperinflammation that is thought to drive disease severity and death. However, it is unclear whether tissue inflammation is induced by a direct response to the virus or by an independent immunopathological process. By analysing SARS-CoV-2 organotropism and organ inflammation in post-mortem tissues from 11 patients who died of COVID-19, Dorward et al. report that, despite a wide distribution of viral products in pulmonary and extra-pulmonary tissues, severe inflammation was limited to the lung and reticuloendothelial system and was not consistently associated with presence of virus. Overall, this preprint suggests that immune mechanisms of SARS-CoV-2 tissue-specific tolerance function independently of viral clearance and that fatal COVID-19 is a consequence of immunopathology that may be dissociated from virus presence.
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Dorward, D. A. et al. Tissue-specific tolerance in fatal Covid-19. Preprint at medRxiv https://doi.org/10.1101/2020.07.02.20145003 (2020)
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Belabed, M. Virus dissociated from inflammation in fatal COVID-19. Nat Rev Immunol 20, 519 (2020). https://doi.org/10.1038/s41577-020-0403-5
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DOI: https://doi.org/10.1038/s41577-020-0403-5