Respiratory failure in COVID-19 usually not driven by cytokine storm

The turning point for people with COVID-19 typically comes in the second week of symptoms. As most people begin to recover, a few others find it increasingly difficult to breathe and wind up in the hospital. It has been theorized that those whose lungs begin to fail are victims of their own overactive immune systems.

A new study from Washington University School of Medicine in St. Louis and St. Jude Children’s Research Hospital in Memphis, Tenn., however, suggests that an out-of-control  is not the main problem for the vast majority of hospitalized COVID-19 patients. Only 4% of patients in the study had the sky-high levels of immune molecules that signify a so-called “cytokine storm.” The rest had inflammation, but not a remarkably high amount for people fighting infection. If anything, the COVID-19 patients had less inflammation than a comparable group of influenza patients.

The findings, published Nov. 13 in Science Advances, help explain why anti-inflammatory medications such as dexamethasone benefit only a fraction of people with severe COVID-19, and suggest that more research is needed to identify the causes of respiratory failure in COVID-19 patients.

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