Yan Leyfman
Coronavirus disease 2019 (COVID-19), a respiratory illness caused by the novel betacoronavirus SARS-CoV-2, has rapidly caused a global pandemic. This viral infection has broad symptomatic presentations, ranging from asymptomatic to fatal. Studies have demonstrated that patients with severe symptoms and elevated pro-inflammatory (IL-1β, IL-6, IFN-γ, and TNF-α) and lower anti-inflammatory cytokine levels (IL-10) tend to possess a poor prognosis. Based on the available evidence, we proposed a mechanism by which SARS-CoV-2 infection causes systemic organ damage through IL-6-mediated inflammation. Elevated IL-6 fuels a cytokine release syndrome and hypoxia, resulting in vast systemic injury, multi-organ damage, and eventually organ failure. Additionally, we propose a potential synergism between influenza virus and SARS-CoV-2, which we termed “COVI-Flu.” Under our model, simultaneous infection with both viruses will cause a further increase in IL-6 production, which will yield more widespread systemic inflammation and injury than infection with either virus alone. Currently, there are no available safe and effective therapeutic interventions against SARS-CoV-2 or COVI-Flu. Based on the similarities between the disease mechanisms of SARS-CoV-2 and influenza virus, we proposed the idea of a combination therapy that can control the systemic inflammation induced by both viruses. One promising approach is a cellular therapy that has yielded promising preliminary efficacy in COVID-19 patients. Looking forward, we see combinational therapies being used that can better thwart the virus’s heterogeneity and mutational adaptations. In anticipation of the impending COVI-Flu pandemic, we propose a preventative approach that can be implemented now to better prepare for the future. Based on our model, we feel that enacting a flu immunization program can provide some protection against the synergism of the two viruses.