Department of Clinical Immunology, Auckland Hospital, Grafton Auckland, New Zealand.
Department of Virology and Immunology, Auckland Hospital, Grafton Auckland, New Zealand.
Expert Rev Clin Immunol. 2022 Jun;18(6):557-565. doi: 10.1080/1744666X.2022.2074403. Epub 2022 May 26.
COVID-19 has had a calamitous impact on the global community. Apart from at least 6 M deaths, hundreds of millions have been infected and a much greater number have been plunged into poverty. Vaccines have been effective but financial and logistical challenges have hampered their rapid global deployment. Vaccine disparities have allowed the emergence of new SARS-CoV-2 variants including delta and omicron, perpetuating the pandemic.
The immunological response to SARS-CoV-2 is now better understood. Many of the clinical manifestations of severe disease are a consequence of immune dysregulation triggered by the virus. This may explain the lack of efficacy of antiviral treatments, such as convalescent plasma infusions, given later in the disease.
T cells play a crucial role in both the outcome of COVID-19 as well as the protective response to vaccines. Vaccines do not prevent infection but reduce the risk of a chaotic and destructive cellular immune response to the virus. Severe COVID-19 should be considered a virus-induced secondary immune dysregulatory disorder of cellular immunity, with broad host susceptibility. This perspective of COVID-19 will lead to better diagnostic tests, vaccines, and therapeutic strategies in the future.
COVID-19 对全球社会造成了灾难性的影响。除了至少 600 万人死亡外，数亿人感染了 COVID-19，更多的人陷入了贫困。疫苗已经被证明是有效的，但资金和物流方面的挑战阻碍了它们在全球范围内的快速部署。疫苗分配不均导致了新的 SARS-CoV-2 变体（包括 delta 和 omicron）的出现，使大流行持续存在。
现在人们对 SARS-CoV-2 的免疫反应有了更好的了解。许多严重疾病的临床表现是由病毒引发的免疫失调引起的。这也许可以解释为什么在疾病后期使用抗病毒治疗（如恢复期血浆输注）效果不佳。
T 细胞在 COVID-19 的结果以及对疫苗的保护反应中都起着至关重要的作用。疫苗不能预防感染，但可以降低对病毒产生混乱和破坏性细胞免疫反应的风险。严重的 COVID-19 应被视为一种由病毒引起的继发性免疫调节障碍性细胞免疫紊乱，具有广泛的宿主易感性。这种对 COVID-19 的看法将导致未来更好的诊断测试、疫苗和治疗策略。
