Possible immunopathological sequelae of severe COVID-19 immunotherapy: The lesser of two evils?

Eighteen months into the COVID-19 pandemic the number of people infected with SARS-CoV-2 is still increasing worldwide [1], rapidly in many countries, due to a spike in incidence related to community transmission of a hitherto locally unseen variant of this beta-coronavirus. The global confirmed case mortality statistic continues to escalate in the face of a steady roll out of immunization programs with one or other regulatory authority-approved efficacious vaccine [1]. As infected individuals may experience a potentially life-threatening course of infection, especially those in high-risk groups such as the elderly, people with health conditions and pregnant women, there remains an urgent need for effective drug therapy for severe COVID-19. Due to the sheer scale of the public health crisis caused by the pandemic, the consensus of the global biomedical research community is that time is too short to develop novel specific agents. Thus, existing antivirals or immune modulators with known safety profiles are gaining traction as the fastest route to treat hospitalized cases of COVID-19 [2]. Compounds that have already been tested in other indications now have priority, in particular those shown to be effective in treating infection with the closely related coronaviruses that are the causative agents of SARS and MERS