TY - JOUR T1 - Does inflammation help during COVID-19? JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00557-2020 VL - 6 IS - 4 SP - 00557-2020 AU - Lokesh Sharma AU - De Chang AU - Charles S. Dela Cruz Y1 - 2020/10/01 UR - http://openres.ersjournals.com/content/6/4/00557-2020.abstract N2 - Coronavirus disease 2019 (COVID-19) has emerged as the most devastating pandemic in the last 100 years and has already killed almost 1 million people [1] despite the most aggressive efforts to contain the infection in recorded history. Currently, it remains unclear what drives disease severity in COVID-19, limiting therapeutic options. Various immune modulators such as glucocorticoids and anti-inflammatory therapies are being used to treat COVID-19 without clear evidence of inflammation playing a detrimental role. Here we review evidence to suggest that the host's ability to clear the viral infection is the major determinant in the host survival where a robust early inflammatory response in the lung provides a survival advantage to the host by aiding effective viral clearance. However, failure to clear the viral infection leads to an exacerbated inflammatory response at a later time point, which becomes detrimental to the host's survival. This concept can explain the high susceptibility associated with advanced age or male sex and at the same time explains why children are largely spared of this lethal disease but have inflammatory manifestations such as multi-system inflammatory syndrome in children (MIS-C) or Kawasaki-like disease.Persistent viral presence, rather than the early exaggerated inflammation, may be a key determinant of disease severity in #COVID19. If so, the focus of new therapies should be to promote viral clearance to decrease disease severity and mortality. https://bit.ly/3ahgzkP ER -