COVID-19

Mechanism of entry and role of immune system

By: Teresa C.
Mechanism of Entry

■ COVID-19 can be transmitted from an infected person breathing out droplets and small
particles, and breath in by another person within 6 feet.
■ Can be transmitted by droplets in the eyes, nose, mouth or touching contaminating
surfaces
■ COVID-19 enters the host
cells through the interaction
of angiotensin-converting
enzymes 2 knowns as ACE 2
viral spike protein allowing
infection.
■ The viral load peaks around
when symptom onsets
COVID-19 Pathology

■ COVID-19 is characterized by flu- like symptoms caused by a virus. Some patients

develop acute lung injury known as pneumonia followed by coagulopathy.
■ Majority of patients with severe COVID-19 are elderly males with comorbidities like
hypertension, atherosclerosis, ischemic cardiomyopathy, coronary heart disease,
diabetes, chronic obstructive pulmonary disease and obesity.
Symptoms

Can be spread easier than the flu

Symptoms start appearing 2 to 14 days after exposure to the virus include:

• Fevers or chills -shortness of breath or difficulty breathing
• Cough -muscle aches
• Fatigue -soar throat
• Loss of taste or smell -nausea and/ or vomiting
• Congestion or runny nose -diarrhea
Critical illness includes acute respiratory distress syndrome, septic shock, multiple organ failure,
including heart, liver, kidney and brain.
Role of Immunity System
■ COVID-19 can be divided into three stages
– The first stage is 7-10 days after onset of symptoms. The patient is infected with the virus and
develops no symptoms or flu-like symptoms such as fever, dry cough, and fatigue.
– Second stage is the period from 7-10 to 14-21 days after onset of symptoms. In this stage some
patients recover while others worsen. Chest imaging can show infiltrations in the lungs, and
patients present dyspnea and hypoxemia. Can easily progress to acute respiratory distress
syndrome.
– Third stage is the period from 14-21 days or more after onset of symptoms. Some patients start
having organ failure including heart, brain, lung, liver and kidney, causing death.
Stage One: Normal or Hypofunction
Immune Response
■ The white blood cells decrease in early stage
■ The innate immune system is the first line of defense against invasion of COVID-19
– Including neutrophils, NK cells, monocytes and dendritic cells or DCs.
■ DCs are the most powerful full time antigen presenting cells that ingest, process, and present antigen
■ The mature DCs activate T cells, which initiate, regulate, and maintain the immune response
■ CD4+ T cells can differentiate into a range of helper and effort cells types, indicating B cells assisting CD8+ T cells to repair
tissue
■ CD8+ T cells kill infected cells and affect immune response activation
■ The B lymphocytes secrete the antibodies that attack the virus.
Stage Two: Immune Response/
Hyperactivation
■ In most cases people with mild illness recover, but in others the peripheral blood
lymphocytes decrease.
■ The decrease cause the activation of pathogenic CD4+ T cells causing a cytokine storm,
resulting in multiple organ failure.
■ The Tre lymphocytes increase causing a negative influence in the immune system
■ The neutrophils increase indicating myelopoiesis causing coagulopathy, which leads to
cortical necrosis and kidney failure.
■ DCs and NK cells decrease, causing the innate immune system to start collapsing.
Stage Three: Anergy

■ If the immune system is effective, the virus can be suppressed allowing the patient to
recover. But if the immune system is impaired, causing state of incompetence and the
number of the lymphocytes continue to decrease.
■ Cell functions of CD4+ T cells are low, activating receptors and increase CD45RA and
CD28, triggering the immune system to enter the anergy state.
■ At this point the patient cannot resist the infection.
■ In those who survived and recovered, the immune system takes 6.1 months to return to
the physiological levels.
The change in the innate immune
system of the elderly, which has
reduced DCs, mayce cause
unfavorable outcomes with those
infected with COVID-19.
Age related difference
in the immune system
response

Age affects the immune system,

when COVID-19 enters in an
elderly the imbalance in cellular
functions decreases the activation
of the immune system, leading to
inflammation.
COVID-19 In Children
■ Children for the most part are asymptomatic or pauci-symptomatic with fever, cough,
fatigue, and nasal congestion.
■ In infants and newborns COVID presents with gastrointestinal symptoms such as
diarrhea, abdominal cramps, and vomiting.
■ Severe COVID-19 in children overlaps with symptoms for a rare inflammatory
syndrome, toxic shock syndrome and Kawasaki disease.
■ Inflammatory syndrome can cause some organ such as the heart, lungs, blood
vessels, kidneys, brain and skins or eyes.
■ Emergency warning signs are pale, gray or blue-colored skin, confusion and inability
to wake up or stay awake.
■ The excessive immune response might be a cause of the inflammation syndrome.
References
■ Bajaj, Varnica, et al. “Aging, Immunity, and Covid-19: How Age Influences the Host Immune Response to Coronavirus Infections?” Frontiers, Frontiers, 1 Jan. 1AD,
https://www.frontiersin.org/articles/10.3389/fphys.2020.571416/full. 

■ Bösmüller, Hans, et al. “The Pulmonary Pathology of Covid-19.” Virchows Archiv : an International Journal of Pathology, Springer Berlin Heidelberg, Jan. 2021,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7892326/. 

■ Mayo Foundation for Medical Education and Research. (2021, November 12). Multisystem inflammatory syndrome in children (mis-C) and covid-19. Mayo Clinic.
Retrieved March 23, 2022, from https://www.mayoclinic.org/diseases-conditions/mis-c-in-kids-covid-19/symptoms-causes/syc-20502550

■ “Symptoms of COVID-19.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention,
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. 

■ Shanmugam, C., Mohammed, A. R., Ravuri, S., Luthra, V., Rajagopal, N., & Karre, S. (2020, October). Covid-2019 - a comprehensive pathology insight. Pathology,
research and practice. Retrieved March 23, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7498473/

■ Zhou, Xi, and Qing Ye. “Cellular Immune Response to COVID-19 and Potential Immune Modulators.” Frontiers, Frontiers, 1 Jan. 1AD,
https://www.frontiersin.org/articles/10.3389/fimmu.2021.646333/full.