• Hui Li, Liang Liu, Dingyu Zhang, Jiuyang Xu, Huaping Dai, Nan Tang, Xiao Su, and Bin Cao.
• Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Center of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Beijing, China; Institute of... more Respiratory Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. less
• Lancet. 2020 May 9; 395 (10235): 151715201517-1520.

AbstractSince the outbreak of coronavirus disease 2019 (COVID-19), clinicians have tried every effort to understand the disease, and a brief portrait of its clinical features have been identified. In clinical practice, we noticed that many severe or critically ill COVID-19 patients developed typical clinical manifestations of shock, including cold extremities and weak peripheral pulses, even in the absence of overt hypotension. Understanding the mechanism of viral sepsis in COVID-19 is warranted for exploring better clinical care for these patients. With evidence collected from autopsy studies on COVID-19 and basic science research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and SARS-CoV, we have put forward several hypotheses about SARS-CoV-2 pathogenesis after multiple rounds of discussion among basic science researchers, pathologists, and clinicians working on COVID-19. We hypothesise that a process called viral sepsis is crucial to the disease mechanism of COVID-19. Although these ideas might be proven imperfect or even wrong later, we believe they can provide inputs and guide directions for basic research at this moment.Copyright © 2020 Elsevier Ltd. All rights reserved.

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