ReviewPediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology2020
The first, holistic immunological model of COVID-19: Implications for prevention, diagnosis, and public health measures.
Review in Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 109 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
109 citing papers in PubMed, 3 syntheses or guidelines pooled it, 218 citations in OpenAlex.
- Practice and associated factors of Covid-19 prevention among health professionals in Ethiopia: a systematic review and meta-analysis.Scientific reports · 2025Pooled it
- COVID-19 and the Immune Response: A Multi-Phasic Approach to the Treatment of COVID-19.International journal of molecular sciences · 2022Pooled it
- Is loss of smell an early predictor of COVID-19 severity: a systematic review and meta-analysis.Archives of pharmacal research · 2021Pooled it
- Long-term alveolar-capillary diffusion impairments after severe SARS-CoV-2 pneumonia.Annals of medicine · 2025Article
- Immunity and Coagulation in COVID-19.International journal of molecular sciences · 2024Review
- The influence of Omicron on vaccine efficacy and durability: a neurology perspective.Clinical and experimental vaccine research · 2024Review
- mRNA vaccines protect from the lung microvasculature injury and the capillary blood volume loss occurring in SARS-CoV-2 paucisymptomatic infections.Multidisciplinary respiratory medicine · 2024Article
- Bioinformatics and system biology approaches to determine the connection of SARS-CoV-2 infection and intrahepatic cholangiocarcinoma.PloS one · 2024Article
- Resilient communities? A qualitative interview study on sustaining a community project for health promotion among socially disadvantaged women during the first two years of the COVID-19 pandemic.BMC public health · 2023Article
- Generalizing the Wells-Riley Infection Probability: A Superstatistical Scheme for Indoor Infection Risk Estimation.Entropy (Basel, Switzerland) · 2023Article
- Superimposed Pulmonary Tuberculosis (PTB) in a 26-Year-Old Female with No Underlying Co-Morbidities Recovering from COVID-19-Case Report.Tropical medicine and infectious disease · 2023Article
- Complement and COVID-19: Three years on, what we know, what we don't know, and what we ought to know.Immunobiology · 2023Review
- Review
- Article
- SARS-CoV-2 Altered Hemorheological and Hematological Parameters during One-Month Observation Period in Critically Ill COVID-19 Patients.International journal of molecular sciences · 2022Article
- Clinical course of patients with severe SARS-CoV-2 infection co-treatment with Jin Si Herbal Tea in Eastern Taiwan: A retrospective cohort study.Journal of herbal medicine · 2022Article
- Molecular mechanisms involved in pathogenicity of SARS-CoV-2: Immune evasion and implications for therapeutic strategies.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2022Review
- Dietary Habits and Lifestyle Behaviors of Saudi Residents during the COVID-19 Pandemic: A Cross-Sectional Study.International journal of environmental research and public health · 2022Article
- γδ T Cells in Emerging Viral Infection: An Overview.Viruses · 2022Review
- Nanotechnology Toolkit for Combating COVID-19 and Beyond.ChemNanoMat : chemistry of nanomaterials for energy, biology and more · 2022Review
49 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
Abstract
The natural history of COVID-19 caused by SARS-CoV-2 is extremely variable, ranging from asymptomatic or mild infection, mainly in children, to multi-organ failure, eventually fatal, mainly in the eldest. We propose here the first model explaining how the outcome of first, crucial 10-15 days after infection, depends on the balance between the cumulative dose of viral exposure and the efficacy of the local innate immune response (natural IgA and IgM antibodies, mannose-binding lectin). If SARS-CoV-2 runs the blockade of this innate immunity and spreads from the upper airways to the alveoli in the early phases of the infections, it can replicate with no local resistance, causing pneumonia and releasing high amounts of antigens. The delayed and strong adaptive immune response (high-affinity IgM and IgG antibodies) that follows, causes severe inflammation and triggers mediator cascades (complement, coagulation, and cytokine storm), leading to complications often requiring intensive therapy and being, in some patients, fatal. Low-moderate physical activity can still be recommended. However, extreme physical activity and oral breathing with hyperventilation during the incubation days and early stages of COVID-19 facilitates re-inhalation and early direct penetration of high numbers of own virus particles in the lower airways and the alveoli, without impacting on the airway's mucosae covered by neutralizing antibodies ("viral auto-inhalation" phenomenon). This allows the virus to bypass the efficient immune barrier of the upper airway mucosa in already infected, young, and otherwise healthy athletes. In conclusion, whether the virus or the adaptive immune response reaches the lungs first is a crucial factor deciding the fate of the patient. This "quantitative and time-/sequence-dependent" model has several implications for prevention, diagnosis, and therapy of COVID-19 at all ages.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.