Figure 8.

Scheme of events that are likely to occur in SARS-CoV-2 infection and the two phases of cytokine response in COVID-19. Initially there will be hyperinflammation due to release of excess of pro-inflammatory cytokines. Subsequently there could occur diminished release of cytokines and immunosuppression. During the hyperinflammation phase dexamethasone and anti-TNF or anti-IL-6 and other cytokine antagonists will be helpful. Once immunosuppression sets in dexamethasone is not of significant help and inflammation resolution molecules are needed to enhance the recovery process. In severe COVID-19 there will be persistently elevated PGE2 and LXA4 fails to rise to induce resolution of inflammation. In contrast, in mild COVID-19, initially there will be an elevation in PGE2 that falls to the normal physiological level that is accompanied by increase in LXA4 to induce resolution of inflammation as shown in the figure. Compare this with Figure 9. This figure is modified from Das UN. Arch Med Sci 2014; 10: 325-35