Letter to editor: Alimentary system is directly attacked by SARS‐COV‐2 and further prevents immune dysregulation caused by COVID‐19

Dear editor,

We have read with great interest the article titled “Alimentary System is Directly Attacked by SARS‐COV‐2 and Further Prevents Immune Dysregulation Caused by COVID‐19” by Chen.¹ The article pointed that alimentary system is possibly attacked by SARS‐COV‐2 other than hyperinflammation or immune dysregulation caused by it, and involvement of alimentary system might further protect mild and moderate cases from lymphocyte depletion caused by COVID‐19.

We have some comments for this conclusion. Firstly, the included patients were too few, although the author also mentioned this point, the age span of patients was large, and the number of patients in each group was small. More importantly, the diseased group was older than the control group, which inherently had a selection bias, and there was no subgroup analysis for further discussion. Secondly, the patient's medical history was not reported, and it cannot be ruled out that the patient's underlying disease caused the increase in CRP, IL and other indicators, leading to differences in the results, because these indicators can appear in many diseases, and this is common sense. Thirdly, the author compared the confirmed COVID‐19 patients with the suspected COVID‐19 patients, which was not correct in itself, because the suspected patients can also present these non‐specific inflammatory manifestations. Furthermore, what is the final follow‐up of the suspected patients? Has any suspected patient finally become a confirmed patient? If so, what is the point of comparison?

Actually, there are already a lot of COVID‐19 patients at this stage. We recommend that the author collect further information, re‐evaluate the number of people included and groupings and finally get a more convincing conclusion.

DISCLOSURES

The authors have declared no conflicts of interest for this article.

DATA AVAILABILITY STATEMENT

None.