Clinical evidence and therapeutic treatments at the time of the coronaviruses responsible for SARS: a perspective point of view

The clinical evolution of the COVID-19 patients highlights a significant minority of subjects with very rapid lethal outcomes with respect to the almost complete healing after coronavirus infections for most of the subjects involved. In addition, the reckless use of some drugs and therapeutic protocols that have not shown any efficacy in reducing mortality in those patients where the progression of the disease was unstoppable suggests a different interpretative way in the pathogenesis of severe cases. Starting from the 19 clinical data already known for almost twenty years on the behavior of human SARS coronaviruses it is possible to advance a new hypothesis. The reference points taken into consideration are: i) the comparison of the histological evidence of the autoptic material; ii) the poor pharmacological response in subjects with severe phenotype of the pathology; iii) the common elements of endotheliitis that a subgroup of the population characterized by the unfortunate clinical outcome expresses during the evolution of the pathology. The tendency to develop a widespread, massive endothelial lesions not responding to any drug therapy or health treatment necessarily play a crucial role in the onset of the systemic and severe stage of the disease. The present hypothesis opens the door to a different therapeutic approach both to the full-blown phase of COVID-19 and to the preventive phase or the very first manifestations of the disease, suggesting greater attention to the protection of the vascular endothelium in subjects who already have it predisposed to the severe evolution of this ailment than to simple antiviral defense.