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The sobering mortality of coronavirus disease 2019 (COVID-19), the pandemic triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the few proven treatments have stimulated a global effort to rapidly discover and disseminate novel therapies. A noteworthy feature of the disease is the marked degree of lymphopenia in many hospitalized patients with COVID-19 and the association of lymphopenia with adverse outcomes.1
Lymphopenia during infection, and particularly during sepsis, is not unique to COVID-19, nor even to viral illness. In studies of hospitalized patients with positive blood cultures, most had lymphopenia, and persistent lymphopenia was associated with mortality.2 However, during many acute viral respiratory infections, lymphopenia is transient and coincident with peak symptoms but then rapidly resolves as the patient improves.3 The severity, and in some cases persistence, of lymphopenia in patients with COVID-19 is different.3 As patients with sepsis have concomitant inflammation and features of immune exhaustion, an attractive strategy might augment specific immune responses, particularly if it could be predicted which patients would be most likely to benefit.
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Meyer NJ, Lindell RB, Wherry EJ. Immune Stimulation With Recombinant Human Granulocyte Colony–Stimulating Factor for Coronavirus Disease 2019 (COVID-19)—Beware of Blind Spots. JAMA Intern Med. Published online September 10, 2020. doi:10.1001/jamainternmed.2020.5536
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