Successful clearance of SARS-CoV-2 cannot guarantee the complete remission of symptoms and that severe symptoms can occur in the absence of virus. #SARSCoV2
 Two possible mechanisms: #COVID19
a. Pathological inflammation: We already know enough about this. Causes severe respiratory symptoms, cardiovascular events and coagulopathies etc. Also, explains the clinical benefit seen with corticosteroids
b. Virus-induced autoimmunity: Persistence of autoreactive T cells and antibodies — endure after the acute phase of infection or even develop after viral clearance.
 Emerging evidence suggests that self-reactive antibodies can reach the brain and cause neurological symptoms.
 Cross-reactive antibodies generated in response to SARS-CoV-2 may explain the persistence of symptoms in patients who have recovered from initial viral infection
 Monitoring for self-reactive antibodies and post-challenge autoimmunity should be incorporated into vaccination trials.
Nature, 6 Oct 2020