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The International Journal of the Royal Society of Thailand
Volume XI - 2019

Short Communication

Further Understanding of COVID-19

Somchai Bovornkitti 1
Surajit Sunthorntham 2

This communication has been written as an addition to a paper recently
submitted by the author to the Thammasat Medical Journal. The purpose is to
elucidate three interesting questions or facts highlighted by Katarina Zimmer,
Shu-Tuan Xiao and colleagues, and Tara Haelle.

1. Why are some COVID-19 cases worse than others? (Twitter @katari-
nazimmer; Feb 24,2020):
Current data from the present outbreak indicated that the vast majority
of confirmed cases suffered symptoms ranging from only those of the common
cold to mild pneumonia, but the elderly and those with pre-existing illnesses

were affected worse than others. The pattern of increasing severity, especially
among the elderly and ill, may due to dysfunctional immune systems that fail to
keep the body’s response to pathogens in check. This could cause an uncontrolled
immune response, triggering an overproduction of immune cells and their
signaling molecules, leading to a so-called cytokine storm, associated with a flood
of immune cells into the lung, ending up with inflammatory conditions, such as
severe pneumonia. The same outcome could occur if the virus replicates faster
than the immune system can respond.

On the other hand, the “cytokine storm” hypothesis may explain the rare
incidence of COVID-19 in children under 10 years of age, in whom the immune
system is not yet strong enough to execute the overproduction of immune cells.

1 The Academy of Science, The Royal Society of Thailand, Bangkok
2 HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy

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Surajit Sunthorntham 107

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