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The coronavirus disease (COVID-19) is now a worldwide pandemic and is the most significant global health crisis of our time. COVID-19 disease continues to present us with major healthcare challenges with over 8 million cases around the world and still less than optimal treatment options [1]. The virus initially was identified in Wuhan, Hubei Province, China in 2019. COVID-19 disease is caused by a novel coronavirus, which has been named “Severe Acute Respiratory Syndrome Corona virus-2 (SARS-CoV-2)” [2]. COVID-19 is highly transmissible among humans and primarily, but not only, affects the lower respiratory tract and lungs. The virus attaches to the angiotensin converting enzyme-2 (ACE-2) receptor in order to help enter the target cell by attaching its spike-like surface projections (“corona”) to the receptor. This receptor is expressed on various cell types such as myocardial cells, type II pneumocytes, enterocytes and vascular endothelium. Most of the symptomatic patients have mild flu-like features but a significant subset develop a bronchopneumonia, which clinically is the acute respiratory distress syndrome (ARDS), and leads to significant morbidity and mortality [3]. The fatality rates of COVID-19 are highest amongst older patients with concomitant comorbidities and/or patients who are immunosuppressed [4]. Our current understanding of the pathology and the pathogenesis of COVID-19 disease and SARS-CoV-2 transmission is at an early stage and much still remains to be learned [5, 6]. Additionally, there are also published reports on the pathogenesis of other coronaviruses such as SARS-CoV and MERS-CoV [7–9]. In early April a Letter to the Editor appeared online in Chest entitled “A call to action: the need for autopsies to determine the full extent of organ involvement associated with COVID-19” [10]. This was prompted by the stunning lack of publications relating to autopsy findings in decedents who had succumbed to COVID-19 infections despite the fact that several hundred thousand individuals already had died by that time [11]. Since then, at the time of this writing in late June and to the best of our knowledge, there have been at least 13 reports describing autopsy findings in approximately 250 decedents who have succumbed to COVID-19 [4, 12–22] In the meantime, as of June 15, 2020, the number of confirmed cases has climbed to over 2.1 million and over 115,000 deaths in the United States and 8 million cases and more than 440,000 deaths worldwide. Therefore, the total number of autopsies performed is miniscule compared to the number of deaths, but nevertheless they are both very revealing and important in order to better understand the multi-organ involvement associated with COVID-19 infection and for the development of better treatment strategies [1, 3]. The three largest and most recent of these are reports from the Mount Sinai Hospital in New York City of 67 decedents [12], the L. Sacco Hospital in Milan, Italy of 38, limited to the lungs [14] and the University Hospital in Basel Switzerland of 21 decedents [19]. These three reports taken together have provided a more complete picture of the various organs that can be involved in individuals who succumb to COVID-19. What initially was thought to be a disease almost exclusively involving the lungs now is being recognized as one that involves multiple organ systems including the heart, kidneys, bone marrow, lymph nodes and brain. The underlying pathology of COVID-19 infection

The spectrum of pathological findings in coronavirus disease (COVID-19) and the pathogenesis of SARS-CoV-2