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Coronavirus disease 2019 (COVID-19), an acute respiratory infection, is largely associated with dysregulation and impairment of the immune system. This study investigated how the immune system changes were related to disease severity in COVID-19 patients. The frequencies of different immune cells and levels of pro- and anti-inflammatory cytokines in whole blood of participants were determined by flow cytometry and enzyme-linked immunosorbent assay, respectively. The values of other inflammatory agents were also studied. In the late recovery stage, unlike CD56 high  CD16 +/−  NK cells and monocytes, CD56 low  CD16 +  NK cell numbers were increased ( P   0.05). B cell showed an increased percentage in patients compared to healthy subjects ( P   0.05). Lymphocyte numbers in patients were significantly decreased ( P &lt; 0.001), unlike ESR value ( P &lt; 0.001). Lymphocyte number was negatively correlated to ESR value and Th2 number ( P &lt; 0.05), while its association with monocyte was significantly positive at the first day of recovery ( P &lt; 0.05). The immune system changes during the disease recovery to improve and regulate immune responses and thereby may associate with the reduction in disease severity.

Immune system changes during COVID-19 recovery play key role in determining disease severity