Massive viral replication and cytopathic effects in early COVID-19 pneumonia

SARS-CoV-2 is the cause of COVID-19 acute respiratory illness that like its predecessors, MERS and SARS, can be severe and fatal 1-4. By April of 2020, COVID-19 infections had become a worldwide pandemic with nearly 3 million infections and over 200,000 deaths. The relative contributions of virus replication and cytopathic effects or immunopathological host responses to the severe and fatal outcomes of COVID-19 lung infections have as yet to be determined. Here we show that SARS-CoV-2 replication and cytopathic effects in type II alveolar pneumocytes causes focal lung injury in an individual with no history of pulmonary symptoms. These findings point to the potential benefit of early effective antiviral treatment to prevent progression to severe and fatal COVID-19 pneumonia.