Introduction:

Coronavirus disease-2019 (COVID-19) and the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) are causing a pandemic associated with high mortality. Although many uncertainties still remain because it is a new viral infectious disease, knowledge of clinical behavior and pathogenesis has advanced.

Objective:

To review the most current scientific evidence on the pathogenesis of the disease and its association with high mortality in elderly patients with comorbidities.

Material and Methods:

A literature review of the information published to date on this respect was carried out. Databases such as MEDLINE, LILACS, SCIELO, LATINDEX, MEDIGRAPHIC, MEDSCAPE, Science Direct, Elsevier and PubMed were searched; important data were also obtained from WHO / PAHO bulletins, the Cuban National Health Care Telecommunications Network and Portal (infomed) and other news agencies that present good scientific evidence.

Development:

An analysis of the current knowledge about the pathogenesis and the pulmonary inflammatory process is carried out while observing that this process does not respond to a simple viral pneumonia but to a local and systemic inflammatory process that involves different organs, coagulation disorders and alterations of immunity that make elderly patients with comorbidities more vulnerable, causing severity and increasing mortality.

Conclusions:

The pathogenesis of this disease, which is better known at present, explains the implications in critical and severe cases with high mortality, especially the most vulnerable ones. SARS and its evolutive complications are not explained by lung inflammation only. Other factors are involved in the well-known pathogenesis of a much greater severity that leads to the fatal outcome.

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