Comparative pathogenesis of COVID-19, MERS, and SARS in a nonhuman primate model

Rockx, Barry; Kuiken, Thijs; Herfst, Sander; Bestebroer, Theo; Lamers, Mart M.; Oude Munnink, Bas B.; de Meulder, Dennis; van Amerongen, Geert; van den Brand, Judith; Okba, Nisreen M. A.; Schipper, Debby; van Run, Peter; Leijten, Lonneke; Sikkema, Reina; Verschoor, Ernst; Verstrepen, Babs; Bogers, Willy; Langermans, Jan; Drosten, Christian; Fentener van Vlissingen, Martje; Fouchier, Ron; de Swart, Rik; Koopmans, Marion; Haagmans, Bart L.

The current pandemic coronavirus, SARS-CoV-2, was recently identified in patients with an acute respiratory syndrome, COVID-19. To compare its pathogenesis with that of previously emerging coronaviruses, we inoculated cynomolgus macaques with SARS-CoV-2 or MERS-CoV and compared the pathology and virology with historical reports of SARS-CoV infections. In SARS-CoV-2-infected macaques, virus was excreted from nose and throat in the absence of clinical signs, and detected in type I and II pneumocytes in foci of diffuse alveolar damage and in ciliated epithelial cells of nasal, bronchial, and bronchiolar mucosae. In SARS-CoV-infection, lung lesions were typically more severe, while they were milder in MERS-CoV infection, where virus was detected mainly in type II pneumocytes. These data show that SARS-CoV-2 causes COVID-19-like disease in macaques, and provides a new model to test preventive and therapeutic strategies.