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Clinical data indicate that severe COVID-19 most commonly manifests as viral pneumonia-induced acute respiratory distress syndrome (ARDS), a clinical entity mechanistically understood best in the context of influenza A virus-induced pneumonia. Similar to influenza, advanced age has emerged as the leading host risk factor for developing severe COVID-19. In this review we connect the current understanding of the SARS-CoV-2 replication cycle and host response to the clinical presentation of COVID-19, borrowing concepts from influenza A virus-induced ARDS pathogenesis and discussing how these ideas inform our evolving understanding of COVID-19-induced ARDS. We also consider important differences between COVID-19 and influenza, mainly the protean clinical presentation and associated lymphopenia of COVID-19, the contrasting role of interferon-\u03b3 in mediating the host immune response to these viruses, and the tropism for vascular endothelial cells of SARS-CoV-2, commenting on the potential limitations of influenza as a model for COVID-19. Finally, we explore hallmarks of ageing that could explain the association between advanced age and susceptibility to severe COVID-19.<\/jats:p>","DOI":"10.1183\/13993003.02049-2020","type":"journal-article","created":{"date-parts":[[2020,8,3]],"date-time":"2020-08-03T16:54:43Z","timestamp":1596473683000},"page":"2002049","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":199,"title":["Pathogenesis of COVID-19-induced ARDS: implications for an ageing population"],"prefix":"10.1183","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9939-7401","authenticated-orcid":false,"given":"Manuel A.","family":"Torres Acosta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5775-8427","authenticated-orcid":false,"given":"Benjamin D.","family":"Singer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2020,8,3]]},"reference":[{"key":"2020092406401501000_56.3.2002049.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2001017"},{"key":"2020092406401501000_56.3.2002049.2","unstructured":"World Health Organization . 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