Careful descriptions of the clinical features of acute disease in patients infected with the novel coronavirus SARS-CoV-2 had begun to emerge before WHO declared the outbreak of COVID-19 a public health emergency of international concern on Jan 30, 2020.

As the global pandemic took hold, the need for data to inform patient management drove research efforts to describe the clinical spectrum of COVID-19, the determinants of disease severity, the mechanisms underlying the multiorgan manifestations of SARS-CoV-2 infection, and the response to a range of interventions.

Little more than a year on, a picture of a new disease entity is coming into focus with a distinct range of clinical and pathophysiological features—as described by Marcin Osuchowski and colleagues in the first of a Series of four papers in The Lancet Respiratory Medicine.

The Series highlights the wealth of data pertaining to the pathophysiology of acute disease that has emerged over the past year, but emphasises that many uncertainties about the mechanisms of acute disease—and potential targets for intervention remain.

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