Recent studies have provided insights into the pathogenesis of COVID-19. Yet, longitudinal immunological correlates of disease outcome remain unclear. Here, we serially analysed immune responses in 113 COVID-19 patients with moderate (non-ICU) and severe (ICU) disease.

Immune profiling revealed an overall increase in innate cell lineages with a concomitant reduction in T cell number.

We identify an association between early, elevated cytokines and worse disease outcomes.

Following an early increase in cytokines, COVID-19 patients with moderate disease displayed a progressive reduction in type-1 (antiviral) and type-3 (antifungal) responses.

In contrast, patients with severe disease maintained these elevated responses throughout the course of disease.

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