ABSTRACT
The current COVID-19 pandemic has posed an unusual challenge to health services in all countries. Although physiopathological knowledge about other coronaviruses, mainly SARS-CoV-1 and MERS, has been useful, SARS-CoV-2 has very particular aspects. Its lethality is lower than the previous ones, but its infectivity is much higher, which has resulted in a global expansion, not reached by previous viruses. The physiopathology of acute respiratory failure, in COVID-19, is especially complex and must be understood under a triple prism: specific viral action, the immunopathological response (which in turn has several phases) and the microvascular response. The fact that the elderly are particularly fragile to this virus is a particular challenge. Firstly, to understand what the differential physiopathological facts are. Secondly, to transfer this knowledge to the diagnostic and therapeutic field, in an attempt to reduce morbidity and mortality in this age group. At present, we need to continue to deepen our knowledge of the physiopathology of respiratory failure in the elderly in order to achieve the final objective in therapeutic terms. © Springer Nature Switzerland AG 2020.