From COVID-19 Infection to social level disease (SLD)

  • Klaus Kayser Charite - Berlin
  • Norbert Rottmann


AIM: To analyse, diagnose, and forecast the development of the pandemic Corona disease and to transfer the data into a corresponding virtual ‘orders of structure system’.

Background: COVID-19 pandemic is a RNA virus transmitted human respiratory tract infection of moderate to high infection rate (20 % – 40 %) and a case fatality ratio of 2 % – 5 %.  The infection rate depends upon age and health condition of exposed persons, density of virus droplets, air temperature, legal regulations as well as social life style and behaviour. 

Stage of prevention:  The high modulation rate of virus RNA and its protein structure require protective strategies at cellular and macromolecule level (preventive immunization), individual protection (personal risk) such as mouth masks, strict regulations of the social behaviour, shutdown of restaurants, hotels, of travel, public demonstrations, private festivals, etc. Legal regulations often hinder the state and federal government from acting in fully restrictive manner. Numerous citizens are not convinced of the ordered restrictions. They fear severe damage to their ‘freedom’ and economic situation. Therefore, COVID-19 also causes a social level disease (SLD), and should be diagnosed and treated accordingly.

Explanation and diagnosis of a social level disease (SLD):   Nature has organized human life in ordered communicative structures which can be represented by horizontal and vertical coordinates. Horizontally arranged neighbouring structures can often replace damaged or lost structures, in contrast to vertical structures. External interaction, forecast and potential repair of involved structures require statistical algorithms. Calculation of entropy at different structure levels is a useful tool to forecast the disease’s course.

Conclusions and advices:  COVID-19 disease is primarily a RNA virus infection which starts at low level structures (macromolecule) and induces alteration of communicative higher order structures. They include primarily pulmonary cells, airways, additional organs, individual persons, human behaviour, profession, trade, organization of societies, states and countries. Severe changes of social behaviour and civil laws are unavoidable consequences. They belong to basic natural laws of communication, droplet distribution, decay of infectious agents and individual protection.


Download data is not yet available.


1. Balinska M, Rizzo C. Behavioural responses to influenza pandemics: what do we know? PLoS Curr. 2009;1:RRN1037 .
2. Crooke SN, Ovsyannikova IG, Kennedy RB, Poland GA. Immunoinformatic identification of B cell and T cell epitopes in the SARS-CoV-2 proteome. Sci Rep. 2020;10(1):14179.
3. Ietto G. SARS - CoV-2: Reasons of epidemiology of severe ill disease cases and therapeutic approach using trivalent vaccine (tetanus, diphtheria and Bordetella pertussis). Med Hypotheses. 2020;141:109779.
4. Liu YC, Kuo RL, Shih SR. COVID-19: The first documented coronavirus pandemic in history. Biomed J. 2020;43(4):328-33.
5. Maki DG. SARS: 1918 revisited? The urgent need for global collaboration in public health. Mayo Clin Proc. 2003;78(7):813-6.
6. Mammas IN, Theodoridou M, Spandidos DA. COVID-19 threat and the 1918 Spanish flu outbreak: The following day. Exp Ther Med. 2020;20(6):292.
7. Morens DM, Daszak P, Taubenberger JK. Escaping Pandora's Box - Another Novel Coronavirus. N Engl J Med. 2020;382(14):1293-5.
8. Grubic AD, Ayazi S, Zebarjadi J, Tahmasbi H, Ayazi K, Jobe BA. COVID-19 outbreak and surgical practice: The rationale for suspending non-urgent surgeries and role of testing modalities. World J Gastrointest Surg. 2020;12(6):259-68 .
9. Jinila BY, Shyry PS. Transmissibility and Epidemicity of COVID-19 in India: A Case Study. Recent Pat Antiinfect Drug Discov. 2020.
10. Nawaz S. Covid-19, SARS -CoV-2, Origin, transmission and treatment aspects, a brief review. Infect Disord Drug Targets. 2020 .
11. Van Damme W, Dahake R, Delamou A, Ingelbeen B, Wouters E, Vanham G, et al. The COVID-19 pandemic: diverse contexts; different epidemics-how and why? BMJ Glob Health. 2020;5(7).
12. Kiros M, Andualem H, Kiros T, Hailemichael W, Getu S, Geteneh A, et al. COVID-19 pandemic: current knowledge about the role of pets and other animals in disease transmission. Virol J. 2020;17(1):143 .
13. Rajaraman R, Yedida D, Nagaraja SS, Selvakumar I, Ramakrishnan P, Sankaran P, et al. Literature review on Virus and Host Response Proteins in COVID-19: Pathobiology, Management, Diagnosis and Treatment. Acta Virol. 2020.
14. Karmouty-Quintana H, Thandavarayan RA, Keller SP, Sahay S, Pandit LM, Akkanti B. Emerging Mechanisms of Pulmonary Vasoconstriction in SARS-CoV-2-Induced Acute Respiratory Distress Syndrome (ARDS) and Potential Therapeutic Targets. Int J Mol Sci. 2020;21(21) .
15. Shah VK, Firmal P, Alam A, Ganguly D, Chattopadhyay S. Overview of Immune Response During SARS-CoV-2 Infection: Lessons From the Past. Front Immunol. 2020;11:1949 .
16. Brown R, McKelvey MC, Ryan S, Creane S, Linden D, Kidney JC, et al. The Impact of Aging in Acute Respiratory Distress Syndrome: A Clinical and Mechanistic Overview. Front Med (Lausanne) . 2020;7:589553.
17. El-Hage W, Hingray C, Lemogne C, Yrondi A, Brunault P, Bienvenu T, et al. Health professionals facing the coronavirus disease 2019 (COVID-19) pandemic: What are the mental health risks?. Encephale. 2020;46(3S):S73-S80.
18. Holmes L, Jr., Enwere M, Williams J, Ogundele B, Chavan P, Piccoli T, et al. Black-White Risk Differentials in COVID-19 (SARS-COV2) Transmission, Mortality and Case Fatality in the United States: Translational Epidemiologic Perspective and Challenges. Int J Environ Res Public Health. 2020;17(12).
19. Martins LD, da Silva I, Batista WV, Andrade MF, Freitas ED, Martins JA. How socio-economic and atmospheric variables impact COVID-19 and influenza outbreaks in tropical and subtropical regions of Brazil. Environ Res. 2020;191:110184.
20. Pathak KP, Gaire T, Ho MH, Chang HCR. Why has COVID-19 not hit the countries like Nepal yet? Rev Environ Health. 2020.
21. Rengeling D. The 2020 Corona Pandemic-Beyond Omnipresent Prevention. NTM. 2020;28(2):211-7.
22. Sukut O, Ayhan Balik CH. The impact of COVID-19 pandemic on people with severe mental illness. Perspect Psychiatr Care. 2020 .
23. Kithiia J, Wanyonyi I, Maina J, Jefwa T, Gamoyo M. The socio-economic impacts of Covid-19 restrictions: Data from the coastal city of Mombasa, Kenya. Data Brief. 2020;33:106317.
24. Kumar A, Malla MA, Dubey A. With Corona Outbreak: Nature Started Hitting the Reset Button Globally. Front Public Health. 2020;8:569353 .
25. Kayser K, Kayser G. Virtual Predictive Autopsy: From knowledge and understanding to education, research and communication in digital tissue – based diagnosis. Diagnostic Pathology. 2019;5(1).
26. Kayser K, Borkenfeld S, Kayser G. Digital Image Content and Context Information in Tissue-based Diagnosis. Diagnostic Pathology. 2018;4(1) .
27. Kayser K. Das virtuelle Universum - Fiktion oder Realität. Berlin: Lehmanns media; 2020.
28. Kayser K, Stute H, Bubenzer J, Paul J. Combined morphometrical and syntactic structure analysis as tools for histomorphological insight into human lung carcinoma growth. Anal Cell Pathol. 1990;2(3):167-78.
29. Kayser K, Sandau K, Bohm G, Kunze KD, Paul J. Analysis of soft tissue tumors by an attributed minimum spanning tree. Anal Quant Cytol Histol. 1991;13(5):329-34.
30. Kayser K, Sandau K, Paul J, Weisse G. An approach based on two-dimensional graph theory for structural cluster detection and its histopathological application. J Microsc. 1992;165 ( Pt 2):281-8.
31. Kayser K, Kremer K, Tacke M. DNA and MST entropy and current of entropy. New parameters of tumor biological characterization. Zentralbl Pathol. 1994;139(6):427-31.
32. Kayser K, Gabius HJ. The application of thermodynamic principles to histochemical and morphometric tissue research: principles and practical outline with focus on the glycosciences. Cell Tissue Res. 1999;296(3):443-55 .
33. Kayser K, Stute H. Minimum spanning tree, Voronoi's tesselation and Johnson-Mehl diagrams in human lung carcinoma. Pathol Res Pract. 1989;185(5):729-34 .
34. Kayser KK, Kiefer B, Toomes H, Burkhard HU. Analysis of adenomatous structures in histopathology. Anal Quant Cytol Histol. 1987;9(3):273-8.
35. Kayser K, Jacinto SD, Bohm G, Frits P, Kunze WP, Nehrlich A, et al. Application of computer-assisted morphometry to the analysis of prenatal development of human lung. Anat Histol Embryol. 1997;26(2):135-9.
36. Kayser K, Ziehms S, Kayser G, Andre S, Bovin NV, Dong X, et al. Glycohistochemical properties of malignancies of lung and pleura. Int J Oncol. 1998;12(5):1189-94.
37. Werle B, Lotterle H, Schanzenbacher U, Lah TT, Kalman E, Kayser K, et al. Immunochemical analysis of cathepsin B in lung tumours: an independent prognostic factor for squamous cell carcinoma patients. Br J Cancer. 1999;81(3):510-9.
38. Kayser K, Richter B, Stryciak R, Gabius HJ. Parameters derived from integrated nuclear fluorescence, syntactic structure analysis, and vascularization in human lung carcinomas. Anal Cell Pathol. 1997;15(2):73-83 .
39. Kayser G, Baumhakel JD, Szoke T, Trojan I, Riede U, Werner M, et al. Vascular diffusion density and survival of patients with primary lung carcinomas. Virchows Arch. 2003;442(5):462-7.
40. Görtler J, Kayser K, Borkenfeld S, Carvalho R, Kayser G. Cognitive Algorithms and digitized Tissue – based Diagnosis. Diagnostic Pathology. 2017;3(1).
41. Kayser G, Görtler J, Weis CA, Borkenfeld S, Kayser K. The application of structural entropy in tissue based diagnosis. Diagnostic Pathology. 2017;3(1) .
42. O'Callaghan JF. An alternative definition for neighborhood of a point. IEEE Trans Comput. 1875;24:1121-5
43. Kayser K, Donnwald D, Zink S, Kayser G. Small pulmonary lesions--a challenge for thoracic surgery? ScientificWorldJournal. 2001;1:906-13.
44. Kayser K, Hagemeyer O, Runtsch T. Morphologic lesions in non-neoplastic bronchial mucosa associated with bronchial carcinomas. Zentralbl Pathol. 1991;137(5):425-9 .
45. Kayser K, Schmidt A, Stute H, Bach S. DNA-content, inflammatory tissue response and tumour size in human lung carcinoma. Pathol Res Pract. 1989;185(5):584-8 .
46. Kayser K, Gabius HJ. Graph theory and the entropy concept in histochemistry. Theoretical considerations, application in histopathology and the combination with receptor-specific approaches. Prog Histochem Cytochem. 1997;32(2):1-106.
47. Kayser G, Radziszowski D, Bzdyl P, Sommer R, Kayser K. Theory and implementation of an electronic, automated measurement system for images obtained from immunohistochemically stained slides. Anal Quant Cytol Histol. 2006;28(1):27-38.
48. Kayser K, Kayser G, Becker HD, Herth F. Telediagnosis of transbronchial fine needle aspirations--a feasibility study. Anal Cell Pathol. 2000;21(3-4):207-12.
49. Kayser K, Schwarzmann P. Aspects of standardization in telepathology. Zentralbl Pathol. 1992;138(6):389-92.
50. Kayser K. Interdisciplinary telecommunication and expert teleconsultation in diagnostic pathology: present status and future prospects. J Telemed Telecare. 2002;8(6):325-30.
51. Kayser K, Hoffgen H. Pattern recognition in histopathology by orders of textures. Med Inform (Lond). 1984;9(1):55-9.
52. Kayser K, Kremer C, Tacke M. Integrated optical density and entropiefluss (current of entropy) in bronchial carcinoma. In Vivo. 1993;7(4):387-91 .
53. Kayser K, Radziszowski D, Bzdyl P, Sommer R, Kayser G. Towards an automated virtual slide screening: theoretical considerations and practical experiences of automated tissue-based virtual diagnosis to be implemented in the Internet. Diagn Pathol. 2006;1:10 .
54. Kayser K, Radziszowski D, Bzdyl P, Sommer R, Kayser G. Digitized pathology: theory and experiences in automated tissue-based virtual diagnosis. Rom J Morphol Embryol. 2006;47(1):21-8.
55. Kayser K, Amir-Hoshang S, Metze K, Goldmann T, Vollmer E, Radziszowski D, et al. Texture- and Object-Related Automated Information Analysis in Histological Still Images of Various Organs. Anal Quant Cytol Histol 2008;30:323-35
56. Kayser K, Hoshang SA, Metze K, Goldmann T, Vollmer E, Radziszowski D, et al. Texture- and object-related automated information analysis in histological still images of various organs. Anal Quant Cytol Histol. 2008;30(6):323-35 .
57. Ahmed I, Ahmad M, Rodrigues J, Jeon G, Din S. A deep learning-based social distance monitoring framework for COVID-19. Sustain Cities Soc. 2020:102571.
58. Moraru C, Mincea M, Menghiu G, Ostafe V. Understanding the Factors Influencing Chitosan-Based Nanoparticles-Protein Corona Interaction and Drug Delivery Applications. Molecules. 2020;25(20).
59. Tomasoni D, Adamo M, Italia L, Branca L, Chizzola G, Fiorina C, et al. Impact of COVID-2019 outbreak on prevalence, clinical presentation and outcomes of ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown). 2020;21(11):874-81.
60. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. medRxiv. 2020:2020.03.09.20033217.
61. Trigaux C, Salla S, Schroeter J, Tourtas T, Thomasen H, Maier P, et al. SARS-CoV-2: Impact on, Risk Assessment and Countermeasures in German Eye Banks. Curr Eye Res. 2020:1-6.
62. Setti L, Passarini F, De Gennaro G, Barbieri P, Pallavicini A, Ruscio M, et al. Searching for SARS-COV-2 on Particulate Matter: A Possible Early Indicator of COVID-19 Epidemic Recurrence. Int J Environ Res Public Health. 2020;17(9).
63. Jayaweera M, Perera H, Gunawardana B, Manatunge J. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. Environ Res. 2020;188:109819-.
64. Chiappelli F. CoViD-19 Susceptibility. Bioinformation. 2020;16(7):501-4 .
65. Costa K, Carnauba ATL, Rocha KW, Andrade KCL, Ferreira SMS, Menezes PL. Olfactory and taste disorders in COVID-19: a systematic review. Braz J Otorhinolaryngol. 2020;86(6):781-92 .
66. Lopez M, Luber S, Prater S, Ostrosky-Zeichner L, McCarthy J, Suarez G, et al. A sentinel COVID-19 case in Houston, Texas: Informing frontline emergency department screening and preparedness. J Am Coll Emerg Physicians Open. 2020;1(2):92-4.
67. Moein ST, Hashemian SM, Mansourafshar B, Khorram-Tousi A, Tabarsi P, Doty RL. Smell dysfunction: a biomarker for COVID-19. Int Forum Allergy Rhinol. 2020;10(8):944-50.
68. Schurink B, Roos E, Radonic T, Barbe E, Bouman CSC, de Boer HH, et al. Viral presence and immunopathology in patients with lethal COVID-19: a prospective autopsy cohort study. Lancet Microbe. 2020;1(7):e290-e9 .
69. Ludvigsson J, von Herrath MG, Mallone R, Buschard K, Cilio C, Craig M, et al. Corona Pandemic: Assisted Isolation and Care to Protect Vulnerable Populations May Allow Us to Shorten the Universal Lock-Down and Gradually Re-open Society. Front Public Health. 2020;8:562901.
70. Alboraie M, Piscoya A, Tran QT, Mendelsohn RB, Butt AS, Lenz L, et al. The global impact of COVID-19 on gastrointestinal endoscopy units: An international survey of endoscopists. Arab J Gastroenterol. 2020;21(3):156-61.
71. Cai M, Zhao X, Chen L, Yuan W, Wang G, Wang X. The Preventive and Control Recommendations on Patient With Cleft Lip and Palate During COVID-19 Pandemic in Shanghai. J Craniofac Surg. 2020.
72. Fitzgerald DA, Nunn K, Isaacs D. Consequences of physical distancing emanating from the COVID-19 pandemic: An Australian perspective. Paediatr Respir Rev. 2020;35:25-30.
73. Oldfield E, Malwal SR. COVID-19 and Other Pandemics: How Might They Be Prevented? ACS Infect Dis. 2020;6(7):1563-6.
74. Petersen E, Koopmans M, Go U, Hamer DH, Petrosillo N, Castelli F, et al. Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics. Lancet Infect Dis. 2020;20(9):e238-e44 .
75. Honigsbaum M, Methot PO. Introduction: microbes, networks, knowledge-disease ecology and emerging infectious diseases in time of COVID-19. Hist Philos Life Sci. 2020;42(3):28.
76. Romanelli RJ, Azar KMJ, Sudat S, Hung D, Frosch DL, Pressman AR. The Learning Health System in Crisis: Lessons from the Novel Coronavirus Disease Pandemic. Mayo Clin Proc Innov Qual Outcomes. 2020 .
77. Akaji K, Konno H. Design and Evaluation of Anti-SARS-Coronavirus Agents Based on Molecular Interactions with the Viral Protease. Molecules. 2020;25(17) .
78. Griffith DM, Jayaram DT, Spencer DM, Pisetsky DS, Payne CK. DNA-nanoparticle interactions: Formation of a DNA corona and its effects on a protein corona. Biointerphases. 2020;15(5):051006 .
79. Maslanka Figueroa S, Fleischmann D, Goepferich A. Biomedical nanoparticle design: What we can learn from viruses. J Control Release. 2020 .
80. Vieira C, Nery L, Martins L, Jabour L, Dias R, Simoes ESAC. Downregulation of Membrane-bound Angiotensin Converting Enzyme 2 (ACE2) Receptor has a Pivotal Role in COVID-19 Immunopathology. Curr Drug Targets. 2020 .
81. Feng R, Yu F, Xu J, Hu X. Knowledge gaps in immune response and immunotherapy involving nanomaterials: Databases and artificial intelligence for material design. Biomaterials. 2020;266:120469 .
82. Nicoletti M, Gambarotti C, Fasoli E. Proteomic exploration of soft and hard biocorona onto PEGylated multiwalled carbon nanotubes. Biotechnol Appl Biochem. 2020.
83. McGowan EM, Haddadi N, Nassif NT, Lin Y. Targeting the SphK-S1P-SIPR Pathway as a Potential Therapeutic Approach for COVID-19. Int J Mol Sci. 2020;21(19) .
84. Villapol S. Gastrointestinal symptoms associated with COVID-19: impact on the gut microbiome. Transl Res. 2020;226:57-69 .
85. Wei L, Huang W, Lu X, Wang Y, Cheng L, Deng R, et al. Contamination of SARS-CoV-2 in patient surroundings and on personal protective equipment in a non-ICU isolation ward for COVID-19 patients with prolonged PCR positive status. Antimicrob Resist Infect Control. 2020;9(1):167 .
86. hao J YQ, Wang H, et al. . Antibody Responses to SARS-CoV-2 in Patients With Novel Coronavirus Disease 2019. Clin Infect Dis 2019;7(16):2027-34
87. He JL LL, Luo ZD, et al. . Diagnostic performance between CT and initial real-time RT-PCR for clinically suspected 2019 coronavirus disease (COVID-19) patients outside Wuhan, China. Respir Med 2020;:105980.
88. Wang W XY, Gao R et al. . Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020;323(18):1843-4
89. Gillissen A. Übersicht zu Sensitivität und Spezifität des SARS-CoV-2-Nachweises mittels PCR. Pneumo News. 2020;12(5):21-3
90. Din A, Li Y, Khan T, Zaman G. Mathematical analysis of spread and control of the novel corona virus (COVID-19) in China. Chaos Solitons Fractals. 2020;141:110286 .
91. Rawat M, Chandrasekharan P, Hicar MD, Lakshminrusimha S. COVID-19 in Newborns and Infants-Low Risk of Severe Disease: Silver Lining or Dark Cloud? Am J Perinatol. 2020;37(8):845-9 .
92. Kayser K, Berthold S, Eichhorn S, Kayser C, Ziehms S, Gabius HJ. Application of attributed graphs in diagnostic pathology. Anal Quant Cytol Histol. 1996;18(4):286-92.
93. Kayser K, Liewald F, Kremer K, Tacke M. Integrated optical density (IOD), syntactic structure analysis, and survival in operated lung carcinoma patients. Pathol Res Pract. 1994;190(11):1031-8 .
94. Kayser K, Gortler J, Bogovac M, Bogovac A, Goldmann T, Vollmer E, et al. AI (artificial intelligence) in histopathology--from image analysis to automated diagnosis. Folia histochemica et cytobiologica / Polish Academy of Sciences, Polish Histochemical and Cytochemical Society. 2009;47(3):355-61.
95. Kayser K, Gortler J, Borkenfeld S, Kayser G. How to measure diagnosis-associated information in virtual slides. Diagn Pathol.6 Suppl 1:S9 .
96. Kayser K, Gortler J, Borkenfeld S, Kayser G. Interactive and automated application of virtual microscopy. Diagn Pathol.6 Suppl 1:S10 .
How to Cite
KAYSER, Klaus; ROTTMANN, Norbert. From COVID-19 Infection to social level disease (SLD). Diagnostic Pathology, [S.l.], v. 6, n. 1, dec. 2020. ISSN 2364-4893. Available at: <>. Date accessed: 15 apr. 2024. doi:

Most read articles by the same author(s)

1 2 > >>