Auto Antibodies contribute to a multitude of conditions including :Guillain Barre Syndrome , Hypercoagulability from anticardiolipin antibodies, Coma from autoantibodies to the Orexin Receptor in the hypothalamus, and Generalized immunodeficiency and interferonopathies. Some of these autoantibodies (ie against interferons) may exist prior to COVID 19 infection whereas others evolve subsequently. It is possible that lysosomal exocytosis which occurs with viral egress is contributing to this auto-immune phenomenon.
Rhinitis and Nasopharyngitis- The viruses main body entry point is through the nose and via binding to goblet and ciliary cell ACE-2 Receptors. The initial infection may initially inhibit mucin production and stimulate inflammatory fluid production. Subsequent immune system recruitment can either lead to clearance of the infection or progression. The infection in these tissues causes the symptoms of rhinorrhea, nasal congestion, sinus congestion with sinus headache, and sore throat. Along with constitutional symptoms of fever, nausea, fatigue, chills, and myalgia.
Tracheitis and Bronchitis may result from local spread of the virus from the nasopharynx.
Pneumonia with pulmonary infiltrates and ground glass CT findings. Monitoirng pulse oximetery will help determine the progression and severity of this life threating disease. It can be complicated with multiple other comorbidities including coinfections, pulmonary emboli, ARDS-Acute Respiratory Distress Syndrome/ cytokine storm, hypersensitivity pneumonitis, and functional anemia.
Ilieum-Small Intestinal infection results in diarrhea, nausea, and possible abdominal pains due to ilieum ulcers.
Neutrophil NETosis causes strokes, heart attacks, pulmonary emboli/thrombosus, renal micro emboli/renal failure, and purple fingers and toes. It can develop 7 days from infection start date due to development of the body’s humoral immune response.
Activation of Complement may cause Levido Reticularis and/or a Hive like Rash
Liver Failure from tissue necrosis due to decreased section perfusion may be partially due to the lack of diaphragm movement after intubation and induction of the comatose state.
Severe cases of COVID-19 which lead to death are associated with high Neutrophil / Lymphocyte ratios and evidence of Netosis. Netosis creates a vicious cycle of inflammation, necroptosis, and apoptosis which leads to respiratory failure The Netosis causes microthombosis and which damages the Kidneys, Heart, and Brain. Targeting NETs may be a successful strategy in preventing deaths due to Severe COVID-19 infection. DNAse I / dornase alpha is one potential treatment.