A new look at the COVID-19 pathogenesis: the disease is a generalized viral vasculitis, and the lung tissue damage is a variant of angiogenic pulmonary edema

Based on the data about angiotensin-converting enzyme 2 (ACE2) as the main receptor for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), hematogenous spread of the virus is hypothesized, followed by killing of ACE2-expressed cells in the microvessel walls. Damage to the blood vessels (primarily arterioles) leads to the development of microthromboses and results in the exit of the blood liquid phase in perivascular space, which is pathogenetically similar to the angiogenic edema development. In fact, this disorder is multi-organ in nature, and in the lung tissue its occur as “pulmonary edema” variant, the signs of which during CT scan precede predicts the development of severe respiratory failure. The hypothesized COVID-19 pathogenesis allows us to explain the causes and stages of occurrence of many symptoms of this disease. Possible changes in COVID-19 diagnostic and therapeutic protocols are discussed.