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COVID’s Razor: RAS Imbalance, the Common Denominator Across Disparate, Unexpected Aspects of COVID-19

Authors Czick M, Shapter C, Shapter R

Received 1 June 2020

Accepted for publication 4 August 2020

Published 11 September 2020 Volume 2020:13 Pages 3169—3192

DOI https://doi.org/10.2147/DMSO.S265518

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Professor Ming-Hui Zou


Maureen Czick,1 Christine Shapter,2 Robert Shapter3

1University of Connecticut, Department of Anesthesia, Farmington, CT, USA; 2 University of Saint Joseph, West Hartford, CT, USA; 3Independent Consultant ( Medical Research, Medical Communications, and Medical Education), Hartford, CT, USA

Correspondence: Maureen Czick Email [email protected]

Abstract: A modern iteration of Occam’s Razor posits that “the simplest explanation is usually correct.” Coronavirus Disease 2019 involves widespread organ damage and uneven mortality demographics, deemed unexpected from what was originally thought to be “a straightforward respiratory virus.” The simplest explanation is that both the expected and unexpected aspects of COVID-19 share a common mechanism. Silent hypoxia, atypical acute respiratory distress syndrome (ARDS), stroke, olfactory loss, myocarditis, and increased mortality rates in the elderly, in men, in African-Americans, and in patients with obesity, diabetes, and cancer—all bear the fingerprints of the renin-angiotensin system (RAS) imbalance, suggesting that RAS is the common culprit. This article examines what RAS is and how it works, then from that baseline, the article presents the evidence suggesting RAS involvement in the disparate manifestations of COVID-19. Understanding the deeper workings of RAS helps one make sense of severe COVID-19. In addition, recognizing the role of RAS imbalance suggests potential routes to mitigate COVID-19 severity.

Keywords: ACE, ACE2, silent hypoxia, atypical ARDS, stroke, myocarditis

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