Wayne Persky

Most of us have heard about the research that describes how COVID-19 gains entry into our cells by hitchhiking on angiotensin-converting enzyme (ACE) 2. But what really happens to enable the virus to take over so many vital body functions and damage so many organs? COVID-19 is actually a relatively simple virus (as viruses go). Why is it so uniquely qualified to cause such extensive organ damage that it carries a relatively high risk of a fatal outcome for certain groups of people?

To understand how this virus manages to wield so much power, let’s consider how it goes about it’s dirty work. As it develops, COVID-19 can starve the body for oxygen, (hypoxia), cause a loss of the sense of smell (olfactory loss), cause inflammation of blood vessel walls (endothelialitis) and the heart (myocarditis), and other isues. The elderly are especially at risk, as are men, certain ethnic groups, and patients who have certain preexisting conditions such as obesity, diabetes, and kidney disease. All of these conditions are normally caused by imbalances in the body’s renin-angiotensin system (RAS) (Czick, Shapter, and Shapter, 2020).¹ This suggests that the RAS may be the common pathway by which COVID-19 can invade and damage so many of the body’s vital organs.

As we were evolving, during the paleolithic period, our bodies learned to maximize our survival chances by restricting certain normal body processes whenever severe injury or illness became life-threatening. Constriction of blood vessels and blood clotting, for example, was developed to stop excessive blood loss. When we encountered a fight or flight situation, our sympathetic nervous system learned to restrict digestive functions and maximize resources for our muscles. This requires coordinated control of our lungs, heart, blood vessel elastici5ty, and kidneys, in order to optimize our oxygenation, blood flow, and blood pressure rates. All of these functions are regulated and coordinated by the RAS (Wilner, 2020, December 18).² So it’s not surprising that by corrupting the RAS, COVID-19 is able to affect so many organs.

Normally, the functions of the RAS are automatically balanced, so that organs are protected from damage during a traumatic event. The ACE/angiotensin II/AT1 receptor axis promotes processes such as blood clotting, inflammation, and insulin resistance. And those actions are counterbalanced by the ACE2/angiotensin1-7/Mas receptor/AT2 receptor axis, which is designed to have an opposite effect. But after COVID-19 uses ACE2 to gain entry into our cells, and hijacks the cellular processes that allow viral replication, then it suppresses the production of ACE2. By doing that, it removes the normal balance maintained by the ACE2 axis, and this allows the RAS to promote inflammatory processes without the normal balancing limitations. Without those limitations, issues such as blood clotting, inflammation, and insulin resistance, for example, can become life-threatening.

Many of the vital organs affected by the virus, including the heart, kidneys, and brain, are capable of producing their own RAS proteins. So it’s possible for COVID-19 to invade them and suppress ACE2 production, which opens the door to unlimited inflammation and possible damage due to out-of-control blood clotting, independent of the bloodstream status.

Endothelialitis (inflammation of the lining of the blood vessels) has been proposed by researchers as the primary mechanism that allows COVID-19 to cause such widespread damage in the body (Ackermann et al., 2020).³ But enothelial function is controlled by the RAS, so endothelialitis is only one part of a much larger spectrum of functions controlled by the RAS. Diseases such as diabetes and atherosclerosis are examples of RAS overactivtion. With these diseases, the lining of blood vessels (the endothelium) can become inflamed, and clotting can occur (when neither is appropriate), and this can lead to an increased risk of stroke or heart attack.

In addition, the endothelialitis theory cannot account for COVID-19 symptoms such as loss of the sense of smell, loss of glucose control, and arrhythmia (irregular heart beat). But all of these clinical symptoms can be caused by RAS imbalances.