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Non-Cardiogenic Pulmonary Oedema as the first pathogenic feature in COVID-19 and potential benefit of nitrates in SARS-CoV-2 infection
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  • Ahran Arnold,
  • NIna Stafford,
  • Vijay Manglam,
  • Arvind Sangwaiya,
  • Bruce Hendry,
  • Stuart Rosen,
  • Jayantha Arnold
Ahran Arnold
National Heart and Lung Institute
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NIna Stafford
London North West University Healthcare NHS Trust
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Vijay Manglam
London North West University Healthcare NHS Trust
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Arvind Sangwaiya
London North West University Healthcare NHS Trust
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Bruce Hendry
King's College London
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Stuart Rosen
National Heart and Lung Institute, Imperial College London
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Jayantha Arnold
London North West University Healthcare NHS Trust
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Abstract

We wish to highlight a new hypothesis, that the early phase of COVID-19 is characterised by non-cardiogenic pulmonary oedema (‘leaky lungs’). We hypothesize that COVID-19 complications in lungs might progress through the initial stages of ‘leaky lungs’, to ‘cytokine storm’ and Acute Respiratory Distress Syndrome (ARDS ) , with high case fatality rates once ARDS sets in. SARS-CoV spike protein binding to Angiotensin Converting Enzyme 2 cell membrane receptors with down-regulation of the latter, followed by increased Angiotensin II, has been shown to increase pulmonary vascular permeability, potentially inducing pulmonary oedema. This hypothesis is supported by serial computerised tomographic scan findings on COVID-19 patients from China and post-mortem studies from around the world. Early attention and targeted treatment towards this pathological feature of non-cardiogenic pulmonary oedema may be of benefit, and warrants a clinical trial.