COVID-19 spike protein requires cleavage by human furin enzyme, which is fairly ubiquitously made in cells across virtually every system. Although we think of it mainly as a respiratory disease, it is important to pay attention to all kinds of symptoms. People with diarrhea as the first symptom tend to present later in the course of infection and have worse outcomes. The virus is definitely able to replicate in the G.I. tract. It also seems to have systemic effects which remind me of severe sepsis with ARDS then MSOF, which is probably mediated by a cytokine storm. Obviously, age and pre-conditions like coronary artery disease, diabetes, and hypertension are important risk factors, but there is some combination of X factors that occasionally causes an otherwise healthy young doctor or nurse to crump & die. Genetics? Viral dose? Meds? Virus sub-strain? The good news is that the furin binding site on the spike protein presents an obvious target for drug therapy. Block that site and you block activation/infection.
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