Peter Openshaw

is appearing at a time when there's still virus there and there is a sort of immunological overreaction which causes the ARDS, the inflammation of the lungs that we see on chest X-ray and on CT scan.

That probably reflects this immunological hyper-reactivity which is contributing to the disease at that stage.

In this particular case, there seem to be hints that the cardiovascular system is affected later in the disease in some of the patients with severe disease, severe infections.

We don't know why this is.

We do know that the virus gets in via the same receptor as SARS, which is the ACE2 receptor.

There may be other co-receptors, but this appears to be one of the main ones.

And that, of course, angiotensin converting enzyme is involved in the control of blood pressure.

The patients with severe disease sometimes are actually slightly hypertensive rather than hypotensive.

Often patients with severe illness are hypotensive.

Some of these have a slight rise in blood pressure.

And we don't know whether there is some sort of inflammation process going on in the heart.

It could be a myocarditis or even an endartritis, we don't know.

And that could be related to the virus actually reaching the heart tissue and might be involved in some of the deaths.

We know that patients who've been put on ECMO,

who are extra corporeal membrane oxygenation in order to support them through the respiratory failure.

Sometimes they die regardless.

And perhaps that could reflect myocardial infection with the virus.

This is all speculation.

We don't know yet.

And we're really waiting for detailed studies where the virus is being sought in the heart and in other tissues as well.