Is arrhythmicity of microvascular "flowmotion" responsible for COVID-19-related acute respiratory distress syndrome and might it be treated through an adequate Mg supplementation?

Since the report of an emergence of severe respiratory viral infections of unknown etiology in China in December 2019, termed COVID-19-associated acute respiratory distress syndrome (ARDS), a large number of cases and deaths have been documented worldwide, with the pandemic still spreading around the world. In most critical cases, the acute symptoms may be accompanied by uncontrolled inflammatory cytokine responses and by multiorgan failure. The clinical observation that in severely ill patients, COVID-19 was characterized by cytokine storm and endothelial dysfunction, leading to fast and fatal progression of the disease, has prompted many investigators to consider COVID-19 as a systemic disease that primarily injures the vascular endothelium. Aim of this brief review is not to refute or even question a quite possible role of the vascular endothelial dysfunction as a potential trigger for ARDS, but rather to highlight a more probable role for the main function of the smooth muscle cells in the microcirculation, called "vasomotion", which helps physiologically to ensure an optimized energy supply to the tissues. Alterations in the rhythms of this microcirculatory vaso motion might thus play a similar role as a trigger of the ARDS diagnosed in COVID-19 patients. Furthermore, since obesity, type 2 diabetes, arterial hypertension, decrease in immune response, cytokine storm, endothelial dysfunction, and arrhythmias, which are frequent in COVID-19 patients, have been reported to be associated with hypomagnesemia, an adequate treatment with magnesium supplementation could be beneficial for COVID-19 patients in some specific cases and should also be taken into consideration.