COVID - 19 infection: Angiotensin II has a major role in the mortality rate. Low dose of inhaled Nitric oxide may be the treatment.

Since who characterized COVID-19 as a pandemic, all scientists and clinicians studied the viral effects on the various organs and tissues of the infected patients. The virus irreversible binding to the ACE2 in the target cell in the lungs is the first step of the viral deleterious pathway to invade the target tissues. As the virus replicates and its number increase, the ACE2 in lung type II alveolar cells become inactive. ACE2 is also located in the arterial and venous endothelial cells and arterial smooth muscle cells in most organs. ACE2 is the enzyme catalyzing the conversion of angiotensin II to angiotensin (1–7). The accumulated angiotensin II has a paracrine effect in the pulmonary system in increasing the mean pulmonary pressure and vasoconstriction affect the lungs. One of the suggested treatments is the use of low dose inhaled nitric oxide, which has minimal systemic effects. Treatment with low dose inhaled Nitric oxide can be done first to preserve the patient's condition and as a quick solution at first, and then inject him with angiotensin (1,7) for varying periods to maintain the rate of angiotensin II / angiotensin (1,7) which will provide two antagonists to the angiotensin II to decrease its effect on the infected tissue. In addition, this will increase the blood flow to the infected tissue, which will decrease the virus effect and will enhance the immune response. The nitric oxide usage will also increase the immune response, which will lower the infection period. Angiotensin (1,7) has anti - angiotensin II effect and should be used as a potential treatment.