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Superoxide anion radicals (O2 − ) can cause injury directly and can be converted into more damaging oxidant species such as hydroxyl radical (OH − ) and hypochlorous acid (HOCl).37 Of the two, OH − has been demonstrated as the key reactive oxygen species to cause pulmonary edema during acute lung injury.38 Hypoxemia secondary to Adult Respiratory Distress Syndrome (ARDS) and pulmonary edema may occur during COVID-19 infection.39 Besides causing tissue injury, ROS can also activate the NF-kB pathway to amplify inflammation through upregulation of expression of multiple genes, such as IL-6, TNF-α, and chemokines
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