Fig. 1

COVID-19 Cancer Model. SARS-CoV-2 acts via both a direct and indirect pathway to induce systemic injury. The virus enters the body via ACE2 receptors on the cell surface of most of the organs resulting in invasion, replication, and damage. It causes a hypercoagulable state within the blood vessels and dyspnea within the lungs, which also secrete IL-6 that goes into the indirect pathway. In the indirect pathway, SARS-CoV-2 acts via PAMPs and DAMPs to activate antigen presenting cells (APCs) to secrete IL-6. Additionally, the virus activates pulmonary macrophages which secrete IL-6 directly and/or via IL-1. Malignancy and severe SARS-CoV-2 induce hypoxia, which is a trigger for IL-6 secretion. IL-6 activates downstream pathways to promote a pro-inflammatory state. Ultimately, this leads to increased cytokine release resulting in systemic inflammatory damage. The image of SARS-CoV-2 was derived from the Centers for Disease Control and Prevention (CDC) website: https://phil.cdc.gov/Details.aspx?pid=23312