Critical COVID-19 cases in ARDS show perverse hypoxemia in spite of decent lung compliance.

This is odd. Some people have even made far-fetched claims about supposed damage to RBCs or heme, but evidence contradicts.

We think it may arise from microvascular endothelial damage. https://twitter.com/__ice9/status/1247187797364084738
Also, to be clear: inflammation and edema occur first. Formation of thrombi is a potential downstream effect.

Implications: (1) 'silent hypoxemia' requires only lung endothelial damage, not damage to RBCs, (2) DIC risk in severe cases, could cause MODS. https://twitter.com/__ice9/status/1247596927534927876?s=19
More on that: https://twitter.com/__ice9/status/1246967249765883905?s=19
The situation resembles high-altitude pulmonary edema: https://twitter.com/__ice9/status/1247692298525323264?s=19
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