Potential Role of Autonomic Dysfunction in Covid-19 Morbidity and Mortality

Figure 1. Contribution of altered autonomic function in hypertension, diabetes, and heart disease to poor outcomes in Covid-19 patients. It is well-known that sympathetic nerve activity is significantly increase in patients with hypertension, diabetes, and heart disease. In contrast, parasympathetic activity is markedly decreased in these patients. In Covid-19 patients both sympatho-excitation and parasympathetic withdrawal may play a pivotal role in increasing the risk of life-threating events. Enhanced sympathetic activity directly increases circulating catecholamines and increases myocardial work and oxygen demand, adding more stress to the Covid-19 heart. Simultaneously, the reduction in parasympathetic activity reduces the neuro-vagal anti-inflammatory reflex hastening the release of pro-inflammatory cytokines and potentially contributing to cytokine storm.