Table 2.

Hypothesis for COVID-19 protective down-regulation state

1. A severe prolonged COVID 19 infection produces extreme metabolic demands, hypoxia, and a global scarcity of ATP.

2. Aggressive intensive care management often requires sedation with heavy doses of GABAergic anesthetics to maintain adequate oxygenation.

3. In certain COVID-19 patients, hypoxia cannot be fully rectified by optimization of mechanical ventilation. The ensuing ATP scarcity leads to opening of neuronal K-ATP channels and a global shut-down of brain activity, likely marked by burst suppression.

4. The combination of global ATP scarcity and heavy sedation with GABAergic anesthetics likely helps initiate a protective down-regulation state.