Coronavirus disease (CoVID-19), caused by recently identified severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), is characterized by inconsistent clinical presentations. While many infected individuals remain asymptomatic or show mild respiratory symptoms, others develop severe pneumonia or even respiratory distress syndrome. SARS-CoV-2 is reported to be able to infect the lungs, the intestines, blood vessels, the bile ducts, the conjunctiva, macrophages, T lymphocytes, the heart, liver, kidneys, and brain. More than a third of cases displayed neurological involvement, and many severely ill patients developed multiple organ infection and injury. However, less than 1% of patients had a detectable level of SARS-CoV-2 in the blood, raising a question of how the virus spreads throughout the body. We propose that nerve terminals in the orofacial mucosa, eyes, and olfactory neuroepithelium act as entry points for the brain invasion, allowing SARS-CoV-2 to infect the brainstem. By exploiting the subcellular membrane compartments of infected cells, a feature common to all coronaviruses, SARS-CoV-2 is capable to disseminate from the brain to periphery via vesicular axonal transport and passive diffusion through axonal endoplasmic reticula, causing multiple organ injury independently of an underlying respiratory infection. The proposed model clarifies a wide range of clinically observed phenomena in CoVID-19 patients, such as neurological symptoms unassociated with lung pathology, protracted presence of the virus in samples obtained from recovered patients, exaggerated immune response, and multiple organ failure in severe cases with variable course and dynamics of the disease. We believe that this model can provide novel insights into CoVID-19 and its long-term sequelae, and establish a framework for further research.

冠状病毒病 (CoVID-19) 由最近发现的严重急性呼吸窘迫综合征冠状病毒 2 (SARS-CoV-2) 引起，其特点是临床表现不一致。虽然许多感染者仍然无症状或表现出轻微的呼吸道症状，但其他人则出现严重肺炎甚至呼吸窘迫综合征。据报道，SARS-CoV-2 能够感染肺、肠、血管、胆管、结膜、巨噬细胞、T 淋巴细胞、心脏、肝脏、肾脏和大脑。超过三分之一的病例表现出神经系统受累，许多重症患者出现多器官感染和损伤。然而，只有不到 1% 的患者血液中检测到 SARS-CoV-2 水平，这引发了该病毒如何在全身传播的问题。我们认为口面部粘膜、眼睛和嗅觉神经上皮中的神经末梢是大脑入侵的入口点，使 SARS-CoV-2 能够感染脑干。通过利用受感染细胞的亚细胞膜区室（所有冠状病毒共有的一个特征），SARS-CoV-2 能够通过囊泡轴突运输和轴突内质网被动扩散从大脑传播到外周，从而独立于病毒感染而引起多器官损伤。潜在的呼吸道感染。所提出的模型阐明了 CoVID-19 患者中广泛的临床观察到的现象，例如与肺部病理无关的神经系统症状、从康复患者获得的样本中病毒长期存在、夸大的免疫反应以及严重病例中的多器官衰竭疾病的病程和动态变化。我们相信该模型可以为 CoVID-19 及其长期后遗症提供新的见解，并为进一步研究建立框架。