The
coronavirus disease 2019 (COVID-19) caused by
infection of the severe respiratory syndrome coronavirus-2 (SARS-CoV-2) significantly impacted human society. Recently, the synthetic pure
glucocorticoid dexamethasone was identified as an effective compound for treatment of severe
COVID-19. However,
glucocorticoids are generally harmful for
infectious diseases, such as bacterial
sepsis and severe
influenza pneumonia, which can develop
respiratory failure and systemic
inflammation similar to
COVID-19. This apparent inconsistency suggests the presence of pathologic mechanism(s) unique to
COVID-19 that renders this
steroid effective. We review plausible mechanisms and advance the hypothesis that
SARS-CoV-2 infection is accompanied by infected cell-specific
glucocorticoid insensitivity as reported for some other viruses. This alteration in local
glucocorticoid actions interferes with undesired
glucocorticoid to facilitate viral replication but does not affect desired anti-inflammatory properties in non-infected organs/tissues. We postulate that the virus coincidentally causes
glucocorticoid insensitivity in the process of modulating host cell activities for promoting its replication in infected cells. We explore this tenet focusing on SARS-CoV-2-encoding
proteins and potential molecular mechanisms supporting this hypothetical
glucocorticoid insensitivity unique to
COVID-19 but not characteristic of other life-threatening
viral diseases, probably due to a difference in specific virally-encoded molecules and host cell activities modulated by them.