The clinical picture of COVID-19 including acute respiratory distress syndrome (ARDS), related to interstitial pulmonary fibrotic inflammation, cardiomyopathy and shock, strongly suggests that the renin–angiotensin system (RAS) is dysfunctional owing to interaction between angiotensin converting enzyme 2 (ACE2) and SARS-CoV2 spike protein. Here, ACE2 is linked to acute respiratory distress syndrome.