A COVID-19-mediated thromboinflammatory state associated with endotheliopathy can lead to pulmonary and systemic thrombosis through the enhanced release of plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor, factor VIII, or angiopoietin-2 from endothelial cells; this mechanistic pathway is considered to be the possible major pathogenesis of organ injury in severe COVID-1914–20. The gene discussed is SERPINE1; the disease is COVID-19.