Asymptomatic patients are at a greater risk due to the cycle of tissue damage, metabolic acidosis and alteration of blood gases, at first it is difficult to notice the severe drop in P02 as it is compensated by heart rate, it is an alteration between PO2 and PCO2 due to kidney, gastrointestinal and adrenal damageThe probability that the virus invades the brain through axonal transport and transneuronal spread from the olfactory nerves to the rhinencephalon and finally reaches the brainstem causing respiratory failure is mentioned.COVID-19 has been shown to be neurotoxic to brain stem neurons, in turn, neurogenic respiratory failure is suspected, this is reflected when patients after going through pneumonia cannot be removed from the mechanical ventilator causing death.Subsequent studies will have to be carried out where both aspects of neuronal damage and respiratory failure are considered to see the true severity of COVID-19.