The article analyzes the links of pathogenesis of a new coronavirus infection that lead to severe clinical manifestations of the disease – acute respiratory distress syndrome, multiple organ failure and endotoxicosis. The sequence of development of the infectious process from the moment the virus enters the body from the external environment to the damage of the alveolar-capillary barrier and the development of acute respiratory distress syndrome is presented. Factors of initiation of pathological processes leading to the development of acute respiratory distress syndrome are described, among which special attention is paid to oxidative stress, hyperreactivity of the immune system, endothelial dysfunction and cytotoxic action of the virus. Possible pharmacotherapeutic directions of COVID-19 treatment are discussed, taking into account different pathogenesis links. Flowcharts for the sequence of events during COVID-19 infection have been developed.