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Its the perfect storm, really, and this combination of increased pressure inside the thin-walled capillary together with a negative alveolar pressure on the other side of the capillary wall creates a huge pressure difference across the capillary wall, causing rupture and EIPH

"Meta-analysis of randomised controlled trials with N-acetylcysteine in schizophrenia." Aust N Z J Psychiatry

doi:10.1124/jpet.103.055202 13

Ariboflavinosis in humans causes various symptoms like sore throat, hyperaemia, oedema of the oral and mucous membranes, cheilitis and glossitis, hair loss, inflammation of skin, cataract development, migraine and a decrease in Hb

We thank Rufus Watson, Hiromi Matsuyama, and Nobue Sakanishi for providing updated information on COVID-19