Abstract
Coronavirus disease 2019 (COVID-19) is a contagious respiratory and vascular disease that continues to spread among people around the world, mutating into new strains with increased transmission rates, such as the delta variant. The scientific community is struggling to discover the link between negative COVID-19 outcomes in patients with preexisting conditions, as well as identify the cause of the negative clinical patient outcomes (patients who need medical attention, including hospitalization) in what seems like a widespread range of COVID-19 symptoms that manifest atypically to any preexisting respiratory tract infectious diseases known so far. Having successfully developed a nutritional formulation intervention based on nitrate, a nitric oxide precursor, the authors hypothesis is that both the comorbidities associated with negative clinical patient outcomes and symptoms associated with COVID-19 sickness are linked to the depletion of a simple molecule: nitric oxide.
Highlights
Applied Bioenergetics Lab, Faculty of Sport and PE, University of Novi Sad, 21102 Novi Sad, Serbia; The main author would like to dedicate this paper to his father, Hourmouzis Nikolaidis, who passed away from drug-resistant pneumonia at the age of 65
It is well established through human clinical trials that Nitric oxide (NO) synthase expression, especially eNOS, declines with age, which leads to a drop into serum NO metabolite levels [29], and that the consequent deficiency in NO levels can negatively impact the progression of geriatric diseases [30]
While it is well known that correlation does not necessarily equal causation, and that just this one link could be overlooked as a mere coincidence, it is the correlation with all the other major COVID-19 comorbidities and low levels of nitric oxide that may establish a more than coincidental link
Summary
Coronavirus disease 2019 (COVID-19) is a contagious respiratory and vascular disease caused by infection with the coronavirus SARS-CoV-2 [1]. Increased severity of diseases is commonly associated with a persistent drop in blood oxygen saturation levels (SpO2 ). A characteristic of COVID-19 infection severity is the almost linear association with age, with most of the severe and fatal cases occurring in the elderly, while children, especially those under the age of 11, remain relatively unscathed by the pandemic [6] (Figure 1). Many comorbidities have been associated with negative and severe COVID-19 clinical outcomes. The link between these risk factors and COVID-19 severity remains unknown, many theories have emerged including the lower amount of ACE receptors in children, which increases with aging, being one of the first suggested and explored [10]. Fueled by encouraging clinical data [12], the authors propose the theory that a key molecule is tied to the severity of COVID-19: nitric oxide.
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