COVID-19 Update Episode 5

The COVID-19 Update Episode 5

Dr. Dicken Weatherby & Beth Ellen DiLuglio, MS, RDN, LDN

Welcome to episode 5 of "COVID-19 Update" recorded June 3rd, 2020.

Here's a breakdown of what we covered and timing:

1. Introduction (0:00)
2. COVID-19 Testing Update - (0:01:10)
3. Vitamin D Update (0:05:30)
4. T Cells (0:07:49)
5. COVID-19, Co-Morbidities and How to evaluate the weaknesses (0: 09:40)
6. Optimal - The Biomarkers: Omega 3 Index (0:17:45)
7. Optimal - The Biomarkers: LDL-HDL Ratio (0:30:00)
8. Optimal - The Biomarkers: Apo B - Apo A1 Ratio (0:40:20)

Research Studies and Links

CDC Interim Guidelines for COVID-19 Antibody Testing in Clinical & Public Health Settings

Three strategies can be used to improve positive predictive value:

• Choosing a test with a very high specificity, perhaps 99.5% or greater, will yield a high positive predictive value in populations tested with prevalence >5%.
• Another strategy is to focus testing on persons with a high pre-test probability of having SARS-CoV-2 antibodies, such as persons with a history of COVID-19-like illness. A third approach is to employ an orthogonal testing algorithm in which persons who initially test positive are tested with a second test.
• Effective orthogonal algorithms are generally based on testing a patient sample with two tests, each with unique design characteristics (e.g., antigens or formats).

At present, the immunologic correlates of immunity from SARS-CoV-2 infection are not well defined. "additional data are needed before modifying public health recommendations based on serologic test results, including decisions on discontinuing physical distancing and using personal protective equipment? [R]

McCartney recommends vitamin D for COVID19 prophylaxis

Conclusions: Vitamin D deficiency (serum 25(OH)D is less than 50 nmol/l [20 ng/mL]. Supplementation with doses up to 100µg/d [4000 IU] has been shown to be safe for adults, and many agencies and expert groups now advocate supplementation in older adults, albeit at lower levels than this. Vitamin D deficiency is common and may contribute to increased risk of respiratory infection including Covid-19.

McCartney, D M, and D G Byrne. “Optimisation of Vitamin D Status for Enhanced Immuno-protection Against Covid-19.” Irish medical journal vol. 113,4 58. 3 Apr. 2020 [R]

Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19)

Conclusions: T cell counts are reduced significantly in COVID-19 patients, and the surviving T cells appear functionally exhausted. Non-ICU patients with total T cells counts lower than 800/μL may still require urgent intervention, even in the immediate absence of more severe symptoms due to a high risk for further deterioration in condition.

Diao, Bo et al. “Reduction and Functional Exhaustion of T Cells in Patients With Coronavirus Disease 2019 (COVID-19).” Frontiers in immunology vol. 11 827. 1 May. 2020 [R]