One aspect of immune health that often does not receive the attention it deserves is nitric oxide’s role in immune competence. The vulnerable populations in the current pandemic may have lower levels of endogenously produced nitric oxide (NO) generated through the nitric oxide synthase (NOS) enzyme system. Aging is the largest risk factor for severity and mortality in adult COVID-19 (C19). NO synthesis drops with age. Production of NO through NOS decreases to around 50% by the time we are 40 and to around 15% by the time we are 60. Furthermore, patients with chronic vascular inflammation, such as in type 2 diabetes, metabolic syndrome, chronic obstructive pulmonary disease, obesity, autoimmune disorders, and hemoglobinopathies may produce less NO.¹ These types of diseases are also the same underlying conditions tied to worse outcomes in C19. Further suggesting a connection between NO levels and C19 is the finding that increased risk of C19 death is significantly associated with disease cases that have lower vascular NO concentrations.²

Other factors that impair the production of NO are the SAD (Standard American Diet) devoid of essential nutrients, cofactors, and lack of nitrate-rich vegetables, lack of exercise, medications such as antibiotics, antidepressants, birth control pills, NSAIDS, and proton pump inhibitors (PPIs), pollution, any process that increases oxidative stress, the herbicide glyphosate, genetic single nucleotide polymorphisms (SNPs) in NOS, impaired activity of superoxide dismutase (SOD) and catalase, methylenetetrahydrofolate reductase (MTHFR) polymorphisms, or glutathione levels, as well as stress, a particularly important factor involved in depletion of NO.³ Each of these factors is highly common in today’s world and may predispose to susceptibility to immune threats.