Nutrition amid the COVID-19 pandemic: a multi-level framework for action

Abstract

COVID-19, a disease caused by a novel coronavirus, became a major global human threat that has turned into a pandemic. Coronavirus is one of the major pathogens that mainly targets the human respiratory system. In late December 2019, a cluster of patients were admitted to hospitals with an initial diagnosis of pneumonia of an unknown etiology [1]. Early reports predicted the onset of a possible coronavirus outbreak called SARS-CoV-2, causing the disease COVID-19. The ongoing epidemic has been declared by the World Health Organization (WHO) as a global public health emergency [2]. Experiences from previous outbreaks have shown that as an epidemic evolves, there is an urgent need to expand public health activities beyond direct clinical management and extend to cover basic principles of management and optimization of resource utilization [3]. Since the outbreak of the COVID-19, individual and community resilience emerged as a main resource while remaining the first line of defense in emergency preparedness. In fact, psychological and behavioral countermeasures of both the individual and the community are vital determinants to improve resilience and enhance the efficacy of public health approaches vis a vis a pandemic of a magnitude similar to that of COVID-19 [4]. The nutritional status of individuals has for long been considered as an indicator of resilience against destabilization [5]. The ecology of adversity and resilience demonstrates that substantial stressors, such as inadequate nutrition, can lead to long-lasting effects that are linked to health [6]. In fact, poor diet quality has been associated not only with physical but also mental health [7]. Optimal nutrition and dietary intake is a resource that transcends the individual, the community to reach global influence [8]. In order to enhance the physical and mental health of individuals vis a vis the COVID-19 pandemic, this commentary presents a framework for action to maintain optimal nutrition at the individual, community, national and global levels using an adapted version of the ecological model of health behavior (Fig. 1). At the individual level, the common denominator that drives most of the nutrition and dietary recommendations to combat viral infections, including COVID-19, lies within the link between diet and immunity. In fact, existing evidence highlights that diet has a profound effect on people’s immune system and disease susceptibility. It has been demonstrated that specific nutrients or nutrient combinations may affect the immune system through the activation of cells, modification in the production of signaling molecules, and gene expression [9]. Furthermore, dietary ingredients are significant determinants of gut microbial composition and consequently can shape the characteristics of immune responses in the body [10]. Nutritional deficiencies of energy, protein, and specific micronutrients are associated with depressed immune function and increased susceptibility to infection. An adequate intake of iron, zinc, and vitamins A, E, B6, and B12 is predominantly vital for the maintenance of immune function [11]. Therefore, the key to maintaining an effective immune system is to avoid deficiencies of the nutrients that play an essential role in immune cell triggering, interaction, differentiation, or functional expression. COVID-19 world pandemic imposed a new set of challenges for the individual to maintain a healthy diet. First, the state of lockdown announced in many countries around the globe led all public and private sector institutions, with the exception of health care facilities and a limited number of essential services, to close down and, if possible, carry its operations remotely (without face to face interactions). Individuals were asked to stay home and avoid contact with other people [12]. Such measures of self-isolation and social distancing are known to be crucial in limiting the spread of the virus, flattening the curve of incidence rate, and * Farah Naja fn14@aub.edu.lb