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COVID-19 Q&A #2: Antibody-Dependent Enhancement, Cross-Immunity, Immunity Duration & More| Found My Fitness with Dr. Rhonda Patrick

Key Takeaways

  • It’s unclear how long antibodies from SARS-CoV-2 last and whether they protect one from future infections
  • The ability of antibodies to neutralize virus remains uncertain
  • Non-heritable traits such as nutrition, sleep, cross-immunity, biological age, and microbiome seem to play a larger role in the variation of virus symptoms compared to genetics
  • Men and women are equally likely to get COVID-19 but men are more likely to die from it
  • “Deficiencies or insufficiencies in micronutrients negatively affect immune function and can decrease resistance to infections.” – Rhonda Patrick, PhD.


Dr. Rhonda Patrick (@foundmyfitness) provides an updated Q&A to COVID-19, immunity, and immune enhancement.

Notable SARS-CoV-2 Timeline of Symptoms

  • 4-7 days for symptoms to develop
  • Symptoms peak 4-5 days after onset of symptoms
  • 10 days after onset of symptoms there is still measurable RNA in sputum, but risk of spreading is minimal
  • A recent study found people no longer transmit virus to close contacts after 14 days
  • Another study found that from the time of symptom onset, most people test negative by day 20

Can One Become Reinfected Twice?

  • Testing positive after recovery may be due to reinfection, relapse, or inconsistent testing methods
  • Once a person recovers, future flare-ups (barring reinfection) are unlikely
    • SARS-CoV-2 doesn’t have a reverse transcriptase component so the virus can’t insert into DNA like other viruses such as HIV
  • Generally, after recovery from a virus, adaptive immunity in the body develops antibodies for future immunity
  • In a study out of China, 100% of participants develop antibodies against the SARS-CoV-2 within 19 days of exposure but the ability of antibodies to neutralize virus remains uncertain
  • Studies on other SARS, MERS, and coronaviruses show that virus-specific antibodies wane over time and may only result in partial protection from reinfection
  • Immunity to SARS-CoV-2 may diminish following infection
  • No guarantee you can’t get the infection again at some point in the future

Higher risk of contracting COVID-19 while on ACE-inhibitor?

  • SARS-CoV-2 attaches to ACE-2 inhibitor to infect the cell
  • ACE-1 and ACE-2 work together in the body to regulate salt and blood pressure
    • Imbalances are seen in atherosclerosis, high blood pressure, heart failure, chronic kidney disease, inflammation, lung injury
  • When SARS-CoV-2 enters human cells via ACE-2 receptor, ACE-2 receptor is internalized in the cell with the virus –
    • Results in a decrease of the number of functioning ACE-2 receptors and worsening severity
    • Decrease of ACE-2 plus cytokine storm can result in acute respiratory distress syndrome
    • Vitamin D increase ACE-2 levels
  • ACE-2 is a key protective factor of lung edema and acute lung failure
  • Since ACE inhibitors increase ACE-2 they may reduce the risk of severe disease in at-risk populations
  • Cardiologists and physician circles still recommend continuing ACE inhibitor regimen since trade-off is worth the potential risk

Does COVID-19 Cause Irreversible Damage to Lungs?

  • Complications from COVID-19 such as acute respiratory distress syndrome and pneumonia can lead to irreversible lung damage
  • Patients who develop acute respiratory distress syndrome from SARS-CoV-2 are much more likely to die
  • Survivors of acute respiratory distress syndrome have long term lung damage which impairs physical function and quality of life
  • Patients who do not develop acute respiratory distress syndrome or pneumonia do not appear to have long term lung damage

What Accounts for the Range of Virus Symptoms?

  • In general, differences in immune function may be attributed to genetics, previous exposure to pathogens, sleep, microbiome composition, exercise, nutrition, gender, and biological age
  • Variation seems to largely depend on adaptive immunity and non-heritable traits
  • Free viral report through Found My Fitness

Non-Heritable Traits That Account for Immune Variation

Some people may have small residual immunity from common cold coronaviruses

  • Exposure to previous pathogens and viruses may offer cross-immunity
  • At any given time, an individual carries antibodies to 10 viral species
    • Virus neutralizing antibodies bind to the virus and prevent it from infecting a cell, usually by preventing it from binding to receptor

Sleep regulates immune function

  • Relationship between sleep and immunity is important
    • Adults require 7-9 hours of uninterrupted sleep per night
    • More information Dr. Matthew Walker episode
    • Partial and chronic sleep deprivation can negatively affect immunity and immune cell numbers


  • Gut microbiome regulates immune cell populations
    • Gut microbiome directly influences immune cells that reside in the gut and indirectly regulate immune cells outside of the gut via short chain fatty acid


  • Antibody response to vaccination has been used as a proxy for immune response to exercise
    • Moderate exercise of 1-hr/day for five days a week has been shown to improve the immune system
    • Extreme exercise is energetically demanding – intense exercise of 2-hrs or more has been shown to increase the risk of illness


  • Sex hormones differentially effect the immune system
  • Women have better immune responses to vaccination than men possibly due to estrogen
  • Estrogen promotes adaptive T-cell responses in mice
  • Men and women are equally likely to get COVID-19 but men are more likely to die from it

Biological age

  • People age at varying rates because of combination of genetic and lifestyle factors
  • Individuals with the same chronological age have different biological ages
  • Biological age is a predictor of better immune response


  • Most people in US are getting enough macronutrients (proteins, carbohydrates, fats) but not micronutrients (vitamins, minerals, essential fatty acids, essential amino acids)
  • Micronutrients support adaptive immunity
  • Deficiencies or insufficiencies in micronutrients can negatively impact immune function and resistance to infection

Vitamin D

  • Vitamin D gets converted into a steroid that regulates some of the human genome
  • Plays an important role in activating innate immune system since immune cells have vitamin D receptors
  • 70% of US population has vitamin D insufficiency and 28% has a deficiency
  • Vitamin D supplementation can decrease respiratory tract infection
  • Fore more information on Vitamin D and respiratory health, listen to Rhonda’s episode on Vitamin D and susceptibility of lung injury

Vitamin A

  • Important for the maturation and function of epithelial tissues and immune cells
  • Deficiency associated with altered immune response, breakdown of gut barrier, and increases susceptibility to infection
  • Deficiency can impair response to vaccination

Vitamin C


  • Zinc deficiency in the US is rare but people who consume a lot of alcohol and vegetarians may require supplementation
  • Mild zinc deficiency may decrease immune function

Omega-3 Fatty Acids

  • EPA and DHA support an effective immune system by helping to resolve an inflammatory response
  • In animal models, EPA and DHA have been shown to protect against and resolve acute lung injury and respiratory distress syndrome
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