Anemia of Inflammation, IL-6, Hepcidin, Iron and Vitamin C.
During bacterial infections iron is shifted out of hemoglobin production and into ferritin and intracellular storage. (Iron and Anemia of Chronic Inflammation, post) If amounts of the free iron overloads the cell capacity and antioxidant capacity then cell death may result and other damage. The shift of iron involves an increase in the inflammatory cytokine IL-6 (Interleucon-6) which causes an increase in hepcidin, which causes the removal of iron from hemoglobin. (5)
Having extra antioxidants in the diet can help the body cope with the sudden increase in free iron - think of rust - iron oxidizes and the body doesn't want rust anymore than you want it on your car. Antioxidants like vitamin A and C and bioflavonoids can all help stabilize the chemically active iron. The anti-malarial herbal extract called artemisinin may help by binding some of the excess free iron stores. (4) *addition - quercetin, EGCG, resveratrol, turmeric are also iron chelators and lactoferrin is a milk based iron chelator that has not been found an allergy risk for people with a milk-based allergy.
ACE2 receptors are likely more prevalent in the lung cells of smokers (1) and COPD patients, (3), and people living in air pollution because it has a protective effect against lung injury. It helps decrease levels of the inflammatory cytokine IL-6. (2) Which suggests that extra vitamin C and bioflavonoids, and other nutrients may also help reduce the risk of anemia of chronic inflammation and other lung and heart risks from chronic hypoxia (low oxygen levels in the blood).
The COVID-19 illness may have a risk of sudden death due to cardiovascular problems upon relapse/reinfection (6) because of the shift in iron and resulting risk of cell death due to excess free iron. The use of iron chelators or artemisinin and continuing the use of extra antioxidants such as vitamin C and bioflavonoids might help prevent excess coagulation and reverse the shift of iron atoms from hemoglobin molecules to ferritin and free iron within cells. Infectious microbes need iron too so it is a self defense strategy that may become excessive in the case of severe COVID-19 illness.
There is more about bioflavonoids, vitamin C, and coagulation risks of SARS-CoV-2 infection in this post: Bitter Taste Receptors in the Lungs - Hesperidin's Decongestant Properties.
Reference List
SJ Brake, K Barnsley, Wenying Lu, et al., Smoking Upregulates Angiotensin-Converting Enzyme-2 Receptor: A Potential Adhesion Site for Novel Coronavirus SARS-CoV-2 (Covid-19). J. Clin. Med.2020, 9(3), 841; https://doi.org/10.3390/jcm9030841 https://www.mdpi.com/2077-0383/9/3/841/htm
Lin CI, Tsai CH, Sun YL, Hsieh WY, Lin YC, Chen CY, Lin CS. Instillation of particulate matter 2.5 induced acute lung injury and attenuated the injury recovery in ACE2 knockout mice. Int J Biol Sci 2018; 14(3):253-265. doi:10.7150/ijbs.23489. Available from http://www.ijbs.com/v14p0253.htm air pollution studies - ACE2 would be protective against ACE->IL-6 "Increased ACE levels cause the activation of AT1R by Ang II, consequently inducing the expression of the inflammatory cytokines IL-6, TNF-α and TGF-β1 [17]. ACE2 counter-regulates the effects produced by Ang II by converting Ang II to Ang-(1-7), activates Mas to repress the signaling pathways of STAT3 and extracellular signal-regulated kinases (ERK) [18], and acts as an anti-inflammatory factor [19]. "
ACE-2 Expression in the Small Airway Epithelia of Smokers and COPD Patients: Implications for COVID-19. https://erj.ersjournals.com/content/early/2020/03/26/13993003.00688-2020
Inhibitory effect of novel iron chelator, 1-(N-acetyl-6-aminohexyl)-3-hydroxy-2-methylpyridin-4-one (CM1) and green tea extract on growth of Plasmodium falciparum https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590262/ "Artemisinin found in the Chinese medicinal plant (Artemisia annua) binds iron to form ferric-dihydroartemisinin complex, resulting in reactive oxygen species (ROS)-mediated potent anti-malarial activity against ring and late stage of CQ-resistant P. falciparum malaria parasites [5]. "
Covid-19 – Liver – iron overload – lung cascade – coagulation a forum topic on peakprosperity.com with links to research, excerpts and discussion re COVID-19 - Liver - iron overload - lung cascade - coagulation. https://www.peakprosperity.com/forum-topic/covid-19-liver-iron-overload-lung-cascade-coagulation/
Jules Quartly, Exclusive: Chinese doctors say Wuhan coronavirus reinfection even deadlier. Feb 14, 2020, TaiwanNews.com, https://www.taiwannews.com.tw/en/news/3876197