Suggested future research

Based on the above considerations, it is suggested that studies should be conducted to assess the dietary patterns and other lifestyle factors of people who have asymptomatic, mild or severe COVID-19 infections to determine what factors are most associated with various outcomes. During the pandemic crisis, it may be difficult to do these types of studies, but it might be possible via telephone or online surveys of families of those who are ill and/or hospitalized, to assess eating patterns and lifestyle factors of those who got sick and those who did not. For those who are deceased, information on dietary patterns and lifestyle factors could be obtained from close relatives.
Eventually, when there is improved availability of testing and more types of tests for COVID-19, including tests for past exposure using antibody measurements, it should become easier to do these types of studies. Of course, prospective studies are preferable, however, they may not be possible in many cases in the midst of the current pandemic.
Preferably, samples of the microbiome from a variety of sites, perhaps including oral, fecal, blood, urinary and respiratory tract, would be gathered before the illness develops to help assess microbiome-related risk factors. If this is not possible, information on the microbiome might be inferred from diet and lifestyle data, drawing on the growing amount of research on the relationship between these factors and the microbiome composition. The use of large databases of previously gathered microbiome data might also be considered for inclusion in these types of studies. In some cases, autopsy samples of many different organs could be analyzed to attempt to detect microbiome-related patterns.
In addition, the expansion of the types of immune system manipulation methods being studied in cases of severe COVID-19 might be considered. As mentioned above, research could be conducted on medications that are related to mast cell function and/or inhibit hypersensitivity reactions. The use of microbiota manipulation or antimicrobials that target components of a potentially dysbiotic microbiota could be considered. These might be studied alone or in combination with other treatment approaches.