Core Viewpoint - The article discusses a study published in Nature Metabolism that highlights the potential of Nicotinamide to accelerate recovery in mild to moderate COVID-19 patients and its role in modulating gut microbiota changes associated with the virus [2][12]. Group 1: Nicotinamide and COVID-19 - Nicotinamide is essential for the production of NAD+, a key coenzyme in cellular energy metabolism, which decreases during viral infections, particularly COVID-19 [5]. - The study indicates that during acute inflammation caused by SARS-CoV-2, tryptophan metabolism is enhanced, leading to increased kynurenine levels, which is a critical intermediate in the NAD+ synthesis pathway [5]. - COVID-19 is closely linked to gut microbiota dysbiosis, characterized by reduced microbial diversity and beneficial species, which is associated with increased inflammation and immune dysregulation [5]. Group 2: Research Findings - Previous research showed that tryptophan helps maintain gut microbiota homeostasis, and supplementation with Nicotinamide has strong, microbiota-dependent anti-inflammatory effects [6]. - The study developed a pH-dependent matrix tablet formulation for Nicotinamide, designed to release in the lower small intestine and colon, ensuring systemic supply and targeting gut microbiota [6]. - The COVit-2 trial involved 900 symptomatic COVID-19 patients and demonstrated that 57.6% of those treated with Nicotinamide recovered from physical decline by week 2, compared to 42.6% in the placebo group [7]. Group 3: Clinical Implications - The changes in gut microbiome characteristics correlated with clinical efficacy, suggesting that Nicotinamide can regulate fecal microbiota changes associated with SARS-CoV-2 infection [8]. - Follow-up after 6 months indicated that those who responded to Nicotinamide treatment had a lower incidence of post-COVID syndrome compared to the placebo group [8]. - Throughout the study, no safety risks related to Nicotinamide treatment were reported [8].

Group 1 - The COVID-19 positive rate is on the rise, with the national acute respiratory infectious disease sentinel monitoring indicating an increase from 7.5% to 16.2% in outpatient flu-like cases and from 3.3% to 6.3% in hospitalized severe acute respiratory infection cases [1][2] - Southern provinces in China show higher COVID-19 positive rates compared to northern provinces, with some areas experiencing a slowdown in the increase of cases despite earlier rises in positivity rates [2] - The COVID-19 virus is the leading pathogen detected in both outpatient flu-like cases and among different age groups, particularly in the 15-59 and 60+ demographics [2] Group 2 - High-risk groups for severe COVID-19 include individuals over 65, those with underlying health conditions such as cardiovascular diseases, chronic lung diseases, diabetes, and obesity, as well as immunocompromised individuals [3] - Severe COVID-19 patients face additional risks of secondary infections, with 34.3% experiencing pulmonary fungal infections, and this rate increases to 37.2% among patients requiring ventilators [4][5] - Early identification and intervention are crucial for high-risk individuals showing symptoms like cough, sore throat, and fever, with recommendations to undergo COVID-19 screening and seek medical care promptly [5]