Large differences in COVID‐19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage were associated with low death rates in European countries. SARS‐CoV‐2 binds to its receptor, the angiotensin converting enzyme 2 (ACE2). As a result of SARS‐Cov‐2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT 1 R) axis associated with oxidative stress. This leads to insulin resistanceas well as lung and endothelial damage, two severe outcomes of COVID‐19. The nuclear factor (erythroid‐derived 2)‐like 2 (Nrf2) is the most potent antioxidant in humans and can block the AT 1 R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are given: Kimchi in Korea, westernized foods and the slum paradox. It is proposed that fermented cabbage is a proof‐of‐concept of dietary manipulations that may enhance Nrf2‐associated antioxidant effects helpful in mitigating COVID‐19 severity.

Diphtheria is a notifiable infectious disease caused by Corynebacterium diphtheriae. Objective: To establish the epidemiological characteristics in patients with diphtheria in the Autonomous Service University Hospital of Maracaibo. Methodology: Descriptive, cross-sectional, prospective and field research. The sample was represented by patients older than 15 years admitted to the Internal Medicine service. Results: Between January 2018 and December 2018, 67 patients were included, the incidence was 25 cases per million inhabitants, 58,2% were female, aged between 15 -65 years. 92,5% did not travel in the last month, 19,4% reported having had contact with diphtheria. Most of the cases came from the Maracaibo municipality in 46,3%. The predominant educational status was complete secondary with 59,7%. 86,6% do not know their vaccination history. The current occupation that prevailed was merchant in 34,3%, followed by housewife 23,9% and student 17,9%. The socioeconomic status by the Method of Graffar Méndez Castellano, the working class stratum IV predominated with 77,6%. The time elapsed from the onset of symptoms to hospitalization was 1-15 days. Tonsillitis-like respiratory form as a typical clinical presentation in all cases; fever, dysphagia, and presence of adherent pseudomembrane predominated in most patients. 22,4% presented complications. Most of the cases were confirmed clinically 77,6% while 4,5% were laboratory confirmed. The fatality rate was 19,4%. Conclusion: Diphtheria is a re-emerging disease in Venezuela in recent years, it affects any age and sex, in addition, it has been associated with low vaccination coverage and low socioeconomic status, so prevention and control is essential to eradicate the disease.