The First Zinc and COVID-19 Study in Humans: Very Promising

I was an early advocate for zinc in the context of COVID-19, having first recommended it on March 17 in The Food and Supplement Guide for the Coronavirus and providing detailed justifications for zinc dosing in the April 10 issue of this newsletter. I am also involved in the design of a clinical trial that will test a cocktail of supplements that includes high-dose zinc.

Today, New York City physicians released a preprint* providing the first direct evidence for the use of zinc in humans.

Important note: I am not a medical doctor and this is not medical advice. Please see my more detailed disclaimer at the bottom.

As NYC became the epicenter of the crisis, the hospital at New York University Langone Health began using experimental treatments that included hydroxychloroquine, azithromycin, and zinc sulfate. In this study, they retrospectively searched the electronic health records of everyone treated from March 2 to April 5. They included patients who were positive for COVID-19, hospitalized, and treated with hydroxychloroquine and azithromycin, regardless of whether they were treated with zinc, as long as they were not treated with other experimental therapies. An additional requirement was that they were released from the hospital, transferred to hospice, or died. Transfer to hospice represents transition from trying to cure the disease to caring for someone whose disease will likely lead to death.

Hydroxychloroquine was given at 400 mg once and then 200 mg/d thereafter, which is a lower dose than used in most other studies. Azithromycin was given at 500 mg/d. Zinc sulfate was given at 220 mg/d, which presumably refers to the total salt and represents 50 mg/d of elemental zinc.

They compared patients who used hydroxychloroquine and azithromycin with zinc to those who used hydroxychloroquine and azithromycin without zinc.

411 patients took all three treatments, while 521 took the two drugs without the zinc.

The use of zinc was not associated with any difference in length of hospital stay, duration of ventilation, or any specific settings used in ventilation.

However, zinc was associated with a 49% lower risk of either being transferred to hospice or dying, a 44% decreased chance of requiring invasive ventilation, and a 56% increased likelihood of being discharged from the hospital and released to home care.

Zinc sulfate treatment was started on March 25. When controlling for the date, the association with the use of ventilation was no longer statistically significant, but the association with lower hospice care or mortality and greater likelihood of going home remained significant.

Since everyone in this study was treated with hydroxychloroquine and azithromycin, two things are true:

• This study provides no information about the use of these two drugs. It only provides information about the usefulness of zinc.

• This study only provides evidence about the usefulness of zinc in the context of these two drugs. While I do not believe the usefulness of zinc is limited to that context and I doubt it is even enhanced by that context, that is nevertheless the context in which zinc was tested.

Since the study is not randomized, it does not provide clear cause-and-effect evidence for the usefulness of zinc.

Nevertheless, the results are very promising, and are consistent with the position I took early on in mid-March.

The authors give substantial space to the hypothesis that hydroxychloroquine acts as a zinc ionophore. I find that doubtful, as I described here. I believe that zinc alone is likely to be beneficial, which awaits testing in future studies.

Stay safe,
Chris

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Disclaimer

I am not a medical doctor and this is not medical advice. I have a PhD in Nutritional Sciences and my expertise is in conducting and interpreting research related to my field. Please consult your physician before doing anything for prevention or treatment of COVID-19, and please seek the help of a physician immediately if you believe you may have COVID-19.

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*Footnotes

*  The term “preprint” is often used in these updates. Preprints are studies destined for peer-reviewed journals that have yet to be peer-reviewed. Because COVID-19 is such a rapidly evolving disease and peer-review takes so long, most of the information circulating about the disease comes from preprints.