Welcome to another COVID19 Update, based on a recent study that looked at giving vitamin C and Zinc for mild COVID19 illness. Zinc gluconate and vitamin C, aka ascorbic acid, are commonly available over-the-counter supplements that people often take to treat viral illnesses. Zinc is known to play a role in our immune function by helping to produce antibodies, in addition to enhancing our white blood cell’s ability to fight infection, especially when it comes to neutrophils, a type of white blood cell. There is also some evidence that zinc deficiency increases pro-inflammatory cytokines.
COVID19 Update – Vitamin C and Zinc
Also, studies done on the first SARS virus have shown that zinc might inhibit its ribonucleic acid polymerase….thats the enzyme that allows the virus to replicate its RNA. But the biological activity of zinc against viruses may require ionophores like Pyrithione to accomplish this. Vitamin C is an antioxidant that may play a role in our immune system’s ability to fight infection.
In vitro and in vivo studies in chicks have shown that they could be protective against coronavirus. Human trials have found that it may decrease susceptibility to viral respiratory infections. When it comes to the common cold, there is limited evidence to suggest that high doses of oral vitamin C and zinc might reduce the duration of symptoms and decrease the severity of symptoms.
But what does that mean for zinc in real life?
Based on a review of 13 studies, if zinc is taken within 24 hours of the first signs of a cold, it might reduce a mean length by a day. And with vitamin C, some research suggests that it can shorten colds by 8% in adults and 14% in kids, but it doesn’t appear helpful if taken after the symptoms start.
Vitamin C in the INTRAVENOUS form has also been looked at for non-COVID19 patients is variable. A meta-analysis review investigated its use in critically ill patients. It failed to show a significant association with mortality but inconsistent associations with secondary endpoints, including duration of patients requiring a breathing tube with a ventilator and length of stay in the hospital.
But what about zinc and vitamin C for the treatment of COVID19?
The COVID19 A to Z study was a prospective randomized clinical open-label trial at multiple hospitals within a single health system, involving sites in Ohio and Florida. Enrolled participants remained in their own home settings, and all study visits and/or procedures were conducted virtually via telephone, email, computer, or laptop. So we are not talking about hospitalized COVID19 patients. We’re talking about patients with mild, perhaps moderate illness here. A total of 214 patients were randomized, 132 women, 82 men, and 45.
Patients were randomized in a 1:1:1:1 ratio, meaning 1/4th received vitamin C, 1/4th received zinc, 1/4th received both vitamin C and zinc, and 1/4th received neither, just standard of care, which is nothing more than rest, hydration, and maybe some Tylenol or ibuprofen, but no supplements. The vitamin C group received 10 days of 8,000 mg vitamin C after being diagnosed with COVID19 based on PCR testing. The zinc group received 50 mg of zinc gluconate at bedtime. The zinc and vitamin C group received 8,000 mg of vitamin C and 50 mg of zinc.
So we are talking big doses here, much more than what most people take. Patients then tracked their symptoms daily, including potential side effects from vitamin c and zinc. During the course of study, patients admitted to the hospital were considered treatment failures and were no longer required to continue study supplementation or track their daily symptoms.
The trial’s primary endpoint was the number of days required to reach a 50% reduction in symptom severity score from peak symptom score. Secondary endpoints were the number of days required to get a total symptom severity score of 0, cumulative severity score at day 5, hospitalizations, deaths, adjunctive prescribed medications, and adverse effects of vitamin C and Zinc.
Based on statistical analysis, there was no significant difference in the primary outcome of days required to reach a 50% reduction in symptoms among the 4 study groups. Patients who received usual care without supplementation achieved a 50% reduction in symptoms on average 4.4 days compared with 3.7 for the vitamin C group, compared to 4.9 days for the zing group, and 3.4 days for the group that received both.
Dr. Mike Hansen, MD
Internal Medicine | Pulmonary Disease | Critical Care Medicine