Do people with COVID-19 need to take zinc preparations?

This article is from NEJM Journal Watch

Zinc for Patients with COVID-19?

Do people with COVID-19 need to take zinc preparations?

Reviewed by Daniel Kaul, MD

In a randomized, blinded, multicentre study in Tunisia, oral zinc formulations appeared to be beneficial in reducing COVID-19 progression, particularly in critically ill hospitalized patients
.

Since the onset of the COVID-19 pandemic, there have been several preliminary reports suggesting that various repurposed drugs or vitamins (e.
g.
, vitamin C, hydroxychloroquine) may improve patient outcomes, but these reports have not been confirmed
in larger randomized studies.
This time, the researchers reported the results
of a randomized trial of zinc preparations.
From 15 February to 4 May 2022, 470 patients attending the COVID-19 triage area of five hospitals in Tunisia were randomized into two groups, either with a zinc preparation orally (25 mg twice daily) or placebo for 15 days
.
Patients with severe comorbidities, requiring assisted ventilation, or symptoms lasting more than 7 days were excluded
.
The mean age of patients was 54 years, 60% required supplemental oxygen at the time of trial inclusion, and 23% had received at least one dose of COVID-19 vaccine
.

At 30 days, the primary composite outcome (admission to ICU or death) was 10.
4% and 16.
7%,
respectively, in the zinc and placebo groups.
Patients in the zinc preparation group had a shorter hospital stay than the placebo group
.
Outpatients receiving zinc reported a shorter duration of symptoms, but there was no reduction
in those requiring hospitalization.

comments

Most COVID-19 trials included critically ill hospitalised patients, or mild to moderate outpatients
.
The study included both populations, making the results more difficult to interpret.

Because high mortality and high ICU hospitalization rates no longer exist, confirmatory studies
are difficult.
I wouldn't recommend zinc in hospitalized patients with COVID-19 (and certainly not for proven regimens for COVID-19 of any severity), but it doesn't seem to hurt if a patient or clinician wants to try zinc on top of other proven regimens, and there is some scientific evidence
now.

Articles that were commented on

Ben Abdallah S et al.
Twice-daily oral zinc in the treatment of patients with coronavirus disease 2019: A randomized double-blind controlled trial.
Clin Infect Dis 2022 Nov 4; ciac807; [e-pub].
(https://doi.
org/10.
1093/cid/ciac807)