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Covid-19: a puzzle with many missing pieces

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Can zinc be used as supplement in prevention and early recovery from coronavirus disease?

Dear Editor

In view of rapidly spreading coronavirus disease across the world, various public health strategies need to be devised which can be administered to the whole population at a time. Addressing nutritional component in prevention and treatment is the need of the hour.

Zinc is a crucial micronutrient that plays a diverse role in physiological functions as well as in controlling viral infections. Its antiviral action has been proved in vitro infection models through the induction of host viral response. (1, 2). The literature shows that zinc inhibits coronavirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture (4). Moreover, a metanalysis has also demonstrated that zinc in various forms such as lozenges, tablets, etc. has an important role in the common cold due to its antiviral activity. It decreases the duration of nasal discharge, congestion, sore throat, muscle ache at a dose of 80 mg/day taken for less than 2 weeks. (3)

An estimated 17.3% of the world's population is at risk of inadequate zinc intake and in South Asia, it is up to 30% (6,7). However, around 800,000 people die annually due to zinc deficiency, 450,000 of these being children under the age of five according to the World Health Organization (WHO) estimates.(5) As per the Comprehensive National Nutrition Survey also (2016-18), zinc deficiency is reported to be around 21% among the age group 1-4 years (8). Zinc deficiency has serious health consequences in humans especially in children, who are more susceptible to contract infections like malaria, diarrhea.

Furthermore, increasing carbon dioxide levels due to pollution can accelerate zinc deficiency in crops and consequently in humans (9). A study from Harvard university projected 50 million people in India especially the south and northeastern region to become zinc deficient by 2050. As these areas consume large proportion of rice in their diet which is deficient in zinc. Considering all the pieces of evidence, taking zinc supplements and increasing zinc in the diet by eating zinc fortified flour and salt, legumes, seeds, dairy, eggs, whole grains, nuts could be one of the additional public health measures especially in zinc-deficient populations, and it needs to be explored further to deal with the current panic situation.

References

1. Kaushik N, Subramani C, Anang S, Muthumohan R, Shalimar null, Nayak B, et al. Zinc Salts Block Hepatitis E Virus Replication by Inhibiting the Activity of Viral RNA-Dependent RNA Polymerase. J Virol. 2017 01;91(21).
2. Kar M, Khan NA, Panwar A, Bais SS, Basak S, Goel R, et al. Zinc Chelation Specifically Inhibits Early Stages of Dengue Virus Replication by Activation of NF-κB and Induction of Antiviral Response in Epithelial Cells. Front Immunol [Internet]. 2019 [cited 2020 Mar 23];10. Available from: https://www.frontiersin.org/articles/10.3389/fimmu.2019.02347/full
3. Hemilä H, Chalker E. The effectiveness of high dose zinc acetate lozenges on various common cold symptoms: a meta-analysis. BMC Fam Pract [Internet]. 2015 Feb 25 [cited 2020 Mar 23];16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4359576/
4. te Velthuis AJW, van den Worm SHE, Sims AC, Baric RS, Snijder EJ, van Hemert MJ. Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture. PLoS Pathog. 2010 Nov 4;6(11):e1001176.
5. Zinc in Health - Zinc.org India [Internet]. [cited 2020 Mar 23]. Available from: http://zinc.org.in/programs-and-activities/zinc-in-health/
6. Maxfield L, Crane JS. Zinc Deficiency. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 [cited 2020 Mar 23]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK493231/
7. Wessells KR, Brown KH. Estimating the Global Prevalence of Zinc Deficiency: Results Based on Zinc Availability in National Food Supplies and the Prevalence of Stunting. PLOS ONE. 2012 Nov 29;7(11):e50568.
8. https://www.popcouncil.org/uploads/pdfs/2019RH_CNNSreport.pdf
9. Smith MR, DeFries R, Chhatre A, Ghosh-Jerath S, Myers SS. Inadequate Zinc Intake in India: Past, Present, and Future. Food Nutr Bull. 2019 Mar 1;40(1):26–40.

Competing interests: No competing interests

23 March 2020
Neha Dahiya
Public health specialist
Mona Duggal, Damodar Bachani, Ankita Kankaria
Post Graduate Institute of Medical Education and Research
PGIMER, Chandigarh