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BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m864 (Published 05 March 2020) Cite this as: BMJ 2020;368:m864

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Zinc supplementation and containment of covid-19 virus pandemic

Dear Editor

Zinc supplementation and containment of covid-19 virus pandemic

Modulation of zinc homeostasis is an important factor in the host-antiviral responses. A review of the antiviral activity of zinc, in a range of viruses, includes coronaviruses [1]. There are three population subgroups that would benefit from zinc supplementation. Zinc deficiency is a feature of lifestyle factor such as vegetarianism and conditions such as inflammatory bowel disease, hepatic cirrhosis and alcoholism. Alcohol promotes zinc excretion.

Zinc absorption is diminished in the elderly. The recommended daily intake for zinc is 9.5 mg for the male and 7.5 mg for the female. The elderly require up to 20 mg per day.

Patients immune-compromised for whatever reason, should receive zinc supplements. Since zinc boosts the overall immune response, all patients infected with the covid-19 virus would derive some benefit from zinc supplementation, especially those with latent zinc deficiency. Antiviral activity for zinc has been shown in coronaviruses such as SARS-CoV, MERS and EAV viruses. Zinc ionophores block the replication of these viruses in cell culture [2]. As yet, no such effect has been shown for covid-19 virus.

Blood and serum levels of zinc do not necessarily reflect the cellular zinc status. Zinc is transported albumin-bound in the blood. Low blood albumin level, in the susceptible subjects described, would require correction. Zinc supplementation may play an important role in limiting the incidence rate for the disease, especially in the elderly.

References

01. Read SA, Obeid S, Ahlenstiel C, Ahleinstiel G. The role of zinc in antiviral immunity. Adv Nutr. 2019; 10, 4:696-710.
02. te Velthuis AJ, van den Worm SH, Sims AC, Bovic RS, Snijder van Hemert MJ. Zinc(+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; 6 (11):e1001176.

Authors

Vinay K Dave
retired consultant dermatologist

Chloe A Hylton
senior biomedical scientist microbiology
Whiston Hospital

Competing interests: No competing interests

30 March 2020
Vinay K Dave
retired consultant dermatologist
Chloe A Hylton
Whiston Hospital, Liverpool