Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four patients
Eric Finzi
Coronavirus 2019 (COVID-19) is a pandemic with substantial mortality and no accepted therapy. We report here on four consecutive outpatients with clinical characteristics (CDC case definition) of and/or laboratory-confirmed COVID-19 who were treated with high dose zinc salt oral lozenges. All four patients experienced significant improvement in objective and symptomatic disease measures after one day of high dose therapy suggesting that zinc therapy was playing a role in clinical recovery. A mechanism for zinc's effects is proposed based on previously published studies on SARS-CoV-1, and randomized controlled trials assessing zinc shortening of common cold duration. The limited sample size and study design preclude a definitive statement about the effectiveness of zinc as a treatment for COVID-19 but suggest the variables to be addressed to confirm these initial findings in future trials.
Funding No funding was provided for this study.
Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References
Carlucci, Petrilli, Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and azithromycin alone: outcomes in hospitalized COVID-19 patients Medrxiv,
doi:10.1101/2020.05.02.20080036
Derwand, Scholz, Does zinc supplementation enhance the clinical efficacy of chloroquine/hydroxychloroquine to win today's battle against COVID-19?, Med Hypotheses. May
Eby, Zinc lozenges as cure for the common cold -A review and hypothesis, Med Hypotheis
Eby, Zinc lozenges: cold cure or candy? Solution chemistry determinations, Biosci Rep
Fig, None
Lanke, Krenn, Melchers, Seipelt, Van Kuppeveld, PDTC inhibits picornavirus polyprotein processing and RNA replication by transporting zinc ions into cells, J Gen Virol
Prasad, Fitzgerald, Bao, Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial, Ann Int Med
Shittu, Afolami, Improving the efficacy of Chloroquine and Hydroxychloroquine against SARS-CoV-2 may require Zinc additives -A better synergy for future COVID-19 clinical trials, Infez Med. Ahead of print
Skalny, Rink, Ajsuvakova, Zinc and respiratory tract infections: Perspectives for COVID-19 (Review), Int J Mol Med
Velthuis, Van Den Worm, She, Sims, Baric et al., 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
{ 'indexed': {'date-parts': [[2024, 3, 31]], 'date-time': '2024-03-31T18:56:39Z', 'timestamp': 1711911399857},
'reference-count': 10,
'publisher': 'Elsevier BV',
'license': [ { 'start': { 'date-parts': [[2020, 10, 1]],
'date-time': '2020-10-01T00:00:00Z',
'timestamp': 1601510400000},
'content-version': 'tdm',
'delay-in-days': 0,
'URL': 'https://www.elsevier.com/tdm/userlicense/1.0/'},
{ 'start': { 'date-parts': [[2020, 6, 4]],
'date-time': '2020-06-04T00:00:00Z',
'timestamp': 1591228800000},
'content-version': 'vor',
'delay-in-days': 0,
'URL': 'http://creativecommons.org/licenses/by-nc-nd/4.0/'}],
'content-domain': { 'domain': [ 'ijidonline.com', 'clinicalkey.jp', 'clinicalkey.com', 'clinicalkey.es',
'clinicalkey.fr', 'clinicalkey.com.au', 'elsevier.com',
'sciencedirect.com'],
'crossmark-restriction': True},
'published-print': {'date-parts': [[2020, 10]]},
'DOI': '10.1016/j.ijid.2020.06.006',
'type': 'journal-article',
'created': {'date-parts': [[2020, 6, 6]], 'date-time': '2020-06-06T15:17:17Z', 'timestamp': 1591456637000},
'page': '307-309',
'update-policy': 'http://dx.doi.org/10.1016/elsevier_cm_policy',
'source': 'Crossref',
'is-referenced-by-count': 91,
'title': 'Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four patients',
'prefix': '10.1016',
'volume': '99',
'author': [{'given': 'Eric', 'family': 'Finzi', 'sequence': 'first', 'affiliation': []}],
'member': '78',
'reference': [ { 'issue': 'Apr Pt 4',
'key': '10.1016/j.ijid.2020.06.006_bib0005',
'doi-asserted-by': 'crossref',
'first-page': '1206',
'DOI': '10.1099/vir.0.82634-0',
'article-title': 'PDTC inhibits picornavirus polyprotein processing and RNA replication '
'by transporting zinc ions into cells',
'volume': '88',
'author': 'Lanke',
'year': '2007',
'journal-title': 'J Gen Virol.'},
{ 'key': '10.1016/j.ijid.2020.06.006_bib0010',
'doi-asserted-by': 'crossref',
'DOI': '10.1371/journal.ppat.1001176',
'article-title': 'Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in '
'vitro and zinc ionophores block the replication of these viruses in '
'cell culture',
'volume': '6',
'author': 'te Velthuis',
'year': '2010',
'journal-title': 'PLOS Pathog.'},
{ 'issue': '5',
'key': '10.1016/j.ijid.2020.06.006_bib0015',
'doi-asserted-by': 'crossref',
'DOI': '10.1177/2054270417694291',
'article-title': 'Zinc lozenges and the common cold: a meta-analysis comparing zinc '
'acetate and zinc gluconate, and the role of zinc dosage',
'volume': '8',
'author': 'Hemilä',
'year': '2017',
'journal-title': 'JRSM Open.'},
{ 'key': '10.1016/j.ijid.2020.06.006_bib0020',
'doi-asserted-by': 'crossref',
'DOI': '10.3892/ijmm.2020.4575',
'article-title': 'Zinc and respiratory tract infections: Perspectives for COVID-19 '
'(Review)',
'author': 'Skalny',
'year': '2020',
'journal-title': 'Int J Mol Med.'},
{ 'issue': '2',
'key': '10.1016/j.ijid.2020.06.006_bib0025',
'first-page': '192',
'article-title': 'Improving the efficacy of Chloroquine and Hydroxychloroquine against '
'SARS-CoV-2 may require Zinc additives - A better synergy for future '
'COVID-19 clinical trials. Infez Med',
'volume': '28',
'author': 'Shittu',
'year': '2020',
'journal-title': 'Ahead of print'},
{ 'issue': '142',
'key': '10.1016/j.ijid.2020.06.006_bib0030',
'article-title': 'Does zinc supplementation enhance the clinical efficacy of '
'chloroquine/hydroxychloroquine to win today’s battle against COVID-19?',
'volume': '6',
'author': 'Derwand',
'year': '2020',
'journal-title': 'Med Hypotheses.'},
{ 'key': '10.1016/j.ijid.2020.06.006_bib0035',
'series-title': 'Hydroxychloroquine and azithromycin plus zinc vs hydroxychloroquine and '
'azithromycin alone: outcomes in hospitalized COVID-19 patients Medrxiv',
'author': 'Carlucci',
'year': '2020'},
{ 'issue': '1',
'key': '10.1016/j.ijid.2020.06.006_bib0040',
'doi-asserted-by': 'crossref',
'first-page': '23',
'DOI': '10.1023/B:BIRE.0000037754.71063.41',
'article-title': 'Zinc lozenges: cold cure or candy? Solution chemistry determinations',
'volume': '24',
'author': 'Eby',
'year': '2004',
'journal-title': 'Biosci Rep.'},
{ 'issue': '3',
'key': '10.1016/j.ijid.2020.06.006_bib0045',
'doi-asserted-by': 'crossref',
'first-page': '482',
'DOI': '10.1016/j.mehy.2009.10.017',
'article-title': 'Zinc lozenges as cure for the common cold – A review and hypothesis',
'volume': '74',
'author': 'Eby',
'year': '2010',
'journal-title': 'Med Hypotheis'},
{ 'key': '10.1016/j.ijid.2020.06.006_bib0050',
'doi-asserted-by': 'crossref',
'first-page': '245',
'DOI': '10.7326/0003-4819-133-4-200008150-00006',
'article-title': 'Duration of symptoms and plasma cytokine levels in patients with the '
'common cold treated with zinc acetate. A randomized, double-blind, '
'placebo-controlled trial',
'volume': '133',
'author': 'Prasad',
'year': '2000',
'journal-title': 'Ann Int Med'}],
'container-title': 'International Journal of Infectious Diseases',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://api.elsevier.com/content/article/PII:S1201971220304410?httpAccept=text/xml',
'content-type': 'text/xml',
'content-version': 'vor',
'intended-application': 'text-mining'},
{ 'URL': 'https://api.elsevier.com/content/article/PII:S1201971220304410?httpAccept=text/plain',
'content-type': 'text/plain',
'content-version': 'vor',
'intended-application': 'text-mining'}],
'deposited': { 'date-parts': [[2020, 10, 24]],
'date-time': '2020-10-24T00:42:25Z',
'timestamp': 1603500145000},
'score': 1,
'resource': {'primary': {'URL': 'https://linkinghub.elsevier.com/retrieve/pii/S1201971220304410'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2020, 10]]},
'references-count': 10,
'alternative-id': ['S1201971220304410'],
'URL': 'http://dx.doi.org/10.1016/j.ijid.2020.06.006',
'relation': {},
'ISSN': ['1201-9712'],
'subject': [],
'container-title-short': 'International Journal of Infectious Diseases',
'published': {'date-parts': [[2020, 10]]},
'assertion': [ {'value': 'Elsevier', 'name': 'publisher', 'label': 'This article is maintained by'},
{ 'value': 'Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four '
'patients',
'name': 'articletitle',
'label': 'Article Title'},
{ 'value': 'International Journal of Infectious Diseases',
'name': 'journaltitle',
'label': 'Journal Title'},
{ 'value': 'https://doi.org/10.1016/j.ijid.2020.06.006',
'name': 'articlelink',
'label': 'CrossRef DOI link to publisher maintained version'},
{'value': 'article', 'name': 'content_type', 'label': 'Content Type'},
{ 'value': '© 2020 Published by Elsevier Ltd on behalf of International Society for '
'Infectious Diseases.',
'name': 'copyright',
'label': 'Copyright'}]}