The Minimal Effect of Zinc on the Survival of Hospitalized Patients With COVID-19

Yao et al., Chest, doi:10.1016/j.chest.2020.06.082, Jul 2020
Mortality 34% improvement lower risk ← → higher risk Zinc for COVID-19  Yao et al.  LATE TREATMENT Is late treatment with zinc beneficial for COVID-19? Retrospective 242 patients in the USA Lower mortality with zinc (not stat. sig., p=0.09) c19early.org Yao et al., Chest, July 2020 0 0.5 1 1.5 2+ RR
Zinc for COVID-19
2nd treatment shown to reduce risk in July 2020, now with p = 0.00000028 from 47 studies, recognized in 23 countries.
Lower risk for mortality, ventilation, hospitalization, progression, recovery, and viral clearance.
No treatment is 100% effective. Protocols combine treatments.
6,300+ studies for 210+ treatments. c19early.org
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Retrospective 242 hospitalized patients in the USA showing adjusted hazard ratio for zinc treatment, aHR 0.66 [0.41-1.07].1 notes that the study would be more informative if baseline serum zinc levels were known.
Although the 34% lower mortality is not statistically significant, it is consistent with the significant 30% lower mortality [12‑44%] from meta analysis of the 22 mortality results to date.
Standard of Care (SOC) for COVID-19 in the study country, the USA, is very poor with very low average efficacy for approved treatments2. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments. This may explain in part the very high mortality seen in this study. Results may differ in countries with improved SOC.
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risk of death, 34.0% lower, RR 0.66, p = 0.09, treatment 73 of 196 (37.2%), control 21 of 46 (45.7%), adjusted per study, multivariate Cox regression.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Yao et al., 22 Jul 2020, retrospective, USA, peer-reviewed, 9 authors.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR USA favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2025 USA Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Taiwan Zambia Fiji Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria USA favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Abstract: [ Chest Infections Research Letter ] The Minimal Effect of Zinc on the Survival of Hospitalized Patients With COVID-19 An Observational Study To the Editor: Zinc is an investigational agent against coronavirus disease 2019 (COVID-19) and has known preventative and therapeutic roles in other infections.1-3 Zinc deficiency is associated with lower survival among older patients with pneumonia and predisposes to other viral infections.3 Established risk factors for critical COVID-19, including older age, diabetes mellitus, and cardiovascular disease, are also associated with zinc deficiency.2 The antiviral and immunomodulatory effects of zinc have made it a candidate against severe acute respiratory Methods In this single-institution retrospective study, we assessed the survival of hospitalized patients with COVID-19 treated with vs without zinc sulfate. This study was conducted in accordance with the amended Declaration of Helsinki. This study’s protocol was approved and was granted a waiver of informed consent by the hospital board on April 15, 2020, based on its retrospective design and the lack of identifying information to be published, collected, or analyzed. Data of all patients with COVID-19 (N ¼ 242) admitted at the Hoboken University Medical Center until April 11, 2020, were retrospectively collected on April 21, 2020. COVID-19 was confirmed in all patients using quantitative real-time reverse transcription polymerase chain reaction for SARS-CoV-2 RNA. Clinical severity was stratified based on World Health Organization8 guidelines according to clinical, radiographic, and laboratory information from the first 24 h of admission. The primary outcome was days from admission to inhospital mortality. Data for patients who did not meet the primary outcome were censored on April 21, 2020. Our primary analysis explored the causal association between zinc therapy and the survival of hospitalized patients with COVID-19. Inverse probability weighting (IPW) and a censorship model derived an effect estimate of zinc therapy on survival using the parameter defined as the Results Of 242 patients, 81.0% received zinc sulfate at a total daily dose of 440 mg (100 mg elemental zinc). The median age of patients who received zinc was 65 years (interquartile range, 53-77), whereas that of the control 108 Research Letter syndrome-coronavirus-2 (SARS-CoV-2) infection.2-4 Zinc may decrease the activity of the angiotensin converting enzyme 2, the receptor for SARS-CoV-2. Zinc T-cell modulation may downregulate the cytokine storm associated with severe COVID-19.2,4 These properties underlie the speculated efficacy of chloroquine, a zinc ionophore, and the derivative hydroxychloroquine, which are investigational agents in the worldwide World Health Organization SOLIDARITY trial.2,5,6 Furthermore, chloroquine may increase cellular zinc uptake, suggesting therapeutic benefit from the combination of the two agents.4 Despite zinc’s low risk of adverse effects, zinc’s role in the management of COVID-19 must be supported by clinical data.7 Therefore, we investigated the role of zinc among hospitalized patients with COVID-19. average treatment effect on the treated (ATET). The lack of sufficient overlap or the positive probability of assignment to each treatment level precluded the estimation of the average treatment effect. Multivariable logistic regression modeled the propensity to receive zinc by assigning weights to established predictors of mortality and..
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Late treatment
is less effective
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