The Minimal Effect of Zinc on the Survival of Hospitalized Patients With COVID-19
Retrospective 242 hospitalized patients in the USA showing adjusted hazard ratio for zinc treatment, aHR 0.66 [0.41-1.07]. [ncbi.nlm.nih.gov]
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 29% lower mortality [10‑44%]
from meta analysis of the 20 mortality results to date
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.
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
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
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..
is less effective
Please send us corrections, updates, or comments. Vaccines and
treatments are complementary. All practical, effective, and safe means should
be used based on risk/benefit analysis. No treatment, vaccine, or intervention
is 100% available and effective for all current and future variants. We do not
provide medical advice. Before taking any medication, consult a qualified
physician who can provide personalized advice and details of risks and
benefits based on your medical history and situation. FLCCC
provide treatment protocols.