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67 zinc COVID-19 controlled studies, 9 RCTs
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+ Derwand 79% 0.21 [0.03-1.47] death 1/141 13/377 CT2 Improvement, RR [CI] Treatment Control Derwand 82% 0.18 [0.07-0.54] hosp. 4/141 58/377 CT2 COVIDAtoZ Thomas (RCT) -44% 1.44 [0.36-5.71] hosp. 5/58 3/50 COVIDAtoZ Thomas (RCT) 12% 0.88 [0.67-1.16] recov. time 58 (n) 50 (n) Aldwihi 24% 0.76 [0.51-1.08] hosp. 53/199 184/539 Asimi 97% 0.03 [0.00-0.44] ventilation 0/270 9/86 CT2 Asimi 99% 0.01 [0.00-0.16] hosp. 0/270 24/86 CT2 Asimi 100% 0.00 [0.00-0.08] severe case 0/270 51/86 CT2 Mayberry 53% 0.47 [0.33-0.65] death 938 (n) 1,090 (n) Mayberry 64% 0.36 [0.27-0.47] ventilation 938 (n) 1,090 (n) Mayberry 60% 0.40 [0.31-0.52] ICU 938 (n) 1,090 (n) Mayberry 58% 0.42 [0.33-0.54] death/v/ICU 938 (n) 1,090 (n) Mayberry 85% 0.15 [0.10-0.22] progression 938 (n) 1,090 (n) VIZIR Abdallah (DB RCT) 30% 0.70 [0.36-1.31] death 15/231 22/239 VIZIR Abdallah (DB RCT) 38% 0.62 [0.37-0.99] death/ICU 24/231 40/239 VIZIR Abdallah (DB RCT) 54% 0.46 [0.23-0.88] ICU 12/231 27/239 VIZIR Abdallah (DB RCT) 42% 0.58 [0.39-0.87] oxygen 31/231 55/239 VIZIR Abdallah (DB RCT) 23% 0.77 [0.65-0.91] oxygen 108/231 145/239 VIZIR Abdallah (DB RCT) 29% 0.71 [0.57-0.88] no recov. 82/231 120/239 VIZIR Abdallah (DB RCT) 14% 0.86 [0.80-0.93] no recov. 180/231 216/239 VIZIR Abdallah (DB RCT) 69% 0.31 [0.03-2.61] hosp. 1/85 4/100 VIZIR Abdallah (DB RCT) 33% 0.67 [0.59-0.75] hosp. time 146 (n) 134 (n) VIZIR Abdallah (DB RCT) 25% 0.75 [0.65-0.87] recov. time 85 (n) 100 (n) Carlucci 38% 0.62 [0.46-0.84] death/HPC 54/411 119/521 Carlucci 18% 0.82 [0.54-1.25] ventilation 29/411 62/521 Carlucci 23% 0.77 [0.53-1.10] ICU 38/411 82/521 Krishnan 18% 0.82 [0.62-1.09] death 31/58 61/94 Yao 34% 0.66 [0.41-1.07] death 73/196 21/46 Frontera (PSM) 37% 0.63 [0.44-0.91] death 121/1,006 424/2,467 CT2 Frontera (PSM) 24% 0.76 [0.60-0.96] death 121/1,006 424/2,467 CT2 Abd-Elsalam (RCT) 1% 0.99 [0.30-3.31] death 5/96 5/95 data issues, see notes Abd-Elsalam (RCT) 34% 0.66 [0.19-2.26] ventilation 4/96 6/95 data issues, see notes Abd-Elsalam (RCT) 6% 0.94 [0.55-1.62] no recov. 20/96 21/95 data issues, see notes Abd-Elsalam (RCT) 4% 0.96 [0.86-1.08] hosp. time 96 (n) 95 (n) data issues, see notes Rosenthal -16% 1.16 [1.05-1.28] death n/a n/a Darban (RCT) 33% 0.67 [0.14-3.17] progression 2/10 3/10 ICU patients CT2 Darban (RCT) 6% 0.94 [0.84-1.06] ICU 10 (n) 10 (n) ICU patients CT2 Patel (DB RCT) 20% 0.80 [0.15-4.18] death 2/15 3/18 Mulhem 46% 0.54 [0.43-0.68] death 256/1,596 260/1,623 Gadhiya -41% 1.41 [0.69-2.57] death 21/54 34/229 Al Sulaiman (ICU) 36% 0.64 [0.37-1.10] death 23/82 32/82 ICU patients Al Sulaiman (ICU) 48% 0.52 [0.29-0.92] death 19/82 31/82 ICU patients Al Sulaiman (ICU) -25% 1.25 [0.84-1.87] ICU 82 (n) 82 (n) ICU patients Al Sulaiman (ICU) -6% 1.06 [0.85-1.33] hosp. time 82 (n) 82 (n) ICU patients Frontera 33% 0.67 [0.44-1.03] PASC 382 (all patients) Frontera 57% 0.43 [0.23-0.83] PASC 382 (all patients) Elavarasi 65% 0.35 [0.24-0.56] death 486 (n) 1,201 (n) Assiri (ICU) -81% 1.81 [0.41-6.97] death 10/60 4/58 ICU patients Reszinate Kaplan (RCT) -14% 1.14 [0.08-16.6] ventilation 1/14 1/16 CT2 Reszinate Kaplan (RCT) -14% 1.14 [0.08-16.6] ICU 1/14 1/16 CT2 Reszinate Kaplan (RCT) -14% 1.14 [0.08-16.6] hosp. 1/14 1/16 CT2 Zangeneh (ICU) -21% 1.21 [0.51-2.90] death n/a n/a ICU patients Alahmari 30% 0.70 [0.63-0.78] hosp. time 130 (n) 847 (n) Doocy 41% 0.59 [0.19-1.85] death 3/28 21/116 Ibrahim Alhajjaji 88% 0.12 [0.01-2.24] death 0/44 4/57 Ibrahim Alhajjaji 26% 0.74 [0.23-2.37] ventilation 4/44 7/57 Ibrahim Alhajjaji 3% 0.97 [0.45-2.10] ICU 9/44 12/57 Ibrahim Alhajjaji 73% 0.27 [0.10-0.74] progression 4/44 19/57 Ibrahim Alhajjaji 29% 0.71 [0.54-0.94] hosp. time 44 (n) 57 (n) Kyagambiddwa 25% 0.75 [0.44-1.25] death 20/89 22/73 Seely (DB RCT) 48% 0.52 [0.10-2.71] progression 2/42 4/44 CT2 Seely (DB RCT) 14% 0.86 [0.61-1.22] no recov. 34 (n) 24 (n) CT2 Seely (DB RCT) 29% 0.71 [0.28-1.75] no recov. 7/34 7/24 CT2 Seely (DB RCT) 29% 0.71 [0.31-1.65] no recov. 32 (n) 31 (n) CT2 Seely (DB RCT) 14% 0.86 [0.37-1.97] no recov. 33 (n) 30 (n) CT2 Seely (DB RCT) 50% 0.50 [0.19-1.34] no recov. 32 (n) 33 (n) CT2 Seely (DB RCT) -12% 1.12 [0.82-1.54] no recov. 30 (n) 25 (n) CT2 Seely (DB RCT) -4% 1.04 [0.77-1.40] recov. time 34 (n) 24 (n) CT2 Seely (DB RCT) 12% 0.88 [0.19-4.02] PASC 3/33 3/29 CT2 Seely (DB RCT) 36% 0.64 [0.16-2.65] PASC 3/35 4/30 CT2 Seely (DB RCT) 1% 0.99 [0.34-2.93] PASC 6/35 5/29 CT2 Milan 56% 0.44 [0.18-1.09] death 9/129 8/51 Milan 13% 0.87 [0.44-1.71] ventilation 22/129 10/51 Milan 10% 0.90 [0.48-1.69] ICU 25/129 11/51 Louca 1% 0.99 [0.93-1.06] cases population-based cohort Mahto 37% 0.63 [0.22-1.49] IgG+ 10/38 83/651 Bejan 18% 0.82 [0.22-3.13] ventilation 155 (n) 9,074 (n) Bejan 30% 0.70 [0.19-2.54] ICU 155 (n) 9,112 (n) COVIDENCE UK Holt 7% 0.93 [0.59-1.44] cases 21/750 425/14,477 Abdulateef 13% 0.87 [0.38-1.97] hosp. 7/111 23/317 Seet (CLUS. RCT) 50% 0.50 [0.34-0.75] symp. case 33/634 64/619 OT1 Seet (CLUS. RCT) 27% 0.73 [0.55-0.97] cases 300/634 433/619 OT1 Israel 100% 0.00 [0.00-0.89] hosp. case control CT2 Bagheri 60% 0.40 [0.04-3.53] severe case 33 (n) 477 (n) Bagheri 41% 0.59 [0.14-1.61] hosp. 4/33 167/477 Gordon 68% 0.32 [0.01-7.87] death 0/104 1/96 Gordon 85% 0.15 [0.02-0.58] symp. case 2/104 9/96 Kumar 20% 0.80 [0.21-2.99] death 6/75 3/30 Nimer -25% 1.25 [0.87-1.77] hosp. 41/326 178/1,822 Nimer -13% 1.13 [0.81-1.56] severe case 46/326 214/1,822 Shehab 47% 0.53 [0.19-1.47] severe case 4/65 22/188 Citu 18% 0.82 [0.12-5.68] severe case 2/74 2/61 CT2 Stambouli (DB RCT) 68% 0.32 [0.03-2.95] symp. case 1/59 3/56 Stambouli (DB RCT) 5% 0.95 [0.29-3.10] cases 5/59 5/56 Stambouli (DB RCT) 21% 0.79 [0.73-0.84] viral load 59 (n) 56 (n) Adrean -12% 1.12 [0.74-1.70] cases 30/2,111 80/6,315 Sharif 40% 0.60 [0.46-0.77] severe case n/a n/a Sharif 97% 0.03 [0.01-0.22] severe case n/a n/a Asoudeh 57% 0.43 [0.21-0.90] severe case 250 (all patients) Seifi 31% 0.69 [0.52-0.94] hosp. n/a n/a per unit change Zinc COVID-19 outcomes c19 earlyDecember 2024 1 OT: comparison with other treatment 2 CT: study uses combined treatment Favors zinc Favors control
Figure S2. Comparison of results for RCTs versus observational studies.
For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.
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