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Consuming high doses of zinc and ascorbic acid (vitamin C) was not associated with improvements in COVID-19 infections, according to a small study published today in JAMA network open.
In an open-label experiment of 214 people with COVID ambulatory patients in Ohio and Florida, those who received one or both supplements had periods of symptom reduction similar to those who received standard care.
Over the years, scientific studies have not conclusively shown that either supplement can help overcome illnesses such as the common cold. Since the start of the pandemic, however, both supplements have seen an increase in the market due to people’s belief that they can boost the immune system. The New York Times reported zinc sales of $ 134 million, and USA today found that vitamin C sales reached $ 209 million in the first half of 2020, up 76% from 2019.
To see how zinc and ascorbic acid could affect COVID-19, the researchers randomly assigned 10 days of zinc gluconate (50 milligrams per day), ascorbic acid (8,000 milligrams per day), both, or the standard of care at 58, 58, 48, and 50 people, respectively. Ambulatory patients knew what treatment they were receiving.
The study ended early because it met criteria for futility, as assessed by the Cleveland Clinic’s Operations and Safety Oversight Committee. “These interventions did not significantly reduce the duration of symptoms associated with the virus compared to usual care,” the researchers conclude.
No significant effect on symptom reduction
The main result was to see if the supplements reduced the time taken to reduce symptoms by 50%. The average time taken for people receiving zinc was 5.9 (standard deviation [SD], 4.9) days. Those who received ascorbic acid reported an average of 5.5 (3.7) days), and those who received both reported an average duration of 5.5 (3.4).
Symptoms were not halved for 6.7 (4.4) days in the group that received only standard care, but the researchers found no statistical significance in any of these differences.
Ambulatory patients measured their symptoms on a four-point severity scale, the values of which were then added for the total symptom grade. Participants registered by July 16, 2020 noted only fever / chills, shortness of breath, cough, and fatigue. But, due to updated guidance from the Centers for Disease Control and Prevention, people enrolled after July 16 rated 12 symptoms that also included headaches, loss of taste, and runny nose / congestion. Those who were asymptomatic at the start of enrollment were classified as “missing” when calculating the time to a 50% reduction in symptoms.
No other significant benefit
The researchers also looked at the hospitalization rate, mortality, and side effects related to any of the treatments or standard of care. No arm in the experiment had significantly different results, but the researchers note that those who received ascorbic acid reported slightly more nausea, diarrhea, and stomach cramps.
(Excess vitamin C and zinc are both associated with gastrointestinal intolerance, and high amounts of zinc are also linked to metallic taste or dry mouth.)
Overall, 17 outpatients (7.9%) required hospitalization before their 28-day individual assessment was complete, and 3 (1.4%) died from causes unrelated to the procedures. One person experienced an exacerbation of chronic obstructive pulmonary disease, but this too was unrelated.
“Most ascorbic acid and zinc consumers take significantly lower doses of these supplements, so showing that even high doses of ascorbic acid and zinc had no benefit suggests a clear lack of efficacy,” write the researchers.
They add: “Recent studies have also shown that vitamin D deficiency is associated with an increased risk of SARS-CoV-2 infection and an increased risk of hospitalization, so the potential role of other supplements in reducing the symptoms of SARS-CoV-2 cannot be concluded. of our study. “
Call to focus research elsewhere
In a related review commentary, two US cardiologists point out the limitations of the study, including the small patient population, the focus only on outpatients, and the non-blind nature of the study. These limitations, however, would more than likely overstate the potential benefits of supplements.
Erin D. Michos, MD, MHS, of Johns Hopkins and Miguel Cainzos-Achirica, MD, PhD, MPH, of Houston Methodist write: “Yet the study yielded zero results, providing further assurance that the early termination of the test did not mask the detection of a real advantage. “
“Given current projections that in the coming weeks the pandemic will continue to peak around the world, as well as the potential for future outbreaks, this new disappointment should not deter further research efforts.”
However, such efforts should focus on more promising therapies for COVID, as well as optimal policies and social interventions to fight the disease, they say.
Regarding supplements like zinc and vitamin C, Michos and Cainzos-Achirica write: “Despite the urgency, we suggest that some break is needed to move forward. While supplements are generally considered benign due to their over-the-counter availability, they are not necessarily free from side effects. “
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