11/16/2020
NEW guidelines re Covid from one of the MDs working in NY... short version is:
1. Keeping taking your Zinc to boost immunity and help avoid infxn
2. If you get infected, temporarily STOP Zn until infxn clears.
Details below:
—> Thank you for this great question! As you know, there is a generally accepted principle that zinc helps to augment the function of the immune system and would therefore be of benefit in preventing initial infections. Our review of the literature confirmed this. [For instance, see this in silico and in vitro study on the related virus SARS: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176]. There are MANY studies that support this line of thought.
We were surprised and concerned, however, to find several in silico analyses which showed that zinc also stabilized SARS CoV-2 protein products, thus allowing for greater viral production after infection has taken hold [for instance: https://www.preprints.org/manuscript/202005.0423/v2]. In another quantum mechanics study, the authors conclude that temporary withholding of zinc and substituting with magnesium may be of benefit in inhibiting the viral Open Reading Frame (ORF) protein production – ORF’s are the viral pro-proteins which are ultimately cleaved into the active structural and non-structural proteins. "... cellular Zn deprivation, with Zn replacement by Mg and/or specific drugs based on Ag(I) or Au(I) (Kluska et al., 2020), might result in a significant slowing down of viral replication, owing to the inhibition of orf7a/BST2 and orf8/BST2 complexes formation." [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533540/]
This review of metal/viral protein interactions discusses at length the vital role of zinc in stabilizing the three-dimensional configuration of viral-derived proteins, and how the lack of zinc can have grave consequences for the protein's structure and function. [https://academic.oup.com/femspd/article/43/2/105/604210]. In particular, SARS CoV-2 NSP (Non-structural proteins)13 and 16 are highly dependent on integrated zinc atoms to maintain their structure and function [https://www.mdpi.com/2073-4409/9/5/1267].
Bismuth salts, which bind SARS CoV-2 viral protein zinc, inhibit viral replication by binding to the Zinc Binding Domain of NSP 13 [https://link.springer.com/article/10.1007/s12250-020-00242-1]. Zinc ejectors have been shown to work against multiple viral proteins, including papain-like cysteine protease (PLpro), NSP 10 (Transcription Factor), and NSP 13 (Helicase), inhibiting multiple structural and catalytic roles essential in viral replication {https://pubs.rsc.org/en/content/articlehtml/2020/sc/d0sc02646h].
There are no solid in vivo comparisons between zinc therapy and placebo, though there are ongoing trials which are pending [for instance: https://clinicaltrials.gov/ct2/show/NCT04542993]. There is an excellent review on the role of zinc for SARS CoV-2 here: https://www.sciencedirect.com/science/article/pii/S2212958820301427.
There is a consensus that zinc deficiency should probably be corrected. We recommend zinc to prevent infection - it is an essential element in immunity. But - is it reasonable to assume that those newly ill who have not been supplementing are likely zinc deficient and should therefore be given zinc empirically? Do we have time to assess zinc status in the very ill before initiating supplementation?
The question of zinc therapy rests upon which effect dominates - zinc augmenting host immunity vs zinc stabilizing viral proteins. And further along that mode of thought, do supra-physiologic levels of zinc help or hinder?
In silico analyses can never predict in vivo responses definitively, but they do raise concerns. There is no consensus on the use of zinc nationally or even among IFM educators. From my point of view, first do no harm. Based on the above analysis I have recommended against empiric zinc supplementation once an infection is established. However, I would check a zinc level and replenish a deficiency. Once we have better in vivo data we will certainly revisit this current recommendation. — feeling breaking news.
The global COVID-19 pandemic has prompted an urgent search for interventions to prevent and treat SARS-CoV-2. Higher risk of infection and adverse out…
