Role of high dose IV vitamin C and zinc in coronavirus

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV2), is now considered as an ongoing global pandemic. Common symptoms include pyrexia, cough, dyspnea, fatigue, sore throat, and loss of sense of taste and smell. Complications that can result from more severe insult on lung tissue is pneumonia and acute respiratory distress syndrome (ARDS), which can further lead to septic shock. It is also not uncommon to find neurological symptoms in patients suffering from COVID-19. The primary treatment for COVID-19 is symptomatic treatment and supportive care. As there is no known vaccination and antiviral therapy for this disease, there is a desperate need to find an alternative to control and stop the spread of disease. Maintaining adequate micronutrient balance might enhance the immunity and protect from viral infections as well. Vitamin C and zinc helps in improving symptoms and shortening the duration of the common cold. Vitamin C (L-ascorbic acid) possesses pleiotropic physiological activity. High dose Vitamin C has shown to be effective against the common flu, rhinovirus, avian virus, chikungunya, Zika, ARDS, and influenza, and there is evidence that supports the protective effect of high dose IV vitamin C during sepsis-induced ARDS due to COVID-19. Zinc has a profound impact on the replication of viruses. Increasing intracellular zinc concentration along with pyrithione (zinc ionophore) has been shown to impair the replication of several RNA viruses efficiently, including poliovirus, influenza virus and several picornaviruses. A combination of zinc and can also inhibit the replication of SARScoronavirus in cell culture. Introduction In December of 2019 large number of patients were presented to the hospitals in the city of Wuhan in the Hubei province of China. All these patients had symptoms related to pneumonia, and the etiological agent was unknown. Epidemiologically patients were all related to the seafood market of the Wuhan region.1,2 This pneumonia causing agent was identified as a novel coronavirus and causes coronavirus disease (COVID-19).3 Coronavirus has genetic makeup related to the family of coronaviruses and is related genetically to severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).4 As compared to SARS caused by coronavirus 1, patients with COVID-19 can be infectious in the asymptomatic stage during their incubation period.5 There are multiple variables of the course of the disease and management that need optimization.5 As of 18 June 2020, there are 8,242,999 confirmed cases and 445,535 deaths worldwide.6 The COVID-19 pandemic requires a quick response but developing vaccination or antivirals specific to COVID-19 is taking time.7 Till now, there are no Food and Drug Administration approved treatments or vaccines for highly pathogenic coronaviruses.8 Strategies that could immediately save lives are needed desperately.7 Patients with coronavirus presents with pyrexia (85%), cough (67.7%), dyspnea (18.6%), sore throat (13.9%) and nasal congestion (4.8%). The complication that can result from more severe insult on lung tissue is acute respiratory distress syndrome (ARDS), which can further lead to septic shock. Apart from these pulmonary symptoms, some patients are found to have neurological symptoms too. A study conducted on 841 patients in a Spanish hospital found that 57.4% of confirmed COVID-19 patients had neurological symptoms of some sort. 19.6% of the test population suffered from altered consciousness state, most of which were elderly and in advance stage of the disease. Of the patients who died, 4.1% had a neurological cause.9 Researchers also have isolated novel coronavirus from the cerebrospinal fluid (CSF) of affected patients; however, a case report also points towards viral encephalitis in which CSF contents are found to be within the normal range. Autopsies have revealed brain edema and partial neuron degeneration in eased patients.10,11 These complications are responsible for mortality and are contributors to Intensive care Unit (ICU) admission of patients older than 60 years, with smoking, or any other preexisting morbidity.5 As there is no specific treatment of this novel coronavirus, there is a desperate need to find an alternative solution to stop and control the spread of this virus.12 Literature is emerging that suggests the adjunctive role of vitamin C in the treatment of viral infection because vitamin C is found to be virucidal in high doses.13 Pneumonia and neurological damage seem to be caused by hyperactive immune cells or cytokine storm.10 IV high dose vitamin C could be the beneficial choice and safe during early stages of COVID-19 because it causes immunosuppression at the level of effector cells.14 Zinc is an essential trace element that is required for the maintenance and development of innate and acquired immune systems. The combination of zinc and pyrithione (zinc ionophore) can inhibit the replication of a variety of RNA viruses efficiently, including SARS-related coronavirus (SARS-CoV). Therefore, zinc supplement has an effect not only on the symptoms related to COVID-19 but also on COVID-19 itself.12 Intravenous vitamin C and zinc as immune boosters Vitamin C (ascorbic acid) and zinc are essential nutrients that play a vital role in Geriatric Care 2021; volume 7:9338 Correspondence: Muhammad Usman Ali Khan, Department of Pharmacology University of Health sciences Lahore, Pakistan. Tel.: +92.3457495041. E-mail: usman.a.khan415@gmail.com