Towards the end of 2019, a severe pneumonia-like illness was reported in persons who had contact with wildlife at the wet market in the Hubei province of China. The patients exhibited symptoms such as shortness of breath, dry cough, fever, fatigue, severe pneumonia, acute respiratory distress syndrome, and death resulted in some cases.
The SARS-CoV-2 virus, as the causative organism (an RNA virus) later came to be named, has spread from the single province in China where it was first reported to almost every country of the globe, resulting in a global crisis of unprecedented proportions, overwhelming many countries’ health systems and leaving millions dead in its wake.
At present, there is no specific antiviral treatment for COVID-19, with most countries adopting a palliative symptomatic care approach that involves among other things, the use of supplements which has been found to help the body’s immune system namely by countering inflammation as well as their antioxidant effects.
Such supplements like vitamin C, D, and zinc have been highlighted to be very helpful in the treatment of COVID-19 patients. They are currently being studied intensively to further elucidate all their potential preventive and therapeutic uses for patients and their contacts who have been exposed to COVID-19.
Pathogenesis of COVID-19
The SARS-CoV-2 encodes for the structural protein, protein S which is the spike protein. Upon infection, the receptor-binding domain of the S protein binds to the angiotensin-converting enzyme 2 (ACE2) receptors on the surface of the epithelial lining of the human heart, liver, gastrointestinal, and lung (alveoli). The lungs, however, seem to have a higher affinity for this binding.
The ensuing infection-mediated inflammatory reaction is described as the cytokine storm syndrome (CSS) – an exaggerated immune response seen in patients who have severe infections and believed to result from the increased pro-inflammatory and insufficient anti-inflammatory stimuli.
Some of these proinflammatory stimuli including cytokines like interleukin (IL-2, IL-6, IL-7), tumor necrosis factor-alpha (TNF-α), and granulocyte colony-stimulating factor are seen to be increased in the coronavirus infection while the anti-inflammatory factors – the cytokines like IL-10 and transforming growth factors beta are found to be decreased.
This CSS is characterized clinically by unrelenting fever and multi-organ pathologies such as acute renal and cardiac injury and acute respiratory distress syndrome. Laboratory features include increased ferritin levels, leucopenia, increased D-dimer, and increased pro-inflammatory cytokines. Recent studies have shown improvement in respiratory system symptoms in COVID-19 patients who have received supplements like vitamins C, D, and Zinc which are understood to have anti-inflammatory and immunomodulatory properties, and so are able to help the body counter these effects of COVID-19 infection.
Immuno Star® is one such supplement that is a combination of all three nutrients, designed to work synergistically to not only help prevent and treat COVID-19 infections but also boost the immune system generally in order to protect the individual against other diseases.
What are the benefits of Zinc, vitamin C, and Vitamin D in the management of COVID-19?
These three nutrients have been found to possess to varying extents, anti-inflammatory, anti-oxidant, anti-viral, and immunomodulatory properties. The administration of higher than normal doses of nutrients like vitamin C and D alongside zinc and omega-3 fatty acid has been found to potentially have beneficial effects in reducing the viral load of SARS-CoV-2 as well as the length of hospital stay.
In fact, deficiencies in these nutrients have been associated with a reduction in immune function and increased susceptibility to viral infections like COVID-19. The increased morbidity and risk of mortality as a result of COVID-19 infections in high-risk groups (the elderly and patients with underlying chronic infections) who are also more likely to have these nutrient deficiencies is a strong pointer to the possible role of these nutrients in immunity against COVID-19.
The Role of Vitamin D in COVID-19
Vitamin D is a fat-soluble steroid hormone precursor whose synthesis starts in the epidermis of the skin with the conversion of 7-dehydrocholesterol (7-DHC) to cholecalciferol (vitamin D3). This form of vitamin D is inert biologically and needs to be hydroxylated in the liver to 25-hydroxyvitamin D. In the kidneys, the final active hormone, 1,2 – hydroxyvitamin D (1,2(OH)2D) is synthesized. It has been found to enhance the innate and adaptive immune response to a pathogenic infection via the following roles:
- Stimulation of the production of antimicrobial peptides like cathelicidin and defensins. These help to maintain the body’s cell membranes and enhance the expression of antioxidant proteins, thereby helping to protect the cells from the damaging effects of inflammation-induced oxidative stress.
- Enhancement of monocyte differentiation into macrophages, increasing superoxide production and destruction of infective pathogens.
- Modulation of adaptive immune response by suppressing T-helper cell function and decreasing the production of pro-inflammatory cytokines (IL-2, interferon-gamma).
- Promotion of the expression of anti-inflammatory cytokines like interleukin 10.
The Role of Vitamin C in COVID-19
Also known as ascorbic acid, vitamin C is a water-soluble vitamin that is not made in vivo in the human body. Studies have suggested that administration of large doses of vitamin C was associated with reduced severity and duration of pneumonia in high-risk patients such as the elderly and immuno-compromised persons – a phenomenon believed to be the focus of the hope that vitamin C supplements could help in the prevention and treatment of COVID-19 infection. This benefit is believed to be a result of the following functions performed by the vitamin:
- It is believed to counter the cytokine storm syndrome that is understood to be central in the pathogenesis of COVID-19. This is achieved by reducing the levels of pro-inflammatory cytokines, like IL-8, IL-6, and TNF-α.
- It increases the concentration of anti-inflammatory cytokines like IL-10 which works to suppress the pro-inflammatory cytokine, IL-6. This effect has been highlighted by some clinical studies which suggested that a daily intake of about 1g/day of vitamin C increases the production of IL-10 by mononuclear lymphocytes.
- It protects against infections by supporting the epithelial defense of the respiratory system as well as resolving flu-like symptoms through its anti-histamine properties.
- It acts as an antioxidant, helping to protect the cell’s nucleotides, proteins, enzymes, and hormones from the damaging effects of reactive oxygen species whose production is occasioned by the cytokine storm syndrome.
The Role of Zinc in COVID-19
Zinc is an important trace mineral, a part of many biochemical reactions that take place in the body including those related to immunity. It enhances both the innate and acquired immune response to viral infections. It has been suggested that zinc supplements could potentially increase the efficacy of some currently utilized treatment options for COVID-19. Zinc is thought to aid the treatment and prevention of COVID-19 through the following means:
- Decreasing the production of pro-inflammatory cytokines like interferon gamma (IFN-ɤ) and tumor necrosis factor (TNF-α), therefore preventing the tissue damage and fibrotic remodeling ensuing from inflammation of vital organs like the lungs.
- Suppressing apoptosis (programmed cell death)
- Recruitment of immunological cells like neutrophils and granulocytes to the sites of infection where they produce antibodies to destroy the infecting pathogens.
- Attracting via its chemotactic effects, natural killer cells, phagocytes, CD4+ and CD8+ cells to the infected organs where they act to destroy infected cells.
- Downregulation of the transcription complex of the coronaviruses. This interferes with SARS-CoV-2 viral replication.
These facts strongly support the potential capacity of Zinc and vitamins C and D to enhance the response of COVID-19 patients to the currently available treatments.
Are there any benefits of combined nutritional supplementation of vitamin C, D, and Zn in COVID-19?
Recent studies suggest that the answer is yes. High concentrations of vitamins C and D have been found to potentially improve the response of the immune system in COVID-19 patients. This is also true for essential minerals like Zinc.
This has occasioned the recommendations from different health quarters for the increment of the amounts of these vitamins and minerals, either in the form of diets (fruits, vegetables, meat, fish, poultry, and milk products) or more efficiently, supplements given to COVID-19 patients as well as high-risk individuals. It is believed that this will help boost the immune response for individuals to aid quick recovery.
However, it is worthy of note that these studies upholding the potential roles of these supplements worked with high doses that are not usually present in the normal daily diet. Hence the recommendation for supplementation for patients and at-risk individuals as the supplements contain high enough doses to ensure efficacy albeit under the careful supervision of managing health personnel.
There are many such supplements available but the Immuno Star® supplement has the added advantage of combining these three nutrients in clinically efficacious, yet safe doses. A doctor-formulated immune booster, the Immuno Star® is recommended for both the treatment and prophylaxis of not only viral infections such as COVID-19 but also other bacterial diseases, owing to its capacity to provide the needed immune system support as well as overall health promotion.
- CDC COVID response team severed outcomes among patients with COVID-19- United States, February 12, 2020. MMWR morb. Mortal. Wkly. Rep. 2020: 343-348.
- Calder P.C. Nutrition, immunity and covid-19. BMJ Nutr. Prev. Health. 2020 bmjnph-2020
- Hemila H. Chalker E. Vitamin C can reduce the length of stay in ICU: a meta-analysis. Nutrients. 2019; 11(4):708.