Acta Scientific Nutritional Health (ASNH)(ISSN: 2582-1423)

Review Article Volume 5 Issue 11

Role of Vitamin-C, Vitamin-D and Zinc in Covid-19 Pandemic

Ayushi Joshi, Krati Goel* and Ranjana Acharya

Ph.D. Research Scholar, Department of Foods and Nutrition, G. B. Pant University of Agriculture and Technology, Pantnagar, Udham Singh Nagar, Uttarakhand, India

*Corresponding Author: Ayushi Joshi, Ph.D. Research Scholar, Department of Foods and Nutrition, G. B. Pant University of Agriculture and Technology, Pantnagar, Udham Singh Nagar, Uttarakhand, India.

Received: September 28, 2021; Published: October 13, 2021



The world is caved under the grips of the COVID-19 pandemic, caused by the SARS-CoV-2 virus, which has mutated to allow human-to-human spread. COVID-19 infection is accompanied by symptoms like fever, dry cough, fatigue, severe pneumonia, respiratory distress syndrome, and in some instances death. This affects the immune system by producing a systemic inflammatory response, or cytokine release syndrome. Patients have shown a high level of pro-inflammatory cytokines and chemokines. While there is no presence of widely available treatment for COVID-19, nutrition plays a key role in maintaining homeostasis in the physiological systems including immunological function. Micronutrient supplementation improving immunity and preventing the onset of severe symptoms. Of all the nutrients, zinc, vitamin-C, and Vitamin-D supplementation in immunity have been investigated in this review as these have the most evidence for immunological support and decrease the morbidity and mortality rates in patients. Evidence suggests that these micronutrients play an immune-modulatory role and the medical literature show that the subjection of the above-mentioned micronutrients can palliate viral respiratory infections, lower the continuance and rigorousness of symptoms, reduce the rate of hospitalization, need for an ICU or ventilator, length of stay in ICU and increase the frequency of discharge from hospital.

Keywords:COVID-19; Supplementation; Antiviral; Hospitalization; Chemokines; Cytokines; Immune-modulatory



  1. Y R Guo., et al. “The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak- A n update on the status”. Military Medical Research1 (2020).
  2. T Xiaolu., et al. “On the origin and continuing evolution of SARS-CoV-2”. National Science Review 06 (2020): 1012-1023.
  3. R Caccialanza., et al. “Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol”. Nutrition 74 (2020).
  4. K Dhama., et al. “An update on SARS-CoV-2/COVID-19 with particular reference to its clinical pathology, pathogenesis, immunopathology and mitigation strategies”. Travel Medicine and Infectious Disease 37 (2020).
  5. Centre for Disease Control and Prevention. “COVID-19”.
  6. John H Humphrey. “immune system”.
  7. D Wu., et al. “Nutritional modulation of immune function: Analysis of evidence, mechanisms, and clinical relevance”. Frontiers in Immunology 10 (2019).
  8. C E Childs., et al. “Diet and immune function”. Nutrients8 (2019).
  9. M Galmiche., et al. “Plasma peptide concentrations and peptide‐reactive immunoglobulins in patients with eating disorders at inclusion in the french EDILS cohort (Eating disorders inventory and longitudinal survey)”. Nutrients 2 (2020).
  10. R Jayawardena., et al. “Response to the letter of L. Santacroce regarding article ‘Enhancing immunity in viral infections, with special emphasis on COVID-19: A review’ (Jayawardena et al.)”. Diabetes and Metabolic Syndrome: Clinical Research and Reviews5 (2020): 839.
  11. G Messina., et al. “Functional role of dietary intervention to improve the outcome of COVID-19: A hypothesis of work”. International Journal of Molecular Sciences9 (2020).
  12. A F Gombart., et al. “A review of micronutrients and the immune system-working in harmony to reduce the risk of infection”. Nutrients 1 (2020).
  13. H Hemilä and E Chalker. “Vitamin C can shorten the length of stay in the ICU: A meta-analysis”. Nutrients 4 (2019).
  14. W B Grant., et al. “Reply: ‘vitamin d supplementation in influenza and covid-19 infections. comment on: Evidence that vitamin d supplementation could reduce risk of influenza and covid-19 infections and deaths nutrients 2020, 12 (4), 988”. Nutrients 6 (2020).
  15. J I Lee and G J Burckart. “Nuclear factor kappa B: Important transcription factor and therapeutic target”. Journal of Clinical Pharmacology11 (1998).
  16. A C Carr and S Maggini. “Vitamin C and immune function”. Nutrients 11 (2017).
  17. L Zhang and Y Liu. “Potential interventions for novel coronavirus in China: A systematic review”. Journal of Medical Virology 5 (2020).
  18. L Pauling. “The significance of the evidence about ascorbic acid and the common cold.”. Proceedings of the National Academy of Sciences of the United States of America 11 (1971): 2678-2681.
  19. H Hemilä and E Chalker. “Vitamin C for preventing and treating the common cold”. Cochrane Database of Systematic Reviews1 (2013).
  20. C S Johnston., et al. “Vitamin C supplementation slightly improves physical activity levels and reduces cold incidence in men with marginal vitamin C status: A randomized controlled trial”. Nutrients7 (2014).
  21. C Hunt., et al. “The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections”. International Journal for Vitamin and Nutrition Research 3 (1994).
  22. H Hemilä. “Vitamin C intake and susceptibility to pneumonia”. Pediatric Infectious Disease Journal9 (1997): 836-837.
  23. F Böhm., et al. “Vitamin C blocks vascular dysfunction and release of interleukin-6 induced by endothelin-1 in humans in vivo”. Atherosclerosis2 (2007).
  24. A F Feyaerts and W Luyten. “Vitamin C as prophylaxis and adjunctive medical treatment for COVID-19?”. Nutrition (2020): 79-80.
  25. A C Carr. “Vitamin C administration in the critically ill: A summary of recent meta-analyses”. Critical Care1 (2019).
  26. A A Fowler., et al. “Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients with Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial”. JAMA - Journal of the American Medical Association13 (2019): 1261-1270.
  27. H M W Khan., et al. “Unusual early recovery of a critical COVID-19 patient after administration of intravenous vitamin C”. American Journal of Case Reports 21 (2020).
  28. P L Langlois., et al. “Vitamin C Administration to the Critically Ill: A Systematic Review and Meta-Analysis”. Journal of Parenteral and Enteral Nutrition3 (2019): 335-346.
  29. G Murdaca., et al. “Vitamin D and Covid-19: an update on evidence and potential therapeutic implications”. Clinical and Molecular Allergy1 (2020).
  30. S A Lanham-New., et al. “Vitamin D and SARS-CoV-2 virus/COVID-19 disease”. BMJ 1 (2020).
  31. M Iddir., et al. “Strengthening the immune system and reducing inflammation and oxidative stress through diet and nutrition: Considerations during the covid-19 crisis”. Nutrients6 (2020).
  32. R Bals., et al. “The peptide antibiotic LL-37/hCAP-18 is expressed in epithelia of the human lung where it has broad antimicrobial activity at the airway surface”. Proceedings of the National Academy of Sciences of the United States of America16 (1998).
  33. C L Greiller and A R Martineau. “Modulation of the immune response to respiratory viruses by vitamin D”. Nutrients 6 (2015).
  34. L G V Buonfiglio., et al. “Effect of vitamin D3 on the antimicrobial activity of human airway surface liquid: Preliminary results of a randomised placebo-controlled doubleblind trial”. BMJ Open Respiratory Research 1 (2017).
  35. Q Ye., et al. “The pathogenesis and treatment of the `Cytokine Storm’ in COVID-19”. Journal of Infection 6 (2020): 607-613.
  36. M A Crane-Godreau., et al. “Vitamin D Deficiency and Air Pollution Exacerbate COVID-19 Through Suppression of Antiviral Peptide LL37”. Frontiers in Public Health 8 (2020).
  37. H Chen., et al. “Vitamin D Receptor Deletion Leads to the Destruction of Tight and Adherens Junctions in Lungs”. Tissue Barriers 4 (2018).
  38. A D’avolio., et al. “25-hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2”. Nutrients5 (2020).
  39. D M McCartney and D G Byrne. “Optimisation of vitamin d status for enhanced immuno-protection against covid-19”. Irish Medical Journal 4 (2020): 58.
  40. D P Misra., et al. “Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets”. Clinical Rheumatology7 (2020): 2055-2062.
  41. W B Grant., et al. “Targeted 25-hydroxyvitamin D concentration measurements and vitamin D3 supplementation can have important patient and public health benefits”. European Journal of Clinical Nutrition 3 (2020): 366-376.
  42. A Panarese and E Shahini. “Letter: Covid-19, and vitamin D”. Alimentary Pharmacology and Therapeutics10 (2020).
  43. P E Marik., et al. “Does vitamin D status impact mortality from SARS-CoV-2 infection?”. Medicine in Drug Discovery 6 (2020).
  44. A Rastogi., et al. “Short term, high-dose vitamin D supplementation for COVID-19 disease: A randomised, placebo-controlled, study (SHADE study)”. Postgraduate Medical Journal (2020).
  45. D O Meltzer., et al. “Association of vitamin D status and other clinical characteristics with COVID-19 test results”. JAMA Network Open9 (2020).
  46. H Yisak., et al. “Effects of vitamin d on covid-19 infection and prognosis: A systematic review”. Risk Management and Healthcare Policy 14 (2021): 31-38.
  47. S Arihiro., et al. “Randomized Trial of Vitamin D Supplementation to Prevent Seasonal Influenza and Upper Respiratory Infection in Patients with Inflammatory Bowel Disease”. Inflammatory Bowel Disease 6 (2019): 1088-1095.
  48. M Loeb., et al. “Effect of Vitamin D supplementation to reduce respiratory infections in children and adolescents in Vietnam: A randomized controlled trial”. Influenza and Other Respiratory Viruses 2 (2019).
  49. A A Ginde., et al. “High-Dose Monthly Vitamin D for Prevention of Acute Respiratory Infection in Older Long-Term Care Residents: A Randomized Clinical Trial”. Journal of the American Geriatrics Society 3 (2017): 496-503.
  50. K Hueniken., et al. “Effect of high-dose Vitamin D supplementation on upper respiratory tract infection symptom severity in healthy children”. The Pediatric Infectious Disease Journal 6 (2019): 564-568.
  51. Y Shimizu., et al. “Erratum to: Intake of 25-hydroxyvitamin D3 reduces duration and severity of upper respiratory tract infection: A randomized, double-blind, placebo-controlled, parallel group comparison study”. The Journal of Nutrition, Health and Aging (2018).
  52. J Zhou., et al. “Preventive effects of Vitamin D on seasonal influenza a in infants: A multicenter, randomized, open, controlled clinical trial”. The Pediatric Infectious Disease Journal 8 (2018): 749-754.
  53. M Aglipay., et al. “Effect of high-dose vs standard-dose wintertime Vitamin D supplementation on viral upper respiratory tract infections in young healthy children”. JAMA3 (2017).
  54. R Scragg. “The Vitamin D Assessment (ViDA) study - Design and main findings”. Journal of Steroid Biochemistry and Molecular Biology 198 (2020).
  55. D R Gold., et al. “Lung VITAL: Rationale, design, and baseline characteristics of an ancillary study evaluating the effects of vitamin D and/or marine omega-3 fatty acid supplements on acute exacerbations of chronic respiratory disease, asthma control, pneumonia and lung fu”. Contemporary Clinical Trials 47 (2016): 185-195.
  56. J A E Manson., et al. “Principal results of the VITamin D and OmegA-3 TriaL (VITAL) and updated meta-analyses of relevant vitamin D trials”. Journal of Steroid Biochemistry and Molecular Biology 198 (2020): 105522.
  57. S A Read., et al. “The Role of Zinc in Antiviral Immunity”. Advances in Nutrition4 (2019): 696-710.
  58. J Brewer., et al. “Potential interventions for SARS-CoV-2 infections: Zinc showing promise”. Journal of Medical Virology3 (2021): 1201-1203.
  59. B X Hoang and B Han. “A possible application of hinokitiol as a natural zinc ionophore and anti-infective agent for the prevention and treatment of COVID-19 and viral infections”. Medical Hypotheses 145 (2020).
  60. S Maggini., et al. “Essential role of vitamin c and zinc in child immunity and health”. Journal of International Medical Research2 (2010).
  61. G C Sturniolo., et al. “Effect of zinc supplementation on intestinal permeability in experimental colitis”. Journal of Laboratory and Clinical Medicine 5 (2002): 311-315.
  62. K Shin., et al. “Tight junctions and cell polarity”. Annual Review of Cell and Developmental Biology 22 (2006): 207-235.
  63. M Maares and H Haase. “Zinc and immunity: An essential interrelation”. Archives of Biochemistry and Biophysics 611 (2016): 58-65.
  64. F Coperchini., et al. “The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system”. Cytokine and Growth Factor Reviews 53 (2020): 25-32.
  65. M T Rahman and S Z Idid. “Can Zn Be a Critical Element in COVID-19 Treatment?”. Biological Trace Element Research 2 (2021): 550-558.
  66. A V Skalny., et al. “Zinc and respiratory tract infections: Perspectives for CoviD’19 (Review)”. International Journal of Molecular Medicine1 (2020).
  67. A JW te Velthuis., et al. “Zn2+ inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture”. PLoS Pathogen11 (2010).
  68. A I Q Truong-Tran., et al. “New insights into the role of zinc in the respiratory epithelium”. Immunology and Cell Biology2 (2001): 170-177.
  69. A S Prasad. “Zinc: Mechanisms of host defense”. in Journal of Nutrition 137.5 (2007): 1345-1349.
  70. R O Suara and J E Crowe. “Effect of Zinc Salts on Respiratory Syncytial Virus Replication”. Antimicrobial Agents and Chemotherapy 3 (2004): 783-790.
  71. N Kaushik., et al. “Zinc: A Potential Antiviral Against Hepatitis e Virus Infection?”. DNA Cell Biology7 (2018).
  72. K Lanke., et al. “PDTC inhibits picornavirus polyprotein processing and RNA replication by transporting zinc ions into cells”. Journal of General Virology 4 (2007).
  73. I Cakman., et al. “Zinc supplementation reconstitutes the production of interferon-α by leukocytes from elderly persons”. Journal of Interferon and Cytokine Research 8 (1997).
  74. K Berg., et al. “Zinc potentiates the antiviral action of human IFN-α tenfold”. Journal of Interferon and Cytokine Research7 (2001).
  75. M F McCarty and J J DiNicolantonio. “Nutraceuticals have potential for boosting the type 1 interferon response to RNA viruses including influenza and coronavirus”. Progress in Cardiovascular Diseases3 (2020): 383-385.
  76. R Speth., et al. “Concentration‐dependent effects of zinc on angiotensin‐converting enzyme‐2 activity (1067.4)”. FASEB JournalS1 (2014).
  77. SW McPherson., et al. “Investigate Oral Zinc as a Prophylactic Treatment for Those at Risk for COVID-19”. American Journal of Ophthalmology 216 (2020).
  78. M Singh and R R Das. “Zinc for the common cold”. Cochrane Database of Systematic Reviews4 (2015).
  79. AS Prasad., et al. “Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate: A randomized, double-blind, placebo-controlled trial”. Annals of Internal Medicine 4 (2000): 245-252.
  80. H Hemilä and E Chalker. “The effectiveness of high dose zinc acetate lozenges on various common cold symptoms: A meta-analysis”. BMC Family Practice1 (2015): 24.
  81. H Hemilä., et al. “Zinc acetate lozenges for treating the common cold: an individual patient data meta-analysis”. British Journal of Clinical Pharmacology (2016).
  82. Y Tian., et al. “Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission”. Alimentary Pharmacology and Therapeutics 9 (2020): 843-851.
  83. F D’Amico., et al. “Diarrhea During COVID-19 Infection: Pathogenesis, Epidemiology, Prevention, and Management”. Clinical Gastroenterology and Hepatology8 (2020).
  84. C Huang., et al. “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China”. Lancet 10223 (2020): 497-506.
  85. L Pan., et al. “Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study”. American Journal of Gastroenterology5 (2020): 766-773.
  86. S Bhatnagar and U C M Natchu. “Zinc in child health and disease”. in Indian Journal of Pediatrics 71.11 (2004): 911-915.
  87. M Lazzerini. “Oral zinc provision in acute diarrhea”. Current Opinion in Clinical Nutrition and Metabolic Care 3 (2016): 239-243.
  88. J Sánchez., et al. “Efecto del zinc aminoquelado y el sulfato de zinc en la incidencia de la infección respiratoria y la diarrea en niños preescolares de centros infantiles”. Biomedica1 (2014).
  89. X Wang., et al. “Zinc supplementation modifies tight junctions and alters barrier function of CACO-2 human intestinal epithelial layers”. Digestive Diseases and Sciences1 (2013): 77-87.
  90. P Medeiros., et al. “The micronutrient zinc inhibits EAEC strain 042 adherence, biofilm formation, virulence gene expression, and epithelial cytokine responses benefiting the infected host”. Virulence 7 (2013).
  91. Z S Lassi., et al. “Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months”. Cochrane Database of Systematic Reviews12 (2016).
  92. H Shakoor., et al. “Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19?”. Maturitas 143 (2021): 1-9.
  93. E Finzi. “Treatment of SARS-CoV-2 with high dose oral zinc salts: A report on four patients”. International Journal of Infectious Diseases 99 (2020): 307-309.
  94. P T James., et al. “The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review”. Journal of Nutrition7 (2021).
  95. J S Yao., et al. “The Minimal Effect of Zinc on the Survival of Hospitalized Patients With COVID-19: An Observational Study”. Chest 1 (2021).
  96. J Singh., et al. “Impact of Covid -19 on alterations in Food habits and lifestyle behaviour of Indians: A Review”. ACTA Scientific Nutritional Health 5 (2021).


Citation: Ayushi Joshi., et al. “Role of Vitamin-C, Vitamin-D and Zinc in Covid-19 Pandemic".Acta Scientific Nutritional Health 5.11 (2021): 23-33.


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