**Study design on:**
The relationship between zinc status and risk for severe and fatal outcome of COVID-19 disease
Zinc is an essential micronutrient for proper functioning of the immune system in particular. It is involved in generating innate as well as acquired antiviral immune response and is known to possess direct antiviral activity towards a variety of viruses.
**Type op study:**
A literature study on available scientific data on zinc, related to antiviral immunity,
coronavirus SARS-CoV, SARS-CoV2 virus and COVID-19 disease.
**Aim of the study:**
To investigate if there could be a causal relationship between zinc status of individuals and their risk for severe COVID-19 disease. The study aims to analyse available scientific literature on zinc in antiviral immunity, risk factors for low zinc status and a possible role of low zinc status in the progression of SARS-CoV2 infected patients. For this, epidemiological data on low zinc risk status and COVID-19 disease, including possible risk factors like age, sex, co-morbid conditions, drug use, nutrition and other lifestyle factors (such as smoking, alcohol intake, bodyweight) as well as clinical presentation of low zinc status and COVID-19 disease will be included.
How is zinc status of individuals related to severe and fatal outcome of COVID-19 disease? Is zinc status a predictor of COVID-19 disease progression?
**Sub research questions:**
• What are the known risk factors for severe and fatal outcome of COVID-19 disease?
• What are the known risk factors for low zinc status or zinc deficiency?
• How is zinc status related to age, sex, co-morbid conditions, drug-use and nutrition related factors predictors to a severe and fatal outcome of COVID-19 disease?
• Are there indications for zinc deficiency risk factors to be related to risk factors for severe COVID-19 disease? If so, how are they related?
• How are co-morbid conditions, drug use, nutritional and other lifestyle factors related to zinc homeostasis?
• Are there indications for zinc deficiency or low zinc status in the clinical presentation of COVID-19 disease?
• If zinc status is a risk factor for severe COVID-19 disease, what could be done (in the short term) to reduce this risk and to further preventing severe COVID-19 disease?
A systematic search in databases for the most recent reviews and meta-analysis on zinc and antiviral immunity, zinc balance and related risk factors, zinc and (SARS) corona viruses, supplemented with any more recent study related to these reviews or meta-analysis. In addition, studies are included which are relevant to meeting the aim of the review.
All related English language articles on the subject are collected. Studies are included only when the full-length article is available so that important reported details can be verified.
**Presentation of study results:**
Publication of a scientific paper on the subject in an Open Acces scientific medical journal or scientific journal on nutrition.