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Frontiers in Medicine
Infectious Diseases – Surveillance, Prevention and Treatment
This article is part of the Research Topic
Insights in Coronavirus Disease (COVID-19) - Surveillance, Prevention and Treatment View all 62 Articles
Marc J. Struelens
Université libre de Bruxelles, Belgium
Faris H. al Lami
University of Baghdad, Iraq
Nitya Singh
University of Florida, United States
Western Sydney University, Australia
Front. Med., 13 December 2021 | https://doi.org/10.3389/fmed.2021.756707
A Case-Control Study for the Effectiveness of Oral Zinc in the Prevention and Mitigation of COVID-19
Antonio M. Gordon1 and Patrick C. Hardigan2*
1Department of Internal Medicine, University Health Care, Hialeah, FL, United States
2Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
Background: The ongoing coronavirus disease-19 (COVID-19) pandemic (caused by an infection with severe acute respiratory syndrome (SARS)-coronavirus (CoV-2) has put a burden on the medical community and society at large. Efforts to reduce the disease burden and mortality over the course of the pandemic have focused on research to rapidly determine age-stratified seroepidemiologic surveys, a centralized research program to fast-track the most promising rapid diagnostics and serologic assays, and the testing of potential anti-viral agents, immunologic therapies, and vaccine candidates. Despite the lack of official recognition for the role of nutrition in the fight against COVID-19 infection, multiple groups proposed zinc supplementation as an adjuvant for the management of participants.
Method: In an ambulatory, interventional, prospective, single-blind study, we evaluated the effectiveness of zinc supplementation in the prevention and mitigation of COVID-19 in two similar participant groups. In Clinic A (n = 104) participants were randomized to receive 10 mg, 25 mg, or 50 mg zinc picolinate daily, and Clinic B control participants paired according to their demographics and clinical parameters (n = 96). All participants were compared based on demographics, clinical comorbidities, blood counts, renal functions, vitamin D levels, and their development of symptomatic COVID-19 infection.
Results: Symptomatic COVID-19 infection was significantly higher among the control group participants (N = 9, 10.4%) than the treatment participants (N = 2, 1.9%), p = 0.015. The unadjusted odds ratio indicates that symptomatic COVID-19 infection was 5.93 [95% CI: 1.51, 39.26] higher in the control group, p < 0.01. Controlling for co-morbidities, individuals in the control group were 7.38 (95% CI: 1.80, 50.28) times more likely to develop symptomatic COVID-19 infection as compared with individuals in the treatment group (p < 0.01). For every-one unit increase in the number of co-morbidities, the likelihood of developing symptomatic COVID-19 infection increased 1.57 (95% CI: 1.16, 2.19) (p = 0.01).
Discussion: The findings from our study suggest that zinc supplementation in all three doses (10, 25, and 50 mg) may be an effective prophylaxis of symptomatic COVID-19 and may mitigate the severity of COVID-19 infection.
Conclusion: Zinc is a relatively inexpensive mineral nutrient that is an effective prophylactic agent to prevent and mitigate the potentially deadly symptomatic SARS-CoV-2 infection. As the COVID-19 pandemic continues with a lag in vaccinations in some regions and the continued emergence of dangerously infectious variants of SARS-CoV-2, it is important to replicate our data in other populations and locations and to engage public health and nutrition services on the emergent need to use zinc supplantation or fortification of staple foods in the prevention and mitigation of COVID-19 infection severity.
The ongoing coronavirus disease-19 (COVID-19) pandemic (caused by an infection with severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2) has put a strain on the medical community and society at large, as it has spread at a rapid pace globally (1). The pandemic has progressed since it was first identified as an epidemic of a new illness and manifested initially as pneumonia secondary to a novel coronavirus in December 2019 in Wuhan, China (2).
The infection ranges symptomatically among individuals from asymptomatic to milder symptomatology that includes fever, sore throat, cough, lung infections, and in more severe manifestations of the illness, acute respiratory distress syndrome (ARDS), sepsis, and death. The most reported co-morbidities including hypertension, diabetes, chronic obstructive pulmonary disease (COPD), obesity, and cardiovascular diseases, have been shown to put participants with COVID-19 infection at greater risk of severe adverse events and death (3). As many as 50 percent of participants have been reported to have at least one of these co-morbidities when admitted to hospital with COVID-19 infection.
Over the course of 2020 and into 2021, the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) aimed to prioritize research to rapidly determine age-stratified seroepidemiologic surveys, establish a centralized research program to fast-track the most promising rapid diagnostics and serologic assays, and the testing of potential anti-viral agents, immunologic therapies, and vaccine candidates (1). Despite the lack of official recognition for the role of nutrition in the prevention and mitigation of COVID-19 infection, multiple research and clinical groups proposed zinc supplementation as an adjuvant for the management of participants (4).
During the previous coronavirus pandemic of SARS and its aftermath, zinc supplementation was found to play an important role in the reproduction of SARS through its inhibition (in vitro) of the SARS CoV-1 RNA (5, 6). Furthermore, during the current COVID-19 pandemic, zinc has been identified as a clinical marker whose deficiency manifested clinically as hypozincemia and was strongly associated with serious complications including ARDS and increased mortality (4). Some researchers proposed to study the role of zinc supplementation in the prophylaxis of COVID-19 infection, but data has not been published on its effectiveness (7). Although the availability of effective vaccines against COVID-19 infection have started to ease the devastating effects of SARS-CoV-2 in some regions of the developed world, socio-economic and political issues and the lack of public health and technological infrastructure in most of the world have yet to resolve the ongoing pandemic, which is negatively impacting Latin America, the Caribbean, Asia, and Africa due to limited access to vaccination (2, 8, 9). As such, in May 2020, we proposed to evaluate the prophylactic effects of oral supplementation with zinc in out-patients in a community where SARS CoV-2 was circulating and COVID-19 infection was prevalent at a level of least 100 cases per 100,000 population.
Participants enrolled in University Health Care (UHC) ambulatory primary care centers in Hialeah, Florida (FL) were recruited for the study group to be treated prophylactically with orally administered zinc. We initially designed a double-blind type of study using placebo capsules identical to the zinc capsules for two sets of participants selected at random from the volunteers who accepted our announcement. However, most participants in the internal medicine clinic were already taking a zinc supplement on the advice of their attending physician, AG. It was unethical to ask participants to stop taking zinc during the 2020 peaks of the pandemic at a time when the mineral supplement was already being promoted as being helpful against COVID-19 infection. Instead, we decided to study the dose of zinc necessary to prevent or mitigate COVID-19 infection from participants in AG's clinic, hereafter labeled Clinic A, who were willing to be randomized to one of three daily dose regimens: 10, 25, or 50 mg. A diagram was posted in the clinic visible to all participants attending the primary care UHC centers in Hialeah, FL illustrating the invitation to become participants in the COVID-19 prevention and mitigation clinical study (Figure 1). The controls would be participants from the adjacent UHC clinic (Clinic B) where zinc was not routinely used or recommended by their attending physicians. The study was open to all participants in the center, and a few of the clinic B participants participated in the randomized zinc dose treated group. Participants, 50–84 years of age, were recruited because individuals who acquired COVID-19 infection in this age range had the most likely emergence of complications leading to hospitalization and death (2). Exclusion criteria included taking zinc-containing supplements other than a multi-vitamin such as Centrum for adults, living outside the area of Miami-Dade and Broward counties, unable to follow instructions or dementia, taking immunosuppressive agents in the context of having had a transplant, diagnosis of rheumatoid arthritis or inflammatory arthritis, diagnosis of a terminal illness or hospice care, cirrhosis of the liver, hemodialysis being required on a chronic basis, human immunodeficiency virus disease, housebound persons, individuals known to have a history of intolerance to oral zinc supplements, and lastly having a positive test for having had or having SARSCoV-2 infection as demonstrated by a baseline laboratory test done in all Clinic A participants through a blood sample submitted to a clinical reference laboratory for SARS-CoV-2 IgG, IgM, or IgA antibodies in their serum.
Figure 1. Promotional flier.
Participants who were routinely seen in Clinic A who accepted to participate in the clinical study were randomized to receive 10, 25, or 50 mg oral zinc picolinate daily, specially compounded for this study from pharmaceutical grade product. Unrestricted randomization using a list of random assignments generated by a computer was employed, with supplement dosages masked to the participant. Participants were monitored by telemedicine every 2–3 weeks to collect data on the zinc supplement tolerance and monitor the symptoms of all participants enrolled in the study. All participants in the treated group were reminded during these telemedicine sessions not to take their zinc supplements with iron or calcium supplements. This guideline had been instructed at the outset to prevent issues with the intestinal absorption of zinc and was stressed in the inform consent document, which was reviewed and signed by all participants in the treated group. The process of refinement of the control participants is outlines in Figure 2.
Figure 2. Clinic B: Flowchart of control participants.
Permission was obtained from the medical attending in Clinic B and in January, 2021, we reviewed the electronic health records (HER) of their panel of participants from which we found 206 participants who had been active, seen a physician and had blood work done in the last 6 months and had none of the exclusion criteria noted above for Clinic A except for the presence or absence of SARS-CoV-2 antibodies in serum because Clinic B participants were not routinely assessed for these tests. The process of refinement of the control participants is outlines in Figure 3. Participants from Clinic B outside the ages 50–84 years or with any of the exclusion criteria listed above for Clinic A participants were discarded without further consideration. From the 206 controls obtained in this manner, 96 participants were further selected on their demographics and laboratory studies to be paired with the Clinic A recruited participants in the study. All participants from Clinic A and Clinic B had routine visits to the clinic during the study that involved participation in a COVID-19 questionnaire about the presence or absence of symptoms suggestive of COVID-19 infection and checked for compliance on precautions to avoid contagion with regards to physical distancing and appropriate use of antimicrobial gel and face masks. Baseline zinc levels were not available for participants from Clinic B. Both Clinic A and Clinic B participants share the same front desk at our Hialeah centers where the COVID-19 questionnaires were and are routinely administered to all participants during the pandemic when they were equally monitored and reminded of all recommended measures to avoid the COVID-19 contagion.
Figure 3. Clinic B: Flowchart control participants.
We tested a superiority hypothesis or the use of Zinc in an ambulatory setting will results in a 20% or greater percentage of non-infected COVID-19 patients. All subject assessments will be measured by improvement of scores from baseline to end of treatment.
Primary Endpoints
Part A:
Ho: H0 = πc – πt = 10%
Ha: Ha = πc – πt ≥ 10%
πc are the percentage of non-infected patients for the control group
πt are the percentage of non-infected patients for the treatment group.
We operationalized the percentage of symptomatic Covid-19 for the treatment vs. the control group as a dichotomous outcome variable (symptomatic yes vs. symptomatic no). The sample-size estimate was based on exact tests with actual levels of significance and power. In a two-arm study with P0 (unacceptable response rate) = 10%, P1 (response rate that is desirable) = 90%, specified α = 5% and power = 80%, the A'Hern approach yielded a minimum of n = 30 per arm.
After the data were cleaned, we examined the distribution and dispersion of data through descriptive numerical summaries and graphical tools. Bivariate analysis using either a Fisher's Exact test or a Wilcoxon test was conducted between the independent variable group (treatment vs. control) and the dependent variables symptomatic Covid-19 (yes vs. no), race (white vs. other), gender, age (yrs.), body mass index (BMI, kg/m2), cardiovascular disease (yes vs. no), diabetes (yes vs. no), chronic obstructive lung disease [COPD] (yes vs. no), chronic renal failure (yes vs. no), recent cancer (yes vs. no), alcohol use (yes vs. no), coffee use (yes vs. no), tobacco use (yes vs. no), white blood cell count (WBC, 1000/mcL), hemoglobin (Hgb, g/dL), platelet count (1000/mcL), HgbA1c (%), creatin (cr, mg/dL), blood urea nitrogen (BUN, mg/dL), estimated glomerular filtration rate (eGFR), albumin (Alb, g/dL), vitamin D levels (ng/mL), and the number of co-morbidities. Logistic regression modeling was employed to look for associations between the dependent variable, symptomatic COVID (yes vs. no), the independent variable group (treatment vs. control) and other study variables. Model fit was tested using AIC, and to see if the data met the assumption of collinearity, we calculated VIF for each predictor. Mean values are presented with corresponding standard deviations. All hypothesis testing was carried out at the 5 percent (two-sided) significance level a priori. All subsequent statistical tests were conducted post-hoc. Missing data was deleted in all statistical analysis. P-values were rounded to three decimal places. P-values <0.001 were reported as <0.001 in tables. P-values >0.999 were reported as >0.999. R (version 4.2.0) statistical package was used for descriptive calculations, group comparisons, and regression modeling.
All 129 participants who initially agreed to participate in the study received their allotted bottle of zinc supplements within 5 days of signing up. Initial laboratory studies were not available until days later, at which time five participants were informed of having had asymptomatic SARS-CoV-2 infection and thus removed from further analysis. Within 1 week of having been accepted into the study, seven participants signed out from the study because of fears and concerns raised by their immediate family and children after they read the informed consent document previously signed by the participants. One hundred seventeen participants were then officially followed post-randomization. During the first 4 weeks of monitoring, five participants experienced intolerable side effects; two had headaches potentially attributable to zinc supplementation (one on 25 mg, and the other on 50 mg zinc picolinate), three participants experienced gastrointestinal symptoms including nausea and constipation and refused to take the zinc supplement (two participants on 25 mg and one participant on 50 mg zinc picolinate). One hundred twelve participants were available for analysis after the study).
Participants from Clinic A treated with oral zinc picolinate and control participants from Clinic B were statistically equivalent in their demographics, as well as in their prevalence of obesity, diabetes mellitus, and hypertension (Table 1). Both groups of participants resided in Miami-Dade and Broward counties in Southern Florida and were followed for their primary care in one of the two managed care ambulatory medical centers of UHC. Most of the participants in our study were Hispanic, as the geographic area where they reside has a population of 95 percent Hispanic. As noted earlier, a double-blind study could not be performed for ethical reasons because most participants in Clinic A had been on zinc supplementation and taking them off their zinc supplement was not appropriate or acceptable.
Table 1. Bivariate categorical comparisons.
A total of 200 participants were enrolled in the study (treatment = 104, control = 96). Overall, the median age was 74 (IQR: 69–79), 90 percent were Hispanic white, 62 percent were female, and the median BMI was 28.50 (IQR: 25.57–32.15). Participants in the study from Clinic A had 3.47 ± 0.83 encounters during the time of the study from August 2020 until January 2021. Participants from Clinic B whose records were selected as controls for the study had 3.08 +/−1.60 encounters where they were equally monitored and reminded of all recommended measures to avoid the COVID-19 contagion. Treated and control participants also had statistically equivalent hematologic and clinical chemistry parameters (Table 2). In addition, the participants who were paired from Clinic B (n = 96) had a vitamin D serum level comparable from the treated participants. All participants in Clinic A had a pre-study and a post-study laboratory test for SARS-CoV-2 IgG antibodies. Two participants from Clinic A also had a positive SARS-CoV-2 IgG antibody test corresponding to those two individuals who had symptomatic COVID-19 infection.
Table 2. Bivariate continuous comparisons.
Fisher's exact test revealed that the experimental group 1.92% (N = 2) had significantly fewer symptomatic COVID-19 infections than the control group 10.42% (N = 10) (95% CI: 1.20, 56.61) (p = 0.01). Statistical analysis between the experimental and control also revealed group differences for the variables age and chronic obstructive lung disease–Tables 1, 2 (p < 0.05). Specifically, the treatment group was older (Median difference = 3 years, [95% CI: 1.26, 4.00, p = 0.003]), and had more COPD (Percentage difference = 15.41%, [95% CI: 0.09,29.20, p = 0.033]). No difference in COVID-19 symptomology was found between the different dosage groups. No participant receiving 10 mg of zinc developed COVID-19 symptoms; meanwhile, one participant each in the 25 mg and 50 mg zinc picolinate daily groups reported COVID-19 symptoms.
Of the two participants who developed COVID-19 infection, they had mild symptoms–cough, sore throat, low-grade fever, and generalized malaise. Both participants were managed in the outpatient service via telemedicine without complications. In the control group, there were nine cases of symptomatic COVID-19 infection, and three participants required hospital admission for severe hypoxemia, and one of these hospitalized participants died.
Based on clinical judgment and the statistical results, we created six logistic regression models. Model fit was tested using the Akaike information criterion (AIC) and likelihood ratio tests (LR). To ascertain if the models met the assumption of collinearity, we calculated a variance inflation factor (VIF) for each predictor. For our study, a VIF of 1 indicated no correlation among the kth predictor and the remaining predictor variables. The general rule of thumb is that VIFs exceeding 4 warrant further investigation, while VIFs exceeding 10 are signs of serious multicollinearity requiring correction.
• Base Model: Experimental group
• Model 1: Experimental group + number of comorbidities
• Model 2: Experimental group + number of comorbidities + age
• Model 3: Experimental group + number of comorbidities + age + BMI
• Model 4: Experimental group + number of comorbidities + age + BMI + COPD
• Model 5: Experimental group + number of comorbidities + age + BMI + COPD + gender + vitamin D levels.
AIC values increased by model (adding additional predictors); however, LR tests indicted no significant difference between the models. Meaning no significant reduction in residual deviance and higher AIC values. No VIF was larger than our threshold of 4, in fact, all were close to one.
Results from the logistic regression models–Table 3 and Figure 4–revealed.
• Base Model: Individuals in the control group were 5.93 (95% CI: 1.51, 39.26) times more likely to develop symptomatic COVID-19 infection as compared with individuals in the treatment group (p = 0.01).
• Model 1: Controlling for co-morbidities, individuals in the control group were 7.38 (95% CI: 1.80, 50.28) times more likely to develop symptomatic COVID-19 infection as compared with individuals in the treatment group (p < 0.01). For every-one unit increase in the number of co-morbidities, the likelihood of developing symptomatic COVID-19 infection increased 1.57 (95% CI: 1.16, 2.19) (p = 0.01).
• Model 2: Controlling for comorbidities and age, individuals in the control group were 6.89 (95% CI: 1.67, 47.08) times more likely to develop symptomatic COVID-19 infection as compared with individuals in the treatment group (p = 0.01). For every-one unit increase in the number of co-morbidities, the likelihood of developing symptomatic COVID-19 infection increased 1.60 (95% CI: 1.20, 2.38) (p = 0.01).
• Model 3: Controlling for comorbidities, age, and BMI, individuals in the control group were 6.92 (95% CI: 1.68, 47.39) times more likely to develop symptomatic COVID-19 infection as compared with individuals in the treatment group (p = 0.02). For every-one unit increase in the number of co-morbidities, the likelihood of developing symptomatic COVID-19 infection increased 1.64 (95% CI: 1.19, 2.36) (p < 0.01).
• Model 4: Controlling for comorbidities, age, BMI, and COPD, individuals in the control group were 6.31 (95% CI: 1.50, 43.55) times more likely to develop symptomatic COVID-19 infection as compared with the treatment group (p = 0.02). For every-one unit increase in the number of co-morbidities, the likelihood of developing symptomatic COVID-19 infection increased 1.67 (95% CI: 1.22, 2.42; p < 0.01).
• Model 5: Controlling for comorbidities, age, BMI, COPD, gender and vitamin D levels, individuals in the control group were 6.09 (95% CI: 1.45, 42.12) times more likely to develop symptomatic COVID-19 infection as compared with the treatment group (p = 0.03). For every-one unit increase in the number of co-morbidities, the likelihood of developing symptomatic COVID-19 infection increased 1.68 (95% CI: 1.22, 2.43; p < 0.01).
Table 3. Logistic regression model results.
Figure 4. Predicted probability of developing symptomatic COVID-19 based on comorbidities.
This study found that zinc supplement was associated with a reduced risk in developing symptomatic COVID-19. Controlling for co-morbidities, individuals in the treatment group were also less likely to develop symptomatic COVID-19 infection as compared with individuals in the control group. Additionally, it was found that co-morbidities, regardless of groups, increased the likelihood of developing symptomatic COVID-19 infection. The findings from our study suggest that zinc supplementation may be an effective prophylaxis of symptomatic COVID-19 and may mitigate the severity of COVID-19 infection.
It is important to note that these data should not be interpreted to support the use of oral zinc in participants with symptomatic COVID-19 infection admitted to the hospital or the ICU. The latter will likely need close monitoring of their zinc status and appropriate intravenous supplementation (10). We and others have used intravenous zinc in the past in participants with HIV disease successfully (11, 12).
COVID-19 is a disease with a wide clinical spectrum that ranges from asymptomatic carriers to symptoms such as fever, sore throat, cough, lung infections, and in severe cases, ARDS, sepsis, and death (4). As many as 50 percent of participants admitted to hospital have been reported having at least one comorbidity, and ~70 percent of participants who require intensive care unit (ICU) care have been observed to have co-morbidities. The common comorbidities that have been identified that places participants at a greater propensity for serious complications and death have been obesity, diabetes, COPD, cardiovascular diseases including hypertension, malignancies, and human immunodeficiency virus disease (HIV). Participants with HIV were not included in our study because HIV disease is widely known to be associated with zinc deficiency and our participants with HIV are followed closely to keep their zinc nutritional status as optimal as possible.
In terms of demographics, an analysis of our patient population, revealed that the control participants were slightly younger than the zinc treated participants. Since SARS-CoV-2 tends to affect older individuals more severely, this minor difference in our two study groups places the zinc treated participants from Clinic A presumably at a greater risk of acquiring COVID-19 infection and suffering its serious adverse events or even death as compared with the paired control participants from Clinic B (Table 1). Still, the results revealed that after adjusting for age the observed protective effects from zinc picolonate supplementation remained significant. This is contrary to what may have been expected if the effect of zinc supplementation was not appreciably in favor of the treated group. Participants treated with zinc prophylactically faired significantly better statistically than those who did not take zinc-Table 1.
Vitamin D has been recognized as an important immune system active agent whose deficiency is associated with acquiring SARS-CoV-2 and serious or fatal outcomes from COVID-19 (12). In the paring of participants from Clinic B to our treated participants from Clinic A, we used not only the exclusion criteria noted above for the study but also the vitamin D status of participants. We were fortunate to find that Clinic B participants had their vitamin D levels updated regularly. Unfortunately, none of the Clinic B participants had ever had their zinc levels measured because it is not a laboratory test routinely conducted in primary care. However, the deleterious effects of vitamin D deficiency on participants with COVID-19 have been known and demonstrated to be an important factor associated with greater risk of hospitalization and mortality, particularly in Hispanic participants (8). Having paired our controls to our treated participants for vitamin D status allows us to concentrate on the role of zinc in the prevention of SARS-CoV2 infection in our mostly Hispanic population.
When controls and treated participants were compared by gender and history of cardiovascular disease (CVD), both groups were essentially equal. The presence of diabetes in both groups was slightly higher in the control group (44.8 percent) as compared with the treated group (36.5%). This is an area where the control group would have been expected to do worse than the treated group. Meanwhile, the HgbA1c level in both groups was similar at 7.16 percent in the treated group and 7.11 percent in the control group.
Chronic kidney disease (CKD) III or IV was present in 19.2 percent of the treated participants and 9.4 percent of the controls. This parameter would also place the treated participants at greater theoretical odds of having COVID-19 infection as compared with the control group. In addition, when both groups were compared in terms of their laboratory determinations for serum creatinine, both groups were fairly similar. This suggests that the CKD burden in the treated group was larger than in the control participants; however, the results demonstrate that the treated participants faired statistically better than the controls despite the increased burden of this illness. It should also be discussed here that the fact that the renal functions of both groups were found to be not significantly different suggests that both clinics under independently practicing physicians had coded properly the issue of CKD in their participants. However, Clinic A had more CKD III and IV, not on hemodialysis, than Clinic B.
In terms of chronic obstructive lung disease (COPD), the treated and control groups were populated by 52.9 percent and 37.5 percent of individuals with COPD. When all of these factors and others summarized in Table 1 were compared, we concluded that both groups were essentially similar, with the caveat that older age, CKD, and COPD were more prevalent among the treated participants, which should have placed them at a greater theoretical risk of developing COVID-19 infection and making them also theoretically more prone to COVID-19 infection complications and at increased mortality risk. The one area where the controls had a slightly higher, but not statistically significant number of individuals at a greater theoretical risk for COVID-19 was in the area of diabetes mellitus. Still, the HgA1c levels of both groups were essentially equivalent. Therefore, both treated and control groups can be declared similar but with a propensity of the treated group to be at a slightly higher risk of COVID-19 infection. This very fine difference between the groups gives the results of the study a greater significance, as the treated group did appreciably and statistically better than the control group in terms of their protection against COVID-19 infection and its complications.
In the developed world, it may be useful at this time to offer those individuals who for whatever reason have refused to undergo vaccination against COVID-19 and recommended to them to consider taking in a disciplined manner a supplement of 10 mg or 25 mg zinc daily. Most participants should be able to tolerate well 10 mg daily zinc picolinate, but without specific data, we feel those participants with co-morbidities known to be associated with severe COVID-19 infection or increased risk of mortality to use 25 mg daily. Further data on this recommendation is needed. It is felt that in each of these settings, individuals will be well-served in terms of their protection against the dangerous contagion when they are prophylactically suspended with oral zinc supplementation. Perhaps for some individuals who also refuse to take an oral supplement daily, some modification of their diet to include sufficient zinc to at least meet the RDA at 11 mg for men and 8 mg for women should be considered strongly.
Relatedly, we have witnessed lower vaccine efficacy against SARS-CoV-2 variants. Initial research showed that dose vaccine effectiveness against the alpha variant for hospitalization was 69.4% for the BNT162b2 (Pfizer) vaccine and 76.7% for the ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccine (13). Recent research on the effectiveness after one dose of the Pfizer vaccine showed it was lower among persons with the delta variant-−30.7%. With the Oxford-AstraZenca vaccine, the effectiveness after one dose was 48.7% (14). Zinc supplements deserve consideration here as well because of additional benefits they provide for upper respiratory tract infections (15).
All participants in Clinic A had a pre-study and a post-study laboratory blood test for SARS-CoV-2 IgG antibodies. We found that no participants in Clinic A on zinc supplements had asymptomatic COVID-19 infection. None of the 104 participants in the treated group who were asymptomatic had a positive test for SARS-CoV2 IgG antibodies in their serum. The two individuals who did have a positive SARS-CoV-2 IgG antibody were the two who had symptomatic COVID-19 infection, and were treated in the outpatient service after they tested positive for SARS-CoV-2 antigen via a nasal swab test in the community. This has a very valuable epidemiologic perspective since, if our findings are replicated at other locations and in additional populations, oral zinc supplementation even at 10 mg daily may be beneficial in the prevention of the spread of the contagion from asymptomatic individuals to susceptible hosts during the COVID-19 pandemic.
SARS-CoV-2 has been known to affect the immune response resulting from its presence in the human body (16). It is important to highlight that the role of zinc in the human immune response encompasses activity in the innate and acquired immune responses, cell-mediated immunity, and also humoral B-cell mediated immunity (17).
Participants who are severely zinc-deficient suffer from lymphopenia, a decreased CD4/CD8 ratio, decreased natural killer (NK) cell activity, and increased monocytic cytotoxicity (18, 19). Correction of zinc nutritional status resolves all these abnormalities in the human immune response. Our study was not designed to determine the precise mechanism of action through which zinc affords prevention to our participants. However, because all treatment groups, 10 mg, 25 mg, and 50 mg, seemed to fare equally well in terms of protection against SARS-CoV-2 when compared with untreated participants, it is possible to speculate that the effect through which zinc helped our treated participants did not require to fully replenish their zinc nutritional status (18, 19). Along this line of reasoning, zinc can be thought of as being able to be a modulator of immune functions, a modifier of the interaction of SARS- CoV-2 with a host factor such as an angiotensin-converting enzyme (ACE)-2 receptor, or the integrity of the epidermal tight junctions, or even an agent capable of acting in the microbiome. These three modalities of action of zinc may be invoked as possible sites where the mineral exerts its protective effect in terms of the prevention of SARS-CoV-2 infection. Furthermore, zinc has been known to serve as a modulator of various immune functions including T cell interactions and functions and cytokine production.
However, with regards to the cytokine response to SARS-CoV-2, it has been proposed that a cytokine release, or also referred to as "cytokine storm," is the pathophysiologic mechanism underlying the progression of COVID-19 infection from a relatively benign to a severe illness, which can result in significant morbidity and mortality. Therefore, the role of zinc in the therapeutics of COVID-19 is not addressed in this study but needs to be systemically approached to abate the morbidity and improved the mortality of these participants. In this context, it has been postulated that zinc could be a needed factor for the proper cytokine functions. This hypothesis applies more to the use of zinc in the therapeutics of COVID-19 infection, but the replenishment of zinc would be intuitively more difficult to achieve if a deficiency exists, to begin with.
The antiviral properties of zinc are virus-specific, but it appears that zinc ion availability plays a significant role in the antiviral efficacy of zinc (15). Additionally, the literature shows the importance of Zn as an essential mineral immunomodulator with relevant antiviral activity in the body (20). In terms of the ACE-2 receptor, it has been known that SARS-CoV-2 utilizes ACE-2 receptors found at the surface of the host cells to get inside the host cell. ACE-2 is a zinc metalloenzyme and in certain comorbidities are associated with a strong ACE-2 receptor expression and higher release of proprotein convertase that enhances the viral entry into the host cells (6). Meanwhile, zinc ions are capable of downregulating the response (21). As a result, it is plausible to suggest that zinc supplementation in relatively low doses may protect against COVID-19 infection by the downregulation of the ACE-2 enzyme and receptor through, which SARS-CoV-2 gains entry into our patient's host cells. In addition, zinc is active within the microbiome and gastrointestinal tract. Therefore, it can be hypothesized that the prevention of symptomatic infection with SARS-CoV-2 may be mediated through this pathway (22). The precise mechanism involved will require further specific studies in all of these complex areas of zinc physiology and SARS-CoV-2 pathophysiology.
Zinc deficiency is not uncommon since according to HANES III from 35 to 45% of American adults 60 years or older have a zinc deficiency (23). It has been proposed that the higher mortality associated with COVID-19 infection among elderly participants may be related to undiagnosed zinc deficiency (21). Elderly participants are prone to zinc deficiency due to the presence of chronic diseases and potentially due to the consumption of zinc-deficient diets. The dietary intake of zinc is deficient among 52 percent of elderly men and 34 percent of elderly women (22). This is understood in the context for the treatment of COVID-19 infection. Recent research found that the zinc status of COVID-19 patients did not exhibit a significant role in development of anosmia and/or hyposmia or disease severity; nevertheless, zinc therapy may play a significant role in shortening the duration of smell recovery in patients without affecting the total recovery duration from COVID-19 (24, 25).
We have performed a study in our UHC Hialeah participants recently and found by looking at 24-h dietary recalls that women consume 7.01 +/- 2.61 mg Zn daily less than the zinc RDA for women (23).
Two out of three of the women consume a zinc-deficient diet. Men did not fare much better having 4 out of 5 individuals consuming less than the RDA for men (26). The men consumed 9.72 +/−5.9 mg Zn daily. The best sources of dietary zinc in the American diet are beef, crustaceans, some beans, poultry, and fortified cereals (9). It is known that ageusia and dysgeusia, symptoms that have been reported infrequently among COVID-19 participants, have been known to be associated with zinc deficiency for more than 30 years (23).
The public in general, at least in the United States, is not always well-informed on the role of zinc in their immune system functions. In addition, primary care providers are not generally well-versed in evaluating zinc deficiency and may be unsure about its management. Furthermore, zinc levels in the components of blood have not always correlated with a total scarcity of this trace mineral. Earlier concerns about variations in zinc levels in blood were better understood when it was found that serum zinc levels are 16 percent greater than plasma zinc levels (4). This is due to the release of intracellular zinc from erythrocytes and platelets in the process of clotting. In addition, the hour of sampling blood for zinc determinations should be the same days because there is a diurnal variation in the level of zinc in the blood (26). Plasma zinc levels can be 67 percent lower in the early evening when compared to the levels determined at 08:00 h (16, 27, 28). Some commercial laboratories make no distinction between plasma or serum zinc determinations. Furthermore, a rather wide range of "normal" plasma zinc levels are reported which are not in agreement with the recommendations from the nutrition literature suggesting a range from 80 mcg to 135 mcg in plasma for humans (4).
Our study has limitations. Most of the participants included in the study were Hispanic, and caution must be exercised in extrapolating our data to other ethnic groups without first attempting to duplicate our findings. Other limitations include no adata about control subjects' zinc level or vaccination status was collected and relevant comorbidities. In addition, all our participants receive primary care in a single medical ambulatory center. As such, a multi-center, double-blind study is warranted to validate our findings and determine if they can be extrapolated to other locations and populations. Currently, it remains ethical to withhold COVID-19 vaccination where it is available. Meanwhile, it may be possible in certain communities where COVID-19 vaccination is not widely available, to evaluate the effect of zinc supplementation in relatively low doses and follow unvaccinated participants for at least 6 months to determine if indeed the protection we have reported can be replicated. In addition, such a double-blind study may be proposed ethically in locations in Latin America, the Caribbean, Southern Africa, or Asia where the prospects for vaccination remained limited.
Overall, zinc supplementation must be further studied as our data suggests that it can be used to protect populations that are now vulnerable to succumb to SARS-CoV-2, including those participants with multiple co-morbidities. Zinc deficiency is a co-morbidity that places participants infected with SARS-CoV-2 at greater statistical risk of having complications. Our data also suggest that individuals using zinc, even in low doses, were protected from developing asymptomatic COVID or acquiring COVID from close relatives who had been symptomatically affected by the virus. Furthermore, participants who took their zinc supplement daily and who did not develop relatively mild cases of COVID-19 did not have evidence in their blood of having had asymptomatic SARS-CoV-2 infection. Since it is now imperative to replicate our findings in other populations and locations, it is necessary to seek support to demonstrate the positive role of oral zinc supplementation in the prevention of COVID-19. assess the zinc nutritional status by, measuring the plasma zinc level when possible, and heed attention to the zinc content of dietary intake in various populations including Hispanics in other locations in the US, non-Hispanics, and African-American communities to improve our ability to control the COVID-19 pandemic. The effect of zinc supplementation should also be important for individual health care workers, school administrators, teachers, students, and participants in long-term care nursing facilities among others. These arguments are also important to heed in the battle against COVID-19 infection globally since the prophylactic use of zinc orally to prevent or mitigate COVID-19 symptomatology may assist individuals in countries where the vaccine has lagged behind Europe and North America.
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by Sal Castaner, JD and VP of University Health Care for legal issues and compliance. The patients/participants provided their written informed consent to participate in this study.
AG designed and implemented the study. PH performed the data analysis. All authors discussed the results and contributed to the final manuscript.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
Our most sincere gratitude to Ms. Maggie Quevedo, President of University Health Care, Doral, Florida for her support of this study. This study could not have been done without the input and oversight of Sal Castaner, J.D. Our gratitude is also expressed to Dr. Lorilei Perez-Freiria for her support and input in the preparation and execution of the study and Dr. Tyler Harrold of Universal Compound Pharmacy, Hialeah, Florida for his engagement and assistance in obtaining and preparing the zinc supplement requested. And finally, our gratitude to the managers and staff at UHC Hialeah Centers who handled the extra work and assisted participants participating in the study with professionalism and grace during the pandemic.
1. Who.int. (2021). Available online at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200402-sitrep-73-covid-19.pdf?sfvrsn=5ae25bc7_2 (accessed July 12, 2021).
2. Adil M, Rahman R, Whitelaw D, Jain V, Al-Taan O, Rashid F, et al. SARS-CoV-2 and the pandemic of COVID-19. Postgrad Med J. (2020) 97:110–6. doi: 10.1136/postgradmedj-2020-138386
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4. Yasui Y, Yasui H, Suzuki K, Saitou T, Yamamoto Y, Ishizaka T, et al. Analysis of the predictive factors for a critical illness of COVID-19 during treatment—relationship between serum zinc level and critical illness of COVID-19. Int J Infect Dis. (2020) 100:230–6. doi: 10.1016/j.ijid.2020.09.008
5. te Velthuis A, van den Worm S, Sims A, Baric R, Snijder E, van Hemert M. Zn2+ Inhibits coronavirus and arterivirus rna polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture. PLoS Pathogens. (2010) 6:e1001176. doi: 10.1371/journal.ppat.1001176
6. Mayor-Ibarguren A, Busca-Arenzana C, Robles-Marhuenda Á. A hypothesis for the possible role of zinc in the immunological pathways related to COVID-19 infection. Front Immunol. (2020) 11:1736. doi: 10.3389/fimmu.2020.01736
7. Skalny A, Rink L, Ajsuvakova O, Aschner M, Gritsenko V, Alekseenko S, et al. Zinc and respiratory tract infections: perspectives for COVID-19 (Review). Int J Mol Med. (2020) 46:17–26. doi: 10.3892/ijmm.2020.4575
8. Diaz-Curiel M, Cabello A, Arboiro-Pinel R, Mansur L, Heili-Frades S, Mahillo-Fernandez I, et al. The relationship between 25(OH) vitamin D levels and COVID-19 onset and disease course in Spanish participants. J Steroid Biochem Mol Biol. (2021) 212:105928. doi: 10.1016/j.jsbmb.2021.105928
9. Prasad A. Discovery of human zinc deficiency: its impact on human health and disease. Adv Nutr. (2013) 4:176–90. doi: 10.3945/an.112.003210
10. Perera M, El Khoury J, Chinni V, Bolton D, Qu L, Johnson P, et al. Randomised controlled trial for high-dose intravenous zinc as adjunctive therapy in SARS-CoV-2 (COVID-19) positive critically ill participants: trial protocol. BMJ Open. (2020) 10:e040580. doi: 10.1136/bmjopen-2020-040580
11. Evaluation du taux d'endotheline plasmatique chez les malades en choc septique. Fr Ann Anesth Resuscitation. (1992) 11:R187. doi: 10.1016/S0750-7658(05)81996-3
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13. Hyams C, Marlow R, Maseko Z, King J, Ward L, Fox K, et al. Effectiveness of BNT162b2 and ChAdOx1 nCoV-19 COVID-19 vaccination at preventing hospitalizations in people aged at least 80 years: a test-negative, case-control study. Lancet Infect Dis. (2021) 21:1539–48. doi: 10.1016/S1473-3099(21)00330-3
14. Bernal L, Andrews N, Gower C, Gallagher E, Simmons R, Thelwall S, Stowe J, et al. Effectiveness of covid-19 vaccines against the B.1.617.2 (Delta) variant. N Engl J Med. (2021) 385:585–94. doi: 10.1056/NEJMoa2108891
15. Hemila H, Chalker E. Vitamin C and zinc lozenges for COVID-19? J Am Pharm Assoc. (2003) 61:e39. doi: 10.1016/j.japh.2021.05.018
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16. Pathania M, Bhardwaj P, Pathania N, Rathaur VK. Amisha. A review on exploring evidence-based approach to harnessing the immune system in times of corona virus pandemic: Best of modern and traditional Indian system of medicine. J Fam Med Prim Care. (2020) 9:3826–37. doi: 10.4103/jfmpc.jfmpc_504_20
17. Gordan. Zinc deficiency in participants with HIV/AIDS and Adjunctive Zinc therapy in AIDS participants. San Diego, CA: American College of Nutrition (1992).
18. Mocchegiani E, Romeo J, Malavolta M, Costarelli L, Giacconi R, Diaz L, et al. Zinc: dietary intake and impact of supplementation on immune function in elderly. Age. (2012) 35:839–60. doi: 10.1007/s11357-011-9377-3
19. Trujillo-Mayol I, Guerra-Valle M, Casas-Forero Nidia, Madalena M, Sobral C, Viegas O, et al. Western dietary pattern antioxidant intakes and oxidative stress: importance during the SARS-CoV-2/COVID-19 pandemic. Adv Nutr. (2021) 12:670–81. doi: 10.1093/advances/nmaa171
20. Marreiro DDN, Cruz KJC, Oliveira ARS, Morais JBS, Freitas BJESA, Melo SRS, et al. Antiviral and immunological activity of zinc and possible role in COVID-19. Br J Nutr. (2021) 1–8. doi: 10.1017/S0007114521002099. [Epub ahead of print].
21. Matteo B, Ernesto P, Giovanni L, Paolo P, Giuseppe B. The malnutritional status of the host as a virulence factor for new coronavirus SARS-CoV-2. Front Med. (2020) 7:146. doi: 10.3389/fmed.2020.00146
22. Mariani E, Neri S, Cattini L, Mocchegiani E, Malavolta M, Dedoussis G, et al. Effect of zinc supplementation on plasma IL-6 and MCP-1 production and NK cell function in healthy elderly: interactive influence of +647 MT1a and−174 IL-6 polymorphic alleles. Exp Gerontol. (2008) 43:462–71. doi: 10.1016/j.exger.2007.12.003
23. Calder P. Nutrition, immunity, and COVID-19. BMJ Nutr Prevent Health. (2020) 3:74–92. doi: 10.1136/bmjnph-2020-000085
24. Rani I, Goyal A, Bhatnagar M, Manhas S, Goel P, Pal A, et al. Potential molecular mechanisms of zinc- and copper-mediated antiviral activity on COVID-19. Nutr Res. (2021) 92:109–28. doi: 10.1016/j.nutres.2021.05.008
25. Abdelmaksoud AA, Ghweil AA, Hassan MH, Rashad A, Khodeary A, Aref ZF, et al. Olfactory disturbances as presenting manifestation among egyptian patients with COVID-19: possible role of zinc. Biol Trace Elem Res. (2021) 199:4101–8. doi: 10.1007/s12011-020-02546-5
26. Cabrera Á. Zinc, aging, and immunosenescence: an overview. Pathobiol Aging Age Relat Dis. (2019) 5:25592. doi: 10.3402/pba.v5.25592
27. Chisholm JC Jr, Martin HI. Hypozincemia, ageusia dysgeusia and toilet tissue pica. J Natl Med Assoc. (1981) 73:163–4.
28. McMillan EM, Rowe DFJ. Clinical significance of diurnal variation in the estimation of plasma zinc. Clin Exp Derm. (1982) 7:629–32. doi: 10.1111/j.1365-2230.1982.tb02488.x
Keywords: COVID-19, zinc, morbidity and mortality, comorbidities, treatment
Citation: Gordon AM and Hardigan PC (2021) A Case-Control Study for the Effectiveness of Oral Zinc in the Prevention and Mitigation of COVID-19. Front. Med. 8:756707. doi: 10.3389/fmed.2021.756707
Received: 10 August 2021; Accepted: 12 November 2021;
Published: 13 December 2021.
Marc Jean Struelens, Université libre de Bruxelles, Belgium
Faris Hasan al Lami, University of Baghdad, Iraq
Nitya Singh, University of Florida, United States
Jennifer Hunter, Western Sydney University, Australia
Copyright © 2021 Gordon and Hardigan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Patrick C. Hardigan, patrick@nova.edu


Warm welcomes and good vibes: community is what matters most to us here.
Right in the heart of Dublin, Dorset Point benefits from an excellent location, superb transport links, and a sociable, relaxed atmosphere that makes getting to know new faces easy.
want to learn more about living at Dorset Point?
477 students call Dorset Point home, staying in a variety of en-suite rooms and 2 and 3-bed apartments. Modern, stylish and spacious, student digs have never looked this good.
Choose to stay with us for the whole year or give back your room over the summer.
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Our Silver Ensuites are an extremely popular choice, located on the first floor or above.
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All the benefits of an ensuite room, but with the exclusivity of sharing with just 1 other student.
All the benefits of an ensuite room but you'll share an apartment with just two other students.
A team of dedicated, friendly staff work around the clock to make sure you and your building are in tip-top condition. From quick fixes to long talks, you'll get to know them well during your time here. There are even a couple of furry, four-legged members of the team roaming around, too.
Ian keeps us organised and makes sure we're working at optimal efficiency.
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With an onsite gym, cinema, games room (complete with consoles) and spacious courtyard, not to mention a superb location, Dorset Point is an excellent location to further your university career.
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Rydex Mutual Funds
Last Updated: Thursday, 05 November 2020
In this article, we're going to be providing a review of Rydex Mutual Funds. At one time, Rydex was geared more towards the elite investor, since their minimum investment for any fund was $25,000 (it is now $100). It's also a relatively small player in the mutual fund space, with only a little over $25 billion in assets under management.
Rydex Family of Mutual Funds
Rydex Funds is a relative newcomer to the mutual fund scene. Started in 1993 by its founder Skip Viragh, his aim was to create a family of mutual funds that performed well, regardless of market conditions. Rydex is also known for starting the first leveraged mutual fund: Rydex Nova Fund.
PIMCO Mutual Funds
Pioneer Mutual Funds
Putnam Mutual Funds
Van Kampen Mutual Funds
Today, Rydex offers investors leveraged equity, fixed income, as well as inverse equity funds. Rydex mutual funds are offered through large brokerage houses including Fidelity, Charles Schwab, T.D. Waterhouse, and E*Trade. Rydex offers more than 140 investment products tailored to a variety of market conditions, including 18 sector funds. They also offer retirement planning options such as Traditional IRAs, Roth IRAs, Rollover IRAs, SEP IRAs, as well as 403(b) plans.
In 2010, Rydex combined with Security Global Investors and the combined company was known as Rydex/SGI. In 2012, Guggenheim Investments purchased Rydex/SGI, and the holding company now manages $265 billion in assets.
Funds Fee Structures and Returns
Morningstar ratings indicate the expense ratios for mutual funds at Rydex are Above Average. This includes their domestic stock funds (1.86%) and taxable bond fund (1.80%). Although Rydex claims they offer investors options to match any market condition, this does not translate into a balance of stock and bond funds. Their distribution of asset class indicates only 1.86% in bonds (taxable bond funds). In fact, nearly all assets sit in domestic stock funds or cash (98.14%) as of September 2019.
As previously mentioned, the minimum investment at Rydex is $2,500, and 82.2% are no-load mutual funds. As of September 2019, the average return for the Rydex family of mutual funds over the last five years was 11.12%, among the best reviewed to date.
Top Rated Funds at Rydex
When looking at the top rated funds at Rydex, there does not appear to be any pattern. One of the mutual funds has a front-load of only 1.00%. All three funds require a $2,500 minimum, while the fund types range from growth stocks to blends. With that brief introduction, listed below are the top rated mutual funds from Rydex:
Rydex High Yield Strategy (RYHGX)
Assets: $94.1 million
Category: US Fund High Yield Bond
Specialty: None
Top Three Holdings: Ishares Iboxx $ High Yield
Load: None
Minimum Investment: $2,500
5-Year Average Return: 7.90%
Rydex Inverse Mid Cap Strategy (RYMHX)
Assets: $0.70 million
Category: US Fund Bear Market
Specialty: Bear Market
Top Three Holdings: S&P Midcap 400 Index
5-Year Average Return: -9.45%
Rydex Inverse Russell 2000 (RYCQX)
Assets: $9.5 million
Category: Large Blend
Top Three Holdings: Russell 2000 Index
Load: 1.0%
5-Year Average Return: -10.46%
About the Author - Rydex Mutual Funds

redpajama_set_name: RedPajamaCommonCrawl


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Omani author on 2019 Man Booker International Prize shortlist
https://www.youtube.com/watch?v=jx3Qwb7MkNA
Photo: Sandstone Press and Amazon
Photo - Omani author Jokha Al Harthi
Muscat: Omani author Jokha Al Harthi is among the six writers shortlisted for the prestigious 2019 Man Booker International Prize.
With the winner of the prize scheduled to be announced on May 21, the Man Booker International Prize features six foreign-language titles translated into English. The announcement was made on Tuesday.
Jokha Al Harthi's book Celestial Bodies, which is translated into English by Marilyn Booth and published by Sandstone Press, is the only Arabic language publication on the shortlist.
Bettany Hughes, chair of the 2019 Man Booker International Prize judging panel, said: "Wisdom in all its forms is here. Unexpected and unpredictable narratives compelled us to choose this vigorous shortlist. Subversive and intellectually ambitious with welcome flashes of wit, each book nourishes creative conversation. We were struck by the lucidity and supple strength of all the translations."
The other five books are The Years by French author Annie Ernaux, which was translated by Alison Strayer, German author Marion Poschmann's The Pine Islands, translated by Jen Calleja, Polish writer Olga Tokarczuk's Drive Your Plough Over the Bones of The Dead, which has been translated by Antonia Lloyd-Jones.
There are two Spanish-language books, one being by Colombian writer Juan Gabriel Vasquez, called The Shape of the Ruins, translated by Anne McLean, and Chilean writer Alia Trabucco Zeran's The Remainder, which was translated by Sophie Hughes.
A statement from the Man Booker Prize organisation said, "The Man Booker International Prize has this evening, Tuesday 9 April, revealed the shortlist of the six books in contention for the 2019 prize, which celebrates the finest works of translated fiction from around the world. The £50,000 prize for the winning book will be divided equally between its author and translator. The announcement was made at an event at Somerset House."
"The shortlist is absolutely brilliant, diverse, intellectually and morally extremely ambitious," said Pankaj Mishra, one of the judges, as Maureen Freely, another judge, added, "All six books open up new spaces for conversation between literatures and readers all over the world."
Bettany Hughes said: "This is a prize that is for both the books themselves and for the translations and translators, and what an extraordinary skill to be able to deliver the fluidity, the kind of captivating charisma of words through translation," with Elnathan John saying it was about "how they were able to transport feelings, emotions, but also large histories, large relationships, other complete universes, into a language like English."
Professor Angie Hobbs, FRSA, added, "I think choosing a winter is going to be really hard. We have six very strong books here, and there's going to be very detailed and interesting discussions, and I am really looking forward to these discussions."


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The Dark Rose Erin Kelly - FB2
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a story of secrets and guilt set among the ruins of a sixteenth- century english garden, the dark rose explores the extremes of obsessive love and loyalty, devotion and desperation. like kelly's critically acclaimed debut novel, the poison tree, this fantastically creepy, atmospheric novel thrills until the final shocking moments. business.
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a story of secrets and guilt set among the ruins of a sixteenth- century english garden, the dark rose explores the extremes of obsessive love and loyalty, devotion and desperation. like kelly's critically acclaimed debut novel, the poison tree, this fantastically creepy, atmospheric novel thrills until the final shocking moments. sample of geographic numbers, set out in the officially approved ofcom number groups: 2. After that final announcement, there has been no word from the band, and their myspace page is no longer active. The irs has indicated that it will issue guidance on this point soon. This ride was quite enjoyable and comfortable as a result. After they hatch, crane fly larvae eat grass crowns and roots, leaving large brown patches on lawns.
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Book Club Advisor
Fall down the rabbit hole of books with me-eclectic finds, binge-worthy authors, and links to author interviews and disucssion questions. Find your new favorite book here!
binge-worthy
About Book Club Advisor
Category: award winners
Prison Song
Two stunning novels touch the heart of American history in a place that is still raw and aching. The stories of Jojo and Richie, and Dara and Lead Belly, will cling to your heart.
Current Day: Jojo is on his way to pick up dad from Mississippi State Penitentiary, the former site of Parcham Prison, a prison camp meant to extend slavery for black men for white profit.
1923: Dara is fleeing Midland, Texas, after being outed in her small town as a lesbian. She gets a job and finds friendship and a way out of her own prison of fear, while seeing first hand the Imperial Prison Farm, another prison camp extending slavery for black men.
A piercing look at the history that shapes us, the choices we are thrown up against, and the powerful connection of family to lead us through, Sing Unburied, Sing and Sugarland are two novels you will be thinking and talking about long after you put them reluctantly down.
Bones tell tales: Human remains have been found under a school district building site. The remains are related to the Imperial Prison Farm in Fort Bend County, Texas. Read more…
Take me home: Ward (MacArthur Genius Grant Winner) takes PBS newshour on a tour of her hometown in Mississippi and talks about her influences and the power of seeing yourself in stories.
Frankenstein in Baghdad
Car bombs. Lost limbs. A strange man is gathering them up for something that is going to turn Baghdad upside down. When the body comes to life, each body part has an act to grind. What could be a slasher tale is an intricate examination of the human heart, war, and the roles everyone plays in revenge and peace. Structured with deference to the original, it is still fresh, reimagined, and just as horrifying and heartbreaking and culturally relevant. Winner of the International Prize for Arabic Fiction and longlisted for the Man Booker Prize, Ahmed Saadawi, a film director and writer, has reimagined a classic for our age, one that will be a touchstone for the discussion of Frankenstein for years to come.
Favorite quotations for discussion:
"…all the security incidents and tragedies we're seeing stem from one thing—fear." (P.123)
"They didn't know anything about him, but they were driven by that latent hatred that can suddenly come to the surface when people meet someone who doesn't fit in." (P. 131)
"I was careful about the pieces of flesh that were used to repair my body. I made sure my assistants didn't bring any flesh that was illegitimate—in other words, the flesh of criminals, but who's to say how criminal someone is?" (P. 156)
"Anyone who puts on a crown, even as an experiment, will end up looking for a kingdom." (P.181)
Family is Complicated
For some the word mother is comfort. For some it is fear. For some it is heartbreak. For many of us it is all of those things at the same time and then some. In this searing collection of short stories, Bonnie Jo Campbell lets us into the lives of mothers, daughters, grandparents, sisters, husbands, kids and all the people who make up our modern families who are trying to survive as best they can. Taking an unflinching view at post-industrial America, Mothers, Tell Your Daughters is a collection of voices that will stay with you long after the story is over. Continue reading "Family is Complicated" →
Your Book Club Advisor: Christine Thomas Alderman
Writer, reader, and educator.
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A Girl, a Whale, and a Song
Winter of the Wolves
Shop #indie
Click on book covers for links to my favorite #indie booksellers.
(I don't receive compensation, I just adore my local bookstores!)
Many thanks to Blue Willow Bookshop and Brazos Bookstore for the summaries.


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LSE BPP
Abolishing the NHS surcharge for health and care workers is not as generous as it sounds – a pay rise is needed
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The government was recently been forced to re-think its plans to continue charging workers in health and social care for using the NHS. But how many pay the surcharge and how much would it cost to abolish it? In answering these questions, Alan Manning explains why the gesture is not as as generous as many might think; more needs to be done to address the poor pay and conditions in this sector.
Currently, most migrants from outside the EEA who are on a visa of six months or more have to pay the Immigration Health Surcharge, which starts at £400p.a. though an increase to £624 is planned for October. This includes workers in the NHS and social care on whose work we have all depended in the pandemic.
Understandably, levying this charge on these workers at this time seemed to many a lack of generosity of spirit. The government, after some delay, has eventually decided to exempt workers in NHS and social care, seemingly permanently. But how generous is this gesture depends on how many migrants in these sectors are actually paying this charge. It is hard even for the government to answer this question because many of the relevant migrant workers are not on work visas, so the Home Office would not know what work they are doing. But here are some rough estimates:
Table 1 shows the fraction of UK-born, EEA-born, and non-EEA-born migrants in the sectors of 'Human Health Activities' (including but quite a lot wider than the NHS) and 'Residential Care Activities'.
These figures come from the Labour Force Survey are a bit different from some other sources. The migrant shares are much higher in some parts of the UK, notably London. EEA migrants do not pay the surcharge (but new arrivals will do so in the future under the government's plans). Not all non-EEA migrants do either – it is only those on visas, essentially those who do not have permanent leave to remain in the UK. Those who have become UK citizens do not have to pay. In health, 63% of non-EEA migrants report being a UK citizen; in care it is 46%.
Even among non-EEA migrants who are not British citizens, those with settlement do not pay. It is harder to estimate this proportion but one indication is length of time in the UK. For non-EEA migrants who are not UK citizens, the distribution of time in the UK is reported as:
Half of this group have been in the UK more than ten years when other data sources suggest most migrants will have settlement (though there are always exceptions). In fact, many of those coming under the family or work route (common in these sectors) will have settlement after five years. It seems likely that no more than half of the non-EEA migrants who are not UK citizens have to pay the charge.
These estimates imply that in health, only 2.1% of workers are paying the surcharge, 12% of migrant workers in the sector. In total, this is 50,000 workers though this includes many who are not in the NHS. Assuming each worker has an average of one dependent who also have to pay the charge (a high estimate I suspect) the total amount it will cost to waive the charge in the health sector would be about £41m annually. For the care sector, the estimates imply that 3.8% of workers are paying the surcharge, 18% of migrant workers in the sector. This amounts to about 39,000 workers paying £31m in the charge.
So, the total cost is estimated to be at most £70m annually and I again suspect this is an over-estimate. A nice gesture, and important for those who currently pay the charge, but perhaps not as generous as many might think.
When Boris Johnson says the charge has raised £900m, he may be summing over many years and including everyone who pays the charge, most of whom are probably students. To exempt health and care workers would cost very much less.
There is a flip side to this coin, however. It costs little because fewer workers in these sectors than many think are paying the charge, even among migrant workers. For those that do pay it, waiving it or abolishing it is an important gesture but perhaps we need to do more to thank workers in these sectors, both migrants and the UK-born.
My suggestion would be to make a start by immediately raising the pay of care assistants. Some supermarkets have already paid bonuses to their staff and the Welsh Government has promised a one-off £500 bonus for care workers. The UK Government has spent plenty of money on other things. But it should be a permanent rise in salary, not just a one-off bonus. That may necessitate resolving the problems of financing the sector, but everyone knows this needs to be done. The poor pay and conditions in this sector were a national scandal before the pandemic and the primary cause of the high level of vacancies. Raising the pay of care assistants would not just be an appropriate gesture of thanks for the present but a good investment for the future.
Alan Manning is Professor of Economics at the LSE and an Associate at LSE's Centre for Economic Performance.
All articles posted on this blog give the views of the author(s), and not the position of LSE British Politics and Policy, nor of the London School of Economics and Political Science. Featured image credit: by Stephanie Martin on Unsplash.
Posted In: Economy and Society | Featured | LSE Comment
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Ron Barrett was an aspiring musician from L.A.'s Fremont High School and knew of the success that many of the students of that school had met under the tutelage of record producer and entrepreneur, Dootsie Williams. Soon with his friend H.B. Barnum, they joined Charles Garner and Marvin Wilkins and formed a vocal quartet.
In early May of 1955, Dootsie announced the signing of this new group which he christened The Dootones after his newly successful record label. In June Dootone #366 was released - "Teller Of Fortune" and "Ay Si Si". Soon because of the breakup of The Medallions, The Dootones took their place behind Vernon Green and became the new version of The Medallions for the rest of the year.
The group soon called it quits and went their separate ways. The Dootones never recorded as the Medallions. Surprisingly, Dootsie revived a new Dootones in the early '60s and released two singles.


New Corporate members for Tenterden Rotary club: On 5th November 2015 Tenterden Rotary Club were delighted to welcome their latest Corporate members - Whitehead Monckton. Their three delegates who will attend each week on a rota basis are: Daniel Bennett, Caroline Speed and Janet Goode. They will participate in all club activities and will be expected to attend committee meetings whenever possible and support the various projects and activities.