TO the Editor—Ben Abdallah et al reported that 50 mg/d elemental zinc shortened the length of hospital stay in Tunisian patients with coronavirus disease 2019 (COVID-19). A few issues about their study seem important. Dietary surveys in the United States estimated that the average zinc intake was about 14 mg/d for males and 9 mg/d for females, whereas a survey in Tunisia estimated that the average zinc intake was only about 7 mg/d. Other studies have also reported low zinc status in Tunisia. Ben Abdallah et al cited the COVID A to Z trial which found that treatment with zinc had no significant benefit on the duration of symptoms in outpatients with COVID-19 in the United States (zinc gluconate, 50 mg/d; elemental zinc, 7.2 mg/d). However, they did not discuss potential explanations for the divergent findings between the 2 studies. Several factors could explain these divergent results, including the relatively low dietary zinc intake in Tunisia, the much higher dose of zinc tested, and differences in disease severity in the patient populations. These issues need to be considered when generalizing the findings.
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