Randomised trial to determine the effect of vitamin D and zinc supplementation for improving treatment outcomes among patients with COVID-19 in India: trial protocol.

INTRODUCTION: Presently, there are few population-level strategies to address SARS-CoV-2 infection except preventive measures such as vaccination. Micronutrient deficiency, particularly vitamin D and zinc deficiency, has been associated with dysregulated host responses, and may play an important role in COVID-19. METHODS AND ANALYSIS: We have designed a 2×2 factorial, randomised, double-blind, multi-centre placebo-controlled trial to evaluate the effect of vitamin D and zinc on COVID-19 outcomes in Maharashtra, India. COVID-19 positive individuals are recruited from hospitals in Mumbai and Pune. Participants are provided (1) vitamin D3 bolus (180 000 IU) maintained by daily dose of 2000 IU and/or (2) zinc gluconate (40 mg daily), versus placebo for 8 weeks. Participants undergo a detailed assessment at baseline and at 8 weeks, and are monitored daily in hospital or every 3 days after leaving the hospital to assess symptoms and other clinical measures. A final follow-up telephone call occurs 12 weeks post-enrolment to assess long-term outcomes. The primary outcome of the study is to time to recovery, defined as time to resolution of all of fever, cough and shortness of breath. Secondary outcomes include: duration of hospital stay, all-cause mortality, necessity of assisted ventilation, change in blood biomarker levels and individual symptoms duration. Participant recruitment commenced on April 2021. ETHICS AND DISSEMINATION: Ethical approval was obtained from institutional ethical committees of all participating institutions. The study findings will be presented in peer-reviewed medical journals. TRIAL REGISTRATION NUMBERS: NCT04641195, CTRI/2021/04/032593, HMSC (GOI)-2021-0060.

Delay in the Effect of Restricting Community Mobility on the Spread of COVID-19 During the First Wave in the United States.

BACKGROUND: It remains unclear how changes in human mobility shaped the transmission dynamic of coronavirus disease 2019 (COVID-19) during its first wave in the United States. METHODS: By coupling a Bayesian hierarchical spatiotemporal model with reported case data and Google mobility data at the county level, we found that changes in movement were associated with notable changes in reported COVID-19 incidence rates about 5 to 7 weeks later. RESULTS: Among all movement types, residential stay was the most influential driver of COVID-19 incidence rate, with a 10% increase 7 weeks ago reducing the disease incidence rate by 13% (95% credible interval, 6%-20%). A 10% increase in movement from home to workplaces, retail and recreation stores, public transit, grocery stores, and pharmacies 7 weeks ago was associated with an increase of 5%-8% in the COVID-10 incidence rate. In contrast, parks-related movement showed minimal impact. CONCLUSIONS: Policy-makers should anticipate such a delay when planning intervention strategies restricting human movement.