The studies summarized below are those that have had the greatest impact on the COVID-19 Treatment Guidelines Panels (the Panel) recommendations. Phytother Res 2021;35:1230-6. [, Voordouw BC, Euser R, Verdonk RE, Alberda BT, de Jong FH, Drogendijk AC, et al. Zinc and respiratory tract infections: Perspectives for COVID19 (Review). Studies have not evaluated melatonin supplementation during pregnancy and breastfeeding, but some research suggests that these supplements might inhibit ovarian function [131]. [, Calder PC. [, Jovic TH, Ali SR, Ibrahim N, Jessop ZM, Tarassoli SP, Dobbs TD, et al. Epub 2020 Jun 20. Director, Mayo Clinic's Covid Activity Rehabilitation Program. This appearance of official approval tallies with the common misperception that natural means safe. Another clinical trial in Saudi Arabia compared the effects of 125 mcg (5,000 IU) vitamin D3 daily for 14 days with the effects of 25 mcg (1,000 IU) vitamin D3 in 69 adults (mean age 49.8 years) who were hospitalized with mild to moderate COVID-19 [323]. Therefore, the present knowledge on the pathophysiology of fatigue and the potential positive impact of Phytother Res: PTR 2020. [, Silveira D, Prieto-Garcia JM, Boylan F, Estrada O, Fonseca-Bazzo YM, JAMAl CM, et al. Nutrients 2020;13. [, Yisak H, Ewunetei A, Kefale B, Mamuye M, Teshome F, Ambaw B, et al. Allergic reactions might also occur [28,33]. Phytother Res: PTR 2010;24:1-8. Raveendran AV, Jayadevan R, Sashidharan S. Diabetes Metab Syndr. For example, one trial in Spain is investigating whether daily micronutrient supplementation with 110 mcg selenium along with 10 other vitamins and minerals for 14 days in 300 adults with COVID-19 reduces the need for hospitalization due to the disease [237]. -. Online ahead of print. Some people who have been infected with the virus that causes COVID-19 can experience long-term effects from their infection, known as post-COVID conditions (PCC) or long COVID. [, Fowdar K, Chen H, He Z, Zhang J, Zhong X, Zhang J, et al. Story MJ. Common initial signs and symptoms include cough, fever, fatigue, headache, muscle aches and pain, and diarrhea [2]. Another study in 235 patients (mean age 58.7 years) hospitalized with COVID-19 found that those with vitamin D sufficiency had less severe disease [301]. Coughing, muscle pain, and shortness of breath were alleviated in 91 to 98% of individuals who received the combination of echinacea, ginger, and hydroxychloroquine, whereas only 69 to 79% of individuals who received hydroxychloroquine alone experienced these benefits. [, Bennouar S, Cherif AB, Kessira A, Bennouar DE, Abdi S. Vitamin D deficiency and low serum calcium as predictors of poor prognosis in patients with severe COVID-19. [, Hernndez JL, Nan D, Fernandez-Ayala M, Garca-Unzueta M, Hernndez-Hernndez MA, Lpez-Hoyos M, et al. Chapter 442: Chronic Fatigue Syndrome. Low Circulating Vitamin D in Intensive Care Unit-Admitted COVID-19 Patients as a Predictor of Negative Outcomes. Effects of Omega-3 Fatty Acids on Immune Cells. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged 65 Years United States, JanuaryMarch 2021. Selenium status varies by geographic region because of differences in the amounts of selenium in soil and in local foods consumed [220,229]. Body mass index and risk for COVID-19-related hospitalization, intensive care unit admission, invasive mechanical ventilation, and death - United States, March-December 2020. Superfoods are those rich in antioxidants, fiber and fatty acids, which are beneficial for health. [, Kroll MH, Elin RJ. [, Hemil H, Chalker E. Vitamin C for preventing and treating the common cold. The FDA classifies intravenous forms of vitamin C as drugs; only oral forms can be classified as dietary supplements. World Gastroenterology Organisation. Vitamin D and lung outcomes in elderly COVID-19 patients. Assistant Director of Pharmacy, Mater Health SEQ in conjoint appointment as Associate Professor of Pharmacology, Bond University and Associate Professor (Clinical), The University of Queensland. A few case reports of vaginal bleeding and mastalgia (breast pain) in the 1970s and 1980s raised concerns about the safety of ginseng; some scientists concluded that ginseng has estrogenic effects [79-82]. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. ", "The other half is how those symptoms affect a person's ability to live their lives. Effects of a 2-Week 5000 IU versus 1000 IU Vitamin D3 Supplementation on Recovery of Symptoms in Patients with Mild to Moderate Covid-19: A Randomized Clinical Trial. A doctor explains why you should keep fruit on the menu, Vitamins and minerals aren't risk-free. [, De Flora S, Balansky R, La Maestra S. Rationale for the use of N-acetylcysteine in both prevention and adjuvant therapy of COVID-19. Vitamin E: 25 mg. Biotin: 5,000 mcg. Older adults are among the groups most likely to have low intakes. No, CBD is not a miracle molecule that can cure coronavirus, just as it won't cure many other maladies its proponents claim. Nevertheless, sales of dietary supplements marketed for immune health increased after the emergence of COVID-19 because many people hoped that these products might provide some protection from SARS-CoV-2 infection and, for those who develop COVID-19, help reduce disease severity [9-12]. Diuretics in clinical practice. Safety: Vitamin C in foods and dietary supplements is safe at intakes up to 400 to 1,800 mg/day for children, depending on age, and up to 2,000 mg/day for adults [220]. [, Carr AC, Rowe S. The emerging role of vitamin C in the prevention and treatment of COVID-19. Another retrospective chart review included 152 patients with COVID-19 (median age 68 years) who were on mechanical ventilation [256]. JAMA 2004;292:828-36. QJM. These upper limits, however, do not apply to individuals receiving vitamin C treatment under the care of a physician. She takes a concoction of vitamins, crafted on the basis of online accounts from others with long COVID, and is exploring traditional Indian medicines for her symptoms. Thus, higher concentrations of omega-3s than of omega-6s tip the eicosanoid balance toward less inflammatory activity [151,152]. More information on vitamin D is available in the ODS health professional fact sheet on vitamin D. Vitamin E, also called alpha-tocopherol, is an essential nutrient that is present in several foods, including nuts, seeds, vegetable oils, and green leafy vegetables. Vitamin D obtained from sun exposure, foods, and supplements is biologically inert and must undergo two hydroxylations in the body for activation. Bleijenberg G., van der Meer J.W.M. People with low vitamin C status might benefit more from vitamin C supplementation than those who already obtain sufficient vitamin C [248]. [, Alamdari NM, Afaghi S, Rahimi FS, Tarki FE, Tavana S, Zali A, et al. Bauer SR, Kapoor A, Rath M, Thomas SA. However, supplements may be beneficial when individuals are unable to achieve a balanced and varied diet. Ingredients are presented in alphabetical order. Vitamin A and Vitamin B. PLoS One 2017;12:e0181780. Med. [, Rubin R. As their numbers grow, COVID-19 "long haulers" stump experts. In addition, the use of loop diuretics, thiazide diuretics or proton pump inhibitors can deplete magnesium levels [114-117]. Neither treatment affected total antioxidant capacity or levels of the inflammatory markers interleukin-6 and procalcitonin. Probiotics are not known to interact with medications. In a clinical trial in Iran, 42 of 128 critically ill patients with COVID-19 (mean age 64 to 66 years) received a 1,000 mg omega-3 supplement containing 400 mg EPA and 200 mg DHA for 14 days [161]. 2019;11:3034. doi: 10.3390/nu11123034. Acknowledging that patients often need reminders to stay hydrated, Vanichkachorn encouraged those with long Covid to carry a bottle with them. Quercetin Phytosome as a potential candidate for managing COVID-19. Zinc deficiency adversely affects immune function by impairing the formation, activation, and maturation of lymphocytes. Serum zinc and pneumonia in nursing home elderly. There's still much left to learn about long Covid. For example, in an analysis of serum magnesium levels of 300 patients (mean age 66.7 years) admitted to the hospital with COVID-19 in France, 48% had abnormally low magnesium levels (less than 0.75 mmol/L) and 9.6% had abnormally high magnesium levels (0.95 mmol/L or higher) [109]. [, Yao JS, Paguio JA, Dee EC, Tan HC, Moulick A, Milazzo C, et al. [. [, Barak V, Halperin T, Kalickman I. [, Poolsup N, Suthisisang C, Prathanturarug S, Asawamekin A, Chanchareon U. Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials. Effect of high-dose zinc and ascorbic acid supplementation vs usual care on symptom length and reduction among ambulatory patients with SARS-CoV-2 infection: The COVID A to Z randomized clinical trial. Australian complementary medicines revenue was estimated at A$5.69 billion in 2021 doubling in size over the past decade. [, Maier JA, Castiglioni S, Locatelli L, Zocchi M, Mazur A. Magnesium and inflammation: Advances and perspectives. As an antioxidant, selenium might also help reduce the systemic inflammatory response that can lead to acute respiratory distress syndrome and organ failure [222,224,227]. In this study, people with vitamin D sufficiency [defined as 25(OH)D levels higher than 75 nmol/L (30 ng/mL)] also had lower levels of C-reactive protein and higher lymphocyte percentages than those with vitamin D insufficiency. [, Guillin OM, Vindry C, Ohlmann T, Chavatte L. Selenium, Selenoproteins and Viral Infection. Historically, the public has purchased supplements from sources that also provide health-care advice. In addition, research findings for one probiotic strain cannot be extrapolated to others [17,177]. Pantothenic acid: 100 mg. Zinc: 30 mg. Hydrolyzed COVID-19: Poor outcomes in patients with zinc deficiency. Beni-Suef Univ J Basic Appl Scie 2021;10:21. The bodys immune response to pathogens leads to inflammation, causing redness, swelling, heat, pain, and loss of tissue function [16]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Efficacy: Data are insufficient to support a recommendation for or against the use of NAC supplements to prevent or treat COVID-19. Pilot trial of high-dose vitamin C in critically ill COVID-19 patients. J Intern Med 2020. However, according to the European Food Safety Authority (EFSA), long-term consumption of EPA and DHA supplements at combined doses of up to about 5 g/day appears to be safe for adults [164]. NPJ Sci Food 2020;4:17. BMJ 2017;356:i6583. [, Frei R, Akdis M, O'Mahony L. Prebiotics, probiotics, synbiotics, and the immune system: experimental data and clinical evidence. Studies of vitamin C regimens in patients with acute respiratory distress syndrome (ARDS) or sepsis not related to COVID-19 have reported variable efficacy and few safety concerns. [. Vitamin C, 500-1,000 mg twice a day. For example, many studies have examined associations between serum or plasma concentrations of vitamins or minerals and risk of COVID-19 infection or disease severity. A 2022 UK study of non-hospitalized adults still experiencing symptoms 12 weeks post-infection So people are doing more shopping online for supplements and turning to the internet, friends or social media for vitamin recommendations. Lockdowns and blanket health messages about social distancing and personal hygiene have created a new normal. In critically ill patients with conditions similar to COVID-19, such as sepsis and ARDS, vitamin C has been studied alone and in combination with thiamine and corticosteroids. Ann Pharmacother 2020;54:820-6. Common symptoms include fatigue, shortness of breath, cough, joint pain, chest pain, muscle aches, headaches, and so on. Washington, DC National Academy Press; 2005. [, Barnett JB, Hamer DH, Meydani SN. Heart disease, certain cancers you can fight all of those diseases with a knife and a fork. The crux of the current treatment trends for Long COVID is that of a multidisciplinary approach with a great portion of the treatment implicating the patient to take an active role in their recovery, self-monitoring and treatment of the syndrome. Multidisciplinary Digital Publishing Institute (MDPI). Biochimie 2020;179:275-80 [, Thibault R, Seguin P, Tamion F, Pichard C, Singer P. Nutrition of the COVID-19 patient in the intensive care unit (ICU): a practical guidance. Vitamin C and zinc supplementation did not affect mortality. Nutrients 2021;13. [, James M, Proudman S, Cleland L. Fish oil and rheumatoid arthritis: past, present and future. When all the vitamins and minerals are working together, that is going to be your best defense.". Nutrients 2018;10: 1614. Eur J Med Res 2021;26:20. These effects on immune response probably increase susceptibility to infections [353] and inflammatory diseases, especially those affecting the lungs [350]. Quercetin is a flavonol (a polyphenolic compound) present in many fruits, vegetables, spices, and beverages, including citrus fruits, apples, onions, berries, broccoli, cilantro, dill, tea, and red wine [201-205]. Vitamin C plus pentoxifylline also significantly increased total antioxidant capacity, but pentoxifylline alone did not. [, Gruber-Bzura BM. 2020; 11:2036. doi: 10.3389/fimmu.2020.574029. Diabetes Metab Syndr 2020;14:367-82. Smell/Taste alteration in COVID-19 may reflect zinc deficiency. In addition, a non-randomized retrospective study in Spain of 537 patients hospitalized with COVID-19 (median age 70 years) found that the 79 patients who received calcifediol (25-OHD3, 532 mcg on the first day and 266 mcg on days 3, 7, 14, 21, and 28) combined with medications had a lower mortality rate during the first 30 days of hospitalization than those who received medications without calcifediol [310]. Am J Respir Crit Care Med 2010;182:1058-64. Ginseng might also inhibit virus replication and have anti-inflammatory activity. Therefore, the presence of dysmagnesemia among patients with COVID-19 does not necessarily mean that magnesium intakes affect the risk of the disease or its severity. [, Dennert G, Horneber M. Selenium for alleviating the side effects of chemotherapy, radiotherapy and surgery in cancer patients. Redox Biol 2020;37:101715. The role of vitamin C as adjuvant therapy in COVID-19. 2022;73(1):5-12. doi: 10.32394/rpzh.2022.0191. 2021 Feb 18;114(1):3-10. doi: 10.1093/qjmed/hcaa234. [, Schleicher RL, Carroll MD, Ford ES, Lacher DA. Stafie CS, Solomon SM, Sufaru IG, Manaila M, Stafie II, Melinte G, Simionescu B, Leustean L. Viruses. Low selenium status in humans has been associated with lower natural killer cell activity, increased risk of some bacterial infections, and increased virulence of certain viruses [14,223,226-228]. Although multiple observational cohort studies suggest that people with low vitamin D levels are at increased risk of SARS-CoV-2 infection and worse clinical outcomes after infection (e.g., Black individuals with 25(OH)D levels below 100 nmol/L (40 ng/mL) had higher risk of COVID-19 than those with higher levels, but the results showed no associations between vitamin D levels and COVID-19 risk among White individuals. Vitamin D can inhibit hyperinflammatory reactions and accelerate the healing process in the affected areas, especially in lung tissue. However, no studies to date have found that vitamin D affects post-COVID-19 symptoms or biomarkers. [, Jalali A, Dabaghian F, Akbrialiabad H, Foroughinia F, Zarshenas MM. Food and Nutrition Board. However, this effect may have been mediated by thiamine and hydrocortisone rather than vitamin C.15 These studies on vitamin C in patients without COVID-19 have conflicting results. Unable to load your collection due to an error, Unable to load your delegates due to an error. Chiropractic modalities and treatment for long COVID. Modern Nutrition in Health and Disease Baltimore, Maryland: Lippincott Williams & Wilkins; 2012. [, Weiss ST. Vitamin D and COVID-19: Can it be protective? However, some evidence suggests that vitamin D supplementation helps prevent respiratory tract infections, particularly in people with 25(OH)D levels less than 25 nmol/L (10 ng/mL) [278]. HHS Vulnerability Disclosure, Help In a double-blind trial conducted from June to October 2020 at 2 sites in Brazil, 240 hospitalized patients with moderate to severe COVID-19 were randomized to The minimal effect of zinc on the survival of hospitalized patients with COVID-19: An observational study. 8600 Rockville Pike Public Health Nutr. Curr Opin Gastroenterol 2015;31:153-8. Because of these findings; NACs potential antioxidant, anti-inflammatory, and antiviral effects; and its mucolytic activity, some researchers believe that using NAC as an adjuvant treatment might improve outcomes in patients with COVID-19 [135-137]. Urinary zinc excretion during treatment with different diuretics. Two hospitals ready to trial traditional Thai medicine in treating COVID-19. Magnes Res 2020;33:21-7. Unfortunately, the symptoms of long-haul COVID can be quite limiting.". The effects of combination of Zingiber officinale and Echinacea on alleviation of clinical symptoms and hospitalization rate of suspected COVID-19 outpatients: a randomized controlled trial. [, Bottari B, Castellone V, Neviani E. Probiotics and Covid-19. [, Laursen RP, Hojsak I. Probiotics for respiratory tract infections in children attending day care centers-a systematic review. Vitamin C as well as the use of adaptogens has shown promising results and is advisable [, Micke O, Vormann J, Kisters K. Magnesium and COVID-19 - Some Further Comments - A Commentary on Wallace TC. A systematic review and meta-analysis of 31 observational studies (including some of those described above) did not find significant associations between serum 25(OH)D levels below 50 nmol/L (20 ng/ml) and incidence of COVID-19, or risk of mortality, ICU admission, or need for ventilation among COVID-19 patients [293]. [. 2020 Dec 7;12(12):3760. doi: 10.3390/nu12123760. Biol Trace Elem Res 2021:1-8. Guidelines on vitamin D and COVID-19 from the National Institute for Health and Care Excellence (NICE) in the United Kingdom state that individuals older than 4 years should consider taking 10 mcg (400 IU) of vitamin D daily between October and early March to maintain bone and muscle health [320]. However, hypozincemia is part of the acute-phase response during infection, and zinc concentrations can also decline substantially as a result of acute physiological stress [367]. A deficiency of omega-3s can cause rough, scaly skin and dermatitis [149]. Crit Care 2020;24:447. Effect of vitamin C, hydrocortisone, and thiamine vs hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: the VITAMINS randomized clinical trial. More information on vitamin E is available in the ODS health professional fact sheet on vitamin E. A wide variety of foods contain zinc, an essential nutrient. Some studies link lower vitamin D status with a higher incidence of COVID-19 and more severe disease [235,279-287] but others do not [288-292]. Higher intakes and blood levels of EPA and DHA are associated with lower levels of inflammatory cytokines [151,153]. Abbreviations: 25(OH)D, 25-hydroxyvitamin D; BMI, body mass index; COPD, chronic obstructive pulmonary disorder; COVID-19, coronavirus disease 2019; CRP, C Other signs and symptoms of excess selenium intakes include lesions in the skin and nervous system, nausea, diarrhea, skin rashes, mottled teeth, fatigue, irritability, and nervous system abnormalities. Signs and symptomsincluding diarrhea, fever, asthenia (weakness), headaches, myalgia (muscle pain), and dyspnea (difficulty breathing)were significantly lower within 7 days in patients taking the probiotic than in those who did not. Omega-3s might also affect immune function by upregulating the activity of macrophages, neutrophils, T cells, B cells, natural killer cells, and other immune cells [14,150,154]. It might also reduce the effectiveness of radiation therapy and chemotherapy by protecting tumor cells from the action of these agents [266,344,345]. Diabetes Metab Syndr 2020;14:561-5. Nutr Rev 2021;79:289-300. Life Sci 2020;250:117583. Quercetin supplementation and upper respiratory tract infection: A randomized community clinical trial. JAMA Netw Open 2021;4:e214117. This adulteration might be due to the surge in popularity of these products, which could have created a supply shortage. The heat from cooking destroys this toxin, so cooked elderberry fruit and properly processed commercial products do not pose this safety concern [15,59,61,64,69]. joint or muscle pain. Korean J Pain. Br J Nutr 2014;112:41-54. Assessment of the association of vitamin D level with SARS-CoV-2 seropositivity among working-age adults. Efficacy: Sales of elderberry supplements more than doubled shortly after the COVID-19 pandemic began in the United States [64], and some researchers have recommended studying the use of elderberry to treat COVID-19 symptoms [15,61,65,66]. "Iron deficiency can cause many symptoms, including anemia and fatigue. Interest in the use of vitamin C supplements to treat COVID-19 comes from research showing that taking 200 mg/day or more vitamin C supplements on a regular basis helps reduce the duration of the common cold and the severity of its symptoms [242,246]. Journal of the American College of Nutrition 2020:1-3. [, Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. Looking for U.S. government information and services. Akhtar S, Das JK, Ismail T, Wahid M, Saeed W, Bhutta ZA. Thus, interest in dietary supplement ingredients that might enhance immune function and reduce inflammation to help prevent COVID-19 or manage its signs and symptoms remains high. [, Parkin J, Cohen B. Front Immunol 2020;11:607734. Because of these findings, many researchers recommend additional research on whether higher vitamin D intakes or vitamin D supplementation can reduce the risk and severity of COVID-19 [90,91,100,123,160,235,251,269,271,272,280,294,295,301,312-318]. An official website of the United States government. Comput Struct Biotechnol J 2021;19:1379-90. [, e Alencar JCG, Moreira CL, Mller AD, Chaves CE, Fukuhara MA, da Silva EA, et al. Another trial is examining whether NAC combined with glycine for 2 weeks improves outcomes in about 64 hospitalized adults aged 55 to 85 years who have COVID-19 [145]. Vitamin C-an adjunctive therapy for respiratory infection, sepsis and COVID-19. J Immunol Res 2020;2020:9207279. However, at this time, only a couple of preliminary clinical trials have examined the use of quercetin supplementation in patients with COVID-19. Ginseng might interact with many medications. An analysis of 348,598 U.K. Biobank participants (median age 49 years), of whom 449 had COVID-19, did not find a link between 25(OH)D concentrations and risk of SARS-CoV-2 infection after adjusting for confounders including ethnicity, BMI category, age at assessment, and sex [292]. Echinacea contains volatile terpenes, polysaccharides, polyacetylenes, alkamides, phenolic compounds, caffeic acid esters, and glycoproteins [22,46,47]. COVID-19: Is there evidence for the use of herbal medicines as adjuvant symptomatic therapy? The Long Can Zn be a critical element in COVID-19 treatment? Metabolism: clinical and experimental 2021;115:154434. Lancet Gastroenterol Hepatol 2020;5:720-1. Cited in: PMID: 32649272. Search strategy. Another trial is examining whether vitamin D3 supplementation for 28 days (240 mcg [9,600 IU] on days 1 and 2, followed by 80 mcg [3,200 IU] on days 3 through 28) in about 2,700 adults aged 30 years and older who were recently diagnosed with COVID-19 helps reduce the severity of disease and risk of transmission to household members [325]. Share sensitive information only on official, secure websites. [, Murugan NA, Pandian CJ, Jeyakanthan J. Computational investigation on Andrographis paniculata phytochemicals to evaluate their potency against SARS-CoV-2 in comparison to known antiviral compounds in drug trials. Others recommend studying the combination of quercetin with vitamin C because these substances might have antioxidant synergy [208]. Vitamin C deficiency is uncommon in the United States, affecting only about 7% of individuals aged 6 years and older [249]. Efficacy: Currently, data are insufficient to support a recommendation either for or against the use of vitamin C supplements to prevent or treat COVID-19. Mechanisms by which vitamin D could decrease the risk of cytokine storm. Clin Biochem Rev 2003;24:47-66. [, Kronbichler A, Effenberger M, Eisenhut M, Lee KH, Shin JI. Safety and efficacy of hydroxychloroquine for the treatment & prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Special Chinese medicine out-patient programme for discharged COVID-19 patients, Usual Nutrient Intake from Food and Beverages, by Gender and Age, What We Eat in America, NHANES 2013-2016, Effect of a Nss to Reduce Complications in Patients With Covid-19 and Comorbidities in Stage III, FDA Drug Safety Communication: Low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs), Safety and efficacy of melatonin in outpatients infected with COVID-19 (COVID-19), The effect of melatonin and vitamin C on COVID-19, Trial of Famotidine & N-Acetyl Cysteine for Outpatients With COVID-19, Glutathione, oxidative stress and mitochondrial function in COVID-19, The effect of omega-3 on selected cytokines involved in cytokine storm, Cod liver oil for Covid-19 prevention study, Qualified Health Claims: Letters of Enforcement Discretion, LOVAZA (omega-3 acid ethyl esters) capsules, prescribing information, Efficacy of probiotics in reducing duration and symptoms of COVID-19 (PROVID-19), Effect of Lactobacillus on the microbiome of household contacts exposed to COVID-19, Effect of Quercetin on Prophylaxis and Treatment of COVID-19, Trial to Study the Adjuvant Benefits of Quercetin Phytosome in Patients With COVID-19 2021, Efficacy of a Dietary Supplementation in Reducing Hospital Admissions for COVID-19. 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