Pharmaconutrition Revisited for Critically ill Covid-19 Patients: Does Selenium Have a Place?

Manzanares, William; Moreira, Eduardo; Hardy, Gil

Corona-virus Disease 2019 (Covid-19) is a global pandemic providing one of the biggest challenges for critical care medicine. Mortality from Covid-19 disease is much greater in elderly males, many of whom succumb to acute respiratory distress syndrome (ARDS) triggered by the viral infection. Since there is no specific antiviral treatment against Covid-19, new strategies are urgently needed. Selenium (Se) is an essential trace element with antioxidant, and immunomodulatory effects. Poor nutritional status increases pathogenicity of viruses and low Se in particular can be a determinant of viral virulence. In the last decade Se pharmaconutrition studies from ourselves and others demonstrated some improvement in overall mortality, reduced incidence of ventilator associated pneumonia (VAP) and infectious complications such as ARDS in the critically ill. Consequently, we postulate that intravenous Se therapy, could be part of the therapeutic fight against Covid-19 in ICU patients with ARDS and that outcomes could be affected by age, sex, and body weight. Our working hypothesis addresses the question: Could high-dose selenite pharmaconutrition as an early pharmacological intervention, be effective at reducing the incidence and the progression from type 1 respiratory failure (non ARDS) to severe ARDS, multiorgan failure, and new infectious complications in Covid-19 patients?