Corona viruses and influenza viruses, the pandemic viruses can cause acute respiratory distress syndrome (ARDS) contributing to lethallyacute lung injuries (ALI) and death.Activation of nuclear factor erythroid 2 (nfe2)-related factor 2 (nrf2), a major regulator of antioxidant response element (ARE)-driven cytoprotective protein expression plays an critical role in preventing cells and tissues from oxidative-stress-induced injury. Both viral and bacterial infections can contribute to cytokine storm that results in increased oxidative stress. Vitamin C is beneficial to critical care management due to its important component of the cellular antioxidant system. High-dose vitamin C has been clinically used for several decades. Intravenous high dose of vitamin C may be applicable to COVID-19 since the prevention and management of oxidative stress could be administered by large dose of antioxidant.By eating a variety of food, particularly fruits and vegetables, individuals can easily achieve 100 to 200 mg of vitamin C that is proved to be adequate to optimize cell and tissue levels for the reduction of the risks of chronic diseases. At least 200 mg of daily vitamin C supplementation is effective in improving the duration and severity of the common cold, both in children and adults. Nevertheless, the “prophylactic” dose of vitamin C for disease prevention is controversial.
A clinical trial in 50 patients with moderate to severe COVID-19 in China revealed that the dose used varied between 2 g and 10 g daily, given over the period of 8 to 10 hours. Improving oxygenation index in real time was achieved and finally, all patients were discharged.
In conclusion, the findings of studies on vitamin C or other vitamins or other antioxidants in preventing and treating patients with COVID-19 will however provide valuable information during future viral outbreaks. Well-designed clinical trials are urgently needed to develop bedside-use standard protocols.