As with most ecological studies, our study has several important limitations. The association between hair selenium and COVID-19cure rate that we note is based on city population selenium statusdata, mostly dating from 2011, although some data are considerably older. Furthermore, we were unable to collect city- or patient-level data for the following likely confounders: age and comorbidities such as cardiovascular disease, diabetes, chronic respiratory disease,hypertension, and cancer (16). We also lack information on variation in medical facilities and therapy protocols (including the use of traditional Chinese medicine or anti-viral therapies). Clearly, we were not able to adjust for these possible confounders in the analysis.We are fully aware, therefore, that the association shown is far from being robust to criticisms of confounding. At best, it points towards the need for further research, particularly when viewed in the context of associations between selenium status and disease outcome found with other viruses (3,5–7). In due course, more individual-level data will emerge, and the association between the severity of COVID-19 and many factors, including selenium, can be explored.