Covid 19 population study, Vitamin D, and controversy

[jim mcnamara]

TL;DR Summary

Marginally good study gives hint about survival rates for Covid 19 populations

My main reason for posting this is to prevent overreaction to the research, especially from the "pill press" internet people and the impact that has on non-science people.

Yes, it is interesting. No, it is not definitive. Worried about it? Take a short 10 minute walk, 5 or 6 days a week, in full sun.

Shortest version: if you are outside in sunshine most days for 10 minutes you are likely okay in terms of Vitamin D. The paper is a reasonable suggestion and not necessarily a fact, that populations with higher serum Vitamin D levels have statistically correlated lower Covid 19 death rates. Higher Vitamin D levels = lower death rates.

Do not rush out and buy pills. Please. Too much Vitamin D is toxic. And in very unpleasant ways. Do not do it. Your liver will thank you. Vitamin D does not fit traditional definitions of vitamin, it is much more like a hormone. And I'm sure you are aware that hormones given in small amounts to humans can have terrifying effects. Ditto Vitamin D. Unlike several other vitamins, excess Vitamin D cannot be excreted. It builds up.

Decent coverage in popular science:
https://www.sciencealert.com/covid-...h-vitamin-d-deficiency-here-s-what-that-means

Paper in preprint:
https://www.researchsquare.com/article/rs-21211/v1

Abstract:

Background/Aims: WHO declared SARS-Cov-2 a global pandemic. The aims of this paper are to assess if there is any association between mean levels of vitamin D in various countries and cases respectively mortality caused by COVID-19.

Methods: We have identified the mean levels of vitamin D for 20 Europeans Countries for which we have also got the data regarding the morbidity and mortality caused by COVID-19.

Results: The mean level of vitamin D (average 56mmol/L, STDEV 10.61) in each country was strongly associated with the number of cases/1M (mean 295.95, STDEV 298.73 p=0.004, respectively with the mortality/1M (mean 5.96, STDEV 15.13, p < 0.00001).

Discussion: Vitamin D levels are severely low in the aging population especially in Spain, Italy and Switzerland. This is also the most vulnerable group of population for COVID-19.

Conclusions: We believe, that we can advise Vitamin D supplementation to protect against SARS-CoV2 infection.

Vitamin D 101:
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

 

[Drakkith]

Vitamin D does not fit traditional definitions of vitamin, it is much more like a hormone.

Interesting. I wasn't aware of this.

 

[Ygggdrasil]

Here's the pre-print's graph showing the correlation between mean levels of vitamin D and COVID-19 deaths:

Does that correlation look convincing to you? It seems to be driven primarily by two outliers.

Performing the correlation analysis at the country level (each dot on the plot is a separate country) is also problematic because there are many confounding variables different between countries (even if they did limit the analysis to only European countries). These countries vary widely in geography (spec. latitude), climate, diet, culture, wealth, etc. which would all be expected to affect both vitamin D levels and the spread of COVID-19. Thus, even if the correlation is true, the correlation says nothing about causation.

Using this data to claim "we can advise Vitamin D supplementation to protect against SARS-CoV2 infection" is scientific malpractice and one step down from suggesting that bleach injections can fight SARS-CoV-2 infection.

 

[Buzz Bloom]

Summary:: Marginally good study gives hint about survival rates for Covid 19 populations

Shortest version: if you are outside in sunshine most days for 10 minutes you are likely okay in terms of Vitamin D.

Hi Jim:

Unfortunately, some days it rains all day. Would an hour in the rain compensate?

Regards,
Buzz

 

[Laroxe]

I think we may be being a little pessimistic about this advice, while there is no evidence specific to Covid 19 there is a growing body of evidence about the importance of this vitamin in immune function and in prevention of chest infections. This is particularly true when people have a deficiency and this is most common at the end of winter, in people who spend a lot of time indoors and in the elderly. In fact this is one of the suggested reasons for some viral infections being seasonal rather than the temperature, influenza continues to spread in the tropics where the seasons have little impact on the rate of spread.
It is also one of the possible reasons that people from BAME groups appear to develop more serious illness, while many of the risk factors associated with disadvantaged groups continue to apply, the risk remains high in healthcare staff. People with darker skin produce less vitamin D on exposure to sunlight.
In the UK the main medical information sources are usually engaged in an information war with the producers of dietary supplements, so I was very surprised to see that Public Health England are now recommending this supplement at a dose of around 10mcg daily.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756814/

https://www.bmj.com/content/356/bmj.i6583

 

[jim mcnamara]

@Buzz Bloom - some places like Vancouver or Portland have notices from the local public heath entity there suggesting moderate doses of vitamin D. Most of the suggestions I've seen were in the 2000 - 5000 units range per day in the winter. Contact your local public health people for a specific recommendation. That is beyond what we do on PF.

We have members who sometimes go overboard with these kinds of topics. I have been in Mexico and seen bottles: Vitamin D 25000 unit per capsule. From a street vendor. So I was trying to fend off the problem. I may have overdone it.

Here is an example why. It demonstrates the 'if X is good then 10X must great' syndrome. Otherwise well meaning people succumb to it.

In the late 1970's the USDA county agent's offices everywhere in the US had a pamphlet on using and misusing toxaphene - a sheep dip you mix with water. Shepherds were killing off their flocks by using Toxaphene at 20 and more times the recommended usage: 1 quart per 1000 gallons of dip bath water. They wanted to be "sure" it worked.

The offices had other pamphlets for other farm pesticides, too. Same intention - prevent problems with misuse of chemicals and medicines..

 

[DaveE]

There's a great description of this sort of problem in medicine in the first 15 minutes of this podcast. An argument for evidence based medicine. Trial and error is difficult to do effectively in the world of advanced health care. Good clinical trials are necessary to make progress. "Don't just do something, stand there".

Daniel Griffin MD PhD is at Columbia University and an ID attending at New York University Hospital. Currently on the front lines of the COVID-19 battle.

https://www.microbe.tv/twiv/twiv-606/

 

[Buzz Bloom]

Vitamin D 25000 unit per capsule.

Hi Jim:

If i remember correctly, a few years ago my PCP had me take a 50,000 unit capsule once a week for two weeks when a blood test shows a very low vitamin D level. I am currently taking a 2000 unit capsule every other day since I get little sunshine until late spring.

Regards,
Buzz

 

[jim mcnamara]

Yes that is common for severe infections, you are correct. The literature of Vitamin D is a mess early on. Later studies of people who live in full sun outdoor showed higher serum levels than are found in indoor dwelling people.

Toxicity of Vit D and 'the if one is good then 10 is better' people and the resulting supplementation 50000 units/day on 4 month old baby:



My position is actually moderate on the subject. Some places in the US suggest 2000 units per day for winter months.

However PF gets members who espouse and do some exceptionally dangerous things. We work on them as fast as we can. My hope was to stem the flow of these problems. As @Ygggdrasil clearly pointed out, thank you, the paper is poor. But it still makes the news and and was published in a clinical journal:
https://link.springer.com/article/10.1007/s40520-020-01570-8