Vitamin D, COVID-19 and Me

2020 May 19

    I have decided to start a blog regarding my experiences imposed by the arrival of COVID-19 in Canada. This first entry is a document that I sent to various federal and provincial political leaders and is based on what I have learned over the past several years. While I wound down my career in Pharmacology at Queen's University, I developed an interest in a variety of topics- vitamin D just happens to be one of them. Accordingly, I do not have any special expertise in vitamin D.  I plan to make regular entries in this blog until we return to our normal lives.

COVID-19: the Case for Making the Canadian Population Vitamin D Sufficient and Relaxing Restrictions

1. Vitamin D deficiency/insufficiency is prevalent in the Canadian population.

G.K. Schwalfenberg*, S.J. Genuis, M.N. Hiltz Addressing vitamin D deficiency in Canada: A public health innovation whose time has come public health 124 (2010) 350–359

These authors reviewed 16 studies and found that 70-97% of Canadians were vitamin D insufficient, and 14-60 % were clearly deficient. Herein insufficiency is defined as less than 72-80 nM and deficiency was less than 25-40 nM.

2. Vitamin D effects go well beyond bone health.

In their 2013 review, Uwe Gröber, ^{1 ,*} Jörg Spitz, ² Jörg Reichrath, ³ Klaus Kisters, ^{1 , 4} and Michael F Holick ⁵ ( Vitamin D: Update 2013: From rickets prophylaxis to general preventive healthcare. Dermatoendocrinol. 5(3): 331–347, 2013) summarized the role of vitamin D in a number of functions beyond bone health. Accordingly, diseases associated with vitamin D deficiency include autoimmune diseases (multiple sclerosis, type 1 diabetes) inflammatory bowel disease (Crohn disease), infections (such as infections of the upper respiratory tract), immune deficiency, cardiovascular diseases (hypertension, heart failure, sudden cardiac death), cancer (colon cancer, breast cancer, non-Hodgkin’s lymphoma) and neurocognitive disorders (Alzheimer disease).

3. Vitamin D is anti-viral.

In the context of COVID-19, the germaine property of vitamin D is its anti-viral action. Vitamin D promotes the activity of both the adaptive immune response and the innate immune response. One mechanism by which the innate anti-viral effect is enhanced is through up regulation of cathelicidin and defensin, which are anti-viral and anti-microbial peptides.

John Campbell a retired academic nurse in the United Kingdom has prepared daily video lessons on COVID-19, and clearly explains the potential of Vitamin D in his video on You Tube. https://www.youtube.com/watch?v=1fxw3nTZYlA. Harvard Medicine’s JoAnn Manson has recently taken a supportive position as well.

https://www.medscape.com/viewarticle/930152 These are just two of a growing number of researchers, physicians and concerned citizens who have marshalled respectable arguments in support of vitamin supplementation to face COVID-19.

4. Vitamin D is effective against COVID-19.

Prabowo Raharusuna*, Sadiah Priambada, Cahni Budiarti, Erdie Agung, and Cipta Budi have released a preprint of their retrospective cohort study of 780 (active and expired) cases with laboratory-confirmed infection of SARS-CoV-2. Cases were divided on the basis of serum 25(OH) vitamin D levels with normal being > 30 ng/ml (75 nM), insufficient being 21-29 ng/ml, and (3) deficient being < 20 ng/ml (45 nM) Individuals whose vitamin D levels were insufficient were ~13 times more likely to die while those who were vitamin D deficient were 19 times more likely to die. There are many more published studies that have implicated vitamin D insufficiency and deficiency with greater risk for viral infections.

5. Current status of vitamin D and COVID-19.

There are abundant data showing an inverse relationship between vitamin D status of individuals and their susceptibility to COVID-19. While it would be desirable to have a randomized, double-blind clinical trial showing that vitamin D supplementation is prophylactic, it can be argued that it is unethical to wait for this. People are getting sick and dying as we wait. It is time to promote supplementary vitamin D (≥2000 IU/day) for the Canadian population.

Effect of supplementary vitamin D.

On the basis of current data from Europe, Asia and USA, it can be estimated that the case fatality rate for COVID-19 exposure is ~0.5% (John Campbell, Friday May 15). Germany’s Hendrik Streeck (Director of the Institute for Virology at the University Hospital Bonn) calculated lower estimates of between 0.24 and 0.37% (https://medicalxpress.com/news/2020-05-team-covid-infection-fatality.html) These values for case fatality rate are based on populations following conventional recommendations for vitamin D intake, which would be based on anti-Rickets dosages. Results of recently released study information suggest that making a population genuinely vitamin D sufficient could reduce this by 10-fold or more- bringing the rate down to the range of 0.05%. This would be similar to influenza, which we have learned to live with.

Economic and social effect.

Undoubtedly, COVID-19 restrictions have had a tremendous economic, mental and social cost. I cannot calculate the economic effect on Canada at large but just one company, Air Canada has stated that it lost over $1 billion in the last quarter. Governments are spending huge sums of money addressing the direct effects of COVID-19, and their tax revenues have diminished. Eventually we will have to pay for this in cash. Another incalculable cost is the future effect on our population health due to reductions in tax revenues. In comparison, the cost of every Canadian taking supplementary vitamin D would be negligible- less than five cents/day.

A recommendation.

In closing, may I suggest that we immediately encourage our citizens to supplement themselves with vitamin D3 (2000 IU/day or more but less than 10,000 IU/day, Michael Holick Boston Univ Sch of Med) or get moderate exposure to sunlight, and then proceed with relaxing our social restrictions and opening our economy as soon as the population can be made vitamin D sufficient.