“Conclusion: Low vitamin D status was highly prevalent and almost universal in this cohort of patients with ARDS (90%). Although this high prevalence limited power for comparing outcomes, the presence of vitamin D deficiency was associated with fewer days free of mechanical ventilation independent of the severity of illness. Further study of the role of vitamin D in the prevention and treatment of ARDS is warranted.”
American Journal of Respiratory and Critical Care Medicine, 2016
“Present analyses and numerous observational studies indicate that age-associated Vitamin D deficiency may contribute to the high mortality of older adults and the elderly. Immediate availability for targeted experimental and clinical interrogations of potential COVID-19 pandemic mitigation agents, namely Vitamin D and Quercetin, as well as of the highly selective (Ki, 600 pm) intrinsically-specific FURIN inhibitor (a1-antitrypsin Portland (a1-PDX), is considered an encouraging factor. Observations reported in this contribution are intended to facilitate follow-up targeted experimental studies and, if warranted, randomized clinical trials to identify and validate therapeutically-viable interventions to combat the COVID-19 pandemic. Specifically, gene expression profiles of Vitamin D and Quercetin activities and their established safety records as over-the-counter medicinal substances strongly argue that they may represent viable candidates for further considerations of their potential utility as COVID-19 pandemic mitigation agents. Significantly, the interventional randomized clinical trial entitled “Effect of Vitamin D Administration on Prevention and Treatment of Mild Forms of Suspected COVID-19” was listed on ClinicalTrials.gov website (https://www.clinicaltrials.gov/ct2/show/NCT04334005 ) with the starting date April 10 and completion date June 30, 2020.”
“The world is in the grip of the COVID-19 pandemic. Public health measures that can reduce the risk of infection and death in addition to quarantines are desperately needed. This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk. Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines. Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40–60 ng/mL (100–150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.”
Vitamin D, the fat-soluble hormone produced in the body when sunlight hits the skin, is responsible not only for bone health but is also believed to help regulate the immune and neuromuscular systems. Vitamin D deficiency has been linked to breast cancer, colon cancer, prostate cancer, heart disease, depression, weight gain and other maladies.1
Research on Vitamin D has exploded in the last ten years, and not only is there a large and growing literature on Vitamin D’s role in reducing the risk of acute respiratory infections and reducing morbidity and mortality in critical care settings,2 but new research confirms a relationship between vitamin D levels and the respiratory illness believed to be caused by the novel coronavirus SARS CoV-2.3 4 5 6 7 8 9
Vitamin D levels correlated with health outcomes in COVID-19 patients
In a study10 published on May 6, researchers reviewed data from 20 European countries. Vitamin D levels are severely low in some aging populations, especially in Spain, Italy and Switzerland, whereas Vitamin D levels were higher in the Nordic countries. The study found a negative correlation between mean levels of Vitamin D and number of cases of COVID-19 and mortality from the new coronavirus.
The authors suggested that Southern European countries have lower levels of vitamin D because of decreased exposure to the sun (because people prefer the shade) and darker skin pigmentation, which decreases Vitamin D synthesis. Northern Europe’s levels are better due to the consumption of cod liver oil, vitamin supplements, and Vitamin D fortification of milk and milk products. Furthermore, they suggested that Vitamin D has a modulating effect on inflammatory cytokines, chemokines, and ACE2, which protects against lung injury.
A small, retrospective observational study11 conducted at Louisiana State University Health Sciences Center found the baseline prevalence of Vitamin D insufficiency (VDI) among ICU patients hospitalized in the intensive care unit (ICU) for any cause is 30 to 40 percent, whereas for patients in ICU units with COVID-19, 84.6 percent had VDI. This is in contrast to only 57.1 percent of the COVID-19 patients hospitalized on general floors testing positive for Vitamin D insufficiency.
Strikingly, 100 percent of ICU patients less than 75 years old had Vitamin D insufficiency. Authors of this study believe their findings also contribute to understanding the racial aspect of health disparities associated with COVID-19 hospitalization and mortality statistics. VDI is highly prevalent in dark-skinned persons: 82.1 percent of African Americans have Vitamin D insufficiency vs. 41.6 percent in the U.S. general population.
In a retrospective study12 of 212 COVID-19 patients in the Philippines published electronically on April 9, 2020, Vitamin D status was significantly associated with severity of COVID-19. In the analysis, 85.5 percent of patients with sufficient Vitamin D had mild cases while 72.8 percent of patients who were deficient in Vitamin D had severe or critical cases.
A retrospective cohort study13 of 780 cases with laboratory-confirmed infection of SARS-CoV-2 in Indonesia revealed that a majority of the death cases were older males with pre-existing conditions and Vitamin D insufficiency. Patients with Vitamin D insufficiency (between 20 and 30 ng/ml) were 12.55 times more likely to die and patients with severe Vitamin D deficiency (<20 ng/ml) were 19.12 times more likely to die than those patients with sufficient levels of Vitamin D. After controlling for age, sex, and comorbidity, Vitamin D status is strongly associated with COVID-19 mortality. When compared to COVID-19 cases with normal Vitamin D status, death was approximately 10.12 times more likely for Vitamin D deficient cases.