Dr Shane looks at whether current research can help us prepare during the COVID-19 pandemic.

We have asked Dr Shane with continued testing and reporting of COVID-19 cases in the UK, can current research give us any direction in how best we can prepare ourselves.

Before any discussion, we must understand that central to controlling the spread of this virus, as well as limiting our own potential infection, is the continued adherence to Government guidelines. Continued frequent handwashing, social distancing, mouth and nose covering and self-isolation upon infection being the most prudent measures.1

Moving forward, it appears that the ongoing rates of infection and controls are going to continue for the foreseeable future, therefore we need to think about how best we can protect ourselves. If we get the virus, the severity of symptoms and outcomes have been reported to wide. The NHS describe those at hight risk (clinically extremely vulnerable) and moderate risk (clinically vulnerable) having co-morbidities (described as the presence of one or more additional conditions often co-occurring with a primary condition) and / or have other factors that may affect their risk are the most vulnerable.2

Internationally, scientists and health professionals are accelerating our knowledge and understanding of the spread of the coronavirus pandemic, help care for those affected and diagnostics, vaccines and therapeutics that show value.3 Some of this research has been citied in previous posts on the Bigvits site, though a recent paper is worth closer inspection as it relates to vitamin D and COVID-19.4

This new study is a random controlled trial (RCT5: reduces certain sources of bias when testing the effectiveness of new treatments). In summary, it showed that vitamin D effectively eradicated the risk of intensive care unit admission and may potentially eliminate the risk of death from COVID-19. The paper describes a group of 76 patients (with COVID-19) were randomly split into two groups.

In one group, fifty received vitamin D supplements (~30 000 IU/day for the first week and 7 600 IU/day thereafter, until they were discharged, were admitted to the ICU or died), the other (Control) group of 26 patients did not receive any vitamin D supplements. 50% of the control group required admission to the ICU compared to only 2% in the vitamin D group. As with all science, these findings need to be replicated. However, they do strongly suggest that public health should include some reference to us all maintaining adequate vitamin D levels and the use of therapeutic doses could be a viable treatment if we become hospitalised.

Personally, this information reinforces what I am currently adhering to when considering current vitamin D levels across the UK population. Namely, ensuring sun exposure as we head into autumn, target vitamin D rich foods and supplementing with a good quality product to ensure levels are appropriately maintained.

Practically, this means that ensuring when it is sunny, I get outside and get sun on my arms and legs. Though as the year draws on the ability to do this is significantly reduced. In regards to food choices, I lean towards selecting foods high in vitamin D. Examples of this involve looking for and consuming fatty fish (for example salmon, tuna, and mackerel), beef liver, cheese, and egg yolks, all sources of mainly vitamin D3 (including its metabolite 25(OH)D3). Plus, you will see supermarkets stating some mushrooms are good sources of vitamin D2 (ergocalciferol). Other products are fortified with vitamin D (including other nutrients that may include vitamins A, C, D, B vitamins, iron, iodine, calcium, zinc, proteins and/or amino acids).6

In respect to supplementation, as reported in the Supporting Your health and Wellbeing Through This Unprecedented Time post, according to the British Nutritional Foundation (BNF), 20% (1 in 5) of the UK population have low Vitamin D levels (defined as serum levels below 25 nmol/L). These levels are reported to be associated with a higher risk of poor musculoskeletal health as well as increased risk and severity of viral respiratory infections.7 Those particularly at risk of low status are older adults, hospital inpatients and nursing home residents. Whilst those with very little or no sunshine exposure (cocooning at home) and /or have darker skin have also been reported to be at greater risk.8 There are many online resources that can help ensure we eat a diet that contains food higher in Vitamin D.9 Though the BNF indicate that there are a limited number of foods naturally containing or fortified with Vitamin D, as mentioned above.

In a recent publication discussing COVID-19, McCartney and Byrne (2020) have stated that, “Vitamin D may also attenuate interferon gamma and interleukin-6 inflammatory responses, both potent predictors of poorer outcome in critically-ill ventilated patients”.10 The researchers go on to say that those at risk, indicated above, in addition to “other vulnerable groups (e.g. those with diabetes mellitus or compromised immune function, vegetarians and vegans, those who are overweight or obese, smokers and healthcare workers) be urgently supplemented with 20-50 µg/day (1,000 to 2,000 IU) of vitamin D to enhance their resistance to COVID-19, and that this advice be quickly extended to the general adult population.

Grant and Baggerly (2020) support the prudent adoption of Vitamin D supplementation.11 They recommend that in order to reduce the risk of infection people should consider taking 250 µg/day (10,000 IU/day) for a few weeks to rapidly raise concentrations, followed by at least 50 µg/day (2,000 IU/day). The goal should be to raise 25(OH)D (circulating form of Vitamin D) concentrations above 40-60 ng/ml (100-150 nmol/l), taking whatever is necessary for that individual to achieve and maintain that level.

To ensure we are consuming enough vitamin D through food and supplementation, it is always best to have our levels measured. If you are already supplementing with vitamin D, you would continue with this practice and have your current levels assessed.12 This will allow you to evaluate how prudent your current routine is, though you will have to factor the effect of sun exposure of your current levels, as these will likely fall during the up and coming months. It is suggested that 1,000 IU of vitamin D per day, in most people, will raise serum levels by about 5 ng/ml.13 This can help you to maintain levels in the 30-40 ng/ml range.14

Bigvits have sorted a range of quality products that can help us support our Vitamin D status and strive for optimal health and wellbeing.

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This post is meant for educational purposes only and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional. In order to make the blog series easier to read, I have used a conversational tone in many places with personal pronouns, such as “I” and “you.” This is meant only to make it more pleasant to read, and is not meant to imply that the information constitutes any form of advice, whether personal or general.