COVID-19 is part of a group of common viruses, coronaviruses, which are well known to cause upper respiratory illness. But COVID-19 is novel in that it appears to cause more severe infection than other coronaviruses. After exposure, the incubation period is 2 to 14 days. About 2% of people who are exposed will develop the disease. Symptoms of infection include fever, cough, shortness of breath, and gastrointestinal symptoms. Of those infected, approximately 20% become critically ill. Individuals who are older, and/or have chronic medical conditions are at increased risk of this. People with darker pigmented skin are sicker. Mortality is thought to be anywhere from 1% to 4% depending on the country and community, and dramatically increases with age.
Medical treatment options are currently limited, no vaccine has yet been developed, and no herd immunity exists. The best protection against the spread of the virus that has been advised to us is social distancing and careful handwashing. These practices, along with the virulence and infectivity of this virus, are changing how we act, live, and practice medicine.
Could this Covid-19 pandemic have been avoided or at least significantly mitigated? Have our lifestyle changes resulted in an increased risk of not only this respiratory viral infection but perhaps other serious health conditions? Scientific research studies are indicating a resounding YES!
Studies are indicating a linear association between Vitamin D deficiency (<20 ng/ml) and several associated diseases, including upper respiratory tract infections. Insufficient vitamin D levels are generally seen in people that lack adequate sunlight exposure to their skin and inadequate oral supplementation. We have known since the Industrial Revolution that Vitamin D supplementation was necessary to prevent Rickets, a condition of abnormal bone mineralization and calcium hemeostasis in children. However, the behavior that caused Rickets (inadequate sunlight exposure to our skin) has not changed and Vitamin D deficiency is getting worse across the globe. Today’s computer age and digital addiction have moved us even further from our outdoor ancestral behaviors.
Along with the skeletal bone diseases, including osteoporosis, the list of extraskeletal diseases associated with Vitamin D deficiency is eye-popping! These include: Cancer, Infectious and Respiratory Diseases, Cardiovascular Disease, Autoimmune Diseases, and Neurologic & Psychiatric diseases (See Table below). This all raises the question as to why is vitamin D Deficiency associated with so many diseases? The answer appears to be the fact that every cell in the body has vitamin D receptors (VDR) and VDR is now known to be a nuclear transcription factor involved in the expression of up to 2000 genes. Without adequate vitamin D levels, our bodies fail to function normally, down to the cellular level.
Several studies in otolaryngology and pediatrics are now confirming the mechanism of action vitamin D has on our immunologic and respiratory systems. Vitamin D is shown to inhibit the pro-inflammatory cytokines and promotes cathelicidin production, an anti-microbial protein that kills viruses, fungi, and bacteria. Vitamin D deficient neonates (<20 ng/ml) are six times more likely to contract the RSV infection during the first year of life. Recurrent ear and sinus infections, allergic rhinitis, and asthma show an association with Vitamin D deficiency. Seasonal influenza rates increase during the winter months when vitamin D levels typically fall.
Could this Covid-19 pandemic have been avoided or at least significantly mitigated? Have our lifestyle changes resulted in an increased risk of not only this respiratory viral infection but perhaps other serious health conditions? Scientific research studies are indicating a resounding YES!
CALL TO ACTION:
How do you diagnose Vitamin D deficiency? Measuring the vitamin D, the 25-Hydroxy total blood level is readily available at most labs. Current guidelines by the Endocrine Society show Sufficiency levels at 30-100 ng/ml, Insufficiency levels at 20-30 ng/ml; and Deficiency levels at <20ng/ml.
Patients at Risk for Vitamin D Deficiency include: African Americans (need 4-6 x more sun-induced vitamin D); Obesity (BMI>30) – need 2-5 x more oral or sun-induced Vitamin D; Elderly; Fat malabsorption (cystic fibrosis); Infrequent sun exposure; and living in the Northern Latitude;
Prevention of Vitamin D Deficiency: Sensible sun exposure – Minimal erythemal dose to the full body (bathing suit) equivalent to ingesting 20,000 IU orally (skin just turning pink). Sunning between 10 am-3 pm in summer arms/lets until pink (approx 15 minutes) could provide 3000 IU. Adults- 2000IU/day D3 oral supplement; Children-1000 IU/day D3 oral supplement (discuss dosage with the child’s pediatrician – measure blood levels).
Summary: This new and sudden crisis with the Covid 19 pandemic may be able to be mitigated by lifestyle choices and Vitamin D supplementation. There is convincing evidence that Vitamin D is active throughout the respiratory tract and deficiency of Vitamin D is associated with upper respiratory infections. Along with the current recommendations of social distancing and proper handwashing, we should all consider having our 25 (OH) vitamin D- total measured and supplement with the appropriate dose of Vitamin D3. I call on our public health officials to raise awareness of this growing Vitamin D science and to support Vitamin D testing, supplementation, and future research.
Table
Extraskeletal Diseases associated with Vitamin D Deficiency:
• Muscle pain, weakness, fatigue (often misdiagnosed as Fibromyalgia)
• Cancer: Bladder, Breast, Colon, Esophagus, Gastric, Lung, Cervical, Endometrial, Ovarian, Rectal, Renal, Vulvar, Hodgkin’s & Non-Hodgkin’s Lymphoma, Melanoma
• Autoimmune disease: Multiple Sclerosis, Insulin Dependent Diabetes Mellitus, Rheumatoid Arthritis, Crohn’s Disease
• Neurologic & Psychiatric disease (Dementia, Depression, Schizophrenia)
• Infertility
• Cardiovascular Disease
• Infectious Disease (Tb, Influenza, Viral Upper Respiratory Infections)
• Dermatologic Disease (Eczema, Atopic Dermatitis)
• Respiratory Disease