byMikko Paunio MD, MHS Medical Counsellor
As a cabinet officer in the Ministry of Social Affairs and Health of Finland, I am convinced that Finland’s COVID-19 control strategy should now include recommendations of vitamin D supplements to all age groups except children. Daylight is becoming shorter by the day. Thus, our ability to produce vitamin D in skin diminishes markedly. As a seasoned epidemiologist and public health specialist, I consider it scientifically proven that high levels of vitamin D provide both protection against severe COVID-19, but even more importantly there is strong evidence that high vitamin D levels slow markedly virus circulation and might even provide ‘herd immunity’ to populations according to a study published a month ago. It is as yet non-peer-reviewed but already can be considered a milestone study. It is a remarkable matched case control study of 52,405 COVID-19 cases and 524,050 matched controls picked up from Clalit Health Services (CHS), which provides comprehensive health services to over 4.6 million members in Israel.
Vitamin D now appears to provide us with a silver bullet solution to protect the most vulnerable and provides us with the means to get rid of these socially disastrous lockdowns even before there is a vaccine available.
The Great Barrington Declaration, which has been signed by almost 4,300 epidemiologists and public health specialists, around 7,700 medical professionals and 108,000 members of the general public, calls for protecting the most vulnerable and opening up society. Vitamin D supplements could significantly improve public acceptance of this alternative strategy, which would allow us to normalise societies.
I have never taken any vitamin supplements in my life and have always overlooked modern snake oil entrepreneurs’ promotions. But after reading the current evidence of how vitamin D levels protect people from COVID-19 and other respiratory infections, I have started two weeks ago to take 100 micrograms of vitamin D daily.
I also take note that the US COVID-19 tsar Dr Anthony Fauci finally admitted – after being silent for eight months since the beginning of the COVID-19 pandemic – that he takes 150 micrograms of vitamin D daily! The World owes a lot to a British A&E nurse (with a PhD) named John Campbell, who has been active in disseminating in his popular YouTube podcasts the good news related to vitamin D and COVID-19 for months. He also recently revealed to the world Dr Fauci’s daily dose of vitamin D.
In this article I will discuss the huge implications of the Israeli study by providing an extra ‘peer review’ to highlight the crucial message of this study.
There is now abundant observational literature showing the inverse association of vitamin D blood levels and severe COVID-19 and risk of COVID-19 contraction (see references), but there is also abundant experimental, though heterogenous, evidence that vitamin D can reduce risk of respiratory infections.
There is also one randomized, blinded trial showing the remarkable efficacy (97%) of administering large doses of prehormone 25 hydroxy vitamin D to COVID-19 patients to prevent them entering ICU in a hospital in Spain.
This is an astonishing paper, which needs to get published rapidly as it offers the world a silver bullet to get rid of lockdowns which are causing enormous harm to societies. It is adding significantly to our knowledge of the role of vitamin D in the prevention and control of infectious diseases. I strongly recommend publishing this paper after revisions suggested below.
The first paragraph of the discussion ends with this sentence:
Conversely, individuals living in communities with a low rate of severe vitamin D deficiency seem to benefit from a herd immunity effect, probably because their neighbours are less likely to spread the virus to them.
The paragraph should be expanded or a paragraph should be added to broader the context of discussion. It is notable now that e.g. in Iran the COVID-19 pandemic has hit the country hard for over seven months without any sign of relief and after seven months now things are getting even worse there. Opposition forces in the country have recently claimed that the true number of COVID-19 deaths is four times greater than the official government statistics, health care workers are losing their peers in large numbers and patient load has been and will be overwhelming in the foreseeable future in hospitals. In the Iranian population, vitamin D levels are low both in men and women but lower among women than among men and almost all elderly people suffer from very low D vitamin levels. The reason for this is the same as in Israel, namely individuals with low vitamin D levels tend to wear a traditional (gender-specific) attire, with more body surface covered than the general population. This affects the ability of the body to absorb sunlight and produce vitamin D.
It is now highly likely that sustained high SARS-CoV-2 transmission and fairly high death rates in Iran owe a lot to low population vitamin D levels.
Last spring, around half of all COVID-19 deaths in Europe happened in nursing homes in which vitamin D levels are very low among the occupants for a variety of reasons. Interestingly, the huge peak in Europe’s mortality took place about three weeks after vitamin D levels had hit their yearly bottom in Finland (presumably also in Europe). After this, almost all Europeans were told to stay inside for months, which might have had devastating effects to public health across Europe. These insights should also be added to discussion to strengthen the message.
In the beginning of the results section, the Israeli authors label COVID-19 risks as prevalences. Attack rate or risk should be used instead of prevalence.
The Israeli paper adds to causal inference significantly by showing dose-response, which is an important aspect in Sir Bradford Hill’s criteria when judging whether there is a cause and effect type of relationship between the exposure and the health effect based on observational data. Authors should bring this up in their discussion.
This study has revealed robust and strong inverse associations between vitamin D levels and COVID-19, especially among ethnic minorities (especially orthodox Jews and Arab women). This is also indicative of cause and effect according to Sir Bradford Hill’s criteria. This also should be brought up in discussion.
In Table 4, when adjusting for ethnic group the inverse associations of vitamin D levels and COVID-19 are attenuated. Authors should note in their discussion that ethnicity is causing (through behaviour) low vitamin D levels. Thus ethnic group is not a confounder but is part of the causal chain. When you adjust for a factor which is part of causal chain, you see attenuation of association. This is sometimes used when establishing or demonstrating causal links. For example, when you study the inverse association (protection) between moderate alcohol consumption and coronary heart disease, you find diminished inverse association when adjusting for the HDL cholesterol, i.e. moderate alcohol consumption raises this “good” cholesterol, which then protects against coronary heart disease.
The paper’s message could be further improved markedly if crude incidences and the number of COVID-19 cases in these three ethnic groups were broken down according to vitamin D levels and their gender groups were given. I presume the population denominators for these calculations can be constructed.