It’s time we used Vitamin D to reduce the risk of COVID-19 severity
People that traditionally exhibit vitamin D deficiency, such as older adults and nursing home residents, are the same groups that have also been excessively impacted by the COVID-19 pandemic. New guidance (Dec 22, 2020) from the UK government allowed the extremely clinically vulnerable people to receive a free 4-month supply of daily vitamin D supplements—similar to an initiative launched earlier in Scotland.
Vitamin D deficiency associated problems:
- Lower levels of vitamin D are associated with several factors such as ethnicity, variation in sun exposure at higher latitudes, season, time of day, clothing, sunscreen use, and skin pigmentation, age, lower sun exposure, obesity, and chronic illnesses .
- Previous studies have shown that vitamin D deficiency is associated with an increased incidence of several autoimmune diseases and is also associated with a longer course of acute respiratory infection .
- Studies have also shown that vitamin D supplementation could prevent respiratory infections .
Vitamin D deficiency and COVID-19 severity: Several articles have been published previously assessing the correlation between Vitamin D deficiency and COVID-19 severity [1,2,3,4]. The following conclusions can be summarized from these:
- Vitamin D deficiency is associated with COVID-19 in terms of increased risk of disease development, higher disease severity, higher frequency of intensive care unit hospitalization, and mortality risk.
- Vitamin D deficient individuals were observed to be having higher levels of IL-6 and were associated with inflammatory, pro-thrombotic, and metabolic markers of severity, thereby having experienced a greater inflammatory response.
- A study has also suggested that vitamin D levels could be used as a marker of an impaired response to infection within the pulmonary epithelium, especially in those with severe deficiency.
Benefits of Vitamin D supplementation in COVID-19 patients: Several studies have concluded that the use of Vitamin D supplementation could reduce the risk, severity, and mortality of COVID-19 infection [1,2,3,4]. The following benefits were observed on vitamin D supplementation:
- As vitamin D levels increased:
- The patients' risk of getting COVID-19 infection decreased.
- The number of lung segments with common ground‐glass appearance decreased.
- The level of D‐dimer and CRP decreased considerably.
- Duration of the hospital stay of COVID‐19 patients decreased.
- Some alveolar cells that express ACE2 receptors are very essential for the production of surfactant in the lungs that regulate the alveolar surface tension. Vitamin D increases the ACE2 expression in the lungs that has been downregulated due to SARS-COV-2 viral binding, thereby assisting the production of surfactant .
Vitamin D supplements: Previously, articles on Dental Tribune have reflected studies that show worldwide vitamin D deficiency and insufficiency [5,6]. To maintain the optimal level of vitamin D in the blood, the National Health Service advises taking a 10 µg supplement of the vitamin a day . The oral spray (sublingual) method of delivering vitamin D has also been found to be as effective as taking a capsule and has supported the same rate of improvement in vitamin D levels .
Dental Tribune South Asia has previously covered the role of Vitamin D in COVID-19.
Conclusion: Vitamin D supplementation could prove to be beneficial not only for COVID-19 but also for many other complications with the added benefit of being affordable and easily available. Barring few studies, we have enough evidence supporting the use of vitamin D supplements for COVID-19 and the current situation demands such immediate measures. Recently, The Lancet has also advised the same “Particularly in countries where the pandemic situation continues to worsen (and will continue to do so during the winter months before the effects of vaccinations become perceptible), additional evidence could come in just too late. In an ideal world, all health decisions would be made based on overwhelming evidence, but a time of crisis may call for a slightly different set of rules” .
- Vanegas-Cedillo PE, Bello-Chavolla OY, Ramírez-Pedraza N, et al. Serum Vitamin D levels are associated with increased COVID-19 severity and mortality independent of visceral adiposity. medRxiv; 2021. DOI: 10.1101/2021.03.12.21253490.
- Sulli, A.; Gotelli, E.; Casabella, A.; Paolino, S.; Pizzorni, C.; Alessandri, E.; Grosso, M.; Ferone, D.; Smith, V.; Cutolo, M. Vitamin D and Lung Outcomes in Elderly COVID-19 Patients. Nutrients 2021, 13, 717. https://doi.org/10.3390/nu13030717.
- Teshome A, Adane A, Girma B and Mekonnen ZA (2021) The Impact of Vitamin D Level on COVID-19 Infection: Systematic Review and Meta-Analysis. Front. Public Health 9:624559. doi: 10.3389/fpubh.2021.624559.
- Demir, M, Demir, F, Aygun, H. Vitamin D deficiency is associated with COVID‐19 positivity and severity of the disease. J Med Virol. 2021; 93: 2992– 2999. https://doi.org/10.1002/jmv.26832.
- The Lancet Diabetes Endocrinology. Vitamin D and COVID-19: why the controversy?. Lancet Diabetes Endocrinol. 2021;9(2):53. doi:10.1016/S2213-8587(21)00003-6.