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Is ethnicity linked to incidence or outcomes of covid-19?

BMJ 2020; 369 20 April 2020 BMJ 2020;369:m1548 DOI: 10.1136/bmj.m1548 https://doi.org/10.1136/bmj.m1548 https://www.bmj.com/content/369/bmj.m1548

Concerns about a possible association between ethnicity and outcome were raised after the first 10 doctors in the UK to die from covid-19 were identified as being from ethnic minorities. Rapid response to: Is ethnicity linked to incidence or outcomes of covid-19? 24 April 2020 ''COVID-19 ’ICU’ risk – 20-fold greater in the Vitamin D Deficient. BAME, African Americans, the Older, Institutionalised and Obese, are at greatest risk. Sun and ‘D’-supplementation – Game-changers? Research urgently required.'' Robert A Brown et.al.

https://www.bmj.com/content/369/bmj.m1548/rr-6

Dr Hugh Sinclair almost 100 years ago observed; "The deficiency of any nutrient which is essential for every tissue will eventually lead to abnormal function in every tissue. That is so incontrovertibly obvious that I am continually astonished it must be repeatedly forcefully restated."

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Alipio’s results, viewed in the context of earlier recent vitamin D and COVID-19 publications,[2 9] must now lead to urgent research (Brown).[2, 13] Human nature is such that simple solutions to complex issues, for example vitamin C for scurvy, and hand washing prior to baby delivery, are often not readily embraced; but surely the scale and impact of the COVID-19 pandemic demands all avenues are fully explored; more so when no other effective treatment strategies as yet exist. A safe simple step, the correction of a deficiency state, vitamin D this time, convincingly holds out a potential, significant, feasible ‘COVID-19 mitigation remedy.

Int J Circumpolar Health. 2015; 74: 2015 May 13. Adequate vitamin D levels in a Swedish population living above latitude 63°N: The 2009 Northern Sweden MONICA study Anna Ramnemark, Margareta Norberg, Ulrika Pettersson-Kymmer, and Mats Eliasson

doi: 10.3402/ijch.v74.27963 PMCID: PMC4432023 PMID: 28417824

Results: Mean (median) level of vitamin D3 was 65.2 (63.6) nmol/l in men and 71.0 (67.7) nmol/l in women. Adequate levels were found in 79.2%, more often in women (82.7%) than in men (75.6%). Only 0.7% of the population were vitamin D3–deficient but 23.1% of men and 17.1% of women had insufficient levels. Levels of vitamin D3 increased with age and insufficient status was most common among those aged 25–34 years, 41.0% in men and 22.3% in women.

If subjects using vitamin D-supplementation are excluded, the population level of D3 is 1–2 nmol/l lower than in the general population across sex- and age groups. There were no differences between the northern or the southern parts, between urban or rural living or according to educational attainment. Those subjects born outside of Sweden or Finland had lower levels.

Conclusion: The large majority living close to the Arctic Circle in Sweden have adequate D3 levels even during the second half of the dark winter. Subjects with D3 deficiency were uncommon but insufficient levels were often found among young men. Eur J Clin Nutr 1995 Jun;49(6):400-7. ''Sunlight increases serum 25(OH) vitamin D concentration whereas 1,25(OH)2D3 is unaffected. Results from a general population study in Göteborg, Sweden (The WHO MONICA Project)'' K Landin-Wilhelmsen, L Wilhelmsen, J Wilske, G Lappas, T Rosén, G Lindstedt, P A Lundberg, B A Bengtsson

PMID: 7656883 https://pubmed.ncbi.nlm.nih.gov/7656883/

Results: The concentration of 25(OH)D3 was similar in both sexes whereas 1,25(OH)2D3 concentration was higher in women than in men (P = 0.01). 25(OH)D3 correlated positively to sun exposure, physical activity and negatively to intact parathyroid hormone (PTH) in both sexes, and also negatively to blood pressure in men. The remaining significant relationship for 25(OH)D3, when age and sun exposure were taken into account in multivariate analyses, was a negative correlation to intact PTH in both sexes. 1,25(OH)2D3 correlated positively to intact PTH in both men and women, negatively to height in men, positively to fibrinogen in men and positively to psychological stress and osteocalcin in women. When all variables were included in multivariate analyses 1,25(OH)2D3 concentration correlated negatively to age and positively to intact PTH and osteocalcin in both sexes together.

Conclusions: Sunlight was the only external factor that influenced 25(OH)D3 concentration whereas 1,25(OH)2D3 was unaffected by sun exposure. 1,25(OH)2D3 was not related to environmental or life style factors but declined by age and correlated positively to intact PTH and osteocalcin. Nutrition Reviews, Volume 66, Issue suppl_2, 1 October 2008, Pages S165–S169, 01 October 2008 Vitamin D requirement and setting recommendation levels – current Nordic view Jan I Pedersen

https://doi.org/10.1111/j.1753-4887.2008.00101.x

There is a strong seasonal variation in serum 25(OH)D. A Danish study illustrates the marked downward shift during the winter months, with levels falling below desirable vitamin D status in one half of the population

Under Nordic climatic conditions, exposure to sunlight is thus insufficient for enough vitamin D to be formed in the skin and for vitamin D status to be maintained during the winter months. A study from northern Finland in 1980 showed that vitamin D status was satisfactory during the summer months but that a large number of subjects had unsatisfactory vitamin D status during winter.8 On the other hand, more satisfactory serum levels of 25(OH)D and greater seasonal variation was found among adults in a similar study from Tromsö in northern Norway.9 The results of these studies indicate that the light intensity at 70 degrees north is sufficient during summer to elicit vitamin D formation in the skin. One explanation for the difference observed in vitamin D status between the two population groups during the winter months is that, at the time of these studies, the consumption of fish and margarine fortified with vitamin D was much higher in Norway than in Finland. Dietary vitamin D is thus essential to ensure satisfactory vitamin D status at northern latitudes, particularly during the winter months. The question is how much is needed and what intake should be recommended?

CONCLUSION: Vitamin D intake is at about the same low level in Norway and the other Nordic countries. It is slightly higher in Iceland due to widespread use of cod liver oil and slightly lower in Denmark because, until recently, food fortification has not been used. In all Nordic countries, steps are now taken to increase vitamin D intake at the population level in order to reach the new increased recommendations. In addition to disseminating information, increased fortification of foods is essential to reach this goal.

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As expected, there was considerable variation in prevalence of vitamin D deficiency among the European Union countries, which appeared to be dependent on age group. In studies of adult and older adult populations, the prevalence of vitamin D deficiency was much less in the more northerly latitude countries such as Norway, Iceland, and Finland, whereas more mid-latitude countries such as the United Kingdom, Ireland, Netherlands, and Germany had a higher prevalence, even accounting for ethnicity. The amplitude of an increase in prevalence in vitamin D deficiency in extended winter compared with extended summer was also much lower in the northerly latitude countries, which is likely attributable to higher rates of vitamin D supplement and/or food fortification use in these countries (49–51). In the case of the childhood population studies, the relatively mid-latitude countries (47–60°N) had a higher prevalence range (5–20%) than did southern countries (<41°N) at 4.2–6.9%.

COVID-19 is, in the end, an endothelial disease

Peter Libby, Thomas Lüscher European Heart Journal, Volume 41, Issue 32, 21 August 2020, Pages 3038–3044, https://doi.org/10.1093/eurheartj/ehaa623 03 September 2020

https://academic.oup.com/eurheartj/article/41/32/3038/5901158

Abstract

The vascular endothelium provides the crucial interface between the blood compartment and tissues, and displays a series of remarkable properties that normally maintain homeostasis. This tightly regulated palette of functions includes control of haemostasis, fibrinolysis, vasomotion, inflammation, oxidative stress, vascular permeability, and structure. While these functions participate in the moment-to-moment regulation of the circulation and coordinate many host defence mechanisms, they can also contribute to disease when their usually homeostatic and defensive functions over-reach and turn against the host. SARS-CoV-2, the aetiological agent of COVID-19, causes the current pandemic. It produces protean manifestations ranging from head to toe, wreaking seemingly indiscriminate havoc on multiple organ systems including the lungs, heart, brain, kidney, and vasculature. This essay explores the hypothesis that COVID-19, particularly in the later complicated stages, represents an endothelial disease. Cytokines, protein pro-inflammatory mediators, serve as key danger signals that shift endothelial functions from the homeostatic into the defensive mode. '''The endgame of COVID-19 usually involves a cytokine storm, a phlogistic phenomenon fed by well-understood positive feedback loops that govern cytokine production and overwhelm counter-regulatory mechanisms. The concept of COVID-19 as an endothelial disease provides a unifying pathophysiological picture of this raging infection, and also provides a framework for a rational treatment strategy at a time when we possess an indeed modest evidence base to guide our therapeutic attempts to confront this novel pandemic.'''

BMJ.com [rapid response], 2019

Dr Alex Vasquez (2019) Response to Editorial "remarkable impact of bivalent HPV vaccine in Scotland": Scotland's public health campaigns to improve vitamin D nutriture occurred within the same timeframe as HPV vaccination.

https://www.academia.edu/39207517/Dr_Alex_Vasquez_2019_Response_to_Editorial_remarkable_impact_of_bivalent_HPV_vaccine_in_Scotland_Scotlands_public_health_campaigns_to_improve_vitamin_D_nutriture_occurred_within_the_same_timeframe_as_HPV_vaccination_rapid_response_BMJ_com

In Scotland, programs advocating HPV vaccination (started in 2008) and vitamin D supplementation (started not later than 2006 and again in 2009) occurred in close chronologic proximity; use of nutritional supplements that contain or potentiate vitamin D had started to increase in the population by 2003. Crediting the reduction in HPV-related disease solely to vaccination via retrospective population study is potentially misleading, especially when these authors make no account whatsoever of the national program for vitamin D supplementation which started in the same time-frame. Numerous studies have shown that vitamin D provides immunomodulatory, anti-inflammatory, microbiome-modifying, antiviral and anti-HPV benefits with high safety, good efficacy, low cost, wide availability, and clinically important collateral benefits.

Endocrinology

. 2021 Feb 1;162(2):bqaa218. doi: 10.1210/endocr/bqaa218. Vitamin D-regulated Gene Expression Profiles: Species-specificity and Cell-specific Effects on Metabolism and Immunity Vassil Dimitrov 1, Camille Barbier  1 , Aiten Ismailova  1 , Yifei Wang  1 , Katy Dmowski  1 , Reyhaneh Salehi-Tabar  1 , Babak Memari  1 , Emilie Groulx-Boivin  1 , John H White  1   2 Affiliations

PMID: 33249469 PMCID: PMC7751191 DOI: 10.1210/endocr/bqaa218 https://pubmed.ncbi.nlm.nih.gov/33249469/

Endocr Metab Immune Disord Drug Targets

. 2021;21(5):943-955. doi: 10.2174/1871530320666200805101302. Vitamin D Receptor Gene Polymorphisms and the Risk of Metabolic Syndrome (MetS): A Meta-Analysis Hamidreza Totonchi 1, Ramazan Rezaei  2 , Shokoofe Noori  1 , Negar Azarpira  3 , Pooneh Mokarram  4 , Danyal Imani  5 Affiliations

PMID: 32767922 DOI: 10.2174/1871530320666200805101302 https://pubmed.ncbi.nlm.nih.gov/32767922/

Neurol Sci. 2014 Nov;35(11):1723-30. doi: 10.1007/s10072-014-1821-6. Epub 2014 May 22. Vitamin D status and Parkinson's disease: a systematic review and meta-analysis Zheng Lv 1, Huiping Qi, Le Wang, Xiaoxue Fan, Fei Han, Hong Wang, Sheng Bi

PMID: 24847960 DOI: 10.1007/s10072-014-1821-6 https://pubmed.ncbi.nlm.nih.gov/24847960/

Can Commun Dis Rep. 2021 Mar 31; 47(3): 142–148. Published online 2021 Mar 31. Influenza and Other Respiratory Viruses Impact of nonpharmaceutical interventions on laboratory detections of influenza A and B in Canada Philippe Lagacé-Wiens,1,2,* Claire Sevenhuysen,3 Liza Lee,3 Andrea Nwosu,3 and Tiffany Smith3

doi: 10.14745/ccdr.v47i03a04 PMCID: PMC8109283 PMID: 34012338 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109283/

Abstract:

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Results: While influenza detections the week prior to the implementation of social distancing measures did not differ statistically from the previous nine seasons, a steep decline in positivity occurred between epidemiologic weeks 10 and 14 (March 8–April 4, 2020). Both the percent positive on week 14 (p≤0.001) and rate of decline between weeks 10 and 14 (p=0.003) were significantly different from mean historical data.

Conclusion: The data show a dramatic decrease in influenza A and B laboratory detections concurrent with social distancing measures and nonpharmaceutical interventions in Canada. The impact of these measures on influenza transmission may be generalizable to other respiratory viral illnesses during the study period, including COVID-19. Keywords: social distancing, physical distancing, influenza, COVID-19, SARS-CoV-2, public health, nonpharmaceutical interventions, NPI Proof that Vitamin D Works: Vitamin D prevents or treats 89 health problems

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