Eight in 10 Covid-19 hospital patients are vitamin D deficient, study

Further proof that vitamin D could protect people from coronavirus emerged today after a study found deficiencies in the sunshine nutrient are four times as common among hospitalised patients. 

A mountain of research from around the world has painted a clear picture — infected patients who do not have enough vitamin D are more likely to end up in hospital.

But scientists have so far been unable to pin down whether the nutrient deficiency is making people more vulnerable to the disease, or whether becoming unwell causes vitamin D levels to crash.

Now Spanish experts have uncovered more evidence that suggests cheap vitamin D supplements – which cost as little as 6p per pill – could prove beneficial. 

Experts at the University of Cantabria in Santander looked at 216 Covid-19 patients at the Valdecilla Hospital in the northern Spanish city.

Eighty-two per cent were deficient in vitamin D, whereas just 18 per cent had adequate levels of the nutrient – a fourfold difference.

This was compared to the 47 per cent of people who were deficient in a control group who did not have the infection. 

Forty-four of the deficient Covid-19 patients were moved to ICU because their illness became worse and 37 needed mechanical ventilation — but their vitamin D levels were not any lower than the rest of the group. The other patients recovered without needing extra care. 

The Spanish researchers are now calling for coronavirus patients to be treated with vitamin D supplements ‘since this approach might have beneficial effects’ and there are few negative side effects. 

Although the research does not prove that deficiency led to them falling ill enough to need hospital care, it is the latest in a string of studies to yield similar results.

Others have suggested that treating Covid-19 hospital patients with cheap vitamin D supplements boosts their chances of survival and speeds up recovery. But a lack of clinical trials, the gold standard of scientific research, has made it impossible for scientists to say for certain that they work. 

The overwhelming evidence pointing to vitamin D’s benefit made UK researchers sit up and take notice earlier this month. A trial was launched by Queen Mary University of London, which will see 5,000 volunteers to take the vitamin for six months to see if it can protect people from catching, or falling very ill with, the disease.

The study by the University of Cantabria in Santander looked at 216 Covid-19 patients (in black) and compared their vitamin D levels with a control group (in grey). A level of 20 nanograms/milliliter to 50 ng/mL is considered a healthy concentration of vitamin D. Anything below 13 ng/mL signals a deficiency

Other studies have suggested that treating Covid-19 hospital patients with cheap vitamin D supplements - costing as little as 6p a pill - boosts their chances of survival and speeds up recovery

Other studies have suggested that treating Covid-19 hospital patients with cheap vitamin D supplements – costing as little as 6p a pill – boosts their chances of survival and speeds up recovery

Dr Jose Hernandez, of Santander University, said: ‘One approach is to identify and treat vitamin D deficiency, especially in high-risk individuals such as the elderly, patients with comorbidities, and nursing home residents, who are the main target population for the Covid-19.

‘Vitamin D treatment should be recommended in Covid-19 patients with low levels of vitamin D circulating in the blood since this approach might have beneficial effects in both the musculoskeletal and the immune system.’

His study looked retrospectively at 216 Covid-19 patients hospitalised with the illness in March, when Spain was Europe’s virus epicentre.

They scoured hospital records to analyse their vitamin D levels upon admission and compared them to a control group randomly selected from the population.

Of the 216 hospitalised patients, vitamin D deficiency was found in 82.2 per cent of cases —compared to 47.2 per cent of healthy people. 

Experts consider a level of 25 nanograms/milliliter of vitamin D or above to be healthy. Below 25ng/ml is considered low and sub 20ng/ml signals deficiency. 

As well as in supplements, vitamin D is also available through foods, including oily fish, red meat and eggs (right). A Singaporean study earlier in the year of nearly 800 people found almost 99% of Covid-19 patients who died had vitamin D deficiency (left)

As well as in supplements, vitamin D is also available through foods, including oily fish, red meat and eggs (right). A Singaporean study earlier in the year of nearly 800 people found almost 99% of Covid-19 patients who died had vitamin D deficiency (left)

A correlation graph showing the relationship between levels of viamin D (bottom, measured in nmol/l) compared to infection numbers of coronavirus by the University of East Anglia. Countries with low vitamin D levels tend to have the highest case rates per million - but the graph was from a study in May, when outbreaks looked very different to how they do now and testing was patchy in most countries

A correlation graph showing the relationship between levels of viamin D (bottom, measured in nmol/l) compared to infection numbers of coronavirus by the University of East Anglia. Countries with low vitamin D levels tend to have the highest case rates per million – but the graph was from a study in May, when outbreaks looked very different to how they do now and testing was patchy in most countries

A study by Tehran University, in Iran, and Boston University analysed data from 235 hospitalised patients with Covid-19. Patients who had sufficient vitamin D - of at least 30 ng/mL— were 51.5 per cent less likely to die from the disease. Although no one in the study under age 40 died, fatalities  (red) were more  common among vitamin  D deficient people (under the  black  line) of all ages

A study by Tehran University, in Iran, and Boston University analysed data from 235 hospitalised patients with Covid-19. Patients who had sufficient vitamin D – of at least 30 ng/mL— were 51.5 per cent less likely to die from the disease. Although no one in the study under age 40 died, fatalities  (red) were more  common among vitamin  D deficient people (under the  black  line) of all ages

University of Chicago researchers studying 500 Americans' vitamin D levels  found 60 per cent higher rates of Covid-19 among people with low levels of the 'sunshine vitamin'

University of Chicago researchers studying 500 Americans’ vitamin D levels  found 60 per cent higher rates of Covid-19 among people with low levels of the ‘sunshine vitamin’

UK doctors will finally trial whether vitamin D can protect people from Covid-19 after months of mounting evidence the cheap supplement could be a life-saver 

Doctors will finally trial whether vitamin D can actually protect people from Covid-19 amid mounting evidence the 3p-a-day supplement could be a life-saver.

Researchers from Queen Mary University of London will recruit 5,000 volunteers to take the vitamin for six months if they do not already take high doses.

Experts will then assess whether participants are at less risk of catching the virus and developing a severe bout of the disease over the winter months.

A mountain of studies have found an overwhelming amount of people who test positive for Covid-19 do not have enough vitamin D in their bodies and the sickest of patients are often deficient.

Britons are most at risk of being vitamin D deficient between October and April when sunlight levels are too low for the body to make the vitamin — with those with darker skin at even higher risk. 

Around two in five Brits are deficient during the winter, when respiratory infections are most common. In the US, at least two in five citizens also lack sufficient levels of the vitamin.

It has led to calls for doctors to dish out cheap vitamin D supplements — which cost as little as 3p a day and have no dangerous side effects — to fight the disease, rather than waiting for a vaccine which may never be found. 

Despite health chiefs advising residents should be given supplements all year round because they rarely go outside, academics found this was not happening in care homes in the south east of England.

Trial volunteers will receive tablets containing either 800 IU or 3,200 IU a day of the vitamin, which they will be asked to take for six months.

There will also be a control group taking the NHS recommended amount of 400IU a day. 

Researchers will track the incidence of doctor-diagnosed or laboratory-confirmed acute respiratory infections in participants during the trial, to see whether the supplements have affected their risk or severity of infection.

Volunteers will also be required to do a finger-prick test to check their vitamin D levels.  

Dr David Jolliffe, from Queen Mary University of London, said the study had the potential to give a ‘definitive answer’ on whether vitamin D could protect against coronavirus. 

‘Vitamin D supplements are low in cost, low in risk and widely accessible; if proven effective, they could significantly aid in our global fight against the virus,’ he said.

The researchers found those who had lower quantities of the ‘sunshine vitamin’ had a greater prevalence of high blood pressure and heart disease.  

The study suggests a casual link between a lack of vitamin D — produced by the body when exposed to the sun — and moderate to severe illness from the virus.

But scientists have not yet been able to work out whether vitamin D deficiency is making people more vulnerable to Covid-19, or whether the disease causes vitamin D levels to drop after infection, which is the case with other infections. 

The Spanish research also did not state the ethnicity of the Covid-19 patients it studied. 

People with darker skin are at greater risk of vitamin D deficiencies because the body finds it more difficult to absorb sunlight and convert it.

Most patients in the study group also had underlying health conditions or were overweight — factors which weaken the immune system and make it harder for the body to produce vitamin D.

It comes after researchers from Queen Mary University of London launched a trial probing the potential benefits of the nutrient on Covid-19.

The scientists will give 5,000 volunteers the vitamin for six months if they do not already take high doses.

Experts will then assess whether participants are at less risk of catching the virus and developing a severe bout of the disease over the winter months. 

Britons are most at risk of being vitamin D deficient between October and April when sunlight levels are too low for the body to make the vitamin — with those with darker skin at even higher risk. 

Around two in five Brits are deficient during the winter, when respiratory infections are most common. In the US, at least two in five citizens also lack sufficient levels of the vitamin.

It has led to calls for doctors to dish out cheap vitamin D supplements — which have no dangerous side effects — to fight the disease, rather than waiting for a vaccine which may never be found.  

Arguments on the link between Vitamin D deficiency and its observed link with poor Covid-19 outcomes started to gather pace as early as May. 

The problem lies in the fact there is a lack of gold-standard medical research — the randomised controlled trials which compare people who are given the supplement with those who are not to see which group fares better. 

Only one study has done this so far, conducted by the University of Cordoba in Spain and published last month.

Researchers gave high doses of calcifediol – a type of vitamin D supplement – to 50 patients hospitalised with the disease.  

There were no deaths among volunteers receiving the vitamin and all 50 patients were eventually discharged by the end of the study. But two of the 26 patients in a control group, who were not given the tablets, died.

Just one patient given calcifediol felt ill enough to be admitted to intensive care, whereas half of the participants in the control group were taken to ICU and two died.

But many scientists have criticised the study, saying its sample size is too small for any firm conclusions to be drawn about the impact of vitamin D.

Nonetheless, it was the most promising result for trials of the vitamin so far, and corresponds to earlier research that fixing vitamin deficiency might cut mortality rates by half. 

A Northwestern University study, published in May, found Covid-19 patients with a severe Vitamin D deficiency are twice as likely to experience major complications and die.  

Nearly 99 per cent of Covid-19 patients who are vitamin D deficient die, according to a study from Indonesian researchers who analysed hospital records of 780 people who tested positive for SARS-CoV-2.

Results revealed 98.9 per cent of infected patients defined as vitamin D deficient — below 20ng/ml — died. Yet this fell to just 4.1 per cent for patients who had enough of the nutrient.

Researchers warned the study was not definitive, however, because the patients with high vitamin D levels were healthier and younger.

Another study by Tehran University, in Iran, and Boston University, found hospital Covid-19 patients who had sufficient vitamin D – of at least 30 ng/mL— were 51.5 per cent less likely to die from the disease. 

The study of 235 hospitalized patients with Covid-19 also showed those with enough vitamin D had a significantly lower risk of falling seriously ill or needing ventilation. 

Patients who had plenty of the nutrient also had less inflammation – often a deadly side effect of Covid-19. 

However, there were flaws in these studies, such as a lack of acknowledgement of confounding factors, such as smoking, and social economic status, which were were not recorded for all patients but could have an impact on illness severity.   

Some participants’ underlying health conditions were not defined, despite having a major impact on disease severity. 

There have also been at least three studies which have suggested those who have enough vitamin D are less likely to catch the coronavirus in the first place.

What have just some of the DOZENS of studies into vitamin D and Covid-19 shown?

When? September.

By who? Cordoba University in Spain.

What did scientists study? 50 Covid-19 hospital patients with Covid-19 were given vitamin D. Their health outcomes were compared with 26 volunteers in a control group who were not given the tablets.

What did they find? Only one of the 50 patients needed intensive care and none died. Half of 26 virus sufferers who did not take vitamin D were later admitted to intensive care and two died.

What were the study’s limitations? Small pool of volunteers. Patients’ vitamin D levels were not checked before admission. Comorbidities were not taken into consideration.

When? September.

By Who? University of Chicago.

What did scientists study? 500 Americans’ vitamin D levels were tested. Researchers then compared volunteers’ levels with how many caught coronavirus.

What did they find? 60 per cent higher rates of Covid-19 among people with low levels of the ‘sunshine vitamin’.

What were the study’s limitations?  

Researchers did not check for other compounding factors. Unclear whether or not volunteers were vitamin D deficient at the time of their coronavirus tests. People’s age, job and where they lived – factors which greatly increase the chance of contracting the virus – were not considered.

When? September.

By Who? Tehran University, in Iran, and Boston University.

What did scientists study? Analysed data from 235 hospitalized patients with Covid-19.

What did they find? Patients who had sufficient vitamin D – of at least 30 ng/mL— were 51.5 per cent less likely to die from the disease. They also had a significantly lower risk of falling seriously ill or needing ventilation. Patients who had plenty of the nutrient also had less inflammation – often a deadly side effect of Covid-19. 

What were the study’s limitations? Confounding factors, such as smoking, and social economic status were not recorded for all patients and could have an impact on illness severity.  

When? July.

By Who? Tel Aviv University, Israel.

What did scientists study? 782 people who tested positive for coronavirus had their vitamin d levels prior to infection assessed retrospectively and compared to healthy people.

What did they find? People with vitamin D levels below 30 ng/ml – optimal – were 45 per cent more likely to test positive and 95 per cent more likely to be hospitalised.

What were the study’s limitations?  Did not look at underlying health conditions and did not check vitamin D levels at the time of infection.

When? June.

By Who? Brussels Free University.

What did scientists study? Compared vitamin D levels in almost 200 Covid-19 hospital patients with a control group of more than 2,000 healthy people.

What did they find? Men who were hospitalised with the infection were significantly more likely to have a vitamin D deficiency than healthy men of the same age. Deficiency rates were 67 per cent in the COVID-19 patient group, and 49 per cent in the control group. The same was not found for women.

What were the study’s limitations?  Independent scientists say blood vitamin D levels go down when people develop serious illness, which the study did not take into consideration. This suggests that it is the illness that is leading to lower blood vitamin D levels in this study, and not the other way around.

When? June.

By who? Inha University in Incheon, South Korea.

What did scientists study? 50 hospital patients with Covid-19 were checked for levels of all vital vitamins and compared to a control group.

What did they find? 76 per cent of them were deficient in vitamin D, and a severe vitamin D deficiency (<10 ng/dl) was found in 24 per cent of Covid-19 patients and just 7 per cent in the control group.

What were the study’s limitations?  

Small sample size and researchers never accounted for vitamin levels dropping when they fall ill.

When? June.

By Who?. Independent scientists in Indonesia.

What did scientists study? Checked vitamin D levels in 780 Covid-19 hospital patients.

What did they find? Almost 99% of patients who died had vitamin D deficiency. Of patients with vitamin D levels higher than 30 ng/ml  – considered optimal – only  per cent died.

What were the study’s limitations?  It was not peer-reviewed by fellow scientists, a process that often uncovers flaws in studies.

When? May.

By Who? University of Glasgow.

What did scientists study? Vitamin D levels in 449 people from the UK Biobank who had confirmed Covid-19 infection. 

What did they find? Vitamin D deficiency was associated with an increased risk in infection – but not after adjustment for con-founders such as ethnicity. It led to the team to conclude their ‘findings do not support a potential link between vitamin D concentrations and risk of Covid-19 infection.’

What were the study’s limitations?  Vitamin D levels were taken 10 to 14 years beforehand. 

When? May.

By Who? University of East Anglia.

What did scientists study? Average levels of vitamin D in populations of 20 European countries were compared with Covid-19 infection and death rates at the time.

What did they find? The mean level of vitamin D in each country was ‘strongly associated’ with higher levels of Covid-19 cases and deaths. The authors said at the time: ‘The most vulnerable group of population for Covid-19 is also the one that has the most deficit in vitamin D.’

What were the study’s limitations?  The number of cases in each country was affected by the number of tests performed, as well as the different measures taken by each country to prevent the spread of infection. And it only looked at correlation, not causation.

When? May.

By Who? Northwestern University.

What did scientists study? Crunched data from dozens of studies around the world that included vitamin D levels among Covid-19 patients. 

What did they find? Patients with a severe deficiency are twice as likely to experience major complications and die.

What were the study’s limitations?  Cases and deaths in each country was affected by the number of tests performed.

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