Vitamin D insufficiency is prevalent in severe COVID-19

Abstract

Background: COVID-19 is a major pandemic that has killed more than 196,000 people. The COVID-19 disease course is strikingly divergent. Approximately 80-85% of patients experience mild or no symptoms, while the remainder develop severe disease. The mechanisms underlying these divergent outcomes are unclear. Emerging health disparities data regarding African American and homeless populations suggest that vitamin D insufficiency (VDI) may be an underlying driver of COVID-19 severity. To better define the VDI-COVID-19 link, we determined the prevalence of VDI among our COVID-19 intensive care unit (ICU) patients. Methods: In an Institutional Review Board approved study performed at a single, tertiary care academic medical center, the medical records of COVID-19 patients were retrospectively reviewed. Subjects were included for whom serum 25-hydroxycholecalcifoerol (25OHD) levels were determined. COVID-19-relevant data were compiled and analyzed. We determined the frequency of VDI among COVID-19 patients to evaluate the likelihood of a VDI-COVID-19 relationship. Results: Twenty COVID-19 patients with serum 25OHD levels were identified; 65.0% required ICU admission.The VDI prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients. Strikingly, 100% of ICU patients less than 75 years old had VDI. Coagulopathy was present in 62.5% of ICU COVID-19 patients, and 92.3% were lymphocytopenic. Conclusions: VDI is highly prevalent in severe COVID-19 patients. VDI and severe COVID-19 share numerous associations including hypertension, obesity, male sex, advanced age, concentration in northern climates, coagulopathy, and immune dysfunction. Thus, we suggest that prospective, randomized controlled studies of VDI in COVID-19 patients are warranted.

COVID-19 Pandemic: Is Africa Different?

“…Some preliminary studies have demonstrated that Vitamin D status and sun exposure are important factors to consider for reducing the rates of transmission, infection, and severity of illness. 22 , 23 …”

The Role of Micronutrients in Support of the Immune Response against Viral Infections

“…Considering our knowledge on the role of vitamin D in modulating the immune system and in inhibiting a hyper activation of the inflammatory response, together with data from observational and clinical studies on vitamin D supplementation, various authors have also suggested a potential role of vitamin D in reducing the severity of the disease [ 183 , 184 , 185 , 186 , 187 ]. Vitamin D is especially known for its ability to reduce the “cytokine storm” that contributes to the pathogenesis of various viral infections, including COVID-19 [ 188 ].…”

“…To date, we only have preliminary observations regarding the association of vitamin D deficiency and frequency and severity of COVID-19; the above mentioned study from Ilie and colleagues found a correlation between mean vitamin D levels in each country and COVID-19 cases and deaths [ 181 ]; D’Avolio and colleagues investigated vitamin D concentrations in a small cohort of 107 patients with a positive naso-pharyngeal swab for SARS-CoV2 in Switzerland, and found significantly lower vitamin D levels in patients than in controls with negative swabs [ 187 ]; Lau et al described a high frequency of vitamin D insufficiency (84.6%) in COVID-19 patients admitted to ICU in New Orleans, with a 100% frequency in patients younger than 75 years [ 188 ].…”

Vitamin D deficiency in schizophrenia implications for COVID-19 infection

“…Observational studies have identified associations between suboptimal vitamin D levels and increased respiratory infection risk, including SARs-CoV2 infection (Alipio, 2020;Lau et al 2020), but do not Deficiency: <25 nmol/l (<10 ng/ml) Insufficiency: 25-50 nmol/l (10-20 ng/ml) Sufficiency: >50 nmol/l (>20 ng/ml) attribute causation. There is, however, pre-clinical data providing mechanistic evidence of how vitamin D impacts on risk for viral infections (Grant et al 2020).…”