Coronavirus Epidemic Update 30: More Global COVID-19 Outbreaks, Vitamin D May Aid Prevention


welcome to another MedCram COVID-19
update we’ll do some updates and also talk about preparation from a prevention
standpoint here we have our Johns Hopkins dashboard at ninety four
thousand total confirmed cases total deaths thirty two hundred total
recovered fifty one thousand South Korea has the most confirmed outside of China
and we’re talking about aggressive testing in South Korea Iran quickly shot
up we can see here that’s a pretty large red dot we go to the world ometer
website active cases are actually on the decline probably because we are leaving
a epidemic in China but there are small epidemics relatively outside of China
that are rapidly growing and that’s why this is not continuing to go down if we
look at total cases we can see that the inflection point has started to turn
upwards let’s look at the latest updates a number of countries are reporting
single digits cases and in some cases some deaths interestingly here there’s
586 new cases in Iran but they’re also starting the show recoveries as well we
knew there would be recoveries but we’re just not seeing a lot at this point we
see that there are 10 new cases in Belgium nine of which came from northern
Italy and that seems to be a hotspot of spread throughout Europe remember that
in Europe there are free borders because of the European Union so it’s not as if
this is unregulated constrain travel at least as of a couple of weeks ago four
new cases in the United States all of them being in California which is a hot
spot there’s one in Los Angeles County two who had recently traveled to
countries that have had cava 19 and there’s one new case in Contra Costa
County in Northern California that second case of corona virus in Los
Angeles was reported by Fox 11 News that patient is being taken care of at home
in self isolation and being treated on an outpatient basis the purpose of May
cram and what we’re doing here is to talk about the data the raw numbers to
talk about the medical aspects of this virus and what we know is going
but of course there are things that are out there that are emerging that seemed
to have evidence but don’t quite fit with coronavirus at this point because
we don’t have the data at this point let’s face it we have no randomized
controlled trials for coronavirus Cove at 19 they just haven’t been performed
so we’re forced to look at things that may work vitamin D is one of those
things we don’t have any randomized control trials that show that supplement
with vitamin D works in kovat 19 but we do have data about vitamin D
specifically and so I think it’s interesting to go over I’ve gotten a lot
of comments from people about vitamin D and the potential use for the corona
virus and even though this paper here is for the influenza virus vitamin D is not
actually having an effect on the virus itself as far as we know it’s affecting
the hosts us our bodies our immune system and how they deal with the virus
so potentially might be something that is applicable to other viruses and in
this case the corona virus and if you’ve thought about this you’ll notice that
there’s a lot of talk about what will happen in the summertime to the virus
and a lot of the talk has been about heat and humidity versus dryness and I’m
wondering if there’s another angle on this because vitamin D could be
acknowledged as a quote seasonal stimulus as defined by our Edgar Hope
Simpson it would be crucial to prove it from a potential easy and cheap
prophylaxis or therapy support perspective as far as influenza
infections are concerned now this paper talks about how first of all vitamin D
is absorbed into the body and how it is metabolized the fact that it is a
vitamin you have to understand that we cannot generate or make vitamin D in our
own body but in fact we need ultraviolet radiation from the Sun to convert the
inactive form to the active form I’ve always had a special place in my heart
for vitamin D because that’s what I did in terms of my undergraduate research
working in organic chemistry and so you’ll know that vitamin D for those of
you studied the structure is a lipid soluble vitamin and so it’s possible to
overdose on vitamin D so you have to be very careful with it because it is fat
soluble now there’s a lot of talk about vitamin D in the immune system and how
it bolsters it but something that’s also very in
interesting about vitamin D is its possible role in infections and also it
has a suppressive anti-inflammatory process so in other words vitamin D can
turn things on and it can also turn things off it’s not unimodal and that is
something that could be very helpful especially in the immune response that
we see in kovat 19 remember that it’s the immune system that is going to
suppress the virus which is good but it’s also the immune system that could
cause this storm of cytokines that put your lungs into a RDS and could
potentially kill so what we want is a smart immune system an immune system
that takes care of the virus but doesn’t put us into an inflammatory condition
that could put us on a ventilator so is vitamin D the answer I have no
financial relationships with any pharmaceutical companies or companies
that make nutritional supplements in any way this study that was talked about
here in the Harvard Gazette may be what we are looking for here it says a new
global collaborative study has confirmed that vitamin D supplementation can help
protect against acute respiratory infections the study our participant
data meta analysis so a meta analysis is simply a study that looks at a whole
bunch of other studies breaks down the components and makes a super study out
of it so they took actually 25 randomized controlled trials with an N
number of 11,000 participants that’s a pretty sizable number this was published
in the British Medical Journal I will give you a link to that journal will
actually look through that most people understand that vitamin D is critical
for bone and muscle health Cisco’s Camargo of the Department of Emergency
Medicine at Mass General our analysis has also found that it helps the body
fight acute respiratory infection which is responsible for millions of deaths
globally each year remember this article was published
before coronavirus several observational studies with track participants over
time without assessing the specific treatment have associated low vitamin D
levels with greater susceptibility to acute respiratory infections I don’t
have to tell you that living in high latitudes especially in the wintertime
exposes you to the least amount of sunlight if you have the least amount of
sunlight you would conclude a corporately that your vitamin D levels
are generally going to be on the lower side while it’s possible that the
seasonal variation in the virus may still have something to do with the
survival of the virus outside the body but it may have more than we think to do
with the survival of the virus inside the body it is a postulate but it’s
interesting the meta-analysis of these trials which aggregate data from several
studies that may have different designs or participant qualifications also had
conflicting results and this really has been the issue for some period of time
some studies showed that there is a connection that makes vitamin D look
good in terms of preventing infections others not so good so to resolve these
discrepancies this research team out of Queen Mary University of London
conducted an individual participant data meta-analysis so what does that mean
they grouped all of these studies together and then they stripped it down
to each particular individual and that is very powerful producing what could be
considered a higher resolution analysis of the data from all the studies the
investigators found that daily or weekly supplementation had the greatest benefit
for individuals number one there was a benefit and number two it was the turtle
not the hare what I mean by that is it was the daily supplementation not the
huge doses of vitamin D if you got sick this makes sense the people who have the
lowest levels are going to have the best effect from supplementation and it cut
their risk of respiratory infection get this in half that is a significant
number and could reduce the Arnott or the replication number in viruses and
maybe the reason why we see these viruses disappear in the summer I say
May don’t have proof of that yet but it’s interesting all participants
experience some beneficial effects from regular vitamin D supplementation
administering a high doses of vitamin C did not produce significant benefits
this study was not funded by some nutraceutical company but was funded in
fact by the British National Institute of Health Research so let’s actually go
to that study it’s open access we’ll put the link in the description below this
is from the British Medical Journal that’s a very prestigious publication in
the conclusion vitamin supplementation was safe and it
protected against acute respiratory tract infection overall patients who
were very vitamin D deficient and those not receiving bolus doses experienced
the most benefit so if you go down to the raw data they have to come up with
cutoff points and for those of you who don’t know how to read studies let me
show you here a little bit what they’re looking at is how many respiratory tract
infections they receive so one step’ individual participant data men analysis
proportion of partisans experiencing at least one acute respiratory tract
infection first thing to do is to look at the very top one and that’s overall
how many trials twenty-five proportion with greater than one acute respiratory
tract infection and proportion with greater than one acute respiratory tract
infection in the intervention group and you can see that there was a difference
and what was that difference the adjusted odds ratio is where you want to
look there’s another way of looking at to
looking at p-values to see if there’s a difference between these two groups
those in the control group those in the intervention group and any p-value of
less than point zero five is considered to be statistically significant so you
can see here that a bolus dose of greater than thirty thousand
international units given had a p-value of 0.67 that’s greater than point zero
five therefore not statistically significant in other words a bolus dose
is not going to be helpful if the bolus dose wasn’t given you can see that was
very statistically significant so the question is how much should I take on a
daily dose well here it is daily dose equivalent if it was less than twenty
micrograms highly statistically significant if it was 2250 still
statistically significant however if you took more than 50 micrograms there was
no difference between that group indicating that a modest dose of vitamin
D every single day would be the best here’s more research in the study
showing all of the different individual studies and the proportion with greater
than one acute respiratory tract infection and you can see here where
they lined up relative to number one remember one being no difference if it
was less than number one with a 95% confidence interval less than one then
you could say that that was statistically significant and it was
weighted based on the number of patients in that study and finally we come to the
overall which is down here at the bottom p-value a point zero zero one you can
see that it lands less than one so if you scroll down to the discussion it
says vitamin D supplementation reduce the risk of experiencing at least one
acute respiratory tract infection and it talks about the grade of the data which
was very good the question though is why would a bolus dose of vitamin D be
ineffective and they talked about how the wide fluctuations of circulating 25
hydroxy vitamin D concentrations which is the starting material for the active
form in the body could this right activity of enzymes responsible for the
synthesis and degradation of the active vitamin D metabolite which is 125
dihydroxy vitamin d so my recommendation based on this data would be take a small
supplement of vitamin D every day and again we’ll put the links to these
articles in the description below