With many dark winter days still ahead of us, another pandemic closely related to COVID-19 may be on the rise. Decreased exposure to sunlight during winter months has led many people across the world to become deficient in Vitamin D, and as studies have shown, this could be the difference between life and death for COVID patients. Research, both past and present, has shown that Vitamin D deficiency can aggravate upper respiratory conditions, specifically Acute Respiratory Distress Syndrome (ARDS). ARDS has become one of the primary causes of mortality for victims of COVID-19. For this reason, researchers from the American Journal of Therapeutics ran an observational study on Vitamin D deficient COVID patients with upper respiratory problems. The findings of this study saw the patients experience “improved clinical recovery evidenced by shorter lengths of stay, lower oxygen requirements, and a reduction in inflammatory marker status” (Ohaegbulam et al. 2020). For many, COVID is still an extremely threatening presence with vaccination still out of reach. Vitamin D could potentially become a successful resource to treat victims in the days to come.
In response to the desperate search for viable COVID treatments, the experimenters from the American Journal of Therapeutics hoped to build off the findings of several other researchers within the last decade. For example, while looking into the relationship between Vitamin D and ARDS developed by COVID patients, The Journal of Steroid Biochemistry and Molecular Biology found strong links between Vitamin D deficiency and upper respiratory infections. This scholarly source emphasizes how Vitamin D in the endocrine system helps repair inflamed tissue on the epithelial layer of the lungs (Quesada-Gomez et al. 2020). This inflamed tissue is a major complication of ARDS, along with other diseases such as Pulmonary Fibrosis and Interstitial Lung Disease. Additionally, it has become established that activated Vitamin D receptors reduce the secretion of proteins called cytokines that cause inflammation in the lungs, further aggravating ARDS (Khoo et al. 2012). Following these results, the Journal of Critical Care produced their own experiment, concluding that Vitamin D supplementation did in fact reduce the secretion of cytokines, as well as mortality rates, in ventilator-assisted pneumonia patients (Miroliaee et al. 2018). Recognizing the implications of these results and their connection to the current pandemic, the journal carried out the following observational study.
During the month of April of 2020, Kim C. Ohaegbulam, MD, PhD, Mohamed Swalih, DO, Pranavkumar Patel, MBBS, Miriam A. Smith, MD, FACP, MBA, and Richard Perrin, MD carried out a study at the Long Island Jewish Forest Hills Hospital in New York. The researchers were granted access to observe four Vitamin D deficient COVID patients with ARDS before and after receiving supplementation. The patients were supplemented with a standard dose of 1,000 IU of cholecalciferol (vitamin D3) every day, or a high dose of 50,000 IU of ergocalciferol (vitamin D2) for five days. The day that each patient was diagnosed with COVID, in which the supplementation began, was marked as Day 0. The patients were observed through physical examinations and laboratory metrics, as well as self-proclaimed symptoms. Metrics observed included oxygen use, white blood cell count, inflammatory markers, or how inflamed the respiratory system was, and leukocytosis, which is the increase in white blood cells as an inflammatory response (Ohaegbulam et al. 2020). Following the completion of the study, it was found that the patients who had their Vitamin D levels replenished had a shorter stay in the hospital, lower oxygen requirements, and reduced inflammation in the lungs
As promising as the results of this study seem, they should not be taken as concrete evidence. The study was rather limited considering the small sample size of four patients, as noted by the researchers themselves, meaning the data cannot be extrapolated to the public. Further limits to the study could include the fact that the BMIs of each of the patients were similar. Additionally, none of the patients were under the age of 40 years old. A larger-scale experiment including randomized clinical trials would be necessary to draw a more solid conclusion on the efficacy of Vitamin D supplementation (Ohaegbulam et al. 2020). Interestingly enough, a related article was published in November of 2020 by Critical Reviews in Food Science and Nutrition in which it was concluded that Vitamin D deficiency did aggravate COVID-19 symptoms (Pereira et al. 2020 Nov 4). This article was a meta-analyses of twenty seven observational studies in which the effects of Vitamin D deficiency on COVID-19 patients. It was found that deficiency in Vitamin D had a strong positive correlation with the severity of the case, further indicating that supplementation may have viability as a form of treatment. Further research on ARDS and other complications related to COVID-19 could lead to large-scale distribution of Vitamin D supplementation that could drastically reduce mortality rates. Considering the vast number of encouraging results, governments in England and parts of Spain have begun to provide free Vitamin D supplements to their citizens as part of their pandemic recovery plan until enough citizens are vaccinated.
While the light at the end of the tunnel is approaching, the world is still in dire need of COVID relief. The next step for global powers, aside from providing vaccines, should be conducting more research on effective treatment plans, specifically Vitamin D. Before more conclusive evidence is found, it is still important to consult a physician before starting Vitamin D supplementation.
References
Khoo AL, Chai L, Koenen H, Joosten I, Netea M, van der Ven A. 2012. Translating the role of vitamin D3 in infectious diseases. Crit Rev Microbiol. 38(2):122–135. doi:10.3109/1040841X.2011.622716.
Miroliaee AE, Salamzadeh J, Shokouhi S, Sahraei Z. 2018. The study of vitamin D administration effect on CRP and interleukin-6 as prognostic biomarkers of ventilator associated pneumonia. J Crit Care. 44:300–305. doi:10.1016/j.jcrc.2017.08.040.
Ohaegbulam KC, Swalih M, Patel P, Smith MA, Perrin R. 2020. Vitamin D supplementation in COVID-19 patients: a clinical case series. Am J Ther. 27(5):e485–e490. doi:10.1097/MJT.0000000000001222.
Pereira M, Dantas Damascena A, Galvão Azevedo LM, de Almeida Oliveira T, da Mota Santana J. 2020 Nov 4. Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis. Crit Rev Food Sci Nutr.:1–9. doi:10.1080/10408398.2020.1841090.
Quesada-Gomez JM, Entrenas-Castillo M, Bouillon R. 2020. Vitamin D receptor stimulation to reduce acute respiratory distress syndrome (ARDS) in patients with coronavirus SARS-CoV-2 infections: Revised Ms SBMB 2020_166. J Steroid Biochem Mol Biol. 202:105719. doi:10.1016/j.jsbmb.2020.105719.