Viruses, powerful microorganisms with an agenda to replicate faster and thrive longer on hosts most susceptible to demise, have a new kid on the block.  The Novel Coronavirus, aka SARS-CoV2 (a biologic acronym), evolved from a family of friendly common cold viruses, penetrates deep inside the lung tissue of healthy individuals and transforms their immune system into a lean mean killing machine. For the human race whose facing its greatest health threat of the century, the race is on to find a cure against the deadly Novel Coronavirus, before it’s too late. 

SARS-CoV2 is the master orchestrator of all the living microbes resident in our bodies, laid dormant for years or otherwise remained commensal.  The virus along with its new recruits work fastidiously to elicit a massive immune reaction, called cytokine storm, leading to severe lung injury, septic shock and death.  With no definitive cure, no herd immunity, and no vaccine on hand, doctors and nurses everywhere, everyday enter the COVID floors with guilt and despair while they witness the devastating scene of patients clung to a thread of life by ventilators, dialysis machines and intravenous therapeutics.  In my 20 years of medicine, I have never seen anything like this before — a very clever virus engulfing the organs with its tight grip and taking with it hoards of martyrs in its path to conquest the human genome.

In California, the death rate of COVID-19 (disease caused by SARS-CoV2) is about 4%, which means that 96% of those who’ve contracted COVID-19 will survive.  The biggest question we now have as doctors and scientists, is who are the persons most susceptible to contracting this illness and what contributing variables are responsible for worse clinical outcomes.  As a preventative medicine practitioner, I’m always looking for ways to prevent diseases, especially ones with no cure.  With respect to COVID-19, we knew early on that certain risk factors such as lung injury, heart disease, diabetes, immunodeficiency, advanced aging, obesity, and active cancer contribute to worse outcomes.  Only recently have we discovered a new risk factor and  that is a deficiency in Cholecalciferol otherwise known as Vitamin D.   How naive are we to glance over a fundamental nutrient that protects our bodies against pathogens and immune system failures if in fact it has a place in our armamentarium against the grips of COVID-19.2 

What is Vitamin D?

Vitamin D is technically a hormone, because it enters the cells and directs transcription of proteins.  Experts suggest that this one molecule made of 27 carbons, 44 hydrogens and one oxygen ion is responsible for 5% of all the genome’s transcription!  That’s an enormous quantity of proteins that carry out essential processes in the body, including regulation of the immune system. Synthesis of vitamin D takes place in the skin in response to oxidative stress from UV radiation.  The body has ingeniously figured out how to protect its fragile DNA against damages exerted by reactive oxygen species (ROS) in real time.  From the skin, vitamin D then travels to the kidneys where conversion to activated form, Calcitriol (Vitamin D 1,25) takes place.  The majority of vitamin D’s effects on the cardiovascular system, lungs, bones, gut and brain is carried out by the active form. 

Is Vitamin D the missing link in COVID-19? 

The mechanism by which vitamin D exerts its protective effect against respiratory pathogens, including COVID-19 is two-fold.  One rests on its immune modulating effects particularly on macrophage activation and suppression of cytokine release.  This down-regulation of pro‐inflammatory cytokines prevents the severe form of acute lung injury or ARDS which is the basis of respiratory failure, need for ventilatory support and eventually host demise in COVID-19. 

The second part is vitamin D’s role in the renin‐angiotensin pathway.  This micronutrient is responsible for controlling ACE2 levels in the lung, the point of entry in SARS-CoV1 and CoV2. 

The study below of a European cohort examined rates of infection and mortality in patients with COVID-19, and found a significantly elevated risk of dying when vitamin D level was less than 22 ng/mL.3  

 

Researchers in Asia have discovered similar findings.  One author determined severity of COVID-19 illness goes hand in hand with vitamin D level—those with higher levels have 20 times better chance of developing mild symptoms, in contrast to those in the lowest quantile of vitamin D status who had conferred the worst clinical outcomes.4   

Deficient Vitamin D level, which is anything less than 30ng/mL is extremely common in the elderly, those with obesity, those farther from the equator, and dark-skinned individuals.  At this juncture in the COVID-19 pandemic, we are finding that precisely this cohort of patients are at greatest risk of dying from this disease.  The common link among them is Vitamin D deficiency. 

How best to achieve optimal Vitamin D levels?

There is conclusive evidence that once-daily dosing of vitamin D prevents and mitigates respiratory tract infections.5 Respiratory viruses are less common in the summer time, where longer days and warmer weather takes us outside for a healthy dose of sunlight. 

The primary method to reach optimal levels is daily, direct sun exposure at zenith, for about 10 to 15 minutes or until the skin turns a warm pink color.  This is called MED, minimal erythema dose, which is equivalent to ingesting approximately 20,000 IU of Vitamin D2.6  Do not cover the skin with excess clothing, SPF or try to obtain your sun exposure through a window —this will only reduce your chances of synthesizing adequate D.

Monitor your serum Vitamin D level with a blood test at least twice a year, preferably once in winter time as absorption of proper sunlight is much less.  Replenish your stores with oral Vitamin D3 or D2 if your level is below 30ng/mL, but aim for optimal levels between 50-80ng/mL. Vitamin D tablets are inexpensive and generally considered safe even at high doses.  Consume foods rich in Vitamin D2, such as mushrooms and wild seafood.

The trajectory of SARS-CoV2 is yet to be realized and this pandemic is far from over.  A simple yet powerful micronutrient, has shown us a possible link to survival.  In our quest to defeat COVID-19, as thankful as I am for our fancy hospitals with their hardy ventilators, the doctors and nurses on the frontlines, our scientists with their complex mathematical models, and our biomedical companies venturing on vaccine and antibody production—I am equally indebted to nature for providing us the innate ability to turn sunlight into Vitamin D, the most natural antidote against all pathogens.

Not long ago, I diagnosed a patient in our practice with COVID-19.  He is 82 years old, with diabetes and immune deficiency.  He developed a fever and fatigue and within a week, recovered to his normal health without any adverse sequelae.  His latest Vitamin D level was 40ng/mL, a range I am certain provided this “high-risk” man the protection he needed to whiz through a deadly virus like a champ.   

Be Safe,

Yazdani, MD