COVID-19 AND VITAMIN D

COVID-19 AND VITAMIN D

SARS-CoV-2, the virus that causes COVID-19, continues to spread, leading to more than 24,000 deaths in less than four months and infected more than half a million people worldwide. Efforts are progressing to develop a COVID-19 vaccine, but it's still likely 12 to 18 months away.

 What is novel Coronavirus or COVID-19?

? Coronavirus (COVID-19) is infectious and a Pandemic disease

? A new respiratory virus first identified in Wuhan, China

? First reported to the WHO Country Office in China on 31 December 2019

? It has the potential to cause illness, severe pneumonia in some people and death

How COVID-19 spreads?

? Through the air by coughing and sneezing

? Close personal contact, such as touching or shaking hands

? Touching an object or surface with the virus on it, then touching your mouth, nose, or eyes

Who is at risk of COVID-19 Infection?

According to the Centers for Disease Control and Prevention (CDC):

Those at high-risk for severe illness from COVID-19 include:

• People aged 65 years and older
• People who live in nursing homes or long-term care facility
• Other high-risk conditions could include:
• People with chronic lung disease or moderate to severe asthma
• People who have serious heart conditions
• People who are immunocompromised including cancer treatment
• People of any age with severe obesity (body mass index [BMI] >40) or certain underlying medical conditions, particularly if not well controlled, such as those with diabetes, renal failure, or liver disease might also be at risk
• People who are pregnant should be monitored since they are known to be at risk with a severe viral illness, however, to date data on COVID-19 has not shown an increased risk
• Healthcare professionals who do not take precautionary measures when dealing with COVID-19 infected people

Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications

 What are the symptoms of COVID-19 Infection?

Illnesses can be mild, or in some cases be severe enough to require hospitalization.

Symptoms of this respiratory illness primarily include:

? Fever

? Cough

? Shortness of Breath

How COVID-19 spread is prevented?

Similar to the prevention of other respiratory illnesses, including the flu:

? Wash hands often with soap and uses hand sanitizer

? Avoid touching eyes, nose, or mouth with unwashed hands

? Avoid contact with sick people

? Stay home while you are sick; avoid others

? Cover mouth/nose with a tissue or sleeve when coughing or sneezing

? Keep social distancing

? Eating Nutritious Food to make the immune system strong (WHO)

What is Vitamin D?

Vitamin D is a nutrient found in some foods especially the seafood e.g. fatty fish-salmon fish, tuna and mackerel. Sun is the key source of Vitamin D. It is important to understand that vitamin D is not a “vitamin” at all, but rather a prohormone that is synthesized in response to the interaction

 between precursor of cholesterol in the skin, and sun exposure. Vitamin D is widely studied for all kinds of health benefits, like bone health, calcium absorption, heart health, and immunity. Vitamin D is needed for good health and to maintain strong bones. It does so by helping the body absorb calcium (one of bone’s main building blocks) from food and supplements. Vitamin D is important to the body in many other ways as well. Muscles need it to move, for example, nerves need it to carry messages between the brain and every body part, and the immune system needs vitamin D to fight off invading bacteria and viruses Vitamin D receptor is found in cells throughout the body. There is an epidemic of vitamin D deficiency sweeping across our modern world, and it's an epidemic of such magnitude and seriousness that is not only alarmingly widespread but a root cause of many serious diseases such as rickets, multiple sclerosis, cancer, diabetes, osteoporosis, tuberculosis, and heart disease. Public interest in vitamin D is rising because it is intense and growing activity in the research community on the functions and benefits of vitamin D. People living near the equator who are exposed to sunlight without sun protection have robust levels of Vitamin D - above 30 ng per milliliter (75 nmol/L). Prof. Afrozul Haq of the Department of Food Technology, Jamia Hamdard, New Delhi, India in a retrospective study presented to the 18th vitamin D workshop at Delft, the Netherlands, and later published in 2016 in the Journal of Steroid Biochemistry and Molecular Biology, found that among 136 countries tested-Columbians were having the highest levels (>70 nmol/L) of 25(OH)D. Columbia is located at 4 degrees North and therefore, sunshine throughout the year. However, even in the sunniest areas, vitamin D deficiency is common when most of the skin is shielded from the sun and air pollution. Despite the important role of vitamin D in maintaining bone health, as well as a variety of other physiologic functions, many clinicians are reluctant to treat vitamin D deficiency or insufficiency in kidney stone formers because of the theoretical risk of increased urinary calcium excretion.

Research during the last two decades in the field of vitamin D suggests that vitamin D is much more than a nutrient needed for bone health; it is an essential hormone required for regulation of a large number of physiologic functions. All studies, in virtually all nations, irrespective of latitude, show that the majority of the world’s population has insufficient vitamin D status. It is clear that sufficient levels of serum 25(OH)D are essential for optimizing human health. Public education should be provided about the safety of vitamin D supplementation and the value of sensible sunlight exposure.

Vitamin D Boosts Immunity

When you take vitamin D, you lower your chances of getting sick from viral infections, like colds and the flu, by at least 10 percent. But people who are deficient in vitamin D actually see a greater protective benefit when they supplement, reducing their risk by 50 percent. Most Americans get far less than the recommended daily allowance for vitamin D of 600 IU, setting the stage for rampant deficiencies. Cold and flu viruses are contagious respiratory infections that affect the nose, throat, and lungs with symptoms like congestion, coughing, wheezing, sore throat, body aches, and fever. The flu, in particular, can have serious consequences in people who are at risk: the elderly, infants, young children, people with suppressed immunity, and those with other chronic disorders.

Anti-Viral Effect of Vitamin D

Respiratory tract infections are conditions that affect the air passages. These include acute infections that affect the lower respiratory tract and lungs, such as pneumonia and influenza, which are among the leading causes of death in coronavirus patients worldwide. Therefore, it is important to find interventions that could prevent respiratory conditions.

Vitamin D -- the 'sunshine vitamin'-is thought to protect against respiratory infections by boosting levels of antimicrobial peptides -- natural antibiotic-like substances -- in the lungs. Results of the study fit with the observation that colds and 'flu are commonest in winter and spring when levels of vitamin D are at their lowest. They may also explain why vitamin D protects against asthma attacks, which are commonly triggered by respiratory viruses. According to Dr. Teymoori-Rad from the School of Public Health, Tehran University of Medical Sciences-the pleiotropic role of vitamin D has been explored over the past decades and there is compelling evidence for an epidemiological association between poor vitamin D status and a variety of diseases. While the potential anti-viral effect of vitamin D has recently been described, the underlying mechanisms by which vitamin D deficiency could contribute to viral disease development remain poorly understood. Recent findings indicate a complex interplay between viral infections and vitamin D, including the induction of anti-viral state, functional immunoregulatory features, interaction with cellular and viral factors, induction of autophagy and apoptosis, and genetic and epigenetic alterations. While crosstalk between vitamin D and intracellular signaling pathways may provide an essential modulatory effect on viral gene transcription, the immunomodulatory effect of vitamin D on viral infections appears to be transient. The interplay between viral infections and vitamin D remains an intriguing concept, and the global imprint that vitamin D can have on the immune signature in the context of viral infections is an area of growing interest. A study from Queen Mary University, London provides the most robust evidence that Vitamin D supplements protect against acute respiratory infections including colds and flu. These results, published in The BMJ, are based on a new analysis of raw data from around 11,000 participants in 25 clinical trials conducted in 14 countries including the UK, USA, Japan, India, Afghanistan, Belgium, Italy, Australia, and Canada. Individually, these trials yielded conflicting results, with some reporting that vitamin D protected against respiratory infections, and others showing no effect.

"The bottom line is that the protective effects of vitamin D supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly rather than in more widely spaced doses. By demonstrating this new benefit of vitamin D, this study strengthens the case for introducing food fortification to improve vitamin D levels in countries where profound vitamin D deficiency is common."

Daily or weekly supplementation halved the risk of acute respiratory infection in people with the lowest baseline vitamin D levels, below 25 nanomoles per liter (nmol/L). However, people with higher baseline vitamin D levels also benefited, although the effect was more modest (10 percent risk reduction). Overall, the reduction in risk of acute respiratory infection induced by vitamin D was on a par with the protective effect of injectable 'flu vaccine against 'flu-like illnesses.

Prof. Afrozul Haq, Dean, School of Interdisciplinary Sciences and Technology, Head, Department of Food Technology, Jamia Hamdard, New Delhi, India

Further Readings:

1.WHO. Coronavirus disease (COVID-19) Pandemic. Geneva: World Health Organization; 2019. (https://www.who.int/emergencies/diseases/novel-coronavirus-2019)

2. WHO. Respiratory tract diseases. Geneva: World Health Organization; 2016. (https://www.who.int/topics/respiratory_tract_diseases/en/)

3. WHO. Pneumonia. Geneva: World Health Organization; 2016. (https://www.who.int/mediacentre/factsheets/fs331/en/)

4. Jiang X, Sun L, Wang B, Yang X, Shang L, Zhang Y. Health-related quality of life among children with recurrent respiratory tract infections in Xi'an, China. PLoS One. 2013;8(2):e56945. (https://journals.plos.org/plosone/articlid=10.1371/journal.pone.0056945)

5. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? Journal of Steroid Biochemistry & Molecular Biology.144(2014):138-145.(https://doi.org/10.1016/j.jsbmb.2013.11.003

6. Haq A., Svobodova J., Imran S., Stanford C., Razzaque MS. Vitamin D deficiency: A single-center analysis of patients from 136 countries. Journal of Steroid Biochemistry & Molecular Biology.164 (2016) 209–213. (https://dx.doi.org/10.1016/j.jsbmb.2016.02.007)

7. Charan J, Goyal JP, Saxena D, Yadav P. Vitamin D for prevention of respiratory tract infections: a systematic review and meta-analysis. Journal of Pharmacology and Pharmacotherapeutics. 2012;3(4):300-303.

8. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017;356:i6583.