Covid 19, Vitamin D deficiency, Smoking, Age and Lack of Masks Equals the Perfect Storm
Covid 19 was introduced to the northern hemisphere during the winter of 2019/2020. It is well known that vitamin D levels are significantly lower at the end of winter than in the summer. More than 40% of Canadians have low levels of vitamin D (less than 50nmol/l) at this time of year. Solar radiation is a major contributor to vitamin D levels. Regions in China (Wuhan)(and Italy (northern areas) and parts of Spain again have noticeably less solar radiation annually as well as more air pollution. These areas with high air pollution block ultraviolet frequencies that result in vitamin D production in the skin .
Vitamin D has a significant impact on our immune system being important in barrier function maintaining tight junctions, gap junctions and adherens junctions. Recent evidence shows that vitamin D down regulates the DDP/CD26 binding site of the COVID-19 spike glycoprotein thus reducing the virulence of this virus.. As well it is important for the production of cathelicidins and other antimicrobial compounds. Vitamin D also reduces the cytokine storm by reducing the expression of pro-inflammatory cytokines and improving anti inflammatory cytokines such as LL 17, thus attenuating the risk of cascading responses in the immune system that may lead to death.
In order to correct the vitamin D winter low, rapid supplementation with 10,000IU of vitamin D3 can be safely employed as suggested in a most recent article. Another approach would be the employ the” vitamin D hammer” as a one time 50,000IU dose of vitamin D3 when one becomes ill. Of course this one time dose should be followed by a reasonable daily dose of at least 5000IU until vitamin D levels are at 100nmol/l.
Smoking reduces vitamin D levels, increases inflammation and slows resolution of viral infections. Vitamin D may have a protective effect on lung function and reduce infections of the lung in both adults and children.
Those that are older have an increased likelihood of being vitamin D deficient and the skin with increasing age becomes less efficient at producing vitamin D. Thus supplementation of vitamin D is more important as we age.
Wearing a mask has been shown to reduce infection in clinical situations and may be another protective measure. A rational approach needs to be taken. It appears as this pandemic is unfolding that countries that adopt wearing masks early on (even home made cloth masks) are faring much better than those that do not. Certainly wearing masks is not a panacea without all the other public health measures, but are useful for everyone within a population to wear when public as asymptomatic individuals can transmit this virus.
Modifiable risk factors for covid 19 infections would include discontinuing smoking, normalizing vitamin D levels quickly, and using universal mask protection.
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Competing interests: No competing interests