I am surprised that Drs Vetter, Lan Vu and L’Huillier et al didn’t cast their net wider in reviewing covid-19 – BMJ 2020;369:m1470.
Infections caused by the SARS-CoV-2 virus have some unusual features.
Pregnant women do not usually have a serious infection – despite the fact that they are immunologically compromised. This vulnerability was seen dramatically in the H1N1/09 pandemic in 2009 – when many such women became very ill.
Neonates and infants usually suffer mild forms of the infections only – although they are considered to have a poor immune status.
Both of these immunologically compromised groups survive SARS-CoV-2 infections relatively well.
It has emerged that elderly infected people have a high mortality rate. Elderly people’s immune response is somewhat diminished – but they have a vast range of antibodies to a lifetime of infections and vaccinations.
In media reports it has appeared that people with pigmented skin also seemed to have a high mortality rate. Further media reports suggest that obese people were also dying also disproportionately.
I wondered what factors linked these three groups – the elderly, those with pigmented skin and those who are obese?
Reviewing the literature it was apparent that all three groups are commonly vitamin D deficient. Furthermore vitamin D plays a significant part in the body’s defence to respiratory infections.
I suspect many of the excess deaths due to SARS-CoV-2 infection may be due - sadly - to vitamin D deficiency. It follows that supplementary vitamin D in these people may be warranted.
There is also the possibility that high doses of the vitamin could be used as part of a treatment regimen.
01. Samefors, M, Ostgren, C J, Molstad, S et al Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality. European Journal of Endocrinology, 170(5), 667–675. doi:10.1530/eje-13-0855
02. Weishaar, T, Rajan, S, & Keller, B et al Probability of Vitamin D Deficiency by Body Weight and Race/Ethnicity. The Journal of the American Board of Family Medicine, 29(2), 226–232. doi:10.3122/jabfm.2016.02.150251
03. Pereira-Santos, M, Costa, P R F, Assis, A et al Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obesity Reviews, 16(4), 341–349. doi:10.1111/obr.12239
04. Ginde AA, Mansbach JM, Camargo CA Jr. Vitamin D, respiratory infections, and asthma. Curr Allergy Asthma Rep. 2009 Jan;9(1):81-7. doi: 10.1007/s11882-009-0012-7
Competing interests:
No competing interests
23 April 2020
John M EVANS
Consultant - retired
Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
Rapid Response:
More Clinical features of covid-19
Dear Editor
I am surprised that Drs Vetter, Lan Vu and L’Huillier et al didn’t cast their net wider in reviewing covid-19 – BMJ 2020;369:m1470.
Infections caused by the SARS-CoV-2 virus have some unusual features.
Pregnant women do not usually have a serious infection – despite the fact that they are immunologically compromised. This vulnerability was seen dramatically in the H1N1/09 pandemic in 2009 – when many such women became very ill.
Neonates and infants usually suffer mild forms of the infections only – although they are considered to have a poor immune status.
Both of these immunologically compromised groups survive SARS-CoV-2 infections relatively well.
It has emerged that elderly infected people have a high mortality rate. Elderly people’s immune response is somewhat diminished – but they have a vast range of antibodies to a lifetime of infections and vaccinations.
In media reports it has appeared that people with pigmented skin also seemed to have a high mortality rate. Further media reports suggest that obese people were also dying also disproportionately.
I wondered what factors linked these three groups – the elderly, those with pigmented skin and those who are obese?
Reviewing the literature it was apparent that all three groups are commonly vitamin D deficient. Furthermore vitamin D plays a significant part in the body’s defence to respiratory infections.
I suspect many of the excess deaths due to SARS-CoV-2 infection may be due - sadly - to vitamin D deficiency. It follows that supplementary vitamin D in these people may be warranted.
There is also the possibility that high doses of the vitamin could be used as part of a treatment regimen.
01. Samefors, M, Ostgren, C J, Molstad, S et al Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality. European Journal of Endocrinology, 170(5), 667–675. doi:10.1530/eje-13-0855
02. Weishaar, T, Rajan, S, & Keller, B et al Probability of Vitamin D Deficiency by Body Weight and Race/Ethnicity. The Journal of the American Board of Family Medicine, 29(2), 226–232. doi:10.3122/jabfm.2016.02.150251
03. Pereira-Santos, M, Costa, P R F, Assis, A et al Obesity and vitamin D deficiency: a systematic review and meta-analysis. Obesity Reviews, 16(4), 341–349. doi:10.1111/obr.12239
04. Ginde AA, Mansbach JM, Camargo CA Jr. Vitamin D, respiratory infections, and asthma. Curr Allergy Asthma Rep. 2009 Jan;9(1):81-7. doi: 10.1007/s11882-009-0012-7
Competing interests: No competing interests