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Racism: the other pandemic

BMJ 2020; 369 doi: (Published 11 June 2020) Cite this as: BMJ 2020;369:m2303

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Re: Racism: the other pandemic

Dear Editor

Vitamin D and Covid-19

It has been widely reported that BAME (Black And Minority Ethnic) individuals have a much higher death rate from Covid-19, although the reason for this is not currently understood. However, I note the following facts:

1) Vitamin D is needed for many body systems, not just calcium metabolism, and in particular the immune system [1], although exactly how this system is affected by deficiency is unclear.

2) As you might expect people with darker skin colour. and particularly black skin, have much lower vitamin D levels [2], mostly at what are considered as probable deficiency levels A significant number of white individuals also have abnormally low levels in spring in northern climes [3] - and in some this will be year-round if they see little sun in the summer, such as some older persons and those with disabilities.

One's reaction to a Covid-19 infection is clearly dependent on many factors, but could Vitamin D deficiency help to explain in part the higher death rate? It seems to me that it would be useful to have Vitamin D levels done on everyone admitted to hospital with Covid-19; this should quickly show whether vitamin D deficiency was involved. Also, it would be very interesting to try giving Vitamin D supplements to all Covid-19 patients. Ideally of course this should be in a randomised controlled clinical trial, but it could be argued this was unethical if patients were Vitamin D deficient anyhow because of the other substantial benefits of supplementation.

I would therefore suggest using higher strength Vitamin D (i.e. the 25 mcg. Tablet) on admission. This would be safe until serum levels show whether there was a deficiency (when the higher strength would be indicated anyhow), or not when it could be stopped. Sunlight produces inactive vitamin D. Active vitamin D3 is derived from this by liver enzymes and then enzymes in the kidneys and some other tissues; high doses of sunlight produce other (non-active) compounds in the skin in a dynamic equilibrium so 'sun light' Vitamin D excess does not occur [4]

1. As summarized by Aramow C., J.Invest.Med. 59(6) p881 (2011)
2. As summarized by O'Connor et al. Proc. Cardiovasc. Dis. 56(3) p261 (2013)
3. Sievenpiper et al. BMJ 336 p1371 (14/June/2008)
4. Wacker M. & Holick M. Dermatoendocrinology 5(1) 51 (2013)

Competing interests: No competing interests

16 June 2020
Richard Nutt
Retired GP
Bradford on Avon