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Covid-19: Public health agencies review whether vitamin D supplements could reduce risk

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2475 (Published 19 June 2020) Cite this as: BMJ 2020;369:m2475

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Re: Covid-19: Public health agencies review whether vitamin D supplements could reduce risk

Dear Editor

BAME clinical and support staff are dying in disproportionate numbers, as are those in the general population.

Natural migration patterns may throw light on this issue. It has been suggested that Covid-19 in the Philipines has a low death rate (1), due in part to protection from sun produced vitamin D. However, in the bleak climate of the UK, the mortality of nurses originating from the Philipines has been such as to raise concern with the ambassador. Very real issues of poverty and discrimination have been raised as possibly contributing. But the first 10 doctors who died of covid here were of a BAME background, and were much less likely to be poor than nurses.

Following the finding of high numbers of rickets in Glasgow children of Asian origin, much work has been done in the UK. In particular, the neonate's status depends on its mother's status, so supplements have been recommended in the final months of pregnancy, and not just in veiled Muslim women of Asian heritage (2).

In the US, fibroblasts from skin biopsies were cultured from citizens of european origin, and compared with those with Asian heritage. The enzyme 25(OH)D-24-hydroxylase was more active in the latter, who would therefore be more likely to be vitamin D deficient, and to require higher doses to rectify this deficiency (3). The same authors have found low levels of vitamin D, due to dark skins in US Afro-Americans, who have recently suffered so grieviously from covid.

It is to be hoped that the COVIDENCE UK study will take these sort of factors into account, and give us more evidence on whether or not an adequate vitamin D level for the individual protects against covid infection in the first instance, and more importantly, whether it protects from the later cytokine storm that can be so lethal.

(1).Editorial. low population mortality from COVID‐19 in countries south of latitude 35 degrees North supports vitamin D as a factor determining severity
https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15777

(2).Vitamin D deficiency in UK Asian families: activating a new concern.
https://adc.bmj.com/content/86/3/147

(3).Vitamin D Metabolism Is Altered in Asian Indians in the Southern United States: A Clinical Research Center Study
https://academic.oup.com/jcem/article/83/1/169/2865135

Competing interests: No competing interests

08 July 2020
Gareth H. Jones
MRCP, FRCPsych, Tribunal Doctor
Mental Health Review Tribunal for Wales
Caerphilly, CF83