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Covid-19: Flying before we can walk

BMJ 2020; 370 doi: (Published 17 September 2020) Cite this as: BMJ 2020;370:m3598

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Remembering the UK doctors who have died from covid-19

Dear Editor

Is it a coincidence that of the 33 doctors who died from Covid-19 and who were listed in the BMJ of September 19th, 30 (possibly 31) had inherited melanin-rich skin? Furthermore, the deaths of 20 doctors dying from Covid-19 have appeared in the Obituary columns of the BMJ during the pandemic. Of these 20, 11 appear to have have been of white British ethnicity, with an average age of 88 years, and an age-range of 84 to 107. 9 appear to have been of black African or Asian ethnicity, with an average age of 61 years and an age range of 48 to 79. There is no overlap of the age ranges, and this should make observers stop and think.

Doctors of any ethnicity in the UK are not socio-economically disadvantaged. I do not see any evidence that "racism" might cause this glaringly obvious excess of deaths and difference in ages at death of those with melanin-rich skin. Why do we not accept as a working hypothesis (that can neither be proven or disproven) that this is due to skin pigmentation? Melanin is an extremely effective sun-block that is an advantage when living in the tropics, but when living 50 degrees north of the equator it becomes a serious biological disadvantage, as it impairs the production by UVB of cholecalciferol (vitamin D) from 7-dehydrocholesterol synthesised in the skin. It has been well-established during the past half-century that this has resulted in rickets and osteomalacia, and also that 1,25(OH)D (activated vitamin D) is essential for the escalation of defensive immunity at a time of serious infection.

If we look at the nations of equatorial Africa we can see the citizens are experiencing death rates from Covid-19 between, for example, 1 (Uganda) and 18 (Liberia), compared with their siblings in the UK who are experiencing a death rate well in excess of our national 615 per million. In India the death rate per million is 60 and in Pakistan 30. The reason for the 10 or 20 times higher death rates of citizens of the UK who, or whose ancestors, might have come from these countries is obvious to those who give the subject some thought.

We know from several studies published during the past six weeks, but not yet reviewed in the BMJ, that low levels of vitamin D in the blood lead to an increased risk of Covid-19 infection. We know from a randomised controlled trial undertaken in Cordobá, Spain, that vitamin D given to patients with Covid-19 pneumonia on admission to hospital reduced the need for intensive care from 50% to 2%, and eliminated deaths.

Let us hope that the 33 doctors illustrated in the BMJ have not died in vain. The time has arrived belatedly to protect not just our doctors, whether working or retired, but also the public at large with Vitamin D supplements. We must accept Pascal's wager. The nation requires medical leadership, and the BMJ is in a prime position to provide it.

Competing interests: No competing interests

24 September 2020
David S Grimes
Physician (retired)