Exploring the Links Between Coronavirus and Vitamin D - The New York Times

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In the past decade, studies have found that taking vitamin D can lower the odds of developing respiratory infections like the cold and the flu, especially among people who have documented deficiencies. Now scientists are trying to find out whether vitamin D might also help protect against Covid-19.

Some scientists believe that people with vitamin D deficiencies have weak or abnormal immune responses that make them more susceptible to developing Covid-19 and experiencing severe symptoms. The notion that vitamin D levels could influence the risk of Covid-19 has sparked debate among experts and prompted researchers at Harvard and other universities to start randomized trials examining whether there is a link.

But so far, most of the evidence for the claim comes from observational studies that do not prove causation. And experts are urging people to be cautious about gobbling down high doses of supplements in the hopes of obtaining benefits that may not exist.

The speculation that vitamin D could protect against Covid-19 has been fueled in part by observations that deficiencies are particularly common among groups that have been hit disproportionately hard by the novel coronavirus, such as older adults, nursing home residents, and African-Americans and other minorities. The body synthesizes vitamin D through direct exposure to sunlight, and people who are elderly, homebound or darker skinned tend to produce lower levels of it. Obesity, another risk factor for severe Covid-19, is also associated with low vitamin D levels.

Socioeconomic factors like reduced access to health care and less ability to work from home contribute to the disparate rates of sickness and death from coronavirus among minorities. But some experts point to evidence that low vitamin D levels can hamper the immune system. Vitamin D helps reduce inflammation and can stimulate the release of antimicrobial proteins that kill viruses and bacteria. One team of researchers at Northwestern University released a study, which has not yet been peer reviewed, suggesting that vitamin D could help to quell cytokine storms, a type of immune reaction that appears to worsen outcomes for coronavirus patients.

Another study published in the BMJ in 2017 reviewed data from 25 randomized trials and concluded that people assigned to take vitamin D had a 12 percent lower risk of developing respiratory tract infections compared to those given placebos. But the effect was greater among people who were classified as vitamin D deficient, with very low blood levels, below 25 nanomoles per liter (or 10 nanograms per milliliter): They saw their risk of contracting respiratory infections fall 70 percent when they supplemented with vitamin D. Blood levels of 20 to 50 nanograms per milliliter are generally considered normal.

The study looked at colds, influenza and respiratory infections caused by a variety of viruses. It did not include the novel coronavirus. But it did look at milder infections caused by other strains of coronavirus, said Dr. Adit Ginde, a professor of emergency medicine at the University of Colorado School of Medicine and the study’s lead author.

In March, Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention, wrote an opinion piece suggesting that vitamin D deficiencies could worsen outcomes for people who develop Covid-19 and other respiratory infections. He urged people to avoid deficiencies by spending time outside in the sun, taking supplements, or eating foods rich in vitamin D like fatty fish, egg yolks and fortified milk.

The Institute of Medicine recommends that most adults get 600 international units of vitamin D from food or supplements daily, or 800 IU if they are aged 71 and older, to protect musculoskeletal health. Many experts say that Vitamin D is generally safe at doses up to 2,000 IU a day for those who aren’t deficient. The Institute of Medicine classifies 4,000 IU a day as the tolerable upper intake level, meaning that above that threshold there is a greater chance of side effects such as increased calcium in the blood, which can lead to weakness, digestive complaints or kidney problems.

Since the pandemic began, sales of vitamin D and other supplements promoted for immune health have soared. But preliminary studies of vitamin D and Covid-19 have yielded mixed results.

At the University of Chicago Medicine, which serves a largely black and Hispanic population on the South Side of Chicago, researchers reviewed the medical records of more than 4,300 patients, many of them health care workers, who were tested for Covid-19 in March and early April.

After controlling for factors that can influence vitamin D levels, like age, race and chronic medical conditions, they found that people who were vitamin D deficient before the pandemic began were 77 percent more likely to test positive for Covid-19 compared to people who had normal levels.

Dr. David Meltzer, a professor of medicine at the University of Chicago and the lead author of the study, which has not yet been peer reviewed, cautioned that the findings were correlational and did not prove causation. He said he and his colleagues were recruiting local paramedics, police officers and other emergency workers for a randomized trial that will test whether taking low to moderate doses of vitamin D daily has an impact on their risk of developing Covid-19 or the severity of their symptoms. Dr. Meltzer suspects that people taking vitamin D who contract the virus will have fewer symptoms of Covid-19 “because the immune system will be less likely to have an exaggerated inflammatory response.”

“I think you can learn a lot from observational studies,” said Dr. Meltzer, who is chief of the Section of Hospital Medicine at the University of Chicago Medicine. “But in the end we desperately need randomized trials to determine as rapidly as we can if there’s a real effect here.”

In Britain people from minority ethnic groups, such as those with African or South Asian ancestry, make up a third of all confirmed cases of Covid-19 in critical care, even though they account for just 14 percent of the population. They also experience higher levels of poverty, chronic diseases and vitamin D deficiencies. At least one medical group, the British Association of Physicians of Indian Origin, has urged all British health care workers from minority backgrounds to consider taking vitamin D supplements as a precaution.

But two recent studies using data from the U.K. Biobank, a long running project that has tracked the health of a half million people aged 40 to 69, cast doubt on the links between vitamin D and Covid-19. One group of researchers found that participants who recently tested positive for coronavirus were more likely to have had very low or deficient levels of vitamin D compared to other participants. But the association disappeared after the results were adjusted for factors like age, race, obesity and socioeconomic status.

The findings suggest that the lower vitamin D levels in people who tested positive for coronavirus were not causally related, said Dr. Claire Hastie, a research associate in public health at the University of Glasgow and the first author of one of the two studies, which was published in the journal Diabetes & Metabolic Syndrome.

The Coronavirus Outbreak

• Frequently Asked Questions and Advice

  Updated June 5, 2020

  • Does asymptomatic transmission of Covid-19 happen?

    So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

  • How does blood type influence coronavirus?

    A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

  • How many people have lost their jobs due to coronavirus in the U.S.?

    The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

  • Will protests set off a second viral wave of coronavirus?

    Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

  • How do we start exercising again without hurting ourselves after months of lockdown?

    Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

  • My state is reopening. Is it safe to go out?

    States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

  • What’s the risk of catching coronavirus from a surface?

    Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

  • What are the symptoms of coronavirus?

    Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

  • How can I protect myself while flying?

    If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

  • How do I take my temperature?

    Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.

  • Should I wear a mask?

    The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

  • What should I do if I feel sick?

    If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

  • How do I get tested?

    If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

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“People with lower vitamin D have a higher risk of Covid infection, but it looks like this is explained by other risk factors and not by the vitamin D itself,” she said. “Our findings do not support a link between vitamin D concentration and the risk of Covid-19 infection.”

A second analysis led by researchers at the University of Surrey reached similar conclusions. It looked at 580 U.K. Biobank participants who tested positive for coronavirus and found, on average, that their blood levels of vitamin D were “almost identical” to 723 participants who tested negative for the virus.

“Mechanistically, there is a link between vitamin D and respiratory tract infections,” said Dr. Susan Lanham-New, an author of the study and head of the Department of Nutritional Sciences at the University of Surrey. “But there is nowhere near enough evidence to come out with these claims that Covid-19 is because of vitamin D deficiency.”

Dr. JoAnn Manson, a Harvard Medical School professor and chief of preventive medicine at Brigham and Women’s Hospital in Boston, said the lines of evidence linking low vitamin D to Covid-19 were compelling. She is starting a nationwide randomized trial that will test whether assigning people to take vitamin D every day for a month after a positive coronavirus test reduces the severity of their illness. The trial will also look at whether giving vitamin D to other people in their households helps prevent them from developing the infection.

In the meantime, Dr. Manson said people should take simple steps to avoid vitamin D deficiencies, such as being physically active outside while social distancing and eating foods like fortified cereals, fortified dairy, sun-dried mushrooms and fish. For people who cannot get outside or get enough vitamin D from their diets, supplementing with 1,000 to 2,000 IU a day is reasonable, she said. But she urged people not to take high doses.

“More is not necessarily better,” she said. “The goal is to avoid a deficiency. It’s not to get mega doses.”

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