Coronavirus: why aren’t we talking more about vitamin D?

BAME people suffer more from Covid-19, but the problem probably isn't racism.

Rob Lyons
Columnist

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One area of anger in recent protests against racism has been the differential impact of Covid-19 on black, Asian and minority-ethnic (BAME) people. But assuming that viruses don’t discriminate, can those deaths really be put down to racism or is there something else going on?

The overwhelming risk factor with Covid-19 is age. The majority of deaths have been in those over the age of 70. But there are other apparent risk factors, too. A report by Public Health England in June noted: ‘An analysis of survival among confirmed Covid-19 cases and using more detailed ethnic groups, shows that after accounting for the effect of sex, age, deprivation and region, people of Bangladeshi ethnicity had around twice the risk of death than people of White British ethnicity. People of Chinese, Indian, Pakistani, Other Asian, Caribbean and Other Black ethnicity had between 10% and 50% higher risk of death when compared to White British.’

However, the report adds that this immediate finding didn’t take into account things like occupation. Someone working in a hospital or driving a taxi has been at greater risk of exposure than someone working from home, so differences in the work done on average by different ethnic groups could be a factor. The report also notes that ‘when comorbidities are included, the difference in risk of death among hospitalised patients is greatly reduced’.

Interestingly, Covid-19 seems to be reversing previous trends. The PHE report notes that the elevated death risk for BAME people is ‘the opposite of what is seen in previous years, when the all-cause mortality rates were lower in Asian and Black ethnic groups’. It continues: ‘Comparing to previous years, all-cause mortality was almost four times higher than expected among Black males for this period, almost three times higher in Asian males and almost two times higher in White males. Among females, deaths were almost three times higher in this period in Black, Mixed and Other females, and 2.4 times higher in Asian females compared with 1.6 times in White females.’

Some people are putting these differences down to ‘historic racism’, but that doesn’t square easily with the idea that death rates have been, before Covid-19, higher among white people. Perhaps there is another explanation?

One idea is that there may be something simpler going: vitamin D deficiency. Normally, when people talk about vitamin or mineral deficiencies, I tend to switch off. There is a mildly hypochondriac tendency in modern society to think that we should all be obsessing about supplements of all sorts of trace elements and odd herbal remedies. I tend to give Holland & Barrett a wide berth.

But the case for vitamin D seems stronger. Usually simply thought of as being a factor in osteoporosis and other bone conditions, vitamin D actually has a much wider impact in our bodies than that. In particular, it seems to play a role in regulating aspects of our immune system.

As the science writer Matt Ridley noted in May: ‘There has long been evidence that a sufficiency of vitamin D protects against viruses, especially respiratory ones, including the common cold. Vitamin D increases the production of antiviral proteins and decreases cytokines, the immune molecules that can cause a “storm” of dangerous inflammation. It has long been suspected that most people’s low vitamin D levels in late winter partly explain the seasonal peaking of flu epidemics, and rising vitamin D levels in spring partly explain their sudden ending.’

All sorts of effects of vitamin D have been suggested in recent years. For example, it seems to help with autoimmune diseases, where our immune systems become harmful to us. Type 1 diabetes, multiple sclerosis and psoriasis have been characterised in this way. Type 2 diabetes, usually thought of as a metabolic disease, may in part be an autoimmune disease, too. (Notably, BAME people have much higher rates of type 2 diabetes than white people.)

What does all this have to do with the colour of our skin?

Vitamin D is, arguably, not a vitamin at all, which is usually defined as something we need to get from our diet. The majority of our vitamin D comes from the effect of sunlight – ultraviolet light specifically – on our skin, where a derivative of cholesterol is converted into vitamin D. In northerly latitudes like the UK, we don’t get enough sunlight to produce vitamin D for six months of the year. This is even more pronounced for people with darker skin – it takes more sun exposure to produce sufficient vitamin D than it would for pale-skinned people.

A survey of evidence by Karl Pfleger shows several different lines of evidence pointing to vitamin D as an important factor in Covid-19. For example, comparing the vitamin D status of Covid-19 hospital patients has shown that the ones with low vitamin D are much more likely to end up in intensive care. Areas in northerly latitudes are more likely to be hard hit, but this is offset in countries where supplementation – through fortifying foods – is more common.

Perhaps another pointer is the fact that the first drug to show real promise in treating patients is dexamethasone – a steroid. Steroids work by decreasing inflammation and reducing the activity of the immune system. Vitamin D is a steroid, too. (To be more precise, vitamin D is a collective name for a group of steroids.)

So there is plenty of circumstantial evidence that vitamin D deficiency is important in Covid-19 and there are plausible biological mechanisms for why that might be the case. Giving vitamin D to patients who already have plenty seems to have little effect.

Yet a review of evidence by the National Institute for Health and Care Excellence (NICE), published on Tuesday, advised: ‘There is no evidence to support taking vitamin D supplements to specifically prevent or treat Covid‑19. However, all people should continue to follow UK government advice on daily vitamin D supplementation to maintain bone and muscle health during the Covid‑19 pandemic.’

This is a rather odd conclusion. The review examined five peer-reviewed papers. (It ignored the mass of pre-print research that has not had time to go through peer review in the short time the pandemic has been going.) ‘Four of the studies found an association or correlation between a lower vitamin D status and subsequent development of Covid‑19. However, confounders such as body mass index (BMI) or underlying health conditions, which may have independent correlations with vitamin D status or Covid‑19, were not adjusted for.’

The fifth paper, by Hastie et al, found the effect disappeared when these potential confounders were taken into account. NICE seems to lean very heavily on this one paper. But there are two problems. First, vitamin D status was gleaned from UK Biobank data – which was collected at least 10 years ago. Patients’ vitamin D status wasn’t measured at the time they got ill. Second, ethnicity and body mass index (BMI) are not independent variables from vitamin D. Rather, vitamin D deficiency is an attempt to explain why ethnicity and BMI matter. (People with high BMI are also more likely to have low vitamin D.)

Moreover, the cut-off date for the NICE paper meant it didn’t have a chance to consider two pre-prints of particular interest. A study from Singapore found ‘the active form of vitamin D, calcitriol, exhibits significant potent activity against SARS-CoV-2’ (the virus that causes Covid-19). A study on patients in Newcastle in the UK found that ‘patients requiring ITU admission were more frequently vitamin D deficient than those managed on medical wards, despite being significantly younger’.

In short, there is plenty of evidence to point to vitamin D deficiency as a risk factor for Covid-19. Yet officials and politicians seem wary of talking about it. If we were talking about a drug with significant side effects, like hydroxychloroquine (Donald Trump’s Covid drug of choice), we might have cause to be nervous about recommending it. But this is a vitamin and it is well known that many people across the world are deficient.

Indeed, the NHS already suggests that pretty much everyone takes vitamin D supplements, at least over the winter. In Scotland, for example, the NHS Scotland website is clear: ‘Everyone (including children) should consider taking a daily supplement containing 10 micrograms of vitamin D.’ That’s probably far too little. There is little or no risk of overdosing for adults up to 100 micrograms per day, so taking significantly more would address insufficiency more effectively.

The advice is particularly emphasised for certain groups, including: ‘People who have low or no exposure to the sun, for example those who cover their skin for cultural reasons, are housebound, confined indoors for long periods or live in an institution such as a care home; and people from minority-ethnic groups with dark skin, such as those of African, African-Caribbean and South Asian origin, who require more sun exposure to make as much vitamin D.’

There is, of course, the possibility that Covid-19 deaths could be due to poverty, deprivation and ‘systemic racism’. And any research around the disease is obviously new and should be treated as provisional. Vitamin D is unlikely to be a panacea.

But serious cases seem disproportionately related to vitamin D deficiency. Among doctors – who are unlikely to be economically deprived – 94 per cent of deaths have been BAME medics. Moreover, testing for vitamin D deficiency is cheap. Supplements are cheap, widely available and safe. So wouldn’t it be better to focus more of our attention – both medical and research – on the ‘sunshine vitamin’?

Rob Lyons is convenor of the Academy of Ideas Economy Forum.

Picture by: Getty.

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Comments

Tony Dean

4th July 2020 at 1:28 pm

I am a Taxi driver on the Nightshift. Been taking 10,000 iu of vitamin D3 every day. i have not had a dose of flu or colds in those years to date. It was watching Dr John Cannells videos that got me sold on vitamin d. I will never stop taking them now. I increase to 20,000iu in the dark cold winter months. https://www.youtube.com/watch?v=qeg-5NDyJ84

Meaty Beaty

3rd July 2020 at 1:48 pm

Yet another article that avoids pointing the finger squarely at the elephant in the room – obesity. Its mentioned in passing but ignored as the common factor amongst almost everyone I’v seen with serious outcomes from C19. And some info I’ve seen claims obesity is a bigger problem amongst BAME.

jamie murray

2nd July 2020 at 2:23 pm

Why aren’t we talking more about how this covid1984 scam has left many people jobless with no way of feeding their families?
As i’ve stated in previous posts, none of the house arrest pushing fear mongers are amongst those who’s livelihoods are threatened are they?
Theodore and Amelia -Mummy/daddy, “what did you do in the covid wars of 2020?”
Mummy and Daddy-“We bravely cringed and wailed that everybody should be imprisoned at home, we felt ok doing it as money still went into our banks every month.
Theo/Amelia-“But what the poor who didn’t have that luxury and lost their jobs?
Mummy/Daddy-“F*** em!

Vivian Darkbloom

2nd July 2020 at 12:39 pm

Court case challenging legality of the lockdown regulations commenced 10:30 today.

Matt Coffey

2nd July 2020 at 11:03 am

You are right to be cautious of Vitamin D supplements, they exhibit a notorious poor efficacy. In almost every scenario we’re far better off simply allowing the incredible thing that is the human body to do exactly what it has evolved to do over many millennia. As the author and many commenters have pointed out, there is a growing body of evidence based research that will ultimately prove beyond reasonable question that Vitamin D is essential for a healthy immune response to satisfy those who worship at the alter of science. As for why this is being overlooked (quite deliberately I would say), it doesn’t really fit with the current social narrative.

Jim Lawrie

2nd July 2020 at 11:02 am

Straightforward scientific statements of physiological racial differences are stamped on lest they give rise to other discussion on the same basis.

Gareth Edward KING

2nd July 2020 at 8:31 am

Rickets used to be a common problem in Western Europe due to little exposure to sunlight with its concomitant effect on lack of synthesis of Vitamin D in the skin’s fatty deposits leading to much weaker ‘long’ bones (Vit. D works with calcium in correct bone formation). The article just about touches on the issue of bound-up Muslim women stuck at home all day; for sure, it must be a factor in these women’s general health problems. Funny, that it’s hardly been talked about, I wonder why that is?
You can imagine the utter ridiculousness of Madrid’s almost entire population being instructed to wear these death masks at all times and with the oppresive heat in this city currently at 38 degrees C. max. At the very least, kids need to be out in the cooler parts of the day absorbing the Sun’s rays and without THAT mask on; which in the long term is only going to shore up health problems later on in the year. Talk about a sure-fire way to weaken immune systems on a big scale-it’s criminal!

Jim Lawrie

2nd July 2020 at 8:56 am

Rickets re-emerged in Glasgow among South Asian children children in the 70’s. Particularly Hindus. The combination of dark skin, little sun, and vegetarianism did for them. Sunlight sessions in local health clinics were the answer. And sardines and other fish, which were very cheap in Scotland at the time.

Vitamin D was mentioned at the start of the crisis, and the shelves were emptied of tinned sardines and mackerel.

L Strange

2nd July 2020 at 8:18 am

I suspect the ‘problem’ with discussing vitamin D is that brown-skinned folks are more in need of supplementation in northern climes. To those who see and think of race above all else, it’s probably an uncomfortable reminder that white people are the indigenous ones in such regions.

Christopher Tyson

2nd July 2020 at 8:50 am

There are white people all over the world too.

How do you account for the high sales of sunblock and sun tan lotions for white people, even in temperate climates? Are you simultaneously arguing that white people are not indigenous anywhere in the world (where there is sun), and that white people are indigenous everywhere by some definition of you own?

Jim Lawrie

2nd July 2020 at 9:07 am

There were more white people out walking with more flesh exposed than the dark skinned people.

Vanity among those of African descent means the obese among them stay indoors.

Vlod Barchuk

2nd July 2020 at 8:16 am

A welcome article. The BMJ published a peer reviewed meta analysis a couple of years ago which showed those with low vitamin D levels were much more likely to suffer from seasonal respiratory tract viruses; it would therefore be strange if this were not also true for other respiratory tract infections such as Covid 19. The fall in Covid19 cases across Europe in recent months is probably in part due to summer sunshine increasing vitamin D levels in the population, and is one reason to suspect there may be a second wave in the autumn.

Regarding hydroxychloriquine, this is not done and dusted. The study which has led to it being poo pooed is itself very partial; it was conducted on patients who were already quite ill. Professor Didier Raoult, the eccentric looking director of the University Hospital in Marseille, who has treated thousands of patients with hydroxy, has always argued it needs to be used early on in the disease. It may have value as a prophylactic, which is how Trump is taking it. Hydroxy is a safe drug if taken in the proper dose as many suffering from lupus and rheumatoid arthritis do daily. It would be interesting to undertake an observational study looking at Covid19 rates in those taking hydroxy regularly for other conditions to see if there’s evidence of its effectiveness.

George Whale

2nd July 2020 at 7:46 am

If, like every other flu outbreak, Covid 19 had been allowed to run its natural course (with protective measures only for at-risk groups), it would have been over by now. Instead, there seems no end to the turmoil. Which is precisely what the left wanted, of course.

Melissa Jackson

2nd July 2020 at 7:45 am

It does annoy me to see the mad Left making completely asymmetrical arguments. When a group does better than average, this is entirely natural and laudable and no action is needed. When a group does worse than average, this is clearly systematic discrimination that demands that whole of society radically change.

There is a good deal of evidence that young women today out earn young men. The “equal pay” lobby say this is just because women work harder. But when women in their 30s and early 40s (ie, the group where a huge chunk have become mothers, and almost all who have the choice to work less do so) earn less than men, this is sexism.

It’s maddening to see this complete lack of principle. When white people die more often; no problems at all, no need to even investigate, and asking the question is probably racist. But when BAME people die more; everything is racist. Of course.

Stef Steer

2nd July 2020 at 6:53 am

I’m off down the beach with the other “cov-idiots”

silly billy

2nd July 2020 at 5:38 am

Why aren’t more people dying in Scotland, in that case? No-one cares about bias against gingers, unless they are dyslexic.

L Strange

2nd July 2020 at 8:13 am

Because 98% of them are white and absorb sunlight (what little there is for much of the year) more easily.

Gareth Edward KING

2nd July 2020 at 8:43 am

In Scotland with lower levels of the population’s exposure to sunlight the diet needs to be rich in fatty foods to make up for possible Vitamin D deficiencies. Have you not noticed that the Scottish also seem to be more ‘etiolated’ (taller, thinner)? also, paler with ‘blueish’ skin? It’s also related to exposure, or lack of, to the Sun. Sexual maturity occurs much later in Northern Europe as growth hormones are stimulated by exposure to the Sun; once these hormones begin to be secreted and adolescence occurs; growth in terms of height stops. In Southern Europe, when all other variables are taken into account; people tend to be shorter, hairier, and with onset of sexual maturity occuring much earlier. That’s why you have terms like ‘morrenazo/a’ referring to the Spaniards’ ‘tannedness’ with big, brown eyes and luxurious brown hair thrown in!

Stephen McLean

3rd July 2020 at 6:39 pm

Really? Because of the longer days in the summer many places in Scotland, especially on the east coast, recieve more hours sun than English cities. Dundee gets more than London or Cambridge for example.

https://www.currentresults.com/Weather/United-Kingdom/annual-sunshine.php

Gordon Te Gopher

2nd July 2020 at 5:06 am

‘They’ were saying there was no evidence face masks protect you a couple of months ago. Now face masks are the best thing since sliced bread. In fact even better since sliced bread doesn’t protect you at all and you look stupid with a slice of bread over you face.

Ellen Whitaker

2nd July 2020 at 1:53 am

Vitamin D is cheap and widely available, and making sure that people are not deficient is in their best interests, even if it ends up not being a factor in Covid, which seems unlikely. Dark-skinned people are particularly susceptible to vitamin D deficiency, but more and more white people wear sunscreen in the summer, which puts them at risk too. Doctors should be checking the vitamin D levels of all their patients now, and making sure that they are on supplements through next winter — probably the single most important thing they can do to at this point to prepare for a 2nd wave. Doctors tend to be suspicious of supplements, which don’t require a prescription, and tend to greatly underestimate the amounts that can be safely ingested. I was once trying to get my levels up, under a doctor’s supervision, and it took the better part of a year, taking very high doses, to get my blood levels up. Too much vitamin D can be toxic, but you almost have to try. So the danger is that doctor’s will recommend doses that are too small to do any good.
I’ve known about the connection between Covid-19 and vitamin D for a while. But suddenly a month or so ago, there were a slew of articles about higher death rates for minorities, all of them strongly implying that this was due to white racism, and not one of them even mentioning vitamin D. It highlights the irrational quality of a lot of what can only be called race-baiting, that is going on now.

ZENOBIA PALMYRA

2nd July 2020 at 1:35 am

Excellent article. Calm, reasoned and convincing.

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