Covid-19: We need to understand the risks to tackle them
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3790 (Published 01 October 2020) Cite this as: BMJ 2020;371:m3790Read our latest coverage of the coronavirus outbreak
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Dear Editor
Peter Cobbold says: "D3 has been fighting viruses and other microbes for 500 million years, medicine is not going to better it. SARS-CoV-2 has exploited our near global D3-deficiency. First correct that cause and the risks evaporate."[1]
A recent report in the Irish Times says "People have “nothing to lose”, and much to gain, by taking vitamin D supplements as protection during the Covid-19 pandemic, according to a new paper by Irish and UK scientists".[2]
According to the report, Professor Rose Anne Kenny says new US research indicates that virus patients are four times less likely to require admission to ICU if they have normal levels of vitamin D. But in addition, for the first time the research suggests people with good levels of the vitamin may be less likely to become infected, according to Prof Kenny.
Professor Kenny says vitamin D supplementation "should be mandated for prescription for vulnerable adults and children, such as those in care, prisons, or other institutions where people are likely to be inside for much of the time during the summer".
I don't care much for medical mandates, but surely more should be done to promote the simple intervention of vitamin D supplementation, as suggested by Professor Cobbold and Professor Kenny?
References:
1. Peter H Cobbold BMJ rapid response - Covid-19: We need to understand the cause to tackle the risks. 2 October 2020: https://www.bmj.com/content/371/bmj.m3790/rr
2. Vitamin D deficit link to Covid-19 severity 'considerable'. The Irish Times, 5 October 2020: https://www.irishtimes.com/news/health/vitamin-d-deficit-link-to-covid-1...
Competing interests: No competing interests
Dear Editor
First things first: cause precedes effects. Understand the cause and the risks become understood.
SARS-CoV-2 is obviously a cause but there is also major contributor in our physiology: most of the human population is seriously deficient in the secosteroid hormone D3. Forget about dexamethasone: we are not deficient in any drug and D3 covers its actions. Ignore convoluted arguments such as Spiegelhalter's and the 4C score, many co-morbidities are traceable to D3 deficiency. Paul Garner might try measuring his 25(OH)D3, it is likely on the floor: severe infections "use up" 25(OH)D3.
There is now an abundance of evidence that a serum 25(OH)D below 75 nmol/L is a risk for severity of COVID and for testing positive. Mechanistic data abound for actions of D3 on innate and adaptive immunity. We know that low 25(OH)D increases expression of the ACE-2 receptor for SARS-CoV-2, the major difference between the pandemic virus and others. The use of oral bolus of 25(OH)D2 by the Cordoba hospital to reduce severity of COVID 25-fold makes dex look antediluvian. Meta-analyses such as Martineau's aggregated data of RCTs almost all using D3 doses decided upon by experts in bone D3 with no reference to the known physiological serum level. When Schwalfenberg doses his patients to 100 nmol/L he found 5 years ago a huge reduction in winter colds and flu. Moreover the use of a "D3 hammer" (one off 50,000 IU) stopped infections progressing.
A scientist would look at his results and think "That's odd", and repeat with a large trial. Instead medicine still quotes appallingly bad RCTs into D3. And turns away: mistakes dont come bigger. It is now blatantly obvious that to get on top of this virus that what we need to do is simple: supplement all to around 100 nmol/L 25(OH)D3, use the D3 hammer to check any infection that arises, and use the Cordoba protocol in pts hospitalised with COVID-19. Two papers are all you need to read:
https://www.cfp.ca/content/61/6/507.long
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/
D3 has been fighting viruses and other microbes for 500 million years, medicine is not going to better it. SARS-CoV-2 has exploited our near global D3-deficiency. First correct that cause and the risks evaporate.
Competing interests: No competing interests
The dilemma of Covid-19 -- explaining risks isn't easy
We now seem to understand -- only a little, though -- the dilemma with Covid-19.
The problem is that, according to a JAMA editorial, Covid-19 is most deadly when it leads to an 'overexuberant immune response'. This creates 'collateral damage' (1) (2).
Thus, the BMJ appears to be recommending dexamethasone as a treatment -- which inhibits the immune system.
There may alas be a genetic susceptibility to Covid- 19. You could note the disease is slanted at the expense of males.
Meanwhile, immunity is not being explained with regard to the r nought or basic reproduction number.
The Kermack-McKendrick SIR model compartmentalizes the population to a large extent according to whether there is no acquired immunity, or only temporary immunity, after infection, or whether there is latent infection, and so on.
Yes, the maths is difficult here. The epidemiologists aren't explaining to us ordinary people the underlying assumptions about population immunity, or rather lack of it, in making their models.
What is cruel about Covid-19 is its all too cunning complexity. It is a dangerous and elusive condition.
People are being killed by their own excessive immune response when Covid-19 invades the respiratory system.
It is issues of immunity, medical and epidemiological, that unhappily define this Covid-19 catastrophe.
REFERENCES:
(1) Molecular Underpinnings of Severe Coronavirus Disease 2019. Robert M. Plenge. JAMA Editorial. Volume 324, No.7. Pgs. 138-9. August 18, 2020.
(2) Covid-19 poses a riddle for the immune system. Stanley Perlman. Nature 584, 345-6. (2020)
Competing interests: No competing interests