Common sense COVID-19 risk reduction - masks, social distancing, vitamin D - Oct 2020

Commonsense Approaches to Minimizing Risks from COVID-19

OJPRM: October-2020: Page No: 28-37 DOI: https://doi.org/10.36811/oiprm.2020.110010
Sunil J. Wimalawansa, MD, PhD, MBA, FACP, FRCP, FRCPath, DSc
Professor of Medicine, Endocrinology & Nutrition, Cardiometabolic and Endocrine Institute, N.J, USA

• Corresponding Author: Sunil J. Wimalawansa, Professor of Medicine 661 Darmody Avenue, North Brunswick, NJ 08902, Endocrinology & Nutrition, Cardiometabolic and Endocrine Institute, N.J, USA, Email: suniljw at hotmail.com

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Abstract
Coronavirus belongs to a large family of viruses that usually affecting wild animals. COVID-19 is the latest virus from that family transmitted to human in late 2019 but the origin is not confirmed. It causes predominantly lower respiratory tract syndrome but also affecting other epithelial cells and other systems such as the cardiovascular system. Approximately, 80% of the spread of COVID-19 is occurring through aerosolized form via microdroplets and 80% of the affected are either asymptomatic or having a milder disease. Complications and the rates of deaths from COVID-19 differs from country to country, varying from 0.1 to 3.2%. The fundamental reason for developing serious complications and deaths from COVID-19 is having severe vitamin D deficiency that is associate with weak immune systems. There are no specific, safe, effective, and affordable antiviral or vaccines available yet. Despite claims and hypes, it is unlikely that such would materialize soon. Considering these, the most cost-effective approach to prevent and minimize complications and deaths from COVID-19 is through boosting the immunity through vitamin D adequacy. Meanwhile near total relaxation of public health precautions in certain countries, including allowing crowed gatherings, discouraging the use of face masks, spending time in public places, and allowing unprotected use of crowded public transport systems, failure in adhering to frequently washing hands, etc., (that are necessary for preventing the spread of COVID-19) will be proven as expensive mistakes. This article provides information on the current status of COVID-19 outbreak and commonsense precautions to minimize risks during the current second wave of COVID-19 and future coronaviral pandemics.

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Sections on Vitamin D from the PDF
Adequate vitamin D levels have been associated with reduced incidence and severity of enveloped viruses such as herpes zoster, Epstein-Barr, hepatitis, Ebola, HIV, dengue, measles, and mumps [28,29]. Studies have reported the administration of an oral dose of 50,000IU vitamin D reduces the risks of having influenza [4]. Vitamin D adequacy reduces the severity of pulmonary damage, pneumonia, cytokine storm, and acute respiratory distress syndrome (ARDS), which associated with coronaviral infections. Vitamin D is a natural vitamin, so the risk of adverse effects is minuscule.

Those who are with micronutrient deficiency, especially those with hypovitaminosis D, are at a greater risk of developing viral diseases, including COVID-19 [30]. Thus, the most effective option is to have safe sun exposure and/or taking adequate doses of vitamin D supplements to raise and maintain serum 25(OH)D concentrations above 30ng/mL (see next section) to boost immunity before exposure [1,17,31]. This approach should reduce the risk not only of coronavirus but also of the common cold, influenza, and associated pneumonia, thus reducing deaths [4,31].

High-dose vitamin D and antioxidants reduce the risks and severity of coronavirus infection
Vitamin D is known to improve the immune system: whereas vitamin D deficiency increases vulnerability to viral infections, such as cold. and influenza [28,29]. During the winter months, unless supplements are taken, serum 25(OH)D concentrations are low in most people living in countries located in northern and southern latitudes. Considering its biological and physiological effects, there seems to be a multiple mechanism by which vitamin D causing immune regulatory effects [28].

Emerging data suggests that the maintenance of serum 25(OH)D concentrations in excess of 30ng/mL (75nmol/L) [1,32], preferably at a level greater than 40ng/L (100nmol/L). [1,33], together with sufficiency of other micronutrients, such as zinc, selenium, and antioxidants would provide a greater opportunity to prevent COVID-19.
Considering the inability to diagnose this coronavirus early, during the early stages its several-day incubation period, people feeling unhealthy, who is having a fever. In addition, those who might have been exposed to an infected person or contracted COVID-19 are likely to be benefited from loading dose of vitamin D. Such single oral doses include doses between 200,000 (four capsules of 50,000 or 60,000 IU) and 600,000international units (IU). The efficacy of vitamin D could be increase by additional micronutrient supplements, including zinc, vitamin K2, magnesium, omega 3 fatty acids, quercetin, and resveratrol, to boost the immune system and to stimulate vitamin D receptors to synergize responses.

These can be repeated after few weeks. These approaches would allow the strengthening of the innate. immune within three days of administration. This highly effective therapy cost no more than $8 per person and is expected to reduce the risk so contracting COVID-19, and its severity and reduce deaths. Even if the disease is experienced, unlikely to develop severe syndrome and death, and lead to speedy recovery. To significantly minimize viral infections, including COVID-19, one needs to maintain serum 25(OH)D concertation between 30 and 60 ng/mL, which is safe [31,34-36]. In general, to cause adverse effects from orally administered vitamin D, one needs to take daily doses higher than 20,000 IU for many months or take 1 million IU daily for a few days, reaching serum 25(OH)D concertation in excess of 125 ng/mL with signs and symptoms of hypercalcemia. Thus, the mentioned dose will not cause adverse effects; potential benefits far outweigh any theoretical risk.

A single high dose or a higher dose taken a week apart, as described above can be helpful in disease prevention and reducing its complications. From a disease prevention strategy point of view, the most cost-effective approach would be the prophylactic administration of high-dose vitamin D to the entire community at risk as a preventative measure. While this option was available during the first half of 2020, COVID-19 pandemic, no country had the wisdom to take that opportunity not even guiding its population on daily, safe sun exposure or vitamin D supplementation.

Conclusion
While people infected with COVID-19 reached unprecedented numbers the current death rate related to COVID-19 is significantly less than that associated with SARS or MERS. During the past six months, in many western countries, a large number of deaths occurred due to causes other than COVID-19 that had been documented as this viral illness, overestimating the reported statistics. Reasons for reporting such is complicated but include convenience, and to obtain extra financial incentives from federal governments by hospitals [37]. On the other hand, administrations of most tropical countries underestimated the incidence and deaths due to COVID-19 because they are conducting too little PCR testing (in fact, less than 5% per million population basis) and no community-based testing. Consequently, only a fraction of positive cases is diagnosed in the community. In either case, the statistics reported to the World Health Organization were erroneous and misleading.

Moreover, the incidence and mortality of COVID-19 strongly correlated with vitamin D status, which is intricately linked to effective exposure to UVB radiation. Therefore, it is logical to accept that the incidence, complications, and the mortality of COVID-19 are correlated with sun exposure and the serum 25(OH)D concentration. In those with hypovitaminosis have higher risks of developing the disease [38], the disease severity and deaths with COVID-19 [39]. There are a number of large randomized controlled clinical studies are currently underway that will be providing answers with reference to the efficacy of vitamin D in controlling COVID-19 syndrome.

In most people, daily doses of between 2,000 and 5,000 IU are adequate for the maintenance of serum 25(OH)D concentration above 30 ng/mL which is sufficient for improving most metabolic disorders. However, higher doses are likely needed in certain groups of people such as those with multiple comorbid conditions, such as, obesity, cancer, and to reduce all-cause mortality. In these people, the goal is to maintain serum 25(OH)D concentrations between 40 and 60 ng/mL, necessitating to take about 4,000 IU/day, significantly reducing the complications associated with hypovitaminosis D. Mentioned doses of vitamin D are safe and significantly minimize contracting viral.