There are more ways of fighting COVID-19 than one!

By Joe Yasin

Published 2020-06-30

Since the start of the epidemic in the UK, the Government has hammered home one,  and only one way for fighting COVID-19. Keep your distance from each other, stay at home, and only go out for essentials, and if you have to go out, keep a 2 metre distance from other potentially infectious humans at all times. Until very recently, no other method for controlling COVID-19 has been mentioned or recommended by the UK Government other than spatial distancing – 2 metre spatial distancing and isolation.  

Masks and face-coverings, for example, were denigrated and the public was actively dissuaded from wearing them in the early days of lockdown. Only when it became obvious that it would be impossible to maintain 2 metre distancing on public transport post-lockdown were they made mandatory (only for public transport), despite having been mandatory in public in many other countries who had suppressed COVID-19 far more effectively than the UK. It was said that there was little evidence to support any benefit from wearing them. This was a statement that completely missed the point. There was little benefit in stopping you getting it – but there WAS a huge benefit in stopping you passing it on. This article explains this well… https://theconversation.com/masks-help-stop-the-spread-of-coronavirus-the-science-is-simple-and-im-one-of-100-experts-urging-governors-to-require-public-mask-wearing-138507

So, as the article suggests, if masks or even home-made bandanas could reduce your chances of passing on COVID-19 by a substantial amount (say perhaps 40%), since the R factor is supposed to represent the number of people you will infect, a reduction in the pass-on rate by 40% should reduce R by 40%. Reducing R from the 0.7 to 09 that we have achieved with spatial distancing alone to 0.4 to 0.55 – combining spatial distancing with mask-wearing – would have destroyed the UK  pandemic far more rapidly.

Many other articles actually DO support the efficacy of face masks/covering in catching infection from others , e.g  https://www.medicalnewstoday.com/articles/best-available-evidence-supports-physical-distancing-and-wearing-face-masks  Results quoted in the above article suggested that wearing masks was more effective than increasing the spatial distance from 1 to 2 metres.

And a study of a coronavirus outbreak on aircraft carrier USS Theodore Roosevelt f where a COVID-19 outbreak infected over 1,000 of the 4,900 crew found the infection rate was 56% for personnel wearing masks and 81% for those without – and wearing masks worked comparably to social distancing or hand-washing.

Vitamin D levels have barely been mentioned in any of the official advice, yet studies have shown that Vitamin D has anti-inflammatory and immunity regulatory characteristics, and low levels of Vitamin D are associated with an increased risk of respiratory diseases, including tuberculosis, asthma, and chronic obstructive pulmonary disease (COPD), as well as viral and bacterial respiratory infections. What’s more, vitamin D deficiency has been linked to decreased lung function, which may affect your body’s ability to fight respiratory infections.

A recent review that included 11,321 people from 14 countries demonstrated that supplementing with vitamin D decreased the risk of acute respiratory infections (ARI) in both those who were deficient in vitamin D and those with adequate levels.

Overall, the study showed that vitamin D supplements reduced the risk of developing at least one ARI by 12%. The protective effect was strongest in those with low vitamin D levels. https://www.bmj.com/content/356/bmj.i6583

A new publication from Dr. Eamon Laird and Professor Rose Anne Kenny, School of Medicine, and the Irish Longitudinal Study on Ageing (TILDA), in collaboration with Professor Jon Rhodes at University of Liverpool, highlights the association between vitamin D levels and – specifically -mortality from COVID-19. http://www.imj.ie/wp-content/uploads/2020/05/Vitamin-D-and-Inflammation-Potential-Implications-for-Severity-of-Covid-19.pdf

The authors of the article, just published in the Irish Medical Journal, analyzed all European adult population studies, completed since 1999, which measured vitamin D and compared vitamin D and death rates from COVID-19. They found that the lower your vitamin D level, the higher your chances of dying from COVID-19.

With gathering evidence for the effectiveness of vitamin D at fighting COVID-19, it would seem imprudent to ignore its probable benefit for reducing the damage done by the disease, particularly amongst BAME populations, who tend to have lower than average population levels of the vitamin.

WHO IS TO BLAME FOR THE UK GOVERNMENT’S ‘ONE CLUB’ APPROACH TO FIGHTING COVID-19?

Politicians are not supposed to be experts. They are supposed to take advice from experts and then make the decisions. So it would be reasonable to say – that the ‘one club’ approach, and ignoring other approaches, adopted by the UK – is the fault of the experts, not the politicians. The Health Secretary, Matt Hancock, has said again and again that he is ‘following the Science’. So if the science is partial or flawed, the UK Government’s approach to fighting COVID-19 will be partial or flawed.

As it is, we have ignored two methods for which there is substantial evidence (maybe partial, but reality is not perfect)  can reduce transmission rates and reduce the impact of the disease. And bone-headedly pursued just ONE method, spatial distancing, which obviously has the worst possible economic outcome for the economy.

Social distancing is finally reducing from 2 metres to 1 metre – against ‘expert’ advice. And, it seems with great reluctance, the Government has finally admitted mask-wearing might be of some use on public transport.

I sincerely hope that both mask-wearing and population-wide supplementation with Vitamin D are adopted and promoted with whole-hearted enthusiasm by our Government to keep infection levels and damage done by COVID-19 moving steadily downwards throughout the summer.

It will be ESSENTIAL to do this if we are to avoid a highly damaging second peak as winter re-emerges from its grisly den. The restlessness of the population suggests the ‘one club’ approach of isolation and total lockdown will not work as well a second time. Other methods will be needed to help if they exist – and in mark-wearing and Vitamin D supplementation they do!

In mid-April I wrote the letter, quoted below, to various ministers and advisors involved with the UK pandemic about my thoughts that low levels of Vitamin D was at least partly responsible for BAME populations (specifically those of African and South Asian origin) suffering disproportionately and more severely from COVID-19. By May articles and research began to appear that confirmed that this could be the case, such as https://scitechdaily.com/vitamin-d-linked-to-low-coronavirus-death-rate/   

At the time the response to my letter was pathetic (3 automated emails). But two months (and several thousand deaths) later the mainstream caught up with me. Below is quoted from the  i  of June 19…  https://inews.co.uk/news/health/coronavirus-vitamin-d-bame-community-supplements-451140  with a short summary of its content below…

“Coronavirus: the evidence is mounting that Vitamin D makes a difference – and contributes to the Bame community’s vulnerability…

It has been revealed that UK public health officials are urgently reviewing the potential ability of vitamin D to reduce the risk of coronavirus. Vitamin D deficiency has long been associated with obesity and diabetes – both key pointers to COVID-19 vulnerability.

It also emerged this week that the vitamin may be a key factor in why so many black and ethnic people are also falling victim to the virus.

While current evidence remains circumstantial, it has prompted two bodies, the Scientific Advisory Committee on Nutrition (SACN) and the National Institute for Health and Care Excellence (Nice), to announce urgent reviews of all evidence of the link…”


Letter sent in mid-April to recipients listed

Vitamin D deficiency – a possible reason why darker-skinned ethnic minorities may suffer disproportionately from COVID-19  

I am a fit, full-time working, 76 year old male, with an Indian father and an English mother. My father was a London-qualified doctor, and I was educated at Magdalen College, Oxford in Natural Sciences, and have run my own successful consultancy business since 1988. I am in no way deprived or under-privileged. Yet in 2015, I found in a Vitamin D test with my GP that I was severely deficient in Vitamin D (24.5 nmol/L, when the normal range is 70-150)

Vitamin D is an essential Vitamin for maintaining a strong and healthy immune system. Vitamin D deficiency is associated with many diseases (cardiovascular, cancer, weak bones, diabetes and infections) and higher levels of mortality. In nature, it is primarily obtained by the action of sunlight on the skin, and secondarily from food. It can also be obtained from supplements.

Because of the high latitude of Britain (50+degrees of latitude), our cloudy weather and our modern indoor lifestyle, many Britons are not exposed to enough sunlight to generate healthy levels of Vitamin D and suffer from various levels of Vitamin D deficiency. This is particularly so in winter.

Vitamin D deficiency has been shown to be very much more serious in the case of dark-skinned ethnic minorities. The majority of studies on Africans show they have good levels of Vitamin D while living in Africa, whereas studies of Africans in Europe show low to deficient levels (compared both with Africans in Africa and whites in Europe), which is consistent with the hypothesis that darker skins and weaker sunlight can lead to Vitamin D deficiency. A similar situation has been found with South Asians (Note 2). In the case of both these groups their AVERAGE level of Vitamin D has been found to be low to deficient.

With this as a backdrop, taking Vitamin D deficiency more seriously than at present may be a good policy when fighting  coronavirus  – particularly for dark-skinned ethnic minorities, even those without socio-economic disadvantage.

As part of this, it may be prudent to reverse the government opposition to sunbathing if carried out with social distancing (they are not contradictory). Sun exposure seems as ‘essential’ for health as food or exercise. And a greater effort to distribute Vitamin D tablets should be made, particularly to black and South Asian minorities. (Though I suggest that allowing the enjoyment of sunshine would do more for morale than giving out pills. Morale is important for both compliance and health. Presumably alcoholic drinks are allowed to be sold in off-licenses for reasons of morale rather than directly for health reasons.)

I would suggest that Government policy to keep people in our homes, where the UV sunlight that generates Vitamin D in our skin cannot penetrate (this UV cannot get through window glass), should be changed to classify adequate exposure to the sun as ‘essential’. Because current policy is…

  1. Keeping the low levels of Vitamin D in the population low, when enjoying spring sunshine would boost levels of this essential Vitamin.
  2. Making the population more vulnerable to COVID-19 than they would naturally be
  3. Negatively affecting people’s morale.
  4. Discriminating against people who do not have a garden – the poor, the young and those who live in flats – often the same people.
  5. Racial discrimination against all those with darker skins – to the extent they are more vulnerable.

Almost certainly most of this is NOT deliberate, and is an unintended consequence of otherwise well-meaning policies. But it IS happening.

I recognise that changing policy on exposure to the sun and indeed encouraging it could be politically challenging if it was done in isolation. However, if done as part of the measures relaxing ‘lockdown’, it could be seen as a popular part of the general relaxation, and potentially saving lives by relieving pressure on the NHS.

Professor Neil Ferguson of Imperial College was reported in the Sunday Times on 12th April saying that individual measures such as getting fit and losing weight would improve chances of surviving COVID-19. The evidence suggests that exposure to the sun (with social distancing) would increase both Vitamin D levels and morale and do the same.

Yours respectfully,

Joe Yasin  BA, BSc (Oxon)

Managing Partner, The Planning Business LLP,
and co-founder of The High Skills Partners


NOTES.

Note 1 – Recipients

Rishi Sunak rishi.sunak.mp@parliament.uk

Matt Hancock matt.hancock.mp@parliament.uk

Priti Patel withammp@parliament.uk

Angela Rayner – deputy leader of Labour angela.rayner.mp@parliament.uk

Andy Slaughter slaughtera@parliament.uk  andy@andyslaughter.com

Chris Whitty c.whitty@nhs.net

Sir Patrick Vallance – Chief Scientific Adviser (GCSA ) gcsa@go-science.gov.uk

Yvonne Dole – PHE Medical Director yvonne.doyle@mswha.sthamesnhs.uk

Professor Jonathan Van Tam, Professor of Health Protection – Deputy Chief Medical Officer – Van-Tam

jvt@nottingham.ac.uk

Prof Neil Ferguson – Faculty of Medicine, School of Public Health, Imperial College London

neil.ferguson@imperial.ac.uk

Note 2: Differeence in Vitamin D levels between dark-skinned and light-skinned UK and European residents

Several studies illustrate Vitamin D deficiency is more serious in the case of dark-skinned UK and European ethnic minorities than native ‘light-skinned’ populations. One such (“Lifestyle factors including less cutaneous sun exposure contribute to starkly lower Vitamin D levels in U.K. South Asians compared with the white population.” by Kift R1, Berry JL, Vail A, Durkin MT, Rhodes LE, Webb AR.). This clearly shows the stark difference in Vitamin D levels between South Asians and the white population:

“The 25(OH)D levels of South Asians were alarmingly low. In summer, their median 25(OH)D level was 9·0 ng mL(-1), [interquartile range (IQR) 6·7-13·1], falling to 5·8 ng mL(-1) (IQR 4·0-8·1) in winter. This compared with values in the white population of 26·2 ng mL(-1) (IQR 19·9-31·5) in summer and 18·9 ng mL(-1) IQR (11·6-23·7) in winter.”

This does NOT imply that Vitamin D levels in the white population are sufficient, as the above values are averages, and even in summer and definitely in winter a large proportion of the white population must suffer from deficiency, which is commonly considered to be below 25 ng mL(-1).

While low levels in South Asians are partly due to cultural mores (less Vitamin D in diet, and sun avoidance), a large reason for this level is probably due to darker skins with more melanin inhibiting production of Vitamin D on sun exposure. Consequently, more sunlight and/or more supplementation is required to make up for this. This has been confirmed experimentally:

“This was confirmed when surgically obtained white and black skin was exposed to sunlight in Boston in summer. After 30 min approximately 3% of cutaneous 7-dehydrocholesterol was converted to preVitamin D3 in the white skin sample whereas only about 0.3% of 7-dehydrocholesterol was converted to preVitamin D3 in the black skin (Fig. 34).51Chen TC, Chimeh F, Lu Z, Mathieu J, Person KS, Zhang A, et al. Factors that influence the cutaneous synthesis and dietary sources of Vitamin D. Arch Biochem Biophys 2007; 460:213 – 7; http://dx.doi.org/10.1016/j.abb.2006.12.017; PMID: 17254541  [Crossref], [PubMed], [Web of Science ®][Google Scholar] These findings could explain the positive association between skin lightness and 25-hydroxyVitamin D [25(OH)D] levels as found by Armas et al.52Armas LAG, Dowell S, Akhter M, Duthuluru S, Huerter C, Hollis BW, et al. Ultraviolet-B radiation increases serum 25-hydroxyVitamin D levels: the effect of UVB dose and skin color. J Am Acad Dermatol 2007; 57:588 – 93; http://dx.doi.org/10.1016/j.jaad.2007.03.004; PMID: 17637484  [Crossref], [PubMed], [Web of Science ®][Google Scholar] (Fig. 35). The associations between skin lightness, UVB dose and 25(OH)D are documented in Figure 36.”

Source: https://www.tandfonline.com/doi/full/10.4161/derm.24494


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