The First Randomized Controlled Trial on Vitamin D and Covid-19
sciencedirect.com
sciencedirect.com
“Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%) p value X2 Fischer test p < 0.001.”
Which sounds like as strong a signal as a study of this scale could hope to show.
> Randomization generated groups with comparable percentage of unfavorable risk factors as there was no significant difference in subjects with at least one risk factor, except for high blood pressure and diabetes mellitus, known risk factors for unfavorable disease progression [2], which were more frequent in patients not treated with calcifediol.
These are HUGE risk factors. Also:
> This pilot study has several limitations as it is not double-blind placebo controlled. On the other hand, in the first studies evaluating risk factors for severe disease and/or death from COVID-19, the possible role of obesity was not considered. Therefore, given the isolation characteristics of the patients, we did not collect the BMI, which would have allowed us to add obesity as a risk factor for severe evolution of COVID-19 [37] It is striking to consider that obesity shares with aging and black or asian ethnicity a surprising overlap as risk factors for severe COVID-19 and vitamin D deficiency.
Yeah, BMI would've been nice too.
Still, check out table 2. Even with these limitations, seems powerful.
"At least one prognostic bad risk factor(@)
Group receiving Calcifediol: 48%
Group without Calcifediol: 61.54%"
"@) Patients with at least one of the following risk factors (age >60, previous lung disease, chronic kidney disease, diabetes mellitus, hypertension, cardiovascular disease or Immunosuppressed and transplanted patients)."
That's what can be concluded from "at least one": (52% had no bad risk in D group, but only 38.46% had no bad risk in the other group). But it is also not clear where there were more patients with "multiple" factors! Or if they were those who had more problems at the end.
The whole paper contains neither raw data nor any graphs and only means and standard deviations, as far as I see? I would personally really like to see the graphs of distributions or to use raw data to check myself.
The critical question is how good the randomization was done.
Yes, we can see some things are a little unbalanced. But the effect is so massive: we might see 4/5 of the control's rate of ICU admissions if the "one prognostic bad risk factor" determined outcome entirely; instead, we see 1/50 of the rate.
But we still don't know if the persons with multiple bad risk factors were those who ended with bad outcomes? As far as I understand, if it was like that or not can't be seen from the paper at all, and I can imagine that it could have happened. I would really prefer the more raw data to the tables with the selected means and deviations given.
Indeed, checking that the two groups look similar after randomization is completely optional. This study does an OK job of doing so.
There's both known and unknown reasons why someone might be predisposed to have a bad outcome. The reason we randomize, rather than try and make "balanced" groups, is that it addresses both unknown and known factors.
Yes, you can, by chance, get more people who are going to have a bad outcome in one group; about 5% of the time you'll get a p<0.05 finding this way. :P
But for most people, if you’re over 25 bmi you probably could lose some weight. And at a population levels the errors above average out, even in a smaller group.
People make a big deal over the exceptions to it while ignoring that it is broadly accurate and that exceptions are not as common.
I’ve been in these two modes:
1) genuinely overweight with too much fat and not enough muscle
2) nearly overweight according to BMI while very fit, with low fat and high muscle. got here from the other state by exercising a lot, losing fat and gaining muscle.
I think I would have to become totally sedentary again to get rid of my muscle mass and actually reach the lower end of “normal weight” according to BMI, while starving myself and feeling feeble.
Not knowing you personally, it seems statistically more likely to me that your idea of "fit, low fat, high muscle" is what's at fault here (as opposed to BMI). Sure, you could be an exception. But all things being equal, you probably aren't. (Also maybe I misunderstand - if you mean that BMI was saying you were at the high end of normal then ... isn't that just saying that you're fine?)
(Of course if a medical professional or academic specializing in such matters also thought BMI was inaccurate in your case then I would tend to view things differently.)
This seems like the real question to me; I assume pre-agrarian humans were biologically optimizing to survive famine. Not being an expert on the subject, I wonder what sort of tradeoffs are associated with intense exercise regimes (and how the balance ultimately comes out with respect to modern society).
https://en.m.wikipedia.org/wiki/Persistence_hunting
If that is the case then the body type would have been low mass overall, like marathoners.
As for best body type for quality of life today (at least from a health perspective), that seems relatively aligned.
Infant and child mortality is much much lower.
The claim is that BMI does not differentiate between body lean mass and body fat mass. Things like hydrostatic testing are more accurate for determining body fat mass.
In his prime he was considered overweight. BMI is way too simplistic for taller athletes.
https://www.webmd.com/diet/features/how-accurate-body-mass-i...
It’s well understood that BMI is totally wrong for athletes or anyone remotely muscular.
I assure you that's not my motivation at all. I'm not an expert in that field so I tend to trust the metrics used by the health professionals I encounter.
> BMI is widely regarded as totally obsolete
That is not my impression at all, but again I'm not a subject matter expert here. If you have reliable (ie academic or medical) sources I would be interested in learning more about any current preferred metrics.
What do you have in mind? With a bit of searching I haven't found much that's cheap. (Obviously you can take some tape or caliper measurements to improve your numbers but that's neither new nor particularly accurate.)
First, there is a fundamental constrain that it measures impedance only through legs and a little bit of belly, but no upper body (at least here in .cz, no consumer-grade scales have hand electrodes). I do road cycling as the only sport, and therefore get extremely skewed results as I have strong legs, but the rest of the body is much weaker.
Second, the measurements are almost non-repeatable. You get tens of percent difference across measurements, god forbid if you suddenly have moist feet etc. However, both scales used firmware cheating to mask this noise: once you set up a "profile", it will remember the initial value, and then change the following measurements only slightly. However, set up a second profile (preferably with a slightly modified age etc. to prevent advanced firmware cheating) and you get completely different results.
It's imperfect, but generally correct. More importantly, it's easy to measure. Accurate except for outliers isn't as much of an issue as you think it is, especially as these are generally already accounted for by its users.
I am your height and when I was in my 20s, I think I was in the 140s, later I was a little over 200, and now I am just about 185. So the range makes sense to me, but I've never been far from completely sedentary. I know a pro sports player at ~200 would be very skinny. I think Mariano Rivera was an example.
https://newsroom.heart.org/news/chronic-anabolic-steroid-use...
The data show that waist circumference is more reliable and more closely correlated with diseases associated with obesity.
https://www.webmd.com/diet/features/how-accurate-body-mass-i...
Given that Vitamin D deficiency can cause high blood pressure, their decision not to correct for this might be the better option.
Management of this disease has improved over the last few months. More people hospitalized are surviving.[1]
[1] https://www.latimes.com/california/story/2020-08-09/covid-19...
However, for those who can get skin production it is probably better, as there may be other effects we don’t know of. Plus it self limits, whereas one can overdo supplements.
As most of you may have already seen, there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint.
On top of the hint, we already have dozens of RCTs that vitamin D supplements suppress respiratory infections.
https://www.bmj.com/content/356/bmj.i6583
And now we have this study. Every study and line of evidence has flaws, which is why you look at the totality of the evidence.
From the evidence I've seen, low vitamin D is a bigger problem in modern societies than vitamin D toxicity. Vitamin D is available OTC and many people use it apparently responsibly. I would expect that to continue with appropriate messaging.
It would be great if we could pursue a consensus on this while it can still make a difference, even in the absence of perfect data. It was a mistake in the early US messaging to downplay the importance of masks even though we didn't have perfect data on it.
It's a pretty useless one in this case. Old people are much more likely to have vitamin D deficiency. They are also more likely to die of COVID. The low vitamin D is a marker of frailty, not a cause.
This was not simply observational. There will be no correlation between being given higher dose vitamin D and age in this trial, the results appear at first blush to be showing Vitamin D is working independant of age.
By the by this /exactly/ why a randomised trial has been the gold standard for medical treatment for so long. False correlations, confounding factors etc are all vastly less likely to skew the results. 2 groups chosen at random, nobody in the groups or treating them knows which is which. 1 group given treatment, 1 given a placebo. How much difference do we see in the 2 groups as a result of treatment.
It's a good question. It's always worth asking. It's always worth checking. The rabbit hole of stat analysis of treatments goes pretty deep from there. Ethical issues come in. Expense. But we all need to make the effort to understand it on some level or we're marks for snake-oil.
To put this in perspective: I take 800iu as a maintenance dose to keep my vitamin D levels up. (I'm doing this under a doctor's supervision: I've been sick with low levels and she does blood tests occasionally to be sure). 2 eggs is simply not enough.
https://news.ycombinator.com/user?id=devaboone
And she's done a series on it:
https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...
"with appropriate messaging"
And, also, you're talking about one expert opinion, perhaps this person doesn't live at 41 degrees south where our both too cold and too dark for half the year or more to get enough sun exposure and peoples diets are often quire poor.
That's why we need to look at the data in aggregate, and have localities / states set their own guidelines and encourage / incentivise doctors to do more testing and symptom analysis.
In absurdly high doses, sure. The Institute of Medicine certifies 4,000 IUs as the upper safe daily limit, although doctors will prescribe higher doses for people with a Vitamin D deficiency.
The Mayo clinic did a study of Vitamin D levels in 20,308 people across 10 years. The result was that 8% of people had Vitamin D levels higher than 50ng/ml (typically a sign of Vitamin D toxicity) but found no correlation between those levels of Vitamin D. They found one, one person out of 20k, who actually displayed symptoms of Vitamin D toxicity. Their blood levels of Vitamin D were over 350ng/ml. They had been taking 100k IUs (25x the suggested dose) as a routine daily supplement. I can only find one reported death from Vitamin D overdose, and it was a 10 year old boy who was mistakenly given 600,000 IUs of Vitamin D a day instead of growth hormone by a hospital in 2015.
Let's compare that to Tylenol (acetaminophen). Tylenol contains 500mg of acetaminophen. Maximum suggested daily dose is 8 tablets, so 4g. 25 times that is 100g. So someone abusing tylenol as hard as that person abused Vitamin D would be consuming 100g of tylenol a day. Medical literature suggests that you go to the ER immediately if you consume over 10g of acetaminophen. Of people who hit blood levels requiring treatment, 5% die and 58% have severe liver damage as a result. I can't find a good, easy correlation between the blood levels requiring treatment and amount taken, but I'm going to go out on a limb and guess that taking 200 Tylenols puts you there.
So if we compare the risk, relatively, Vitamin D requires you to take over 150 times your maximum daily dose for an extended period of time (dosing for children is lower than adults) to cause death. If you take 25x the amount of Tylenol once, there's a good chance you die or have severe long term outcomes.
Vitamin D is amazingly safe, provided you treat it like a medication and don't randomly swallow fist fulls of the capsules. Many people in the US (and some parts of Europe, especially in the north) should actually already be taking a supplement. Low Vitamin D levels are exceptionally common now. In the case of the US, obesity causes low Vitamin D levels, not going outside often enough causes low Vitamin D, and not eating foods containing vitamin D causes low Vitamin D. That's a disease practically tailored to our obese, couch-bound, junk-food inhaling residents. In northern Europe, I think they largely blame the seasonal changes in daylight patterns.
I'm all for calling out danger, I just don't see any here. I don't doubt that some people will manage to hurt themselves. I can already hear someone thinking "if 4,000 IUs keeps me a little safe, I can take 1,000,000 IUs and not wear a mask". If we're really that concerned that someone will harm themselves, we should be able to just add Vitamin D to the tracking system we use for Sudafed. Don't let anyone but more than 10k IUs per day. That's enough for 2 adults and a child at healthy doses, but low enough that taking that much every day is unlikely to harm you in the immediate future (and doesn't seem to be likely to harm you at all, but it is above the suggested dose).
Many over-the-counter vitamin D supplements appear dosed for people with problems absorbing the chemical.
Not really. It depends on the person obviously but the recommended values are too low due to statistical errors.
Up to 4000 iu per day likely ok.
Both are very far below the 4000 that's often cited here. So I think that 4000 is not a recommended intake but a limit before it becomes risky. For normal people it doesn't make sense to then aim for that maximum dosage.
One thing to consider is biological inefficiency. A 4,000 IU capsule contains 4,000 IUs, but that doesn't mean your body can't actually extract all 4,000 IUs.
That said, I think 1k IUs is considered a standard dose for people without a deficiency. 4k IUs are generally used by people who are currently deficient, or have other issues that cause the deficiency. Doctors will sometimes prescribe doses up to 10k IUs for deficient people.
200 iu sounds very low.
Also there's some Joe Rogan-esque "just take the 5000 IU bro" even though 4000 is the recommended supplement upper bound. And devaboone warns against even using that much.
It is basically wasteful, only in extreme cases you could 'overdose' vitamins.
This is not true. Vitamin D is fat-soluble, not water-soluble. Your kidneys can only filter out water-soluble vitamins. B vitamins are water-soluble; that's why there's practically no upper limit to how much you can take. Your kidneys will filter out the extra (assuming you aren't eating buckets full of the stuff).
Vitamin D toxicity occurs specifically because your body can't remove the excess vitamin D stored in your fat.
That's also why severe overdose happens over time, as opposed to instantly. You have to take a huge amount of Vitamin D at once to overdose (like millions of IUs) but you can cause toxicity using smaller doses over longer periods of time. If your body could flush it out, that wouldn't be true. Any excess would be removed and you would start each day "fresh".
For breastfed babies, France recommend an intake of 25µg to 30µg but it's half of that in the UK (8.5 to 10µg).
Note, the Endocrine Society currently suggests a minimum 25(OH)D level of 30 ng/ml (75 nmol/liter) and suggests much higher levels of supplementation if you need to raise it: "to raise the blood level of 25(OH)D above 30 ng/ml may require at least 1500 –2000 IU/d of supplemental vitamin D."
Holick, Michael F., Neil C. Binkley, Heike A. Bischoff-Ferrari, Catherine M. Gordon, David A. Hanley, Robert P. Heaney, M. Hassan Murad, and Connie M. Weaver. “Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 96, no. 7 (July 1, 2011): 1911–30. https://doi.org/10.1210/jc.2011-0385.
It's also worth noting that studies have shown that without sun exposure, people may require even higher levels of supplementation to maintain their 25(OH)D levels:
Heaney, Robert P., K. Michael Davies, Tai C. Chen, Michael F. Holick, and M. Janet Barger-Lux. “Human Serum 25-Hydroxycholecalciferol Response to Extended Oral Dosing with Cholecalciferol.” The American Journal of Clinical Nutrition 77, no. 1 (January 2003): 204–10. https://doi.org/10.1093/ajcn/77.1.204.
"CONCLUSIONS: Healthy men seem to use 3000-5000 IU cholecalciferol/d, apparently meeting > 80% of their winter cholecalciferol need with cutaneously synthesized accumulations from solar sources during the preceding summer months. Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin D."
I think this winter I will run an experiment on myself.
Quoting the article (which I hope all here will read),
"[typically] more than 40 % of patients hospitalized because of COVID‐19 pneumonia developed ARDS of which more than 50 % ultimately died."
That's a 20% fatality rate.
Of the 76 patients in this study - regardless of vitamin D treatment - only 2 died, and the rest were eventually discharged. This is an outstanding result.
None (!) of the hospitalized patients died in the vitamin D / HCQ / AZ group.
I will say that the average age - 58 - is rather young. Only 19 out of 76 were over 60.
"All hospitalized patients received as best available therapy the same standard care, (per hospital protocol), of a combination of hydroxychloroquine (400 mg every 12 hours on the first day, and 200 mg every 12 hours for the following 5 days), azithromycin (500 mg orally for 5 days) and for patients with pneumonia and NEWS score≥5, a broad spectrum antibiotic (ceftriaxone2 g intravenously every 24 hours for 5 days) was added to hydroxychloroquine and azithromycin."
They have since discontinued HCQ because they felt that studies had shown that it was ineffective. We shall see.
As with AIDS, it's the cocktail of drugs that appears to matter. What is effective pre-hospitalization (i.e. prophylactic) is different from the best protocol post-admission. And that, in turn, differs from the best course of treatment in the ICU. The improvement in outcomes over the last few months is a result of experience:
https://covid19criticalcare.com/wp-content/uploads/2020/07/F... (pdf)
In such cases, both conditions may required supplementation to correct.
So, fair to say that it can get complicated.
IMHO it would be best to test your vitamin D level anyway and act accordingly.
Populations with lighter skin colors tend to live at higher lattitudes, where there is less sun. Inherited genes probably compensate for this, while also transmitting the paler/darker skin allele.
[1] with the note that generally insurance is a real PITA with vitamin D testing. The trick usually is to list as a diagnosis code a previous history of low vitamin D. Yes it’s like a catch 22. You need prior testing showing low Vit D to get testing to show low Vit D.
Given the huge prevalence of low vitamin D (70+%) amongst African Americans this is maybe a classic example of a dysfunctional health system. A vitamin D supplement is a dirt cheap public health intervention with potentially big pay offs across such a large segment of the population.
FWIW, vitamin D has been among the things tested when I have my blood work for an annual physical and never had any insurance issue about it. And I do take supplements because it was low.
Of course, may be a function of particular insurance provider policies.
This is just one of the many frustrating parts of the way our medical system is set-up. As a doctor, I have even considered not seeing my own doctor for labs and using a private company, as others have mentioned in this thread. At least those companies provide price transparency.
You get a doctor's prescription (from a Florida doctor, good for anywhere in the country) and instructions to go to your nearest Labcorp for a blood draw. So make sure you have a Labcorp near you.
Here are a few alternatives you can look into, mentioned in this discussion: https://news.ycombinator.com/item?id=15868143
[0]: https://www.privatemdlabs.com
[1]: http://www.directlabs.com/
[2]: https://www.walkinlab.com/
So I tried a combination calcium + Vitamin D capsule, and it didn't seem to have the same effect.
Maybe the second one is safe, but I'm wondering what was going on and if there are potential drawbacks to either one.
If you want to argue that the American healthcare system is messed up and that they don't believe in agency for individuals to order their own tests and do their own research, I'm with you. But we live in the reality we got, so... just kinda is how it is.
I mean, don't get me wrong, it's always best to test, but diminishing returns and all, wouldn't most people most of the time be fine with just taking one?
My doctor recommended me to follow a 400 UI/day regime for 3 months but I raised it to 5000 UI/day for a couple of days and started noticing an interesting change: The 20-year-old flat warts on my hands were gone a week after. Told my doctor but the idiot dismissed the relationship.
Part 1: https://news.ycombinator.com/item?id=24138590
Part 2: https://news.ycombinator.com/item?id=24261948
To summarize - popping in large doses of Vitamin D is not exactly safe.
Take my own particular condition: an inherited vascular dysplasia which causes frequent nose and GI bleeds. People with low Vitamin D seem to have a worse time of it in OBSERVATIONAL studies.
But people with GI bleeds so bad they have daily diarrhea from hemorrhages and anemia that disables them to the point they can't work aren't going to be out in the sun, and aren't going to be able to absorb as many vitamins in their gut due to the havoc the hemorrhaging is yielding.
Thinking really hard about the direction the arrow of causality runs here is massively important. Is it:
LOW VITAMIN D ---> BAD BLEEDING?
Or:
BAD BLEEDING ---> LOW VITAMIN D
And as the consequences of overdosing show, this isn't like popping an extra Metamucil cracker a day or something - dire stuff can happen.
You saw the apparent effect size in this study, right?
We already have dozens of RCTs showing that vitmain D supplements prevent respiratory infections.
Here's some studies regarding vitamin toxicity and specifically Vitamin D3 including death rates: https://www.medscape.com/answers/819426-102375/what-is-the-p...
[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460735/ [2]: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona...
....obviously nobody reading this should take anything near those doses without consulting a doctor and without knowing your current blood level, to be clear.
2k definitely ha san effect on a daily basis. To really know, there are two things you can do:
1. Get a vitamin d test. Fairly cheap online
2. Use the dminder app to track estimated D over time from supplements and sun exposure
I don’t think I was clear enough in my post: 60,000 is not a daily dose! Higher than 4000 IU daily over a long period can lead to excess, according to Deva Boone, a doctor who was posting here and wrote some articles on this topic.
60,000 is something I’ve read about where 1. A doctor wants to correct a large deficiency, and 2. Judges large, infrequent doses are best. (My guess would be for adherence)
Do not, do not. Do not take anything anywhere in that range on your own. Stick to sub 4,000 for a daily doses, and ideally get a blood test.
This is mind boggling. These 76 patients had extensive blood work done so why did the study design not include serum concentration testing before and after treatment?
Millions more take HCQ as a malaria treatment. It is generally recognized as safe, if you do not have a heart condition (and even then a short course is unlikely to yield adverse outcomes).
There are no safe drugs for a patient admitted to intensive care. We should not start administering anything in large scale just because most healthy people can tolerate it well.
COVID-19 can infect the heart and damage it. As safe as HCQ might be on its own, here it's adding extra load to a system that's already under stress.
Sadly, this is political.
https://www.sciencemag.org/news/2020/06/three-big-studies-di...
https://drive.google.com/file/d/1l6y3L_KGb1ilMW0FaP4VZsd7WvX...
But it's awfully irresponsible to pretend it's good for society to spread it.
Not everyone has the scientific knowledge necessary to understand p-values and what they mean for research like this. It's a lot to ask that everyone know the standard for publishing in medicine is a p-value < 0.05, which corresponds to a 5% chance of the study's results being wrong. It's a lot to ask that everyone be aware that there were 130 different studies on hydroxychloroquine and to do the math from there to determine that we'd expect 6 or 7 of them to be wrong.
It's much better to say "just because it's not illegal doesn't mean it's a good idea" and just not share such thoroughly bad information.
This is not one. This is a political subject. Wikipedia is a complete disaster for anything that even remotely touches upon modern politics. There are teams of people paid to impose an opinion on Wikipedia, relentlessly wearing down any neutral editor with 24x7 edits and every kind of bureaucratic fight. The people who edit for free are also pulled from a highly-biased population, with strong overrepresentation by unemployed single people with non-STEM degrees.
Simply put, "ineffective and may cause dangerous side effects" is a purely political attack on the US president.
Last year, the drug was handed out freely, with very little worry, to anybody claiming that they would visit a country with malaria. In many places it is non-prescription. Clearly, the "dangerous side effects" aren't such a big deal. You can get deadly "dangerous side effects" from aspirin (Reye syndrome) and from Tylenol/paracetamol/acetaminophen (complete liver failure).
Dangerous on an individual level, not really. But at a population level if hundreds of millions of people start taking it, you're going to have high absolute numbers of bad side effects.
> is a purely political attack on the US president.
As for ineffective, there isn't one single national health agency that recommends taking it for covid. Surely the entire globe isn't killing scores of their citizens by preventing the use of an effective treatment just to make the US President look bad.
Since it's ineffective in this case, there's no benefit to outweigh the downsides of "dangerous side effects" like their is with aspirin or Tylenol.
Not true:
https://www.mohfw.gov.in/pdf/AdvisoryontheuseofHydroxychloro...
Of course, it's controversial because the WHO recommended against it and most health agencies just follow suit.
Also, American politics don't end at the border. There are countries that favor Trump, India being one of them.
Most countries' health authorities don't take into account public opinion about Important Orange Personages when setting policy, astonishingly.
Trump has poisoned the well. If you bring up HCQ, you are immediately under suspicion of being an anti-science Trump-supporting conspiracy theorist. Guilt by association, reductio ad hitlerum, etc.
As for using HCQ as a prophylactic: That was the whole point right from the beginning. Didier Raoult can be credited with starting the HCQ hype, he has been prescribing HCQ+zinc as a prophylactic for at-risk groups. That's not as outlandish as you make it sound, HCQ has been used as prophylactic for malaria for the longest time and that is considered safe.
The studies that tested HCQ at a late stage (ICU) or without zinc are missing the point. HCQ without zinc doesn't work, zinc without HCQ is at least less effective, because the HCQ works as an ionophore, but if you already have a severe case of COVID, none of it is going to work. It's too late.
There are several studies that suggest that this prophylactic treatment works. There are no big RCTs that show it works, but neither are there big RCTs that disprove that it works.
See also this protocol for prophylaxis of COVID-19:
https://www.evms.edu/media/evms_public/departments/internal_...
It includes zinc and quercetin as an ionophore and is thus politically uncontroversial. However, it's unknown to what extent quercetin really works as an ionophore in vivo.
How incredibly self centered must it be to think that everything relates to you, your country, your awful president.
Please.
Any sufficiently intense argument anywhere in the world risks corrupting a wikipedia page.
Well, for a start, no it wasn't (many if not most malarial areas mostly have resistant strains, and other drugs are more appropriate there). But anyone who was given it was warned beforehand (or at least should have been). It's not a safe drug. It is, however, safer than getting malaria, so you should probably take it if you're going to an area where it will be effective.
What you should probably not do is take it because a weird French doctor and some people on the internet said to.
https://www.infectioncontroltoday.com/view/new-study-hydroxy...
"The mechanism of action of hydroxychloroquine is to block entry of the virus into cells. Viral entry requires a helper enzyme. In the Vero E6 cell line, this enzyme is cathepsin L which hydroxychloroquine blocks. However, in the human lung cell line, the helping enzyme is TMPRSS2. Hydroxychloroquine does not effectively block this enzyme and cellular entry of the virus occurs."
So, inspired by the reports of the experiments with wrong cells a French doctor made some false claims about his success when treating patients, which were then promoted by one person wanting to be reelected, and then the followers... the results can be seen in the comments here.
For example, in <https://www.clinicalmicrobiologyandinfection.com/article/S11..., even though the study concludes other anti-virals are better, we see the footnoted, uncontroversial claim: "The antiviral properties of CQ were first explored against viral hepatitis as far back as 1963 [1]. Since then many observations from in vitro and animal experiments have suggested a beneficial role of HCQ and CQ in viral infections [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]." There are of course hundreds more such authoritative references to observed anti-viral activity.
Or regarding Azithromycin (AZM) in <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290142/>, we see: "It has been shown that AZM has significant antiviral properties. In contrast with CQ or HCQ, its antiviral activity has been shown in vitro and/or in vivo on a large panel of viruses: Ebola, Zika, respiratory syncytial virus, influenzae H1N1 virus, enterovirus, and rhinovirus [4–13]. Its activity against respiratory syncytial virus has been demonstrated in a randomized study in infants [10]. Azithromycin exhibited a synergistic antiviral effect against SARS-CoV-2 when combined with HCQ both in vitro [11] and in a clinical setting [13]."
That HCQ is mainly known as an antimalarial doesn't refute that it has, and is often tried for, antiviral effects. That AZM is mainly known as an antibiotic doesn't refute that it has shown broad antiviral effects as well.
(If you're stuck on 'antiviral' as some binary category, or mutually-exclusive with other categories, you're going to miss all the interesting incremental effects in real chemistry/biology. That sort of "sharply-bounded categories" thinking has killed a lot of people recently, as with those insistent on 'droplets vs aerosols' instead of a continuum including every size/variant of both.)
I suspect you have the wrong idea about how the results of the trial are supposed to be interpreted. The point isn't to compare to results outside the study. You should only compare the intervention group to the control group in the same study.
Please name the other drugs that "both work and have a large effect (20%)".
"DESPITE THE HYPE, GILEAD’S REMDESIVIR WILL DO NOTHING TO END THE CORONAVIRUS PANDEMIC"
https://theintercept.com/2020/05/26/coronavirus-gileand-remd...
FTFA:
>While some patients and their families have spent the past few weeks frantically trying to procure remdesivir, another Covid-19 treatment has been quietly been shown to be more effective. Although neither option appears to be the much-needed cure for Covid-19, a three-drug regimen offered a greater reduction in the time it took patients to recover than remdesivir did. People who took the combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin got better in seven days as opposed to 12 days for those who didn’t take it. Critically, the treatment has another leg up on Gilead’s: It clearly reduced the amount of the coronavirus in patients who took it, according to a study published in The Lancet on May 8.<
Of the 75 patients in the trial, 50 people received additionally Vitamin D3 supplementation (in the form of calcifediol), and 25 did not.
Notably, though, diabetes and high blood pressure were substantially more frequent in the control group, which are HUGE risk factors. Also they didn't track BMI or obesity.
Still, check out table 2. Even with these limitations, seems powerful.
How did this happen? Just bad luck with randomization?
Reading Hydroxychloroquine mentioned in this study should make one very suspicious.
Hydroxychloroquine looked promising for a while, and was being studied in an RCT, but that RCT was ended before completion because of the release of an observational study that suggested strongly negative outcomes from Hydroxychloroquine.
Later, that observational study was retracted because it was discovered to be based on falsified data.
So, unfortunately, we don't know very much about Hydroxychloroquine's effectiveness and risks in use -- but we do know that it has become a massive political hot potato, as your comment indicates.
I posted this a few days ago and got an interesting swing of votes on that comment since then:
> So, unfortunately, we don't know very much about Hydroxychloroquine's effectiveness and risks in use
For effectiveness it looks like we actually do, thanks to an experiment Switzerland accidentally ran on their population over May and June [0]. On May 27, they banned use of hydroxychloroquine, and 13 days later the death rate among resolved cases nearly tripled. Just after the spike began, on June 11 they reversed the ban and 13 days later the death rate drops back down. The graph from that article [1] is very stark, comparing the rate from late March through early July.
[0] http://www.francesoir.fr/societe-sante/covid-19-hydroxychlor...
[1] http://www.francesoir.fr/sites/francesoir/files/20200713_fs_...
To me, this seems more likely coincidental or a reporting change.
The original "quack treatment", which is prophylactic zinc+HCQ (as an ionophore) for at-risk groups, has never been shown to be ineffective in an RCT. It is still being studied.
Of course the studies that show it to be effective aren't of the best quality, but they aren't entirely meaningless either.
> We similarly investigated the change in the hypertension hazard ratio (from 1.09 (1.05–1.14) adjusted for age and sex, to 0.89 (0.85–0.93) with all covariates included), and found that diabetes and obesity were principally responsible for this reduction (HR 0.97 (0.92–1.01) adjusted for age, sex, diabetes and obesity). Given the strong association between blood pressure and age we then examined the interaction between these variables; this revealed strong evidence of interaction (P < 0.001), with hypertension associated with a higher risk up to the age of 70 years and a lower risk above the age of 70 (adjusted HRs 3.10 (1.69–5.70), 2.73 (1.96–3.81), 2.07 (1.73–2.47), 1.32 (1.17–1.50), 0.94 (0.86–1.02) and 0.73 (0.69–0.78) for ages 18–39, 40–49, 50–59, 60–69, 70–79 and 80 or over, respectively). The reasons for the inverse association between hypertension and mortality in older individuals are unclear and warrant further investigation, including detailed examination of frailty, comorbidity and drug exposures in this age group.
Thanks for sharing this!
FWIW, I was told that when the Sun is above 45 degrees over the horizon you will accrue DNA damage, and it stacks up over your entire lifetime. There is no "reset" or "heal", it just adds up.
For that reason I'm doing my darnest best to stay in the shade between 9am and 3pm. Or covering clothing.
A lot of what I've read lately suggests we're discovering a lot of benefits of vitamin D that were previously unknown, and some evidence that the recommended vitamin D levels should be higher than they are.
For a generation or so we've told people the sun is dangerous because of skin cancer, and obviously skin cancer is really bad. But I wonder if we have a case of need to weight risks that are high cost, low probability (skin cancer) compared with low cost, high probability (low vitamins D complications). What is the overall effect of these two things?
Short excerpt: People don’t realize this because several different diseases are lumped together under the term “skin cancer.” The most common by far are basal-cell carcinomas and squamous-cell carcinomas, which are almost never fatal. In fact, says Weller, “When I diagnose a basal-cell skin cancer in a patient, the first thing I say is congratulations, because you’re walking out of my office with a longer life expectancy than when you walked in.” That’s probably because people who get carcinomas, which are strongly linked to sun exposure, tend to be healthy types that are outside getting plenty of exercise and sunlight.
My grandpa died due to complications from a basal-cell skin cancer. He was almost 90 years old. The cancer itself was a few decades old. He served in the Navy during WWII, and likely got it from years of tropical sun exposure with no sunscreen.*
So, yeah, as far as cancers go, that's one you'd rather get if given a choice.
* (Well, and the additional years of fishing and other outdoor activities. Obviously the cause can't be pinpointed like that, but it must have contributed)
Note that if we didn't have UV repair mechanisms, we'd blister in a few minutes.
Sort of.
Every time your skin gets 'red' due to sun exposure... that's due to DNA damage.
However, cells have several mechanisms to repair DNA - otherwise we would be in serious trouble after a single radiation burn (which is what UV light does).
They might fully repair an event successfully. Or they might not - in which case the damage may be severe and the cell will either die due to its effects or detect and trigger apoptosis. If the error isn't serious, it might not be detected and be passed on to future cell generations. Those are the ones you need to worry about.
Specifically for the skin, given that skin cells divide quite frequently, they might be caught mid-division, which is a more vulnerable state.
As you get more exposure and more damage, the chances of defects not being properly repaired increase. So you are right that, if you keep letting your skin bake, chances are you will accumulate damage that can't be repaired(over a lifetime, that's a certainty).
Cancer is not the only issue. Have you seen how the skin of people that spent a lifetime working under the sun without adequate protection look like?
Rhee, H. J. van der, E. de Vries, and J. W. Coebergh. “Regular Sun Exposure Benefits Health.” Medical Hypotheses 97 (December 1, 2016): 34–37. https://doi.org/10.1016/j.mehy.2016.10.011.
"Since it was discovered that UV radiation was the main environmental cause of skin cancer, primary prevention programs have been started. These programs advise to avoid exposure to sunlight. However, the question arises whether sun-shunning behaviour might have an effect on general health. During the last decades new favourable associations between sunlight and disease have been discovered. There is growing observational and experimental evidence that regular exposure to sunlight contributes to the prevention of colon-, breast-, prostate cancer, non-Hodgkin lymphoma, multiple sclerosis, hypertension and diabetes. Initially, these beneficial effects were ascribed to vitamin D. Recently it became evident that immunomodulation, the formation of nitric oxide, melatonin, serotonin, and the effect of (sun)light on circadian clocks, are involved as well. In Europe (above 50 degrees north latitude), the risk of skin cancer (particularly melanoma) is mainly caused by an intermittent pattern of exposure, while regular exposure confers a relatively low risk. The available data on the negative and positive effects of sun exposure are discussed. Considering these data we hypothesize that regular sun exposure benefits health."
Hoel, David G., Marianne Berwick, Frank R. de Gruijl, and Michael F. Holick. “The Risks and Benefits of Sun Exposure 2016.” Dermato-Endocrinology 8, no. 1 (October 19, 2016). https://doi.org/10.1080/19381980.2016.1248325.
"This review considers the studies that have shown a wide range health benefits from sun/UV exposure. These benefits include among others various types of cancer, cardiovascular disease, Alzheimer disease/dementia, myopia and macular degeneration, diabetes and multiple sclerosis. The message of sun avoidance must be changed to acceptance of non-burning sun exposure sufficient to achieve serum 25(OH)D concentration of 30 ng/mL or higher in the sunny season and the general benefits of UV exposure beyond those of vitamin D."
This change in thinking has been a long-time coming. There have been results showing studies since the 90s showing lower melanoma mortality from those having more sun exposure, as described in this review:
Egan, Kathleen M., Jeffrey A. Sosman, and William J. Blot. “Sunlight and Reduced Risk of Cancer: Is The Real Story Vitamin D?” JNCI: Journal of the National Cancer Institute 97, no. 3 (February 2, 2005): 161–63. https://doi.org/10.1093/jnci/dji047.
Do you know if the time of day makes a different? I avoid the Sun between 9am-3pm as that seems relatively easy to get sunburned during that time, but I wonder if the alleged benefits are tied to the same time window?
Webb, A. R., L. Kline, and M. F. Holick. “Influence of Season and Latitude on the Cutaneous Synthesis of Vitamin D3: Exposure to Winter Sunlight in Boston and Edmonton Will Not Promote Vitamin D3 Synthesis in Human Skin.” The Journal of Clinical Endocrinology and Metabolism 67, no. 2 (August 1988): 373–78. https://doi.org/10.1210/jcem-67-2-373.
Also, here's a web calculator that can help you calculate UV exposure required to get a desired amount of Vitamin D (and to avoid a sunburn) based on location, time of year and day: https://fastrt.nilu.no/VitD_quartMEDandMED_v2.html
Further, I've known two people in my life who get weird skin issues if they stay out of the sun too long. My wife is one of them! Really weird, considering how damaging the sun is considered.
This study doesn't show that a non-hospitalized person who is not taking hydroxychloroquine and azithromycin should expect better outcomes from Vitamin D. At best, one could argue that if you get hospitalized, it would be good to have built up some Vitamin D.
I'm still supplementing with Vitamin D, though, but may cut back having been reminded that it's a fat-soluble hormone (and not really a vitamin at all).
Dumb questions: What is a parallel pilot | what is open label? And Is double-masked the same as double-blind?
"Open-label" generally means "not blind at all." Basically, the patient knows what treatment is being administered.
"Double-masked" is usually synonymous with "double-blind," because "masking" sounds less violent than "blinding."
What did they actually do in the study? Well, §2.2.1 says the following:
> 2.2.1. Randomization and Masking
>
> An electronically generated randomization 2:1 list was prepared by
> independent statisticians. The list was accessible only to nonmasked
> specialists in the study in an attempt to minimize observation bias.
> The patients' data were recorded in the hospital's electronic
> medical record, with blind access by the technical data collectors
> and the statistician who carried out the study.
It sounds like those who analyzed the data didn't know which group was which, but in the case of unequal 2:1 group allocation it is typical for the larger group to be the treatment group. Why was unequal assignment used in the first place?
The descriptor "open-label" suggests that someone knew which patients were in which groups: was it the people who administered the treatment, or the patients, or both? Unclear.
The authors themselves write: "This pilot study has several limitations as it is not double-blind placebo controlled."
This is literally the first time I've heard of "double-blind" being interpreted this way.
- https://link.springer.com/referenceworkentry/10.1007%2F978-3...
- https://az.research.umich.edu/medschool/glossary/double-mask...
- https://aidsinfo.nih.gov/understanding-hiv-aids/glossary/211...
Best case scenario: Less dead people.
Worst case scenario: We all have healthier bones.
It's available right off the shelf. As long as people aren't taking an entire bottle all at once, it seems pretty safe to me. (Disclaimer: Dammit Jim, I'm a software engineer, not a doctor.)
The point I’m making is there is basically no drawback to giving people a normal, healthy, vitamin D supplement. Plus possible upsides.
It's kidney failure - https://www.cmaj.ca/content/191/14/E390
Or fatal hypercalcemia - https://link.springer.com/article/10.1007/s12098-016-2109-z
And so on.
I frankly think its irresponsible and facile for anyone to suggest there are no downsides to high doses of Vitamin D. This stuff is available OTC and a lot of folks are just gonna dose themselves ad libitum here.
Also, fun side note: Vitamin D is produced as an oil on the skin and actually seeps through your skin overtime to enter the bloodstream. So don't take a shower after getting some sun, because you could be washing off your Vitamin D.
Sarcasm: Yah, getting it from sun and from a supplement are biologically identical.
You absolutely can get too much vitamin D from a few thousand IU per day for a sustained time.
You cannot overdose on vitamin D from sun exposure because the metabolic process that creates it has a concentration limit.
You CAN overdose (experience toxicity) from too much supplementation. They are not equivalent.
Some people do get toxic side effects from supplementing 5000 IUs a day, over long periods of time.
- There was an association shown between low serum levels and bad COVID-19 outcomes, but low vitamin D is an indicator of frailty, so it was how much of this relation was causal.
- Now we have some early data that sure makes it look causal and it seems to be a significant effect, but it's not watertight yet.
- We know that a big fraction of us have low vitamin D levels with other health consequences from it.
- Taking a moderate dose of vitamin D now seems like a reasonable hedge: low risk of health consequences, and a decent chance of health benefits even if it doesn't protect us from the pandemic.
Honestly. I’m making a simple point that giving people a free, normal dose would be beneficial to them either way. So why not.
It’s pretty hard to OD on vitamins unless you can’t read the label.
I know people subscribing to the Vitamin D religion don't like to hear this, but this is one of those claims about Vitamin D that has been tested - and actually isn't true. https://www.medpagetoday.com/endocrinology/osteoporosis/8183...
The answer to every problem shouldn’t be “create a new government-funded agency to make this happen ‘for free’”. Mr Market isn’t the answer for every single thing, but sometimes it’s fine to let existing private supply chains operate. Supplying cheap dietary supplements seems to me like an area where that’s the case.
It may need to be added to SNAP/WIC; that’s a reasonable task for government to busy itself supporting this.
The point of making it free is so everyone will have it - not just because of the price.
The regulation of vitamin D usually occurs before its synthesis after sunlight exposure. Supplementing synthesized vitamin D circumvents the regulation and allows vitaminosis to happen.
I have read wildly different recommendations for the dose. Typical package is 1000 IU, you take 2000 IU, others recommend upwards of 8000 IU due to possible issues with earlier studies leading to FDA/regulatory agencies recommendations. Again, rather stay below 5000 IU unless explicitly told otherwise by a doc. Always get blood work done to REALLY figure out your levels and how to fix them.
Again, why we can overdose with supplements but too much sunlight won't cause an overdose:
Sunlight + components ---> X (regulation) <---> Vitamin D ---> effect in body
Supplements start behind the regulation step...
Also, there's going to be a confounding question based on this study: is it just Vitamin D, or is it Vitamin D in combination with HCQ / Azithromyacin?
That said, it probably wouldn't hurt you to supplement with Vitamin D this winter, even if it doesn't treat Covid.
Vitamin-D in moderate amounts is pretty safe, so for those not already getting adequate sun exposure, it's a low-risk, high-potential-reward supplement.
This doesn't mean go outside and get covid.
I used to get a major cold every 2-3 month and they were really bad lasting two weeks with fever, fatigue, coughs, colds, really stuffy nose, etc. Now? The two colds I've had were over in a week and the symptoms were so incredibly mild - mostly a light runny nose - that I'm legit grateful when I get a cold.
Regardless of vitamin D's effect on covid-19, the supplement has already paid off big time as far as I'm concerned. I've started to take 1g of vitamin C for the same reason, i.e. to boost my immune system. I should add that I live in a Nordic country with long dark winters and that I can't/don't go outside as much as I should.
Careful with Vitamin D. When you get a chance, go see your doctor and ask him to check your vitamin D levels. Don't forget to tell them you are taking suplements.
I swear, it's like people don't understand why we measure R_t. propagation is sigmoidal phenomenon. A reduction in transmission by 10% can easily lead to a reduction in prevalence by nearly 100%.
I haven't had a cold since we initially locked-down in April, which is very unusual for me, but completely explained by social distancing.
Except you can, because that is the conclusion of at least one other study of the effect of Vitamin D. https://pubmed.ncbi.nlm.nih.gov/16959053/
It's also surprising that you've gotten 2 colds in the past few months when it sounds like you have been taking precautions due to covid-19. Seems like any exposure where you could catch a cold could easily have been Covid-19 instead, so you may want to re-evaluate your mask use, physical distancing, and hygiene practices.
Vitamin D is a hormone and is not risk-free. Unless you have been prescribed by your doctor.
In general, be careful with any fat-soluble "vitamins", as they can build up.
Through in the UK the NHS were handing out high doses of Vitamin D like cotton candy last winter.
42% of Americans are deficient, much more the darker your skin is.
https://www.healthline.com/nutrition/vitamin-d-deficiency-sy...
IIRC daily doses above 2000 over a longer timespan can (infrequently) cause your vitamin B12 levels to fall off, and/or the amount of calcium in your blood to build up, so your doctor might want to schedule a follow-up appointment after some time has passed to make sure those levels still look okay, and adjust supplements for those variables accordingly.
If you're not going to see a doctor about this, for laziness/poverty/whatever reasons, I think the average risk from not taking Vitamin D is vastly bigger than the risk from taking it.
[0] https://academic.oup.com/ajcn/article/85/1/6/4649294
[1] https://asbmr.onlinelibrary.wiley.com/doi/full/10.1359/jbmr....
400mg = 400000mcg = 16000000ui https://www.azcalculator.com/calc/vitamin-d-mcg-iu-converter...
Yes it's fat soluble. But the amount you would need to take in supplements to cause a problem is enormous. (Every vitamin is different)
You could probably take an entire bottle and you'd be fine.
The patients in this study were being given 10x the RDA, about 20k IU/day.
You can very very easily get 25k IU out in the sun and your body has no issues.
It's safe to take 2000IU/day and make sure to get sun if possible.
There's very little risk of transmission if you're outside and 2m away from other people, even if intermittently you're closer than that. Even more so if one or the other of you is masked.
Places to be more concerned about are bottlenecks like lobbies and elevators on the way to/from outside.
It may negate the safety of the actual airplane trip, or it may not.
Where are you getting this understanding? You are asking for evidence while providing none yourself...
You've claimed that elevators are an exception to the established guidelines without evidence and are now claiming that that other, well evidenced, claim some how needs additional support to be applied to elevators.
It’s not clear that “avoid elevators” is universally less harmful. Also given the 15 minutes suggested it’s not clear that elevators by default pose a risk, and the large numbers in use in the world make it surprising if they are indeed a major vector but are otherwise undocumented or not part of suggested guidelines thus far.
I’m asking for evidence which shows they are indeed a risk factor, which should also hopefully take into consideration mask usage and number of stories. This would be extremely useful for people to factor in if they need to move, for example.
I'm not sure the concept of "burden of proof" is helpful in a collaborative fact-seeking discussion. It seems more relevant to adversarial debates and trials.
Why is this the case? Well, for this trial the physicians treating patients knew who got the Vitamin D and who didn’t, and thus they may have been more likely to admit those who didn’t to the ICU (subjective). Something like mortality is not as subjective, but there are too few study participants to detect a mortality signal in this trial.
If I had been conducting this small open label trial I would have picked some less subjective outcomes, like maybe P/F Ratio.
I was like I dont know, the data is messy but the sun seems to have something to do with reducing fatalities. (I used weather data as additional covariates)
[1]https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12251
These prescriptions seem to always lack the amount of exposed skin. Is exposed hands enough or should one be naked?
Since I began using this a few months ago I have not been burnt.
"Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
Aren't "open label" and "double-masked" contradictory?
"An open-label trial, or open trial, is a type of clinical trial in which information is not withheld from trial participants. In particular, both the researchers and participants know which treatment is being administered." (Wikipedia)
"Double-Masked Study. A type of clinical trial in which neither the participants nor the research team know which treatment a specific participant is receiving." (NIH)
Are you for real? Smallest effect in the 95% CI is a 4x reduction in ICU admission. Yes, it's probably closer to the bottom end of this range, but this is a fantastically different.
> For randomised trials, it makes no sense to say that the difference in baseline is not significant
For randomized trials, the baselines are not likely to be massively different. And, of course, the authors compared risk factors and ages to rule out some of the ways that the trial could be ridiculously tilted from the outset.
> In this case it's pretty obvious the effect of vitamin D would easily be non significant if you shift around some variables.
...??? The endpoint was pre-declared, and we're just comparing two pre-randomized groups. Exactly what variables would you shift around?
> Reeks of p hacking imo
If you're going to cast aspersions, be a little more concrete.
"Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
To pharmaceutical companies or supplement companies, or the NIH: fund a well powered study, pretty please?
Starting in February I went on a prophylactic supplement of Vit D, Vit C and aspirin because of the then-unnamed Covid-19 virus. The aspirin (actually started that in april) is because of the pervasive excess clotting and sudden strokes in young people showing up in ERs (less attested in the US than some other countries for reasons I’m not sure about). I’d never taken supplements before.
I’m immuno compromised so with my doctor we worked out the regime above plus some prescription drugs I won’t mention.
So far, so good, but I’m isolating' so this could be a case where I’m also preventing tiger attacks.
Though my pills are "cholecalciferol" not "calcifediol", so there's not a perfect 1:1 correspondance, but your body converts cholecalciferol into calcifediol, so based on nothing else my above calculation is probably not far off.
so may be 32.000 IU ???
"Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
sunscreen either blocks, scatters, or absorbs those rays
seems to reason that sunscreen slows down sun burn and vitamin D3 production
1. Uva is the cause of most skin cancer
2. Uvb generates vitamin d and sunburns
3. When uvb is present, you can make sufficient vitamin d quite quickly
This would suggest you would want sunscreen for longer exposures, or with much uva exposure. And could get vitamin d from a briefer exposure pre sunscreen.
I can’t say how completely sunscreen blocks vitamin d however.
I’d delete the above comment if I could. The main point that you can get vitamin d from short exposure without sunburn is correct, but I was incorrect on the risk. But he fact I was wrong about uvb and melanoma also makes me think I may be incorrect on the risk of uva during periods without uvb.
D3 takes 7 days to be fully metabolised to calcifediol. When Drs measure your D levels, they're actually measuring calcifediol.
I assume that the researchers picked it (1) to increase the chances of seeing a significant effect, if there is one, and (2) because if hours are at stake in saving a person's life, the fastest boost may be needed.
I think that it is extremely unlikely, though possible unless a specific study has ruled this out.
EG: Perhaps vitamin D supplementation upon Covid-19 diagnoses is only effective if you have not been supplimenting.
Like: Maybe drinking alcohol at a party is helpful to court a new partner, unless you are an alcoholic already. Not the best analogy but I hope you'll take my point in good faith.
Too many powerful people are heavily invested in the belief that there is no treatment for it.
There are absolutely some powerful vested interests in not seeing an easy treatment for this disease, or, by the same logic, pretty much any other disease either since there's nothing special about this one. (A not infrequent complaint on Hacker News.) I can't prove they're driving the discourse on treatment for COVID-19, but it sure isn't disproved by what I see happening out there.
What you are rebutting is not against what OP is claiming.
* https://www.fda.gov/patients/fast-track-breakthrough-therapy...
https://clinicaltrials.gov/ct2/results?term=vitamin+d&cond=C...
https://clinicaltrials.gov/ct2/results?cond=Covid19&term=&cn...
You could pass through the aerosol and inhale.
Masks make sense outside too, at least in some circumstances.
I use a mask outside if I'm on a narrow sidewalk, but otherwise, I don't think there's much point. My favourite thing is the people who wear a mask over the mouth, but not the nose. Like worst of both worlds.
You have a lot of faith in your immune system. Absent more data, it's just that, faith.
We have simply not seen the increases and flare-ups we would expect if what you're asserting is true. What worries me is October-November. This is for Toronto, Canada.
The beaches and parks are fully of people socially distancing-ish. The streets are full of a mix of people social distancing and not. Maybe half are wearing masks.
Get outside and take care of your physical and mental health! Winter is coming.
EDIT> I'm a physics and biology student. I am not completely unaware of the science.
Did you somehow miss the season in progress when COVID19 hit southern hemispheric countries in the early US spring?
Our current local guidelines are that masks are only required indoors or when distancing is not possible, and that seems to be borne out by the evidence. Over the summer people have been out at the beach, out in the parks, and out on the streets while only social distancing-ish. If walking through someone's exhaust plume were as much of a threat as you guys are trying to make out, we would have certainly seen that in the numbers. We don't.
You're welcome to think that. But it's based on faith, not evidence. I admit that I don't evidence to prove that it's dangerous to a specific level either. I just prefer to err on the side of caution.
All of the guidelines are about statistical safety, not about the physics of your particular situation. As always, use your noggin. Stay safe.
this bit is correct, but the rest is falling for false equivalency by throwing around the same "helps" with every case.
just being outside is overwhelmingly helpful, meaning it overwhelms every other factor by a large margin. relative to that, wearing a mask outside is of such negligible help to be effectively unhelpful. distance also overwhelms masks, both indoors and outdoors. distance outside helps only a little bit, but distance inside helps materially (because the positional and velocity vectors available to droplets and their virii and the dangers to them outside are exponentially greater). masks by themselves indoors are helpful only in limited situations (when in the direct exhaust of others for prolonged periods).
> "...do not drop your chances to zero"
for real-world situations, boolean evaluations like this are nearly always misleading, no matter in which direction. your chances of dying in a bathtub aren't zero either but we don't worry about it. relative magnitudes matter.
yes, use your noggin.
Don't get up-close with crowds of strangers, sure, but growing evidence suggests 6' outdoors is safer than 20'-plus in any enclosed, recirculating-air indoors.
Now, if you go outside in order to enter some other indoors, with people who may be infected, you're creating risks.
"Gyms are closed" (but bars and casinos are open)
A virus that kills old and _obese_ people, and you are shutting down the gym?
If anything I hope Coronavirus shifts politicians from business leaders to scientists.
Open the gyms to save lives.
Gyms are pretty horrible places for spreading COVID and other respiratory infections, as they involve a lot of heavy breathing in confined spaces. They are probably a worse place to be than bars. Would the increase in fitness over a 6 month period for a typical obese person really reduce the risk by more than being in the gym increases it?
https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article https://www.healthline.com/health-news/heres-why-covid-19-ca...
Pre-COVID studies of gyms call out a very high risk factor for respiratory infections.
https://www.researchgate.net/publication/324993154_Infection...
There was one RCT of gym access in Norway that showed no difference, but that's because there was only one case out of over three thousand during the entire study, in either arm, so it's difficult to say that means anything at all.
https://www.medrxiv.org/content/10.1101/2020.06.24.20138768v...
Ancedote sure, inevitable maybe. But this wasn't some January new years resolution, this was April.
2. A gym seems kind-of a high infection risk. Lots of heavy breathing and sweating, wiping of faces, noses, and mouths, sharing of equipment, locker rooms... probably not the ideal place to welcome anyone, let along the (as you say, high-risk) obese amongst us.
Any chance your irritation at closed gyms is more personal, rather than a caring nature looking out for peoples' weight loss regimes?
If you want to get rid of the virus we need to shut down everything.
Of course, someone who is obese will take a long time to get to a healthy weight if they are only losing a pound a week, but most people would have a hard time maintaining extremes of diet or exercise for a long period of time.
If the UV doesn't kill the virus the heat will. But even then, it's not immediate. If droplets containing viruses successfully land in your respiratory system (which is constantly sucking air), it doesn't matter how much sun there is outside, the virus is now cozy.
A beach could be perfect, except that there may be strong winds. You should hope they are not blowing droplets from your neighbor into you.
Similarly, if it's an overcast day, it doesn't really matter much.
Fascinating how hydroxychloroquine is routinely used and considered standard of care in most countries where the drug has not been politicized.
calling it the "standard of care" in the present tense is very disingenuous. it was briefly considered to be effective at the beginning of the outbreak. it was determined relatively quickly that it was not actually an effective treatment. this has nothing to do with politics.
So to add to the infodemic: selenium and iodine deficiency also increases severity. Take some iodized salt and Brazil nuts now, or wait 5 months for the authorities to understand that absence of evidence is not evidence of absence. And no matter what Youtube bans you for going against the WHO: tumeric is an efficient antiviral.
I'll check some CDC sources later to contextualize these claims to the US.
Notice the weird mind crinkle: Got to debunk it, and use "prevent you from getting sick" as the reason for it not working (and the subtle differences between: "No research has shown", "research hasn't shown", and "research has shown that it can't prevent you"). Even though plenty of research shows it prevents you from getting severely sick, when you do get sick. Willing to bet that garlic (a famous folk knowledge cure for the flu, smashed boiled garlic with hot water) is actually effective in recovery and severity, but the fact checkers present it as a "COVID cure" and of course that can be debunked. But it is a debunking based on a weird strawman we saw with masks: Masks are not protective to COVID because the eyes can catch it too. As if protectiveness and immune health is binary and anything else than 0 or 1 has to be a lie.
Could not find anything about the CDC, just https://www.cdc.gov/nutrition/infantandtoddlernutrition/vita... where they recommend Vitamin D for children under 2 years old, to prevent deficiency, but no where mention a recommendation for using it during a pandemic to keep your immune system healthy.
As for selenium deficiency and iodine deficiency, the research is slowly catching up:
> Certain micronutrients are seen as supportive for the treatment of and protection against viral diseases with some vitamins (A, B6, B12, C, D, and E) and essential trace elements (zinc, iron, selenium (Se), magnesium, or copper) discussed as particularly promising .
> However, the data base is very small and it is unknown whether certain vitamins or trace elements are deficient in patients with COVID-19, and whether the concentrations are related to disease severity or mortality risk.
> The collaborative research team from Germany hypothesised that Se may be of relevance for infection with SARS-CoV-2 and disease course of COVID-19 and that severe Se deficiency is prevalent among the patients and associates with poor survival odds in COVID-19.
As for turmeric, mentioned in relation to COVID a bannable offense on Youtube: It inhibits and suppresses Zika, Hepatitis, HIV, Noro, coxsackie, HBV, herpes, influenza, encephalitis, dengue, corona, and chikunya. It also suppresses cytokine signalling. But experts warn that it may interfere with the immune system when fighting COVID, and that it is neither a cure nor a treatment nor a helpful supplement. WHO lists it under hoaxes (except when discussing Chinese traditional medicine). And you are a bad person if you share this potential online, because you don't have a randomized trial to back up that it works against SARS-CoV-2.
MedicalNewsToday: In a rapid review of the evidence published on May 1, 2020, researchers from the Centre for Evidence-Based Medicine at the University of Oxford in the United Kingdom unequivocally conclude: “We found no clinical evidence on vitamin D in [the prevention or treatment of] COVID-19.” They also write that “[t]here was no evidence related to vitamin D deficiency predisposing to COVID-19, nor were there studies of supplementation for preventing or treating COVID-19.”
Potential Effect of Curcumin Treatment of COVID-19: Curcumin may have beneficial effects against COVID‐19 infection via its ability to modulate the various molecular targets that contribute to the attachment and internalization of SARS‐CoV‐2 in many organs, including the liver, cardiovascular system, and kidney. Curcumin could also modulate cellular signaling pathways such as inflammation, apoptosis, and RNA replication. Curcumin may also suppress pulmonary edema and fibrosis‐associated pathways in COVID‐19 infection.
WHO Fact or Fiction: There is no scientific evidence that lemon/turmeric prevents COVID-19.