SARS-CoV-2 positivity rates associated with circulating Vitamin D levels | Hacker News Reader

SARS-CoV-2 positivity rates associated with circulating Vitamin D levels

journals.plos.org

308 pointsspuz255 comments

There is a whole body of research around the ways that vitamin D modulates inflammation, helps regulate calcium homeostasis and strengthens circadian rhythm. Here is some relevant research:

- vitamin D is directly involved in regulating the renin-angiotensin system, including ACE2 expression. ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3999581/ )

- vitamin D has been shown to have anti-inflammatory activity with respect to cytokines specifically involved in advanced COVID-19 cases ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164284/ )

- vitamin D and magnesium insufficiency both cause hypocalcemia, which has been connected to COVID-19 severity: ( https://www.researchsquare.com/article/rs-17575/v1 )

- magnesium and vitamin K2 also modulate calcium homeostasis ( you can look this one up yourself I need to get off this phone )

^^^ this is a snippet from a letter I sent to the local health department. I sure hope someone read it!

I keep seeing data points like this, but does supplementing vitamin D work? Does it make sense to read things like this and conclude that taking a vitamin D supplement pill daily is a good idea?

If you are deficient, yes. If you are any vitamin or mineral dificient you should supplement. What this article says is: it is important, here's how much.

It just shows a strong correlation regardless of other factors such as demographics. The causation of such correlation is not yet determined. Although its probably a good idea to make sure you're not deficient whether or not vitamin D has an effect

N=1 I noticed a huge immediate positive shift in subjective well being when I started on vitamin D.

I cycle 4k iu of vitamin d daily during the darker winter months to keep my mood from tanking. Works every time.

Yep, I’ve noticed the same correlation. Whenever I’m going through a longer stint of feeling down. It’s usually because I’ve stopped taking vitamin d. I’m reasonably convinced there is some kind of correlation.

There is a long history of taking pills of vitamins and minerals not being as good as getting it the way we evolved for. We evolved to produce vitamin D by getting sunlight. We are NOT evolved from nocturnal animals. A vitamin D supplement might help, but a better idea is to take a walk in the park every day, while the sun is up.

Sure, and that's great, but what about the scenarios in which I cannot walk to the park (during 600+ AQI wildfires, as an example), is the reason I'd like the data on supplementation.

You can buy or make a SAD/Sun Lamp.

Most 'sun lamps' do not emit UVB, which is required for your body to make vitamin D.

Then don't buy those if your looking for that feature?

you're missing the point; he's saying that sun lamps don't have the same effect as the sun. This isn't just a "feature" that some lamps have and others don't; it's a crucial missing ingredient that results in the sun lamps you are suggesting simply _not working_.

No, I'm not. There are UVB generating light sources and they also fall under the SAD/Sun lamp definition.

Sure, and that's great, but I'm asking about the efficacy of a supplement

You're never going to get sensible dietary advice on HN.

Get sun. If you can't get sun you should eat a variety of food that contains vitamin D. If you can't do that, you should take a supplement. Take the supplement at the same time as you eat a meal, preferably a meal that has some fat.

Here's the advice for England:

https://www.nhs.uk/live-well/healthy-body/how-to-get-vitamin...

https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...

Freely available advice from the UK's NHS would seem to be a good idea. We fund the NHS mostly out of taxation, so advice provided there has to be as close to non partisan as is reasonably possible.

I personally don't give a shit if you are a foreigner. If the NHS website can provide good advice and help someone - anyone, then my tax squids are being put to good use.

There are bound to be other good sources of health related advice around the place but why not start with the NHS and work out from there?

If you pay close attention, health authorities always play it safe, for example by saying "there's not enough evidence". That's why they didn't recommend masks in the beginning.

Then, if some sort of expert consensus comes up, the authorities adopt that. When that consensus is challenged by new evidence, authorities are slow to change, because that would be implicit admission that they were giving the wrong advice, which is not something that the human egos involved there can easily stomach.

A good example for this is the food pyramid[1]. It was never supported by good evidence, it was adopted through expert consensus (one might also call it lobbying), and it was later removed from the guidelines. You can still see posters of it hanging in doctor's offices, of course.

[1] https://en.wikipedia.org/wiki/History_of_USDA_nutrition_guid...

True that, but the incentives for government bureaucrats in the U.S. and the U.K. are somewhat different. Of the two, the former seem more likely to be swayed by industrial concerns/lobbying. Not saying that the U.K. is totally immune to this kind of thing, but I'd trust the NHS over the USDA.

> I'd trust the NHS over the USDA

Yet, the UK essentially adopted the advice given by the USDA. Why? Expert consensus is formed by research, which is usually funded by interest groups, and a lot of it ultimately comes out of the pockets of US industry.

For instance, the lipid hypothesis (that cholesterol causes heart disease) has been popularized once (with US industry support), became expert consensus, despite lack of evidence to support it, despite lots of contradictory data.

Once something is expert consensus for a while, it becomes harder and harder to challenge. At that point, there is no need for industry to control the narrative anymore, the experts (who do not want to admit being wrong) will control it all by themselves.

The point I am making is that the authorities are the last ones to set things right, their advice is forever outdated and therefore likely wrong.

> You're never going to get sensible dietary advice on HN.

> If you can't get sun you should eat a variety of food that contains vitamin D.

It's admirable that you prove your own point two sentences later.

> You're never going to get sensible dietary advice on HN.

You're never going to get sensible dietary advice, period. Diet is a belief system. Most people, including doctors and health authorities, really just go by clichés, like "eat five a day" or an unspecific "balanced diet". The science on it is poor and forever will be.

> If you can't get sun you should eat a variety of food that contains vitamin D.

Half an hour in the sun, if you are light-skinned, can get your body to produce about 10,000IU of vitamin D. To get that amount in the diet, you would need to eat more than a pound of the right fish.

Diet can get you out of the "severely deficient" range, but almost certainly not into the healthy range.

> Here's the advice for England

They actually advise supplementation, but they err on the low end. The only way to know if you get enough vitamin D is to do blood tests, people react quite different to different doses and forms. One guy here reports 10,000IUs daily gets him to only 55ng/dl (high end of normal), whereas 5000IUs gets others above 70 ng/dl (possibly harmful). Vitamin D builds up over time, so one test is not enough.

Like a supplement for not getting enough sunlight? Supplement your lack of sunlight with appropriate spectrum inside.

It works, I'm not a sunshine person. I work for myself and I usually work after I wake up at noon because I usually stay up til 4 or 5am at night. I get very little outdoors sunshine. I had very low vitamin D. My doc recommended supplementation if I wasn't willing to become a daywalker and my vitamin D levels were perfectly fine after a month of supplementing with 5k IU. I have cut back to 2K IU per day and my vitamin D levels are great since (5 years since I started supplementation).

These days those are called Oracle Lamps.

Here in Tasmania, and given the tone of my skin, in order to get enough sun exposure to provide for my vitamin D requirements...

I will spend enough time in the sun to damage my skin and significantly increase the risk of melanoma.

"There are some people (who are typically not dermatologists or experts in the biology of skin cancer) who have advocated for tanning to get vitamin D. But we know that UVB light causes skin cancer and that protecting yourself against it makes sense. As a doctor who treats patients who have melanomas, I want the general public to be advised that under no circumstances can use of a tanning bed or tanning in general be justified on the basis of vitamin D. Take a supplement instead."

https://www.yalemedicine.org/stories/vitamin-d-myths-debunke...

I heard tanning in short doses is actually ideal to prevent melanoma and procure the best vitamin D intake.

By exposing more of the skin, you absorb more vitamin D quicker, and so if you tan only 5 to 20 minutes depending on your skin complexion, you basically avoid skin burns and excess damage which causes melanoma and you get the benefits of the sun.

What do you think of this?

Edit: Maybe not what people think of as tanning, but it's basically skin exposure to the sun where you want to limit how long each part of the skin is exposed, but maximise the surface area for vitamin D absorbtion.

Source: https://www.outsideonline.com/2380751/sunscreen-sun-exposure...

After having my bloodwork show that I had low vitamin D levels a few years ago, I was told by my physician that under no circumstances should I be getting vitamin D from the sun (as risking cancer was not worth it) and to wear sunblock everytime I go outside.

Frankly, I don't have the time to do an extensive literature search to find primary sources but I have seen from plenty of tertiary sources that it is a poor idea to get vitamin D from the sun. Moreover, there are plenty of foods from which you can get vitamin D.

This is the source that first got me curious about this: https://www.outsideonline.com/2380751/sunscreen-sun-exposure...

There's quite a bit of research that seem to coroborate it.

Sun can cause melanoma, but lack of sun also has negative effects albeit harder to track. Some even unrelated to vitamin D, as it seems the Sun does more than just provide us with vitamin D.

But it seems that the research on melanoma actually indicates that it is sunburn that is the prime cause. And sun exposure while under 20 is another leading cause. But after that, exposure that does not result in burn, like short term exposure doesn't seem to cause melanoma and does provide other health benefits.

I recommend a read in any case.

Not saying to go wild sun tanning, but I think if you can avoid burn (even minor ones), you're good.

Being that we are extant mammals we are evolved from nocturnal animals, just that not recently. Primates diverged to be more diurnal.

https://en.wikipedia.org/wiki/Nocturnal_bottleneck

Some of us don't want to do that so we take vitamin D supplements and we're just fine. "Nature is always better" cult is really just magical thinking. I'm not saying that one shouldn't go for walks in the sun or that it's not healthy, but that's an individual's choice.

This would seem to indicate that for Covid19 the answer is yes: https://www.sciencedirect.com/science/article/pii/S096007602...

Small sample size but the effect seems large.

I have an inflammatory condition, and one of the things my rheumatologist checks is my inactive vs. active vitamin d levels (apparently there are two chemical forms that your body converts between). My poor understanding is that folk with inflammatory issues often have disproportionately high levels of the active form, and too much of it causes damage to the body. Most blood labs only measure the inactive form, though, and so taking vitamin D supplements based on levels from the wrong blood test could be risky.

There are a lot of studies that demonstrate taking daily Vitamin D supplements reduces the likelihood of lung infections.

Moreover, the first double blind clinical trial on Vitamin D and COVID-19 was published [0] which had astonishing results:

N=76

Percentage admitted to ICU: 50% -> 2%

Deaths: 8% -> 0%

I suggest you read the paper for the full picture, or to watch the analysis of Dr John Cambell [1] There’s more and more studies like this that demonstrate that Vitamin D helps prevent bad outcomes. In other words: people who are Vitamin D deficient are much more likely to develop severe complications after contracting COVID-19. 42% of Americans are Vitamin D deficient. For African Americans that percentage is 82%, because darker skin makes Vitamin D more slowly.

In Europe we are going through a 2nd wave of infections, yet the death-rate is much lower than the first wave. This could be explained by the lower Vitamin D deficiency in most people thanks to the summer.

For what it’s worth, I am taking 25mcg/day of Vitamin D supplement. They are dirt cheap (5Eur for 300 days). Dr John Cambell is taking 50mcg and an email from Dr Fauci revealed that he is taking 150mcg/day [1].

So even if you get exposure to sunlight, I would suggest looking into taking a supplement. Why the main media/government channels don’t talk about this more is baffling and potentially criminal. Maybe because there’s no money to be made from Vitamin D because there are no patents?

[0] https://www.sciencedirect.com/science/article/pii/S096007602...

[1] https://youtube.com/watch?v=V8Ks9fUh2k8

> Why the main media/government channels don’t talk about this more is baffling and potentially criminal. Maybe because there’s no money to be made from Vitamin D because there are no patents?

Or perhaps the supplies would run empty if this became big news (?)

Wouldn't that be a good thing for supplement manufacturers? They can charge more due to the scarcity.

It's definitely getting out there anyway, in my local Boots the entire vit D section was empty, still a few bottles of the more expensive versions left (e.g. gluten free versions).

Yes, but supplement manufacturers can't make health claims.

Vitamin D is extremely cheap, so I assume it is very easy to manufacture. It's also freely available in a lot of different stores. So I doubt there would really be a shortage.

Additional data point: In Belgium, it's encouraged to give your children daily Vitamin D supplements until the age of 6. That tells me that there is scientific consensus about the safety, and that there is a large supply of it.

How did you arrive at 25mcg (1000 IU)?

Dr John Cambell did a video on Vitamin D dose [0]. Also, the daily Vitamin D supplements that are freely available are typically in the 15~30mcg range.

[0] https://www.youtube.com/watch?v=Bga_qG30JyY

I would like to point out the limitations of the linked paper (you can follow along in the discussion section of the paper). Hopefully this can generate enough discussion on how to better design studies like this in the future:

1. Statistically significant difference in patients with documented hypertension in the no-vitamin-d group (p value 0.002, 15 vs 11 patients)

2. 2:1 randomization, reducing statistical power. They do not document the sample size needed from a power analysis looking for power > 0.80. They basically assumed that twice as many people without vitamin D would end up in ICU, when in reality 13x as many people ended up ICU. In general, I wish we could have a larger sample size for studies like this, but I know it isn't practical.

3. Biggest for me is no baseline serum vitamin D level recorded, just an assumption that patients selected were overall vitamin D deficient based on population. Seems like a simple enough test that could have been run as a send out test (no need to have the level during hospitalization, just for data gathering purposes).

4. Not placebo controlled, would have helped as placebo effect is real. For all we know, giving the research medication could have meant that the patient received more care and supervision, potentially aiding in their hospital course.

Correct. The sample population was also limited. IIRC the main conclusion of the study is that larger scale studies should be conducted.

Every study has limitations. Do you feel that the limitations you stated mostly invalidate the study?

Nevertheless, like the professor of medicine at Harvard Medical School JoAnn Manson stated in May 2020 [0]: "The evidence is becoming quite compelling [that good Vitamin D status will protect against severe complications]".

[0] https://www.medscape.com/viewarticle/930152

Effect size matters as well, not just sample size. The effect size in this paper is huge.

Sure. It's not a perfect experiment. But the result of 2% vs. 50% ICU admission is astounding. And sure, the sample size is small so it could have arisen by chance (not very likely though). Personally until I saw this result I listened very patiently and mostly agreed with the people who argued correlation vs. causation, lack of data, or random other non-data backed arguments. I think now the balance of the scale has shifted towards until proven otherwise I'm gonna be supplementing vitamin D and if I do get sick with Covid19 I'm going to be asking for this as part of my treatment. And if placebo is so strong here, then I'll get my placebo effect anyways ;) Until there's conflicting evidence or more studies I think that's a reasonable position/risk balance.

I think that's a pretty fair assessment, there's generally minimal risk at normal dosages you find in the store (1000IU or whatever). If you're really concerned, a quick visit to the doctor to get baseline labs is a good way to make sure you're not gonna verge on toxicity.

The other worry on taking vitamin D supplements is that people go overboard with them and end up with too much vitamin D. I'd consider that to be good evidence that you're not just making expensive pee

It absolutely works. I had very low vitamin D (hadn't had a checkup in a few years), and was completely normal within a month of starting a regime of 5000IU per day I was completely normal, so yeah just plain old capsule vitamin d works. I cut back and now take 2000IU a day and have been going in for regular checkups and it's been perfectly normal since.

I think like most Vit, Vit D supplementation works for those deficient.

Isn't going to do much for those not deficient.

You should get your vitamin d levels tested, and then supplement. I feel that I go outside a fair bit, but to get my vitamin D levels up I have to take 10,000IU per day. Now my Vitamin D is about 57 ng/mL. The daily recommend amount on the supplement bottles isn’t going to come anywhere near to cutting it, especially if you spend most of your time inside or live up north.

Could it be that just both, vitamin D deficiency and covid-19 risk, are much higher for people that stay inside most of the day (e.g. have office jobs)? Vitamin D is created from sunlight. Covid-19 is transmitted by aerosols. Is there additional evidence that Vitamin D supplements may help or do we just know about the correlation?

Brilliant thought, though I hope it is untrue.

Well, there's this article, also posted earlier on HN: https://www.devaboone.com/post/vitamin-d-part-3-the-evidence...

My personal experience with Cod Liver Oil (usually taken in Norway due to its high contents of Vitamin D) is that it really helps against dry lips. But you get a rather fishy breath from it...

You can get it in capsules. That should solve any taste and smell problems.

It depends. Some people still find them to be too fishy, but I’ve heard storing the plastic pill bottle in the freezer and downing them frozen can further mitigate the fishiness and reduce fishy reflux.

The study from the title is indeed just a correlation, from the abstract:

"This study used a retrospective, observational analysis of deidentified tests performed at a national clinical laboratory."

Whenever you see a "retrospective, observational" related to anything having to do with medicine or biology, consider that the experts seldom see that as a proof of anything, but only a hint to a possible hypothesis that could be investigated in some other way (and then confirmed or rejected).

As another example that correlation doesn't mean causation, even if the paper is published about the correlation, see:

https://youtu.be/UHDi6tNMHyU?t=2780

That "bald men and Covid-19" study did not control for age (where the older people are more probable to be both more bald and have worse outcome, making correlation not saying much when that is not controlled for), this study seems didn't control for "staying inside most of the day" or even "inside with more people" etc. Good catch.

This recently published study suggests vitD supplements alone provide some protection, even for acute cases. It’s a small sample population (n=75) and a pre-print, but it looks convincing to me (non-scientist, non-medical professional):

“Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission... Of the patients treated with calcifediol, none died, and all were discharged, without complications. The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged.”

https://www.sciencedirect.com/science/article/pii/S096007602...

Previous HN discussion: https://news.ycombinator.com/item?id=24390451

That link has only one comment. Actual discussion with 390 comments is:

https://news.ycombinator.com/item?id=24366006

and my comment there:

https://news.ycombinator.com/item?id=24366933

In short, my problem with that paper is:

"The whole paper contains neither raw data nor any graphs and only means and standard deviations"

Given small number of people in the study, it's not clear that there aren't some problems that aren't visible when reporting the means which would be obvious when looking at the actual data.

Even the randomized studies aren't "true" automatically: the process of randomization can have issues itself, and that should be also possible to check.

I know very little about nutrition but have wondered whether taking supplements actually help, or if it's the process that _creates_ those vitamins that's actually important/healthy.

Like in your example, being exposed to sunlight starts a process in our body that's healthy for our bodies, and vitamin D is just a by-product... and taking it as supplements wouldn't really do anything as we're missing the process.

As I said I have no idea what I'm talking about.

It could easily be some of both, in which case a supplement is not necessarily worthless, but not as good as sunlight (and the exercise and stress reduction that often goes with it).

> if it's the process that _creates_ those vitamins that's actually important/healthy.

By definition, vitamins are substances needed by an organism that it can't create itself, and must be obtained in its diet.

Vitamin D is technically not a vitamin:

https://academic.oup.com/ajcn/article/88/2/491S/4649916#1112...

vit D is an exception here, iirc it's the only 'vitamin' that doesn't fit those criteria

Vitamin D is arguably not a vitamin because we produce it when exposed to sunlight and it's actually a hormone. I guess that makes sunlight the vitamin.

>Is there additional evidence that Vitamin D supplements may help or do we just know about the correlation?

Yes. COVID-19 is known to affect the renin-angiotensin-aldosterone signalling cascade. Vitamin D is also known to be involved in this signalling. That's why speculation about vitamin D is more than just statistical hokum.

There is the chance of an error, but there is also a clear indicator for an underlying mechanism here.

I thought so too, but looks like there's difference even among kids. Kids with darker skin are more affected than their peers with lighter skin.

Could? Sure. But let's not start second guessing the science until after reading the full publication, especialy the part where the correlation is observed across all latitudes, which gives a fairly solid spread of sunlight exposure.

The prevalence of SARS-CoV-2 infection was 12.5%, 8.1%, and 5.9% for patients with deficient, adequate, and high levels of serum Vitamin D, respectively. This study clearly demonstrates correlation but further studies are needed to establish causative links.

The data comes from Quest labs that allowed the researchers to use the unique patient ID to associate SARS-CoV-2 PCR lab results with 25(OH)D blood test results. The dataset includes 190K patients.

Should be noted that the vitamin D levels were from the past 12 months.

This is pure correlation, as Deva Boone’s excellent blog clearly explains.

However, a few days ago there was on the HN front page a link to what appears to be causal effect - Covid patients who were given vitamin D On admission did better than those who didn’t. That study had some limit and they had a couple of uneliminated confounders - but the body of evidence does hint that proper vitamin D supplementation is likely beneficial in fighting Covid.

I believe this is the study you are referring too: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/

Massive effect size which somewhat compensates for the small N in this seemingly well-designed study.

No study can ever establish causative links.

A properly designed, well powered, double blind randomized controlled trial does a much better job at establishing causation than a retrospective correlation study, though.

Really? So atomic bombs explode when we set them off just by coincidence? Penicillin just happens to be administered every time the body decides to start fighting a bacterial infection?

According to some "scientists", if you sailed looking for India and found the Americas your experiment failed and you should go back and now search for the Americas.

Maybe you meant "no observational study"?

"The effects of high-dose cyanide on mortality in lab mice" will establish a very strong correlation, with an impressive effect size.

I suppose inferring causality still requires a leap of faith...

More recently I've seen more discussion of observational power. That's related to bayesian probability.

If someone said they fed a 3 month old mouse a 0.1 mg dose of Chemical X and it died immediately. Hard to argue that sample size of 1 means the result is worthless anecdote. The observability is pretty good.

That's utter nonsense. Of course they can. And they often do. Studies have limitations usually based on the statistics as a result of the size of the group and the degree to which confounding factors can be ruled out. But it is perfectly possible to establish a causative link by doing a well designed study, possibly even with small sample size.

Data availability got much better in the past following years (as a software engineer I can finally do modelling based on data published by medical researchers), but it's still too slow, which costs real lives.

,,Data underlying the study cannot be made publicly available due to ethical concerns about patient confidentiality''

I don't believe that any part of the data couldn't be made available (D-vitamin level - age - covid test results at least, even if location/time would be too sensitive to share). Not sharing any data has ethical concerns as well.

Wouldn't that expose more correlations that aren't proven to be causative?

There's some weird correlation in everything. That's half the numerology. Various correlations can also be useful in meta analysis (if you find some trend across many studies you can run a test for it specifically). Not publishing the raw data just in case someone doesn't know how to interpret the data is not a solution to anything.

> There's some weird correlation in everything.

For anyone who hasn't seen it yet: http://tylervigen.com/spurious-correlations

> Wouldn't that expose more correlations that aren't proven to be causative?

What is wrong with "exposing more correlations"? I don't get how that's an argument against data release.

I agree! It seems like it could have been anonymized. The government site I check regarding covid news that is local to me has the person’s age, sex, test results, and county. I don’t see how vitamin d levels could be an identifier.

Just venting - data during this pandemic has been one of the most frustrating parts for me. Data should be one of the tools we can use to get through this, but it’s been a struggle knowing what’s accurate and lack of certain information makes it hard to make good decisions.

One interesting thing is that the Russian vaccine tests were criticized for not sharing raw data by lots of researchers from western countries as well.

I'm definately taking vitamin D and not signing up for the Russian vaccine, but it seemed hypocrytical to me that only Russian researchers were shamed for not being transparent.

"One interesting thing is that the Russian vaccine tests were criticized for not sharing raw data"

I'm sure that, if one searched hard enough, one could find such a criticism. However, most of the criticism centered around the fact that the vaccine was "approved" on the basis of nearly zero actual human data.

I saw only 1 open letter signed by lots of researchers which contained many problems with the experiment: the main one for me was that the results that were supposed to be from independent experiments were extremely highly correlated. The reason behind that correlation can be not enough original data (cheating) or bad processing, but the western researchers asked for the original data to find it out.

Anonymizing patient data is quite difficult. Try a Google search:

"reidentifying" patient data

come on, it would be pretty easy to find out where it happened, who was treated and who was not treated.

After you uncloak everything, you just send lawyers to the untreated people (the families of those who died) and start litigating.

or you just let people know their loved ones didn't get the life-saving treatment and let them stew a while.

> It seems like it could have been anonymized.

But maybe the consent was not given for such a usage. Even if anonymized, we must respect the guise under which the data was provided to the researchers.

The really interesting data would be comorbidities that cause low Vitamin D. Those are (independent?) risk factors for severe COVID.

We don't know the source of the vitamin D: For example it's entirely possible that the type of person who has higher vitamin D levels is the type of person who takes care of themselves through things like vitamin supplements, and people who take care of themselves are less likely to have preventable underlying conditions.

So, as always, it's important to remember that this study was retrospective, not experimental in nature.

Or even that people who take supplements are more likely to get a “just in case” Covid test than someone who doesn’t supplement.

^ I think this is potentially the largest lurking variable here.

This would mean we should expect positivity and vitamin d levels to correlate. The study found reverse correlation.

I can see how it's confusing, but no.

If the type of person to take Vitamin D comes in for a test with less symptoms "just in case", then the probability that they are positive given that they are tested is lower.

Oh you’re right. I didn’t think carefully enough. Thanks! This does seem like a major factor to tease out.

No, if it's true, then it means that people taking taking vitamin D are more geared towards preventative measures, so they are more likely to get tested when in the absence of symptoms. More people who don't need to get tested would result in more negative test, so the inverse correlation is still the expects result.

Yes: There's evidence that lower-incomes are associated with less use of vitamin supplements [0]. And higher incomes would correlate to higher levels of health-care coverage that would allow for "just in case" testing.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843812/

There's been an rct and the effects of vitamin d are incredibly impressive.

https://www.sciencedirect.com/science/article/pii/S096007602...

There was recently a case in Amsterdam where visitors of a large night club didn’t get infected before 11pm. After 11 the club had to close its windows and people got infected.

Whenever there is a study about VitD deficiency, it could simply mean that it has something to do with time spent outside and temperatures. Isn’t COVID less likely to transmit outside?

Yes, but that's due to aerosols being much more volatile outside than inside.

Certainly, but I think that still leaves a lot of room for a non-causal correlation. In a toy model where Covid-19 is uniformly present in N% of indoor spaces and 0% of outdoor spaces, we'd expect infection rates to correlate strongly with vitamin D levels even if vitamin D doesn't affect the virus at all.

I work as a data scientist in one of the largest US healthcare companies.

We ran a similar analysis back in June and found comparable results based on our claims data. People with low vitamin D rates had higher likelihood of hospitalisation and mortality. Back there were less indications that vitamin D has any effect on Covid severity, and when I presented the analysis to our chief scientist he dismissed my conclusion.

Ok... but why was your conclusion dismissed? This is very troubling.

Quoting him: "Our data is so noisy, you can't really infer such a relationship from claims data" Since all those analyses are retrospective, it's not easy to build a case that will show a causal relationship between the outcome (hospitalization/death) and the covatiates (vitamin D levels). Some will say that this is impossible and only prospective studies will provide an unequivocal evidence.

Therefore, it is not rare that retrospective studies are encountered with skepticism. What baffled me is that recommending people to take vitamin D has almost zero negative consequences, so why not? the data supports it, even if it's not a solid rock proof.

That makes sense to me. If the evidence is not rock solid, you probably should not be making medical suggestions to your customers. The idea of my insurance company suggesting I should take supplements where that isn't within the typical medical consensus or part of government advice would make me uncomfortable.

That sounds like one of the reasons why there were less indications.

I'm not arguing against this paper, or that Vitamin D could be very helpful for covid-19 and other things.

But for casual readers it's good to know that Vitamin D is quite potent (it's a steroid hormone, in the same category as estrogen, testosterone and cortisol).

Too much is also harmful.

https://www.devaboone.com/post/vitamin-d-part-1-back-to-basi...

https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st...

https://www.devaboone.com/post/vitamin-d-part-3-the-evidence

I'd be interested to see the results broken out by racial group. There is evidence that blacks do not metabolize vitamin D the same way that whites do, and the standard test for vitamin D concentration does not measure its bioavailability accurately. This could strongly affect the results depending on the racial distribution of participants. In other words this effect could reduce the significance of the results.

Here's a popular article on the topic. https://www.npr.org/sections/health-shots/2013/11/20/2463933... though there's plenty of research articles available.

The difference is that the test evaluated 25(OH)D concentration, and not 1,25(OH)D which is the useful (metabolized) compound. There is currently no standard test for the latter, which is why they didn't do it. Though I would prefer to see those results, it would be easier at the present time to parameterize the study by racial group to reduce or eliminate this effect.

That said it would be nice if we could all just take a nice cheap vitamin for this. Caveat: I am not in life sciences.

Edit. They do show a figure which breaks out the relationship by race. https://journals.plos.org/plosone/article/figure?id=10.1371/... and it is much stronger for African Americans. Perhaps my hypothesis was incorrect.

Does it means that those studies that says most people of color in northern hemisphere are vitamin-D deficient not that strongly substantiated?

I though people of color produces less vitamin D due the skin pigmentation that filters light in UVB spectrum.

Skin pigmentation does affect vitamin D production.

There are a few stages between production of vitamin D and the delivery of useful vitamin D to the places where it is needed. The form produced by the skin is not the form needed, so it has to be transformed.

The usual test measures vitamin D levels at a particular stage, and then we infer that if the levels are normal at that stage, they will be normal at the final stage too.

The problem seems to be that this was calibrated based on the levels in light skinned people, and it is starting to look like the relative levels at the different stages are different in darker skinned people.

Think of it not as a dark skinned person's skin produces less than a light skinned person's skin, but rather the light skinned person's skin produces more than the dark skinned person's skin. Their bodies both need the same amount of the final form, and both are able to convert enough to that form, and don't bother converting much more than they need. The result is that the light skinned person has more leftover pre-conversion form. The test measures that pre-conversion form.

BTW, as someone who is Black — I didn’t find a single thing in your post racist. It talked about race, but not in a way to oppress or demean any group. At least that was my take.

That's because you are American. As a foreigner, I find the idea that you can label a group as "black" and imagine it to be both descriptive and homegenous enough to see meaningful genetic variations relative to another group labeled as "white" somewhat funny and verging on racism (but then again I have been conditioned from childhood to see the word race applied to humans as something deeply racist whereas it is seen as completely innocuous in an American cultural context).

> I find the idea that you can label a group as "black" and imagine it to be both descriptive and homegenous enough...

No, the whole distinction of black is dark skin colour, which is a proxy for skin melanin, which is (far as I'm aware) the primary factor determining vitamin D production from sun exposure (which is not directly useful in the body, but is the form that is often measured).

Also, because of the effect on vitamin D production from sun exposure, there is some evidence that other aspects of how vitamin D is handled by the body are different for people with darker skin, maybe because their ancestors got more than enough of it.

This isn't even about social categories “Black” and “White”, it is literally about the direct correlates of skin colour.

I mean, black and dark skin colour are overlapping sets, but the word black doesn't define everyone with dark(er) skin.

If you mean darker skin (darker than what???) then use that term.

Accuracy is important.

>This isn't even about social categories “Black” and “White”, it is literally about the direct correlates of skin colour. To expand upon this according to an ONS study "Blacks" in England and whales had a 1.9 times higher rate of dying compared to "Whites" after socioeconomic controls, while Pakistani and Bangladeshi ethnic groups were 1.6 times more likely.[1] This makes sense if you figure lighter skin was a evolved trait for those in latitudes that got less sun. [2]

[1] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...

[2]https://www.pnas.org/content/107/Supplement_2/8962

Whales?

Let's assume that was just a particularly hilarious typo for "Wales".

Indeed, though thinking about it people living in "whales" would probably have low vitamin D levels as well.

I spent about 3 seconds wondering why in the world you were talking about whale vitamin-D levels, and thinking it was vaguely offensive that you were comparing ethnic/racial groups of humans to marine mammals.

Then I remembered that Wales exists :)

I'm a white dude, so obviously I can't speak for black people and it's not typically appropriate for me to get super offended about this on your behalf, but personally there's something so jarring to me when people use "blacks" as a plural noun. I think by prior experience, when I hear it put that way it subconsciously primes me to expect the person speaking is angry and racist. I've just heard so many people say it that way in agitated tones.

Then again, I've also definitely heard older people talk that way and they don't seem to mean harm or be angry.

It’s not a racist post obviously- but it is false to group people into the American race definitions in a scientific discussion, because it doesn’t hold true and has been debunked a long time ago as a genetic definition.

It can apply from a socio economic angle, but that applies only in America or a country that uses American racial profiles for systemic racism.

Edit: Aware this is a controversial viewpoint in non-scientific communities, so here's some interesting comments from Wikipedia on the subject:

> Modern scholarship regards race as a social construct, an identity which is assigned based on rules made by society.[2] While partially based on physical similarities within groups, race does not have an inherent physical or biological meaning.[1][3][4]

> Social conceptions and groupings of races have varied over time, often involving folk taxonomies that define essential types of individuals based on perceived traits.[5] Today, scientists consider such biological essentialism obsolete,[6] and generally discourage racial explanations for collective differentiation in both physical and behavioral traits.[7][8][9][10][11]

> Even though there is a broad scientific agreement that essentialist and typological conceptualizations of race are untenable,[12][13][14][15][16][17] scientists around the world continue to conceptualize race in widely differing ways.[18] While some researchers continue to use the concept of race to make distinctions among fuzzy sets of traits or observable differences in behavior, others in the scientific community suggest that the idea of race is inherently naive[7] or simplistic.[19] Still others argue that, among humans, race has no taxonomic significance because all living humans belong to the same subspecies, Homo sapiens sapiens.[20][21]

I’ve gotten blood tests done where the normal range for various parameters was listed as being different for different racial groups.

If there is no correlation between genes and “American race definitions”, how is this possible?

https://www.nationalgeographic.com/magazine/2018/04/race-gen...

https://www.eurekalert.org/pub_releases/1998-10/WUiS-GSRD-07...

https://theconversation.com/racism-is-real-race-is-not-a-phi...

To add a bit more weight it’s worth reading the intro to race on Wikipedia https://en.m.wikipedia.org/wiki/Race_(human_categorization)

I’m aware that race is not a strictly defined category, and that racial classification is arbitrary to a large extent. However, this doesn’t answer my question.

It demonstrates the logical fallacy - if it's an arbitrary classification, as you say, how can those blood test groupings be accurate? They can, at best, be arbitrary

“Arbitrary” doesn’t mean “uniformly random”. Even though the lines are blurred, there is still a strong correlation between being considered part of a particular racial classification in the US and having certain genes.

Thanks for the interesting first link. Now I understand your earlier comment

Just a note that they are estimating race using zip code. I’m not sure you’d want to draw any conclusions from that.

> To analyze race/ethnicity, patient data were linked to estimated race/ethnicity proportions reported by zip code in the 2018 5-year American Community Survey (ACS)

Dr. John Campbell, a registered nurse in the UK, has spoken about this subject for months evaluating the evidence. You can find several videos about it in his YouTube channel: https://www.youtube.com/channel/UCF9IOB2TExg3QIBupFtBDxg

This would be the one to start with: “Vitamin D, large scale studies” (12 sept. 2020) https://www.youtube.com/watch?v=iNji13yoW9g

Derek Lowe wrote a post this week on the "bradykinin hypothesis," and how it has been gaining traction as a unifying model that can explain many of the observed effects of infection, including sensitivity to vitamin D levels.

[1] https://blogs.sciencemag.org/pipeline/archives/2020/09/08/br...

Yes, this means you should measure your blood Vitamin D and supplement whenever it shows up as deficient (much more likely in the winter). Yes, correlation does not prove causation, and yes, the recent randomized controlled study[0] may have problems too, but in aggregate the evidence is overwhelming. Don’t forget!

[0] https://www.sciencedirect.com/science/article/pii/S096007602...

Never purchased vitamin D before, if I were to walk into a CVS or Wallgreens what would I be looking for? Is this something you can just buy OTC?

Yeah, you can easily purchase it over the counter and it's very cheap. You can find it in the vitamins and supplements section. You should probably be looking for "high-strength" pills of 1000 IU. I won't say exactly how much you should be taking, but typical recommendations are of at least 1000 IU per day.

If you want to do around 1000 IU per day, it may be worth looking at multivitamins. For example, Flintstones Complete [1] chewable children's multivitamins are 800 IU per tablet. One or two tablets a day of those should have you covered.

If you want to take much larger doses of some vitamin, say 5000 IU a day of D, it would probably not be a good idea to do it via multivitamins because you would then be getting large doses of many other vitamins and minerals. At the very least you'd have to do a lot more research to make sure all of them are safe in larger doses.

[1] Just because you an adult doesn't mean you have to settle for the bland or worse taste of "adult" multivitamins. We are allowed to take flavorful children's vitamins too.

It would look like a gallon of milk or a box of cereal. (Many foods are fortified with vitamin D. Check food labels for the level they provide.)

It depends on the milk. The two litre bottle of UK pasteurised milk in my fridge mentions B2 and B12, nothing about D. Is American milk UHT?

It’s otc. You want D3 variant, rather than D2. There is some disagreement about dosage - FDA RDA is 400IU daily for adults, but there are reasons to believe it is way too low.

Personally, I’ve taken 10,000IU daily for years with only positive effects (also Some K2 and Mg - they likely work in tandem). Deva Boone’s blog describes a case where 5000 IU /daily over years was too much for one of her patients. Do your own research.

There also reason to believe it should be take early in the day (say before 10am), as vitamin D is a derivative of sunlight (among others) and taking it in the evening/night seems to mess the body’s internal clock. (Google “gwern vitamin D” for more)

I am severely Vitamin D deficient due to a medical condition I have which prevents my body from absorbing VitD via the gut (which is how many consume it the most, via food you eat, not via sunshine). I’m on prescription strength VitD supplements and take weekly doses that are 50,000IU. I would not recommend self medicating with high doses of Vitamin D without consulting with a doctor because if you aren’t deficient like me, taking high doses like that can be dangerous as the side effects aren’t fun.

I did not bother consulting with a doctor before I started, mostly because my GP is an ultra conservative guy and categorically recommends against everything. But I do get regular Blood tests, and am Consistently at the high end of the “good” Bracket. (55 ng/ml? Don’t remember the exact number and don’t have it accessible this second)

I have an actual minor deficiency as well and had accidentally bought the wrong potency (the bottles are identical except for the 4 pt flyspeck font specifying the amount) from the store and had been mistakenly taking 5000IU/daily instead of 1000IU/daily for about 6 months. When I informed my doctor of my mistake, he ordered a test and although my serum vitamin D levels were not outrageously high they were at the upper limit.

So definitely easy to "overdose" on vitamin D and as you point out - the potential side effects are not pleasant.

> You want D3 variant, rather than D2.

Huhm, I have multivitamins that say "Vitamin D" with no hint as to which type. Any idea which it's likely to be?

Most likely D3. D2 is quite hard to find.

I've been ordering online for a while now, but on store shelves when I was looking it was 3:1 for the D3 -- with the D2 being significantly cheaper.

If it's hard to get D2 these days, that's much better.

Wikipedia has the scientific names.

A walk to the pharmacy (or any outdoor activity) with some skin exposed to the midday UVB rich sunlight might be a better approach than oral supplementation [1]:

> Adequate amounts of vitamin D can be produced with moderate sun exposure to the face, arms and legs (for those with the least melanin), averaging 5–30 minutes twice per week, or approximately 25% of the time for minimal sunburn.

[1] https://en.wikipedia.org/wiki/Vitamin_D#Synthesis_in_the_ski...

During the summer at higher latitudes yes. But as the angle of the sun lowers, the amount of UVB getting through the atmosphere goes down. Also skin tone has an effect. Darker skin creates less from the same amount of sunlight.

At least in the UK, just off the shelf.

Look for a vitamin section, there's probably effervescent soluble tablets in tubes, swallowable capsules in tubs, and swallowable gummy things marketed towards children in tubs.

'Multivitamins' also may or may not include it, check the back.

Buy it on Amazon. Get D3, it's very common and cheap. 1000IU a day should be enough for anyone unless you know you have a deficiency and were told that by your PCP.

I often wonder how fast the effect of vitamins is.

Let's imagine would could measure the level of Covid-19 symptoms with infinite precision. And let's imagine Vitamin D has a positive effect. And let's imagine we have infinitely large test groups.

Then how long after the intake of Vitamin D would we see a difference in symptom levels compared to the placebo group?

Would it take weeks? Days? Hours? Minutes? Seconds?

Hours:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/

FWIIW vitamin-D level is almost certainly why brown people and nursing home residents are disproportionately dying of Corona-chan.

What is corona-chan?

If it exists, there is probably a cute anthropomorphic representation of it. https://www.youtube.com/watch?v=iBoojBTEPaI

I mean, nursing home residents are typically older, meaning that they and everyone around them are more susceptible to the disease (meaning it's likely to spread faster and be more deadly). Black and brown people disproportionately work in service jobs where they get exposed to a lot more people; they're also less healthy on average than whites. It seems like there are other very likely causal factors than just vitamin D.

So I eat two bowls of cereal with milk a day, live in Texas and out in the sun several times a week (mowing, gardening, etc). Do I need to worry about vitamin D?

Your primary care physician is who you should ask. Mine takes a blood test with the yearly physical, which includes a vitamin D measurement. They can tell if you're deficient and by how much.

Consider that your body evolved to be in the sun all day every day. It's possible you could still be D deficient even if you get a lot of sun relative to the typical sedentary person. A vitamin D panel can be purchased at most labs for $70. They usually offer packages that will run a complete blood count, chem, and others for a more economical price. You do not need a Dr's prescription to get these labs done. You can interpret the results yourself with a little bit of research before you go to the Dr.

I get my own labs done a few times a year so when I sit down with my doctor I can show them the labs in Apple Health and then it doesn't take 3 visits to have a real conversation. You are the only advocate in the health care system for your health. I encourage everyone to lean in when dealing with doctors. I make them explain everything including their rationale. You'll find many doctors disagree with each other on even the most common problems. If they don't have the time to sit with you and explain your health to you then they shouldn't be your doctor.

If you're out in the sun every day, probably not. If you are indoors all day, it's probably a good idea to take a supplement. This calculator page is a great way to estimate how much time outside it would take for you to get generate a specific level of vitamin D given your skin colour, latitude, cloud conditions, time of day and so on:

https://fastrt.nilu.no/VitD-ez_quartMEDandMED_v2.html

For me it calculates only 15mins needed in the sun to get an equivalent dose of 1000IU. Note however that depending on where you read, a recommended dose per day may be 10,000-15,000IU.

You need a blood test to know. If you're out in the sun that much though you're probably okay. But never trust the opinion of an online armchair doctor. The tests are relatively cheap if you get it with your annual exam which you should.

Two variables missing, skin color and age.

As a official member of the "old fart" society I have a memory of something from 50ish years ago, probably in Time magazine, that documented the fact the US military found cases of rickets associated with low vitamin D levels in personnel stationed at the DEW (Distant Early Warning) line, a group of radar stations in the high arctic. The cases were among people with darker skin. So there's some old evidence correlating Vitamin D, skin shade and sunlight exposure. Wish I could remember the source...

I don't know anything about academic statistics. Is it a weakness in the study's conclusions that the sample size from predominantly Black & Latino communities is an order of magnitude smaller compared to non-Black & non-Latino communities?

edit: I'm not trying to imply malice or anything, but I have learned the last couple years how ethnic minorities & women are often underrepresented (or not represented at all) in medical studies, leading to poor health outcomes for those communities.

It depends on the inference you want to make. Average treatment effects are integrated over the entire sample. But that means it can “miss” or be biased for a subsample. You can then explicitly model that subsample, but sub samples by definition have less power. It’s not just black or minority, it’s also any subsample, like a history of hear disease, or height.

For further reading google: “Gelman there is never enough data”

I have some experience in that area. If I'm reading this correctly, they don't know race, only ZIP code. They are extrapolating race from zip code. They also seem to be deriving results for extrapolated black/hispanic populations based on using the other populations as a control.

Its really just a question of whether their sample sizes are large enough to justify a conclusion about the overall population. They are reporting a 95% confidence interval. Real back-of-the-napkin math (read: don't take this to the bank) would say that a sample size of 9,604 could get you a 95% confidence interval with a 1% margin of error on a population of 100 million. So it seems they are doing ok, but this is not to say there are not a bunch of other possible issues or confounds to consider if someone dug into the study.

This is actually slowing down some trials in the USA as they don't have enough non-white participants. I don't know if that's because they aren't trying hard enough or ethnic groups just don't trust the studies/corps running them. Probably a mix.

Hmm, could this relationship also somewhat explain the bigger incidence of respiratory viruses during winter, when sun shines less, and we produce less vitamin D?

This is a possibility. Or at least it is a plausible mechanism of action for higher susceptibility. If true we should expect seasonal variance in prevalence to decrease as you move towards the equator.

There is in fact data that shows this correlation, I may post a source later.

It still isn't a strong indicator of causation, since nearly all seasonal climatic effects diminish towards the equator.

It could do, but there are other known effects at work (such as temperature and humidity) that are known to contribute, and that would also be correlated with vitamin D levels. You’d need to do a study to tease out the causality and the relative contribution of all those factors (if one hasn’t been done already).

Edited to add: this looks like a reasonable review of the literature: https://www.annualreviews.org/doi/pdf/10.1146/annurev-virolo...

I believe the factors are alleged to be many, including dry air in heated rooms which irritates nasal passages, many people often huddled indoors which contributes to infection spread, and so on.

Cold temperatures are, of course, involved in all of those, but very tangentially. (Unless one persistently lives in poor heating conditions, which combined with cold outside would likely take a toll on one’s immune system—from my, non-doctor’s, understanding.)

Our family takes vitamin d supplements. I’m not sure what the ultimate efficacy is but the low risk-high potential reward seems compelling. My kids think the yummy gummy versions are a treat anyway. Just be aware that like most things you can take too much vitamin d. By all means take some supplement but don’t overdo it or the low risk part of the equation changes.

Be careful with overdosing, though. Some people need high doses because they are very deficient. It is sold OTC in high doses. The amount of vitamin D in your body accumulates if you take it daily at high doses. Don't go overboard. Beyond a readily attainable threshold, more is not better.

Do any medical experts know, does this mean I should take a vitamin D pill?

Not an expert at all but moderate dosage should have no side effects. Regular Overdose by 2000-3000% can have some long term negative effects.

Not an expert, but as usual, it depends. You may want to check your levels changing too because you can overdo it https://en.wikipedia.org/wiki/Vitamin_D_toxicity Talk to your doctor.

IANAD, but reasonable algorithm looks like:

If you can test, test. Look online what normal levels should be - you'll find several options, pick the higher ones (look for Vitamin D Council for an upper bound recommendation)

If you can't test or you test below optimum and you can sunbathe - do that. A lot. It's inherently safe as far as overdose goes. For skin cancer, it's usually worth the risk, and definitely worth it during the pandemic (unless you have specific reasons to think you're higher risk).

If you can't test and can't sunbathe... in normal times I'd suggest to supplement except in summer. But in Covid times, I'd go with light supplementation during summer (<1000 UI daily) and higher dosage staring autumn (~2000 UI).

Note that not that much sun exposure is required. The dminder app is a good way to estimate update based on sunniness and percent skin exposed.

The replies from the developer to reviews makes me not want to support this dev. Any other good options?

I’d suggest reading this series of blog posts on Vitamin D by Dr. Deva Boone (they were also shared here before):

https://www.devaboone.com/

If you’re deficient or not getting enough exposure to the sun around midday, then supplementing could be useful. As a preventative measure for COVID-19 or as a measure to make COVID-19 less severe (or for reducing the risk of any other ailment), the blog posts cited above conclude that there is no evidence. There are correlations, but we know that correlation does not necessarily mean causation.

Please read the blog posts and arrive at your own conclusion.

Before starting supplementation you should check with your doctor and he would have known from your last annual exam if your vitamin D was low. If you get plenty of sunlight then you most likely don't. If you're a vampire like me then you absolutely need supplementation (my doctor prescribed it about 5 years ago when I showed very low blood levels of vite D).

Interesting study, but it’s has been suspected for long that vitamin D might have all this effects.

Without being able to see the data, this does not feel right. I would like to see how they did cross-validation, test/train split, assigned weights, proportion of missing values. If you have data, this can be easily reproduced and studied. What if it’s overfitting?

Why is Vitamin D not called "Hormone D"?

I understood that vitamins could not be produced by the body, but hormones are produced by our bodies. How many "Scientists" would argue that hormone D therapy actually works instead of arguing against the efficacy of vitamin supplements and lumping the oddball possibly miss named Vitamin D in with them.

At this point it's worth questioning why viral diseases are so prevalent in the winter in the Northern hemisphere and that they show a clear seasonality

Would make a lot of sense to test vitamin d deficiency (Inc beyond RDA) vs immune system response

Most likely, what this shows is just that people with strong immune systems that can fight off the corona-virus also tend to not have vitamin D deficiency (in part because frail people tend to spend less time outside in the sun).

Question: Vitamin-D deficiency is also often associated with Vitiligo, discoloration of the skin.

Is there any correlation between Vitiligo symptoms and COVID-19?

It's nice that HN has finally moved beyond labeling Vitamin D's relevance to Covid a conspiracy theory. I put some articles on here about it a month or two (edit: 6 months) ago, and posters went as far as to go through my submission history and call me a conspiracy theorist for my "history of posting debunked vitamin D conspiracies".

Edit 2: how's this for ironic: looking back over the past year, the single source of information about the virus that has turned out to 'get it right' most frequently (not counting noise) is 4chan.

Fauci says that he takes vitamin D supplements and that they can lessen 'your susceptibility to infection'

https://www.insider.com/fauci-takes-recommends-vitamin-d-and...

Glad he's finally willing to admit it. I hope the factcheckers stop calling it fake news soon. I wonder how many people died because it wasn't taken more seriously sooner.

Sorry you are getting downvoted for having a dissenting view. Everything gets twisted to become political. The same people shaming those for wearing masks initially came around in their own way to advocate strongly for cloth masks. The same people who refused to acknowledge Vitamin D benefits against Covid at the beginning are coming around now. HCQ is even more political ("serious side effects") in the US. It might be less political elsewhere.

I can't speak for all fact checkers, but I'd suspect that sometimes they might be more nuance provider, or in other words: reality checkers.

For example, it would be exaggerated to believe that vitamin D can cure Covid and prevent its spread.

It would also be a bad idea to start high dosing vitamin D unmonitored.

The kind of misunderstanding of the impact and influence of such thing is often an issue when layman hear about medical and other scientific research. So I think a lot of people get worried of some people overblowing things and taking gambles. Science doesn't put its faith in anything, but sometimes layman will put their faith in preliminary results from a few studies.

And another thing is, the science will change over time, and might contradict itself as well, and the layman will again begin to lose faith, because they make it about faith and beliefs, and that's dangerous.

> nuance provider, or in other words: reality checkers

If that were the case, they would be far less emphatic. In fact, since the science can "contradict itself", they seem to be saying far more than they can justify.

> It would also be a bad idea to start high dosing vitamin D unmonitored.

I think when it's compared to the risk of contracting covid, 1000IU / day of vitamin D is justified.

> exaggerated to believe that vitamin D can...prevent its spread

Would it? I think we're finding that vitamin D is probably more effective than face masks.

> layman will again begin to lose faith

Lose faith in the ability of scientists to solve the problem, or lose faith in the PR folks that (demonstrably, sometimes obviously) don't tell the truth? Science is only 'about faith and beliefs' when the layman is told to believe specific people, or blindly obey the experts.

> (not counting noise)

If you ignore _everything_ said on 4chan which turned out to be wrong, of course what's left has to be correct.

Besides, correlation doesn't necessary mean causation. This paper is just a singular piece of evidence, don't jump to conclusion so quickly.

OTOH, I do also think people jump to the conspiracy bandwagon too quickly as well.

And that's still better than e.g. CNN, which took months to admit that hydroxychloroquine might possibly be useful.

That's the difference: over there, you can actually consider possibilities that aren't part of the official story, and then come to your own conclusions. CNN was simply wrong; 4chan was noisy, but did have the right answer.

If you ignore everything on CNN that was wrong, in some cases (like vitamin D and hydroxychloroquine) there's nothing left at all.

There had been trial and so far there is no evidence that hydroxychloroquine is beneficial to COVID-19 patients.

Probably shouldn't get your news from 4chan.

Last I checked, the hydroxychloroquine studies were looking up. "No evidence"? Maybe you should find some better sources.

https://news.ycombinator.com/item?id=24298838

https://edition.cnn.com/2020/07/02/health/hydroxychloroquine...

https://news.ycombinator.com/item?id=23923861

Serious adversarial effect:

https://www.thedailybeast.com/chloroquine-study-ended-in-bra...

https://www.nytimes.com/2020/04/12/health/chloroquine-corona...

Revoked FDA use authorization:

https://www.fda.gov/news-events/press-announcements/coronavi...

Example of researches that doesn't see an effect of hydroxychloroquine:

https://www.nejm.org/doi/full/10.1056/NEJMoa2019014?query=RP

Edit:

However, there were researches showing hydroxychloroquine increase arrhythmia risks, which were actually based on fraudulent data and has been retracted:

https://en.wikipedia.org/wiki/Surgisphere#Lancet_and_NEJM_ar...

So the trails might be stopped prematurely. But I still believe there are not conclusive evidences currently. e.g. as shown by this meta-analysis: https://www.clinicalmicrobiologyandinfection.com/article/S11...

> Serious adversarial effect

It's a well-understood drug, and any doctor worth their license would know how to use it safely.

> Revoked FDA use authorization

All that means is that more evidence is required before there's an official stamp of approval. "this drug may not be effective to treat COVID-19..." is what the actual request to revoke authroization said.

> Example of researches [sic] that doesn't see an effect of hydroxychloroquine

And there's other evidence contradicting that.

You said there's "no evidence" it's beneficial. That's pretty clearly false, merely based on what I already linked (maybe you should broaden your reading habits). We can debate the degree of confidence the accumulation of studies can give us, but that's outside both our leagues.

The "therapeutic" dose of HCQ in COVID-19 patients is usually 600mg and up. The therapeutic dose for e.g. rheumatoid arthritis is 400mg or less. These higher doses were linked to arrhythmia and very little evidence of a beneficial effect has been found.

HCQ has been used in petri dishes against many viruses and been successful there. Whenever they use it in vivo, it fails. This is not a new phenomenon. The link below is somewhat dated at this point (May 2020), but I believe it still stands.

https://www.sciencedirect.com/science/article/abs/pii/S01663...

In any case, if the FDA is saying "may not" the drug is not a slam dunk even if it has some beneficial effect. Winning the rhetorical war on HCQ isn't going to make COVID go away or be less serious in a substantial fashion.

> Winning the rhetorical war on HCQ

You said there's "no evidence". I said you were wrong, and apparently could muster better information than you could. That's not rhetoric, that's logic and evidence.

One more for the pile of evidence that Vitamin D supplementation may(!) help.

It baffles me that masks are officially recommended despite scant evidence that they help, yet Vitamin D is ignored.

EDIT: This is a not an argument against mask usage, it's pointing out the double standard applied to two different cheap and low-risk interventions.

Masks have a 100 year history of helping to stop respiratory infections.

I'm taking vitamin D, but as the sun shining have other advantages as well (being outside, not coughing that much because of the better weather), it's harder to decide whether taking extra vitamin D helps.

There is a lot of evidence for efficiency of masks, actually:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

That is, as usual, a basket of low-quality studies that suggest that surgical masks may(!) decrease infection.

In other words, scant evidence, just like I said. The difference is in the branding.

> basket of low-quality studies

In what way are they low-quality? They are basically as good of a quality as the ethical considerations allow any studies to be made in this area (it's not like you can make an RCT that actively tries to infect participants to study how well the virus does).

In what context are you using the word "scant" here? What kind of practical (realistic) evidence would even satisfy your judgement here as "non-scant"?

It's good enough evidence to act on. Obvious that masks reduce viral load.

I'd like to offer a counterpoint on the masks: as soon as the epidemic started, the Hong Kong population -remembering SARS 15 years ago- started wearing masks and sanitizing hands.

Hong Kong is one of the most densely populated area in the world. There is no way to implement effective social distancing here

The result so far? one of the lowest rate of infection and death per capita of any developed country: 675/M and 12/M respectively.

To put this in perspective, the UK and US are at 50x that death rate.

So we may speculate about what had a strongest effect -sanitizing hands, masks, temporary closure of schools and entertainment venues, partial work form home- but it seems difficult to argue that masks have no effects as most of these measures were also tried elsewhere. A major difference being that, in HK, no-one leaves the house without wearing a mask.

I'm not arguing that masks don't work, I'm arguing that the evidence is of low quality. Not that the evidence is wrong, or that people shouldn't wear masks.

If you're advocating the wearing of masks premised on that sort of evidence, you should be advocating Vitamin D supplementation, and you probably should be advocating Zinc+HCQ as a prophylactic, because you just lowered your scientific standards by that much.

What sort of evidence would you like to see?

Well, of course I'd like to see a double-blind placebo-controlled gold-standard trial on a million subjects from diverse backgrounds!

In fact, I don't need more evidence to wear masks. I have no problem with wearing a mask. I have no problem with advocating the wearing of masks in an honest fashion. It's plausible that masks do help to some degree. It's however also plausible that they hurt in some ways, that they serve as a reservoir for viruses and bacteria.

If anything, I have a problem with the intellectual dishonesty surrounding the advocacy of masks.

There is abundant circumstantial evidence that these two hypotheses are not of equal plausibility.

If you see the various implementations of measures in different countries as large scale experiments, I think you can derive some useful information and answer your own questions.

There is maybe some point of diminishing returns in wearing masks, but what the limit is isn't clear. Sweden seems to agree with you and against general use of masks, although my trust in their approach is limited by their pretty terrible results: death rate of nearly 600/M against HK's 12/M.

Regarding increased risk of falling ill because of the mask, there is not much evidence to support that. That's not saying it doesn't or can't happen but while you emphasise a lack of evidence to convince you that masks are worthwhile at scale, there is even less evidence that wearing a mask will cause any other type of hurt that would cancel-out the benefits.

I personaly hate masks, they itch, are uncomfortable and they pollute. It's clear they are not a panacea. They are however part of the small set of limited practical measures that we can take to help slow the rate of infection (by limiting the exposure of others to the crap we exhale).

Hong Kong will be an interesting experiment to follow because I foresee that people will continue wearing masks long after everyone else. We'll see the long term effects this has on the 8M people living there. I'm sure it will be worthy of a few papers.

> Sweden seems to agree with you and against general use of masks, although my trust in their approach is limited by their pretty terrible results: death rate of nearly 600/M against HK's 12/M.

No matter how often I say "I'm not against masks", people still read it is "this guy is against masks", merely because I question the quality of the scientific evidence. No sane discussion on this topic is possible anymore, it's all "which side are you on, boy?", which is disheartening.

> That's not saying it doesn't or can't happen but while you emphasise a lack of evidence to convince you that masks are worthwhile at scale, there is even less evidence that wearing a mask will cause any other type of hurt that would cancel-out the benefits.

I literally said I don't need more evidence in favor of masks. It's not about masks, it's about Vitamin D in light of our treatment of masks. I don't need more evidence in favor of Vitamin-D supplementation, either. Go for it, just be honest about it.

> No matter how often I say "I'm not against masks", people still read it is "this guy is against masks", merely because I question the quality of the scientific evidence. No sane discussion on this topic is possible anymore, it's all "which side are you on, boy?", which is disheartening.

You've said you're against advocating mask usage. We are arguing that although there could certainly be more and better evidence, that there is more than sufficient evidence to advocate for their widespread usage.

> You've said you're against advocating mask usage

I haven't said that either.

I'm doing D, C, Quercetain and Zinc.

Similar to Tokyo, the masks were on very early in the game, so far it seems relatively mild compared to The USA.

I would say that we don't yet have the desired level of evidence for the effectiveness of either masks or vitamin D supplements when it comes to battling covid-19. The difference is that it's almost certainly not going to harm someone to wear a mask, whereas recommending vitamin D supplements to everyone might.

I really want vitamin D to be the miracle cure for this disease but so far only a single RCT has been published. Like you say, this study adds to the pile but doesn't talk about supplementation as such. This particular paper was completed in July and only published two days ago. Hopefully that means there are more studies waiting to be released that can give us a more concrete answer.

> The difference is that it's almost certainly not going to harm someone to wear a mask, whereas recommending vitamin D supplements to everyone might.

Vitamin-D supplementation is considered safe and is already recommended to everyone by health authorities, at least seasonally, not specifically for COVID-19 related reasons. That's just not part of the media spectacle, but it think it should be.

There were lots of arguments against masks in the beginning, such as people becoming more careless due to feeling "protected". It's a valid argument to make, but you couldn't make it anymore today, "masks are good" is dogma.

Obviously, Vitamin D is not a miracle cure, but there's mounting evidence that it may be beneficial, just like masks, perhaps even drastically more so. I don't accept the "we need to wait for more evidence" argument anymore when I'm simultaneously forced by law to wrap a piece of cloth against my mouth/noise, based on similarly poor evidence.

>> Until treatment and vaccine for coronavirus disease-2019 (COVID-19) becomes widely available, other methods of reducing infection rates should be explored.

Until we figure out how to profit, maybe we should let people use existing stuff so they dont die?

Yeah, I woke up in a bad mood :-/

As with any source, reader be mindful of comments here on HN. When outbreak happened and lockdowns were getting in place, you could've read here people getting chloroquine and how to dose it yourself.

The risk profile of vitamin d is different than chloroquine. Taking vitamin D on weak evidence still passes cost vs benefit.

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