Vitamin-D and COVID-19: do deficient risk a poorer outcome?
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One mostly overlooked factor that could influence outcome of COVID-19 is the relative vitamin D status of populations. Because people are advised to stay at home as much as possible, the government health agencies of Great Britain have recommended that people take vitamin D supplements through summer and autumn during this pandemic. Vitamin D supplementation could be especially important for older people as they are at high risk of poor outcome from COVID-19 and of vitamin D deficiency.

A 2017 meta-analysis of individual patient data from 11 321 participants in 25 randomised controlled trials showed that vitamin D supplementation protected against acute respiratory tract infections and that patients with very low serum 25-hydroxyvitamin D concentrations (a marker of vitamin D status) gained the most benefit.

A role for vitamin D in the response to COVID-19 infection could be twofold:

1. Vitamin D supports production of antimicrobial peptides in the respiratory epithelium, thus making infection with the virus and development of COVID-19 symptoms less likely.

2. Vitamin D might help to reduce the inflammatory response to infection with SARS-CoV-2. Deregulation of this response, especially of the renin–angiotensin system, is characteristic of COVID-19 and degree of overactivation is associated with poorer prognosis. Vitamin D is known to interact with a protein in this pathway—angiotensin-converting enzyme 2 (ACE2)—which is also exploited by SARS-CoV-2 as an entry receptor. While SARS-CoV-2 downregulates expression of ACE2, vitamin D promotes expression of this gene.

“At best vitamin D deficiency will only be one of many factors involved in determining outcome of COVID-19, but it's a problem that could be corrected safely and cheaply; there is no downside to speak of, and good reason to think there might be a benefit”, said the researchers.

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