Suggested role of Vitamin D supplementation in COVID-19 severity

Abstract: Letter to editor ISSN 2413-0516 Suggested role of Vitamin D supplementation in COVID-19 severity Parviz Afshar1, Mohammad Ghaffaripour2, Hamid Sajjadi3 Hospital Director, Iranian Hospital Dubai, Dubai, UAE2 ICU Director, Iranian Hospital Dubai, Dubai, UAE Neuro-Ophthalmology Director, Iranian Hospital Dubai, Dubai, UAE Corresponding Author: Hamid Sajjadi (Email: hsajjadi@yahoo.com) 1 3 Dear Editor in chief The Journal of Contemporary medical sciences Vitamin D, a pre-hormone, regulates and/or affects multiple functions such as immune-, coagulation-, cardiovascular-, central nervous system, inflammation, cancer rates, deep-vein-thrombosis, sleep-apnea, and respiratory tract infections (RTIs).1-8 The role of vitamin D in reducing RTI is outstanding as reported by a meta-analysis.2 Our first reference is a must read document with “over 150 references” regarding the RTI reduction in patients with Vitamin D level (VDL) >40-ng/mL versus those <20-ng/mL.1 VDL and Covid severity has been well-shown in a very recent study.9 The two most important causes of COVID-19 severity, needing ventilators and possible death are: 1. Cytokine Storm and Complement dysfunction ending on a death spiral of respirator and drowning in their fluids.2-6 2. Hyper-coagulation state ending with multiple peripheral system diseases, such as cardiomyopathy or encephalopathy.7,8 Vitamin D plays a major role in both processes.2-9 Over 5,000 patients of neuro-ophthalmology department had VDL checked from 2010 to 2020; 66% had deficiency (<20-ng/mL), prevalence changed to 83% if <30-ng/mL was chosen, and 93% when <35-ng/mL was set as deficient. In between 2010 and 2012 after patients stopped vitamin D once reaching normal levels, VDD recurred in all cases after 4 month follow-ups. Table 1 shows suggested cut-offs accepted by most endocrine societies. VDD is multifactorial and endemic worldwide. Insult to vitamin D may come from artificial coloring and flavoring found in processed foods, soft drinks, lack of sun exposure, any chronic illness such as diabetes, hypertension, chronic kidney disease, obesity, and more. Heat (avoiding sun exposure) and color of skin (less UV effect for Vitamin D in darker skins) cause African countries to have higher VDD than the Scandinavian nations. With inadequate sun exposure and constant poisoning of vitamin D by food additives and chronic illnesses, lifelong Table 1. Typical endocrine societies guideline. Very Low <20 ng/mL Insufficient 21-29 ng/mL Sufficient 30-60 ng/mL Ideal 40-60 ng/mL Considered safe Up to 100 ng/mL Toxic >120-150 ng/ml J Contemp Med Sci | Vol. 6, No. 4, July-August 2020: 191–192 Vitamin D supplementation (LLVDS) for urban residents is a must. We have only seen a few good VDL (>40-ng/mL without Vitamin D supplement), in patients that live in rural areas who consume their own farms’ food including milk with no soft drink usage. The majority of people who consume processed foods encounter VDD. In the latter subgroup, many clinician stop supplementation when Vitamin D reaches normal levels and this will almost always result in VDD recurrence. In the neuro-ophthalmology department, we have been using 70–100-IU of Vitamin D3/Kg/Day for maintenance since 2010. We used 70-IU/Kg/Day in patients with normal eye exams and 100-IU/Kg/Day for retinal and optic neuropathy patients. After supplementation all patients had VDL >40ng/mL with some in-between 60 and 89, and none over 90 in the last 9 years. In a subset of..