Siddiqui, Emaduddin

Waheed, Shahan

English

eCommons@AKU

eCommons@AKU Department of Emergency Medicine Medical College, Pakistan 10-2020 Vitamin D in COVID-19 pneumonia: High yield with low risk Shahan Waheed Emaduddin Siddiqui Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_emerg_med  Part of the Bacteria Commons, Infectious Disease Commons, Pulmonology Commons, and the Viruses Commons LETTER TO THE EDITORJournal  of  the College of  Physicians and Surgeons Pakistan 2020,  Vol.  30 (Supplement 2 COVID-19):S180S180Vitamin D in COVID-19 Pneu-monia: High Yield with LowRiskSir,The  novel  coronavirus  disease  2019  (COVID-19)  is  a  globalpublic health problem with particularly poor outcomes in theelderly.  The  disease  pathogenesis  and  presentation  is  stillevolving. Vitamin D is a fat-soluble, secosterol that exists in twoforms: vitamin D2 and D3. It is obtained mostly from food with asmall portion synthesised by sunlight. The association of lowvitamin D levels with increased susceptibility to upper respira-tory tract infections (URTIs) is known in the literature.1 A meta-a-nalysis did show benefit of taking vitamin D supplementationamong  patients  with  low  25  hydroxy-vitamin  D  levelspresenting with URTIs.3,4 There are studies suggesting utility ofvitamin D both in prevention, and in decreasing severity andmortality among patients with COVID-19 pneumonia. The mech-anism is linked to development of antimicrobial peptides andactivation of dendritic cells, macrophages, T and B lymphocytesthrough utilisation of vitamin D receptors (VDR) that improveimmunity  and  decrease  inflammatory  response  againstCOVID-19.4,5 The virus interacts with ACE2 receptors on type IIpneumocytes  and  leads  to  cell  death.  Vitamin  D  also  hasimmunomodulatory properties that  downregulate activity  ofpro-inflammatory  cytokines  and  further  suppress  ACE2receptor activity.4,5 This protective effect of vitamin D can beachieved by a single oral vitamin D3 dose (2000 IU).The COVID-19 disease severity may be linked to location of coun-tries, which in turn, determines the extent of sunlight exposure.In this regard, it is reported that dermal production of vitamin Dfrom solar  UVB between  October  to  March  is  low  above  35degrees  latitude.  Countries  included  in  these  regions  arepredominantly inhabited by elderly, who are predisposed tohigher probability of cardio-pulmonary and metabolic comor-bidities. This might be a reason for such high incidence andmortality from COVID-19 in Western Europe and America. Thecross-sectional analysis of 20 European countries does provethe notion that majority of  people who suffered death wereelderly and likely vitamin D deficient, based on data analysisfrom  those  regions.  The  problem  is  exacerbated  duringprolonged  lockdown,  where  people  are  not  getting  enoughsunlight exposure and; hence, stressed on already deficientvitamin D levels.Vitamin D can be used as supplementary therapy in patients toboost up the innate immunity and to combat mild to moderateCOVID-19  pneumonia.  Micronutrient  supplementationincluding vitamin D and C should be started early in the diseaseprocess. Though vitamin D utility in COVID-19-related pneu-monia has not been evaluated, trials are underway to furthertest its efficacy in COVID-19-associated pneumonia; and theresults are expected in the coming months. The current treat-ments in use are very expensive and need validation throughsuperiority  designs.  Early  administration  of  vitamin  D  mayprove  beneficial  in  reducing  the  severity  of  symptoms  andpossibly  hospitalisation  rates  in  low  resource  settings  likePakistan.CONFLICT OF INTEREST:Authors declared no conflict of interest.AUTHORS’ CONTRIBUTION:SW, ES: Contributed to conceptualization and write-up of thestudy.REFERENCESGrant WB, Lahore H, McDonnell SL, Baggerly CA, French1.CB,  Aliano  JL,  et  al.  Vitamin  D  supplementation  couldprevent  and  treat  influenza,  coronavirus,  and  pneumoniainfections.  Nutrients  2020;  12(4):988.  doi:  10.3390/nu12040988.Cortegiani A, Ingoglia G, Ippolito M, Giarratano A, Einav S. A2.systematic review on the efficacy and safety of chloroquinefor the treatment of COVID-19. J  Critical Care  2020; 57:279-83. doi: 10.1016/j.jcrc.2020.03.005. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French3.CB,  A l iano  JL ,  et  a l .  Ev idence  that  v i tamin  Dsupplementation  could  reduce  risk  of  influenza  andCOVID-19 infections  and deaths.  Nutrients  2020;  12(4):988. doi: 10.3390/nu12040988.Daneshkhah A, Agrawal V, Eshein A, Subramanian H, Roy4.HK,  Backman  V.  The  possible  role  of  vitamin  D  insuppressing  cytokine  storm and  associated  mortality  inCOVID-19  patients.  MedRxiv  2020;  doi.org/10.1101/2020.04.08.20058578.Daneshkhah A, Eshein A, Subramanian H, Roy HK, Backman5.V. The role of vitamin D in suppressing cytokine storm inCOVID-19.  patients  and  associated  mortality.  MedRxiv2020; doi.org/10.1101/2020.04.08.20058578.Shahan  Waheed  and  Emaduddin  Siddiqui..................................................................................Department  of  Emergency,  The  Aga  Khan  University  Hospital,Karachi,  Pakistan..................................................................................Correspondence  to:  Dr.  Shahan  Waheed,  Department  ofEmergency,  The  Aga  Khan  University  Hospital,  Karachi,PakistanE-mail:  docshahan83@hotmail.com...................................................................Received: August 23, 2020;   Revised: October 23, 2020;Accepted:  October  23,  2020DOI:  https://doi.org/10.29271/jcpsp.2020.Supp2.S180

Vitamin D in COVID-19 pneumonia: High yield with low risk

https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1269&amp;context=pakistan_fhs_mc_emerg_med

Vitamin D in COVID-19 pneumonia: High yield with low risk

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