This is interesting data. I want to see Vitamin D status included in a large population study like this because I've been following two smaller studies covering about a thousand cases total that shows Vitamin D deficiency has a risk ratio of 10 to 20 (more even than being age 80+ in the above study). The studies:
Table 1 in each of those papers show Vitamin D status vs Outcomes. The correlation between Vitamin D status, where Normal is >30 ng/ml (or 75 nmol/L), and death rates is stark.
From [1] (which had n=780 cases) here is the punchline: "98.9% of Vitamin D deficient cases died while only 1.1% of them were active cases. 87.8% of Vitamin D insufficient cases died while only 12.2% of them were active cases. Only 4.1% of cases with normal Vitamin D levels died while 95.9% of them were active cases."
From [2] (which had n=212 cases) here is the punchline: "Of the 212 (100.0%) cases of Covid-2019, 49 (23.1%) were identified mild, 59 (27.8%) were ordinary, 56 (26.4%) were severe, and 48 (22.6%) were critical (Table 1). Mean serum 25(OH)D level was 23.8 ng/ml. Serum 25(OH)D level of cases with mild outcome was 31.2 ng/ml, 27.4 ng/ml for ordinary, 21.2 ng/ml for severe, and 17.1 ng/ml for critical."
Note: the classification for outcomes was "(1) mild – mild clinical features without pneumonia diagnosis, (2) ordinary – confirmed pneumonia in chest computer tomography with fever and other respiratory symptoms, (3) severe – hypoxia (at most 93% oxygen saturation) and respiratory distress or abnormal blood gas analysis results (PaCO2 >50 mm Hg or PaO2 < 0 mm Hg), and (4) critical – respiratory failure requiring intensive case monitoring."
I want to see a dozen more studies like [1] and [2] to see if this holds up to replication with larger populations.
In case you weren't aware, controlled trials have shown that vitamin d supplementation protects against respiratory disease [1]. This is evidence that the association you highlight is more than a spurious correlation.
NHS may say 'no evidence' - but it seems likely what they mean is that nobody has done a vitamin D-coronavirus trial. So it isn't that there is no evidence but rather the evidence is not overwhelming.
"No evidence" makes it sound like there is actually no evidence. There is evidence - it just got linked in the two comments that make up the root of this thread.
If it's true that Vitamin D is such a large factor in reducing the lethality of respiratory disease -- perhaps it's better to loosen lockdown rules to ensure the wider population can get more sun before they inevitably catch the virus.
It may explain why heavily indoors NYC had so many lethal cases, even as most infected were already keeping themselves indoors.
If the extra time out from loosening was all spent out in the sunshine, maybe it might just balance out the increase in cases, but there’s no way that’s what would happen. To make a significant difference requires an extra several hours a day out in sunshine. Better to just advise people to take supplements.
Sunnier countries can still have large vitamin D deficient populations. I read a study regarding the correlation between mental illness and vitamin D deficiency a few years ago, and Italian patients were still often very deficient. If people don't go out in the sun enough, or wear too much sun cream, it doesn't matter how sunny it is.
That's misleading because Europe is on the western edge of the Eurasian landmass, meaning it gets the benefit of warm air heated up over the ocean. By the time the air gets to the eastern edge of a landmass it's a lot colder, which is why London has a milder average temperature than NY and Vladivostok, despite being almost 10° further north than both.
Yes, but vitamin D production relates to direct sunlight ... I think the angle of the sun and amount of atmosphere it has to go through affects UV amounts so a warmer European country does have less direct sun therefor more potential for vitamin D deficiency ...
TBH I am not super solid on every one of these details.
That's a good point, but this paper seems to indicate that the amount of sunlight required over the summer in order to build enough vitamin D to last over winter isn't much for white Caucasians in the UK - nine minutes each day at lunchtime between March and September, assuming shorts and t-shirts are worn during the summer:
Vitamin D deficiency can still occur in sunny countries. To get the adequate amount of Sun from Vitamin D takes a day out in the sun entirely as opposed to basic supplementation.
A friend of mine had cancer and they had him taking D3 immediately.
also I was out shopping recently and they seemed to sell many varieties of D3, but I didn't see any other D vitamins offered for sale. Is D deficiency really D3 deficiency? or have the other D vitamins sold out?
As a vegan, I learned that there's D2 (comes from plants) and D3 (comes from animals), and they are the same as far as I know. Not sure about using them for treatments.
There are a number of other studies on this. From what little I've read, if the effect is real,it seems the it is relatively weak, but still worth doing.
[2] is pretty scary. As a 30 year old I know that my chance of death is low, but I’d like to avoid a “severe” or “critical” case. There are a large number of unpleasant states between “fine” and “dead” that I’d like to not experience. A 50/50 chance of it being no big deal are worse odds than I’d prefer.
[1] is sending me back out onto the patio this weekend for tanning.
I agree, we need better evidence on all the vitamin D claims. Comparing rich white people in the suburbs who have lots of open land to get sun and use for exercise versus poorer darker skinned people in dense inner city apartments who spend most of their time inside introduces numerous confound factors that will be highly correlated with vitamin D.
> I agree, we need better evidence on all the vitamin D claims.
Not really. We should be blasting "get your Vitamin D supplements" from the rooftops, because maybe that's a significant factor in COVID-19 and it's safe and people should get them anyway. There's no downside.
If in a few years it then turns out that Vitamin D had nothing to do with it, it doesn't matter. If it turns out that Vitamin D really was a big factor, we'll be sorry for being hesitant with a safe and cheap intervention.
You are right that vitamin D is relatively safe compared to other potential treatments that were bandied about like hydroxychloroquine. But while there are fewer health risks from taking it, there are still the same behavioral issues that were present with hydroxychloroquine. The first is causing a run on vitamin D that prevents other people from acquiring if for their proven treatments. However the main issue that I think we want to prevent is luring people into a false sense of security that causes them to decrease the proven preventive measures. We don't need large groups of people gathering on beaches because they think the sun will be a miracle cure and they don't have to worry about getting sick. So if you want to personally start taking it without changing your behavior, be my guest. But any advice to take it needs to be clear that the evidence it helps is still very suspect at this point.
> The first is causing a run on vitamin D that prevents other people from acquiring if for their proven treatments.
Vitamin D is an easily manufactured supplement, it's not medicine that some people absolutely have to take every day.
Also, we're heading into summer and the sun is still rising every day.
> However the main issue that I think we want to prevent is luring people into a false sense of security that causes them to decrease the proven preventive measures.
We've had the same discussion about masks, so I think that one's settled.
> We don't need large groups of people gathering on beaches because they think the sun will be a miracle cure and they don't have to worry about getting sick.
If you don't want people gathering on the beaches, prohibit it. Having said that, the risk of infection outdoors is generally considered to be quite low.
> So if you want to personally start taking it without changing your behavior, be my guest. But any advice to take it needs to be clear that the evidence it helps is still very suspect at this point.
The evidence that Vitamin D supplementation works is there and it has already been recommended for everyone with low serum levels, well before COVID-19.
The problem is that people often aren't even aware that their serum levels are low, so that is highly prevalent - especially in the elderly and people with darker skin.
Hand sanitizer is also easy to manufacture and I haven't seen it in a local store for over 10 weeks. The ease to manufacture is just one of the steps to getting it on the shelves. Also getting vitamin D from the sun isn't an option for some people, especially those with darker skin.
The difference between masks and vitamin D is that one is proven to work and one might work. If vitamin D doesn't help as much as people here are claiming, there is a real downside if people are behaving as if it works. That applies to my arbitrary example of beach gatherings as well as other behavior the government has no hope of preventing.
Once again, this doesn't necessarily mean that vitamin D doesn't help. We just need better data. The early indication was that hydroxychloroquine helped too and we all know how that turned out.
What does "proven to work" mean with regard to masks? A lot of the measures put in place are unproven but thought to be reasonable.
Hand washing and social distancing appear to be the most important. That means soap and 6+ feet for at least the next 2 years. That is definitely doable. I don't see masks as a long-term strategy.
> The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts. [1]
When the primary vector of spread is through water droplets expelled while talking, coughing, or sneezing, I would think the importance of reducing the travel distance of those droplets would be self evident.
We shouldn't be telling people to overdose on Vitamin D, obviously. I dread the day that Donald Trump mentions "Vitamin D", but then again even a massive overdose of Vitamin D isn't going to be life-threatening.
The generally safe amount is 4000 IU daily, which should get almost everybody to healthy levels. However, if your doctor finds that you have low levels, he may prescribe far higher amounts for a while.
Then do not overdose. Tell people to take 1000IE per day, not more. This will have no negative impact on the health or economy, but if we are lucky, it will help reduce the impact of COVID-19.
Shutting down the economy is clearly dangerous, yet enough people do not seem to have a problem with that.
Vitamin D pills is just a quick fix. Moderate exercise and fresh air would probably save more lives. Healthy vitamin levels are good, but its many little things which affects health.
Another critical question: Why hasn't this been properly researched, yet? There were indications before, that Vitamin D insufficiency increases risk of respiratory diseases.
That, or perhaps a lack of sun exposure is linked to having preexisting conditions. Diabetics, COPD, asthmatics, etc as a group probably tend to spend less time outside.
There's nothing particular that is required in the diet to synthesize Vitamin D3 from the sun.
Without sun exposure, you'd have to be eating several pounds of fatty fish every day to get to "healthy" levels from diet alone. You need a supplement.
Keep in mind, non-severe Vitamin D deficiency doesn't cause any significant evolutionary pressure, so migrating humans just rolled with it - to this day.
> I want to see Vitamin D status included in a large population study like this
Although vitamin D is not mentioned in this study, it does show that black people have a hazard ratio of about 2 compared to whites. In the UK black people would be more vitamin D deficient than white people.
Now that I think about it, isn't the potential for vitamin D deficiency the reason there are white people in the first place?
> Now that I think about it, isn't the potential for vitamin D deficiency the reason there are white people in the first place?
Yes. Pale skin has better vitamin D production in low light, while black skin avoids skin damage even in extreme sunlight. Skin color is just evolution finding the right trade-off for the local climate.
From NHS advice on vitamin D referenced in my previous comment
“Some people will not get enough vitamin D from sunlight because they have very little or no sunshine exposure.”
..
“ If you have dark skin – for example you have an African, African-Caribbean or south Asian background – you may also not get enough vitamin D from sunlight.”
> Unsurprisingly there's no direct clinical evidence.
"We searched for trials and didn't find any"
Unsurprisingly, there haven't been any (completed) trials on this particular combination of novel disease and possible prevention/treatment yet.
I'm concerned that people conflate "no evidence for efficacy" with "it doesn't work" instead of "we don't know if it works". You always start out with "no evidence".
There are studies that put serum Vitamin D levels against COVID-19 outcomes and they show a highly significant correlation. That's not "causal evidence", but it should put you on alert, you shouldn't be waiting for 2021 for possible Vitamin-D trials to complete.
As the authors of that review are saying, you should be supplementing anyway, whether there is a causal relationship or not.
I don't see why, since vitamin D is not patentable. If you spend the money on research others can make money from it making you lose out. Same reason why herbs are not researched even though they've been used for medicinal purposes for thousands of years: you can't patent a plant.
I think that's a poor summary of the paper, here's the rest of the abstract:
"There is some evidence that daily vitamin D3 supplementation over weeks to months may prevent other acute respiratory infections, particularly in people with low or very low vitamin D status. This evidence has limitations, including heterogeneity in study populations, interventions, and definitions of respiratory infections that include upper and lower respiratory tract involvement."
"The current advice is that the whole population of the UK should take vitamin D supplements to prevent vitamin D deficiency. This advice applies irrespective of any possible link with respiratory infection."
However, evidence of absence is unlikely to be found as the vast majority of researchers tend not to bother publishing papers with negative results. So if an idea seems like it should have been researched already, but no research papers are to be found, it may very well be because the evidence of absence simply hasn't been shared.
I wonder how many papers give a negative result because p was found to be .049 or so. I'm recalling that thread here a while back debating whether the statistical critical value is too high.
"98.9% of Vitamin D deficient cases died while only 1.1% of them were active cases. 87.8% of Vitamin D insufficient cases died while only 12.2% of them were active cases. Only 4.1% of cases with normal Vitamin D levels died while 95.9% of them were active cases."
Wait, only 13.3% (1.1 + 12.2) of all the active cases in total were vitamin D insufficient or worse? I thought the majority of people had insufficient vitamin D.
This data doesn't fully make sense to me. How come that so few people with a vitamin D insufficiency were active cases? I get that most of them died. But I don't get that so few, less than 15 percent, got to become an active case.
Edit: ah, it's an Indonesian study. Nevermind, I wouldn't know the numbers from there.
Since aging reduces vitamin D production in skin, we have that vitamin D level is correlated with age that is correlated with worse response to COVID-19.
Aging reduces vitamin D production in skin. There is a decrease in the concentration of 7-dehydrocholesterol in the epidermis in old compared with young individuals and a reduced response to UV light, resulting in a 50% decrease in the formation of previtamin D3
Is there any data showing which patients took D supplements (or daily multivitamin) vs having naturally normal/high levels? Medical people, does the answer matter?
I am curious, what does it take to innovate in vitamin level testing space? Being able to know vitamin level in your body at any given day just like you can measure your heart rate. Not via mailing in blood sample, but something simpler. is it too far fetched to think that we can have something like a watch to be able to measure our vitamin levels regularly?
I'd picture something like a finger-prick blood sampler akin to a glucose meter.
Might not be something I'd do every day forever, but I could see doing daily samples for a week to get a feel for aboroption, then occasionally to check how my supplements and sun exposure are working.
If you could build a thing that can measure several different parameters depending on which test strips you load into it, I'd buy a pack of vitamin D strips, a pack of vitamin B, a pack of testosterone, and pack that looks for markers of inflammation. Heck yeah. My doctor would eat that data right up.
I've been thinking about vitamin D all last week after listening to Dr. Rhona patrick on joe rogan podcast( dont' hate).
I haven't found and answer to this, if Vitamin D is such big factor then why aren't vitamin D deficient populations in the subcontinent ( india/pakistan ..) being hit hard.
I'm a little bit hesitant about vitamin deficiency. this sounds like orthomolecular medicine and I wouldn't trust that. I'm especially hesitant if that vitamin is fat-soluble because it can accumulate in your body fat and eventually be poisonous.
Table 1 in each of those papers show Vitamin D status vs Outcomes. The correlation between Vitamin D status, where Normal is >30 ng/ml (or 75 nmol/L), and death rates is stark.
From [1] (which had n=780 cases) here is the punchline:
"98.9% of Vitamin D deficient cases died while only 1.1% of them were active cases. 87.8% of Vitamin D insufficient cases died while only 12.2% of them were active cases. Only 4.1% of cases with normal Vitamin D levels died while 95.9% of them were active cases."
From [2] (which had n=212 cases) here is the punchline:
"Of the 212 (100.0%) cases of Covid-2019, 49 (23.1%) were identified mild, 59 (27.8%) were ordinary, 56 (26.4%) were severe, and 48 (22.6%) were critical (Table 1). Mean serum 25(OH)D level was 23.8 ng/ml. Serum 25(OH)D level of cases with mild outcome was 31.2 ng/ml, 27.4 ng/ml for ordinary, 21.2 ng/ml for severe, and 17.1 ng/ml for critical."
Note: the classification for outcomes was "(1) mild – mild clinical features without pneumonia diagnosis, (2) ordinary – confirmed pneumonia in chest computer tomography with fever and other respiratory symptoms, (3) severe – hypoxia (at most 93% oxygen saturation) and respiratory distress or abnormal blood gas analysis results (PaCO2 >50 mm Hg or PaO2 < 0 mm Hg), and (4) critical – respiratory failure requiring intensive case monitoring."
I want to see a dozen more studies like [1] and [2] to see if this holds up to replication.
The show notes for the parent video are quite comprehensive with links to references. The summary above leaves out the detailed discussion of the interplay between Vitamin D, the renin-angiotensin-system, the ACE2 receptor, and SARS-CoV-2:
[3] https://www.foundmyfitness.com/episodes/vitamin-d-covid-19
Interestingly, these papers together are much stronger evidence than either apart. This is because they use different methods. The OP is a population level study, while the second link you shared is a retrospective individual level study.
While I have some concerns with the stats in both papers (I'm always suspicious of p-values close to the magic number of 0.05), this does seem like interesting research, and potentially very helpful to dealing with Covid-19.
The irony of course, is that I suspect many of the Northern latitude people with high levels of Vit-D may be getting it through tourism to Southern Europe, which is very unlikely to happen this year.
If you live in a country with little daylight for part of the year your going to consider supplements of Vitamin d.
Also pickled herring is a delicacy in the many countries which have fared well in Europe in the fight against covid 19.
Also oily fish like salmon and mackerel are good for vitamin D.
Yet for many Brits it's a fish we rarely consider but is one of the biggest
Concerns about the UK denying access to EU nation's to certain waters I believe with Brexit.
A brief vacation to southern Europe won't give a Scandanavian enough stored Vitamin D to last the rest of the year. Supplement use is common, and they tend to eat a lot of Vitamin D rich foods.
Furthermore, vitamin D is added to some product types. At least in Finland there is a requirement for all fat free milk to contain additional vitamin D.
Here's a description of a "press-pulse" protocol that includes fasting, calorie restriction, and ketogenic diet scenarios (main goal seems to be to limit glucose intake as part of the treatment as part of an effort at stressing the energy systems of the cancer cells to cause cell death):
https://nutritionandmetabolism.biomedcentral.com/articles/10...
Check the references for some other papers on fasting and chemotherapy. Also, here's a related human case study: https://www.ncbi.nlm.nih.gov/pubmed/29651419
While lacking in lots of built-in UI widgets, I use Cinder like a UI library. https://libcinder.org/ Perhaps "graphics library" would be a better descriptor and explains why I didn't find it on the list. But with mouse/touch, images, audio, video, etc. support, "graphics library" seems too narrow of a description. Maybe it's better to think of as a GUI library without a lot of commitments to the usual set of GUI widgets.
I used Cinder on a couple of projects and it's great for what it is. It would be a solid start for making your own UI library, but that is a considerable task.
Can anyone simulate this light bulb setup in HFSS or another antenna simulation software? I'm always on the lookout for comparisons on weird cases like this for the simulation code I've written. If I can find material property data on custard as easily as for tungsten (watch the temperature dependence!) I might give that a shot next.
You really don’t need to simulate it. It will just be a electrically small magnetic loop with a large real resistance. Any antenna text book should have it, with gain proportional to frequency.
Of course the nonlinearity of the filament will change things slightly, but it will converge down to a fixed impedance.
I suppose a bit more context would be explanatory. My real interest is not the free-space performance of the antenna, but the eventual installed performance. In the video describing the setup he says "I talked with a couple of engineers, and some other guys, and we've come to the conclusion that if I put 100 watts into it, it might radiate a milliwatt. And not all that well." I'm not sure if they were thinking of it as a magnetic loop antenna the way you described or coming up with the numbers some other way. But then at the end mentions, "I'm gonna set it on the top part of that air conditioner and put it right in the window." How much of his success is a result of sticking the antenna on what may be effectively a (admittedly electrically small compared to 20m) metal box? That's what I think is interesting to simulate.
>Adjusted for inflation, the US economy has more than doubled in real terms since 1975. How much of that growth has gone to the average person? According to many economists, the answer is close to zero.
Simple question to ask yourself and anyone you know: would you rather be alive in your income bracket (inflation adjusted, etc.) today or 30 years ago?
I keep asking this question to people I've met and have yet to have any takers for the 30 years ago option. Clearly these types of economic measurements are missing something important. Deflationary technology improvements not being properly taken into account? Something else?
