welcome to another MedCram COVID-19 update we'll do some updates and also
talk about preparation from a prevention standpoint here we have our Johns
Hopkins dashboard at ninety four thousand total confirmed cases total
deaths thirty two hundred total recovered fifty one thousand South Korea
has the most confirmed outside of China and we're talking about aggressive
testing in South Korea Iran quickly shot up we can see here that's a pretty large
red dot we go to the world ometer website active cases are actually on the
decline probably because we are leaving a epidemic in China but there are small
epidemics relatively outside of China that are rapidly growing and that's why
this is not continuing to go down if we look at total cases we can see that the
inflection point has started to turn upwards let's look at the latest updates
a number of countries are reporting single digits cases and in some cases
some deaths interestingly here there's 586 new cases in Iran but they're also
starting the show recoveries as well we knew there would be recoveries but we're
just not seeing a lot at this point we see that there are 10 new cases in
Belgium nine of which came from northern Italy and that seems to be a hotspot of
spread throughout Europe remember that in Europe there are free borders because
least as of a couple of weeks ago four new cases in the United States all of
them being in California which is a hot spot there's one in Los Angeles County
two who had recently traveled to countries that have had cava 19 and
there's one new case in Contra Costa County in Northern California that
second case of corona virus in Los Angeles was reported by Fox 11 News that
patient is being taken care of at home in self isolation and being treated on
an outpatient basis the purpose of May cram and what we're doing here is to
talk about the data the raw numbers to talk about the medical aspects of this
virus and what we know is going but of course there are things that are
out there that are emerging that seemed to have evidence but don't quite fit
with coronavirus at this point because we don't have the data at this point
let's face it we have no randomized controlled trials for coronavirus Cove
at 19 they just haven't been performed so we're forced to look at things that
may work vitamin D is one of those things we don't have any randomized
control trials that show that supplement with vitamin D works in kovat 19 but we
do have data about vitamin D specifically and so I think it's
interesting to go over I've gotten a lot of comments from people about vitamin D
and the potential use for the corona virus and even though this paper here is
for the influenza virus vitamin D is not actually having an effect on the virus
itself as far as we know it's affecting the hosts us our bodies our immune
system and how they deal with the virus so potentially might be something that
is applicable to other viruses and in this case the corona virus and if you've
thought about this you'll notice that there's a lot of talk about what will
happen in the summertime to the virus and a lot of the talk has been about
heat and humidity versus dryness and I'm wondering if there's another angle on
this because vitamin D could be acknowledged as a quote seasonal
stimulus as defined by our Edgar Hope Simpson it would be crucial to prove it
from a potential easy and cheap prophylaxis or therapy support
perspective as far as influenza infections are concerned now this paper
talks about how first of all vitamin D is absorbed into the body and how it is
metabolized the fact that it is a vitamin you have to understand that we
cannot generate or make vitamin D in our own body but in fact we need ultraviolet
radiation from the Sun to convert the inactive form to the active form I've
always had a special place in my heart for vitamin D because that's what I did
in terms of my undergraduate research working in organic chemistry and so
you'll know that vitamin D for those of you studied the structure is a lipid
soluble vitamin and so it's possible to overdose on vitamin D so you have to be
very careful with it because it is fat soluble now there's a lot of talk about
vitamin D in the immune system and how it bolsters it but something that's also
very in interesting about vitamin D is its
possible role in infections and also it has a suppressive anti-inflammatory
process so in other words vitamin D can turn things on and it can also turn
things off it's not unimodal and that is something that could be very helpful
especially in the immune response that we see in kovat 19 remember that it's
the immune system that is going to suppress the virus which is good but
it's also the immune system that could cause this storm of cytokines that put
your lungs into a RDS and could potentially kill so what we want is a
smart immune system an immune system that takes care of the virus but doesn't
put us into an inflammatory condition that could put us on a ventilator
so is vitamin D the answer I have no financial relationships with any
pharmaceutical companies or companies that make nutritional supplements in any
way this study that was talked about here in the Harvard Gazette may be what
we are looking for here it says a new global collaborative study has confirmed
that vitamin D supplementation can help protect against acute respiratory
infections the study our participant data meta analysis so a meta analysis is
simply a study that looks at a whole bunch of other studies breaks down the
components and makes a super study out of it so they took actually 25
randomized controlled trials with an N number of 11,000 participants that's a
pretty sizable number this was published in the British Medical Journal I will
give you a link to that journal will actually look through that most people
understand that vitamin D is critical for bone and muscle health Cisco's
Camargo of the Department of Emergency Medicine at Mass General our analysis
has also found that it helps the body fight acute respiratory infection which
is responsible for millions of deaths globally each year
remember this article was published before coronavirus several observational
studies with track participants over time without assessing the specific
treatment have associated low vitamin D levels with greater susceptibility to
acute respiratory infections I don't have to tell you that living in high
latitudes especially in the wintertime exposes you to the least amount of
sunlight if you have the least amount of sunlight you would conclude a
corporately that your vitamin D levels are generally going to be on the lower
side while it's possible that the seasonal variation in the virus may
still have something to do with the survival of the virus outside the body
but it may have more than we think to do with the survival of the virus inside
the body it is a postulate but it's interesting the meta-analysis of these
trials which aggregate data from several studies that may have different designs
or participant qualifications also had conflicting results and this really has
been the issue for some period of time some studies showed that there is a
connection that makes vitamin D look good in terms of preventing infections
others not so good so to resolve these discrepancies this research team out of
Queen Mary University of London conducted an individual participant data
meta-analysis so what does that mean they grouped all of these studies
together and then they stripped it down to each particular individual and that
is very powerful producing what could be considered a higher resolution analysis
of the data from all the studies the investigators found that daily or weekly
supplementation had the greatest benefit for individuals number one there was a
benefit and number two it was the turtle not the hare what I mean by that is it
was the daily supplementation not the huge doses of vitamin D if you got sick
this makes sense the people who have the lowest levels are going to have the best
effect from supplementation and it cut their risk of respiratory infection get
this in half that is a significant number and could reduce the Arnott or
the replication number in viruses and maybe the reason why we see these
viruses disappear in the summer I say May don't have proof of that yet but
it's interesting all participants experience some beneficial effects from
regular vitamin D supplementation administering a high doses of vitamin C
did not produce significant benefits this study was not funded by some
nutraceutical company but was funded in fact by the British National Institute
of Health Research so let's actually go to that study it's open access we'll put
the link in the description below this is from the British Medical Journal
that's a very prestigious publication in the conclusion vitamin
supplementation was safe and it protected against acute respiratory
tract infection overall patients who were very vitamin D deficient and those
not receiving bolus doses experienced the most benefit so if you go down to
the raw data they have to come up with cutoff points and for those of you who
don't know how to read studies let me show you here a little bit what they're
looking at is how many respiratory tract infections they receive so one step'
individual participant data men analysis proportion of partisans experiencing at
least one acute respiratory tract infection first thing to do is to look
at the very top one and that's overall how many trials twenty-five proportion
with greater than one acute respiratory tract infection and proportion with
greater than one acute respiratory tract infection in the intervention group and
you can see that there was a difference and what was that difference the
adjusted odds ratio is where you want to look
there's another way of looking at to looking at p-values to see if there's a
difference between these two groups those in the control group those in the
intervention group and any p-value of less than point zero five is considered
to be statistically significant so you can see here that a bolus dose of
greater than thirty thousand international units given had a p-value
of 0.67 that's greater than point zero five therefore not statistically
significant in other words a bolus dose is not going to be helpful if the bolus
dose wasn't given you can see that was very statistically significant so the
question is how much should I take on a daily dose well here it is daily dose
equivalent if it was less than twenty micrograms highly statistically
significant if it was 2250 still statistically significant however if you
took more than 50 micrograms there was no difference between that group
indicating that a modest dose of vitamin D every single day would be the best
here's more research in the study showing all of the different individual
studies and the proportion with greater than one acute respiratory tract
infection and you can see here where they lined up relative to number one
remember one being no difference if it was less than number one with a 95%
confidence interval less than one then you could say that that was
statistically significant and it was weighted based on the number of patients
in that study and finally we come to the overall which is down here at the bottom
p-value a point zero zero one you can see that it lands less than one so if
you scroll down to the discussion it says vitamin D supplementation reduce
the risk of experiencing at least one acute respiratory tract infection and it
talks about the grade of the data which was very good the question though is why
would a bolus dose of vitamin D be ineffective and they talked about how
the wide fluctuations of circulating 25 hydroxy vitamin D concentrations which
is the starting material for the active form in the body could this right
activity of enzymes responsible for the synthesis and degradation of the active
vitamin D metabolite which is 125 dihydroxy vitamin d so my recommendation
based on this data would be take a small supplement of vitamin D every day and
again we'll put the links to these articles in the description below