(1) Vitamin D determines severity in COVID-19 so government advice needs to change, experts urge
Researchers point to changes in government advice in Wales, England and Scotland
Date: May 12, 2020
Source: Trinity College Dublin
Summary:Researchers are urging the Irish government to immediately change recommendations on vitamin D supplements given recent changes by Welsh, English and Scottish governments.Share:
FULL STORY Researchers from Trinity College Dublin are calling on the government in Ireland to change recommendations for vitamin D supplements.
A new publication from Dr Eamon Laird and Professor Rose Anne Kenny, School of Medicine, and the Irish Longitudinal Study on Ageing (TILDA), in collaboration with Professor Jon Rhodes at University of Liverpool, highlights the association between vitamin D levels and mortality from COVID-19.
The authors of the article, just published in the Irish Medical Journal, analysed all European adult population studies, completed since 1999, which measured vitamin D and compared vitamin D and death rates from COVID-19. The article can be viewed at: http://imj.ie/irish-medical-journal-may-2020-vol-113-no-5/
Vitamin D is produced in the skin from UVB sunlight exposure and is transported to the liver and then the kidney where it is changed into an active hormone that increases calcium transport from food in the gut and ensures calcium is adequate to keep the skeleton strong and free of osteoporosis.
But vitamin D can also support the immune system through a number of immune pathways involved in fighting SARS-CoV-2. Many recent studies confirm the pivotal role of vitamin D in viral infections.
This study shows that, counter intuitively, countries at lower latitude and typically sunny countries, such as Spain and Northern Italy, had low concentrations of vitamin D and high rates of vitamin D deficiency. These countries also experienced the highest infection and death rates in Europe.
The northern latitude countries of Norway, Finland and Sweden, have higher vitamin D levels despite less UVB sunlight exposure, because supplementation and fortification of foods is more common. These Nordic countries have lower COVID-19 infection and death rates. The correlation between low vitamin D levels and death from COVID-19 is statistically significant. The authors propose that, whereas optimising vitamin D levels will certainly benefit bone and muscle health, the data suggests that it is also likely to reduce serious COVID-19 complications. This may be because vitamin D is important in regulation and suppression of the inflammatory cytokine response, which causes the severe consequences of COVID-19 and 'acute respiratory distress syndrome' associated with ventilation and death. Professor Rose Anne Kenny said:
"In England, Scotland and Wales, public health bodies have revised recommendations since the COVID-19 outbreak. Recommendations now state that all adults should take at least 400 IU vitamin D daily. Whereas there are currently no results from randomised controlled trials to conclusively prove that vitamin D beneficially affects COVID-19 outcomes, there is strong circumstantial evidence of associations between vitamin D and the severity of COVID-19 responses, including death."
"This study further confirms this association. We call on the Irish government to update guidelines as a matter of urgency and encourage all adults to take supplements during the COVID-19 crisis. Deficiency is frequent in Ireland. Deficiency is most prevalent with age, obesity, in men, in ethnic minorities, in people with diabetes, hypertension and in nursing homes."
Dr Eamon Laird added:
"Here we see observational evidence of a link of vitamin D with mortality. Optimising vitamin D intake to public health guidelines will certainly have benefits for overall health and support immune function. Research like this is still exploratory and we need further trials to have concrete evidence on the level of vitamin D that is needed for optimal immune function. However, studies like this also remind us how low our vitamin D status is in the population (even in sunny countries) and adds further weight to some sort of mandatory vitamin D fortification policy. If the Nordic countries are allowed to do this, there is no reason Ireland, the UK or rest of Europe can't either." make a difference: sponsored opportunity Story Source: Materials provided by Trinity College Dublin. Note: Content may be edited for style and length. Journal Reference:
E. Laird, J. Rhodes, R.A. Kenny. Vitamin D and Inflammation: Potential Implications for Severity of Covid-19. Irish Medical Journal, 2020; 113 (5): P81 [link]
(2) Using antibodies from recovered patients has been life-saving for other acute infections and should be explored in response to COVID-19, Passive immunization may slow down SARS-CoV-2 and boost immunity in patients, buying time
Date: May 12, 2020
Source: IOS Press
Summary: A potential interim solution to the COVID-19 pandemic may be a passive vaccine, or passive immunization (PI), which can provide instant, short-term fortification against infectious agents, a new paper suggests.Share:
FULL STORY The worldwide COVID-19 pandemic has infected more than 4 million people and killed close to 280,000. Finding a vaccine has become a global public health priority. However, creating a viable vaccine might take a long time; scientists estimate a vaccine may be available in between 12 and 18 months. A potential interim solution reported in the International Journal of Risk & Safety in Medicine may be a passive vaccine, or passive immunization (PI), which can provide instant, short-term fortification against infectious agents.
"Using valuable plasma from recovered patients might be useful in our global war against COVID-19," explained Foad Alzoughool, PhD. He and his co-author, Lo'ai Alanagreh, PhD, both of the Department of Laboratory Medical Sciences, Faculty of Applied Medical Sciences, The Hashemite University, Jordan, have studied the application of PI in previous pandemics and conclude that this approach is a potential solution to address the immediate health threat of COVID-19.
After exposure to a viral infection, an individual's body creates antibodies to fight off the virus. These antibodies in the blood of a recovered patient can be collected as convalescent plasma and transferred to the blood of a newly infected patient where it can neutralize the pathogen, eliminate it from the blood stream, and boost immunity. While PI does not provide long-term protection against the virus, it can reduce the aggressiveness and mortality of an infection.
The use of PI immunization dates to the beginning of the twentieth century during the Spanish flu epidemic, when patients who received convalescent plasma serum had lower mortality rates than others. Experimental usage of PI during outbreaks of Ebola virus, chikungunya virus and the H1N1 flu also shows the potential of using PI in the prevention and treatment of viral infecitions.
There is evidence as well of the effectiveness of the PI technique in the SARS-CoV epidemic in Guandong, China and the MERS-CoV in Saudi Arabia, particularly if it is introduced soon after symptom onset. In one report, patients who received PI had a significantly shorter hospital stay and lower mortality than other groups. In another, patients who received convalescent plasma before day 14 of illness had a higher discharge rate. Healthcare workers who were infected with SARS-CoV and failed to respond to treatment survived after transfusion with convalescent plasma.
"If you are looking for COVID-19 treatment, you will find it in the blood of survivors," said Dr. Alanagreah. "In a time when no registered antiviral drug or vaccine is available, PI might help in slowing down the deadly virus and save lives, particuarly for the elderly and patients with pre-existing conditions."
More than 1.5 million people have recovered from the disease,2 and many of them would be willing to donate plasma to help slow down the pandemic. Dr. Alzoughool and Dr. Alanagreh noted, importantly, that practicing this method now will help health systems be prepared in case a second wave of disease occurs. make a difference: sponsored opportunity Story Source: Materials provided by IOS Press. Note: Content may be edited for style and length. Journal Reference:
Foad Alzoughool, Lo’ai Alanagreh. Coronavirus drugs: Using plasma from recovered patients as a treatment for COVID-19. International Journal of Risk & Safety in Medicine, 2020; 1 DOI: 10.3233/JRS-201017
(3) How COVID-19 kills
Explaining the mechanisms, symptoms, and diagnosis of the new coronavirus
Date: May 13, 2020
Summary: Experts review how the SARS-Cov-2 virus can cause an immune overreaction in the form of potentially lethal cytokine storm.Share:
FULL STORY COVID-19, the disease caused by coronavirus SARS-Cov-2, has infected over 4 million people in 212 countries, of whom at least 272,000 have died. The ongoing economic and social impact of the pandemic is staggering, but despite a daily flood of news on the disease, few laypeople know that paradoxically, COVID-19 mostly kills through an overreaction of the immune system, whose function is precisely to fight infections.
In a new review article -- explicitly targeted to non-specialists as well -- in Frontiers in Public Health, a team of experts from Zunyi Medical University review the epidemiology, disease pathway, symptoms, diagnosis, and current treatment of severe COVID-19. They stress the key role of a potentially lethal overreaction of the immune system in the progression of the disease.
They explain step-by-step what is known about how the virus infects the airways, multiplies inside cells, and in severe cases causes the immune defenses to overshoot with a "cytokine storm." This storm is an over-activation of white blood cells, which release too-great amounts of cytokines -- inflammation-stimulating molecules -- into the blood.
"Similar to what happens after infection with SARS and MERS, data show that patients with severe COVID-19 may have a cytokine storm syndrome. The rapidly increased cytokines attract an excess of immune cells such as lymphocytes and neutrophils, resulting in an infiltration of these cells into lung tissue and thus cause lung injury," explains author Professor Daishun Liu from Zunyi Medical University, China.
The cytokine storm ultimately causes high fever, excessive leakiness of blood vessels, blood clotting inside the body, extremely low blood pressure, lack of oxygen and excess acidity of the blood, and build-up of fluids in the lungs ("pleural effusion").
White blood cells are misdirected to attack and inflame even healthy tissue, leading to failure of the lungs, heart, liver, intestines, kidneys, and genitals (Multiple Organ Dysfunction Syndrome, MODS). This may worsen and shutdown the lungs (Acute Respiratory Distress Syndrome, ARDS) due to the formation of a so-called hyaline membrane, composed of debris of proteins and dead cells, lining the lungs, which makes absorption of oxygen difficult. Most deaths due to COVID-19 are therefore due to respiratory failure.
Liu et al. explain how in the absence of a specific antiviral cure for COVID-19, the goal of treatment must be to the fight the symptoms, lowering the mortality rate through intensive maintenance of organ function, for example an artificial liver blood purification system or renal replacement therapy to filtrate the blood through mechanical means.
Especially important are methods to supplement or replace lung function, for example through non-invasive mechanical ventilation through a mask, ventilation through a tube into the windpipe (if possible with the refinement of Positive End Expiratory Pressure, PEEP, where the ventilator delivers extra pressure at the end of each breath of keep the lung vesicles open throughout), the administration of heated and humidified oxygen via a tube in the nose ("transnasal high-flow oxygen"), or a heart-lung bypass.
The authors conclude by stressing the importance of preventing secondary infections: SARS-Cov-2 also invades the intestines, where it causes inflammation and leakiness of the gut lining, allowing the opportunistic entry of other disease-causing microorganisms. They advocate that this should be prevented with nutritional support, for example with probiotics -- beneficial bacteria that protect against the establishment of harmful ones -- and nutrients and amino acids to improve the immune defenses and function of the intestine.
"Because treatment for now relies on aggressive treatment of symptoms, preventative protection against secondary infections, such as bacteria and fungi, is particularly important to support organ function, especially in the heart, kidneys, and liver, to try and avoid further deterioration of their condition," concludes Liu.
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