Care home residents ‘should be given vitamin D’

Doctors will trial whether vitamin D can protect people from Covid-19 amid mounting evidence the cheap supplement could be a life-saver

  • Queen Mary University is recruiting 5,000 people for its Vitamin D study
  • Volunteers will be given either 3,200, 800 or 400 international units a day 
  • Government says 400 a day is enough, but taking more won’t have bad impacts

Doctors will trial whether vitamin D can actually protect people from Covid-19 amid mounting evidence the 3p-a-day supplement could be a life-saver.

Researchers from Queen Mary University of London will recruit 5,000 volunteers to take the vitamin for six months if they do not already take high doses.

Experts will then assess whether participants are at less risk of catching the virus and developing a severe bout of the disease over the winter months.

It comes after a trial at Boston University found those who were aged over 40 and deficient in the vitamin were twice as likely to die from the virus as those who managed to get an adequate amount. Other studies have shown people with sufficient levels of the sunshine vitamin are less likely to get infected in the first place.

Britons are most at risk of being vitamin D deficient between October and April when sunlight levels are too low for the body to make the vitamin — with those with darker skin at even higher risk. 

Around two in five Brits are deficient during the winter, when respiratory infections are most common. In the US, at least two in five citizens also lack sufficient levels of the vitamin.

It has led to calls for doctors to dish out cheap vitamin D supplements — which cost as little as 3p a day and have no dangerous side effects — to fight the disease, rather than waiting for a vaccine which may never be found. 

It comes as researchers from University of Brighton have today called for care home residents to be given the ‘sunshine vitamin’.

Despite health chiefs advising residents should be given supplements all year round because they rarely go outside, academics found this was not happening in care homes in the south east of England.

Vitamin D supplements are safe, cheap and readily available - costing as little as 6p a pill and sold in most pharmacies, supermarkets and health shops

Vitamin D supplements are safe, cheap and readily available – costing as little as 6p a pill and sold in most pharmacies, supermarkets and health shops 

As well as in supplements, vitamin D is also available through foods, including oily fish, red meat and eggs (right). A Singaporean study earlier in the year of nearly 800 people found almost 99% of Covid-19 patients who died had vitamin D deficiency (left)

As well as in supplements, vitamin D is also available through foods, including oily fish, red meat and eggs (right). A Singaporean study earlier in the year of nearly 800 people found almost 99% of Covid-19 patients who died had vitamin D deficiency (left)

CARE HOME RESIDENTS ‘SHOULD BE GIVEN VITAMIN D’ 

Care home residents are not being given vitamin D, which may be protective against Covid-19, despite Government guidance, researchers say.

Advice from Public Health England from before the pandemic states: ‘People whose skin has little or no exposure to the sun, like those in institutions such as care homes, or who always cover their skin when outside, risk vitamin D deficiency and need to take a supplement throughout the year.’ 

They should take a daily supplement containing 10 micrograms all year round, and not just in the winter when there is less sunlight.

However, interviews with people involved in elderly residential care, such as GPs and care home managers in southeast England, found that none was aware of any care home routinely offering the supplement, The Times reported.

Only a dietician seemed aware of the guidance, according to the findings in the journal BMJ Nutrition, Prevention & Health. 

Interviewees considered GPs responsible for vitamin D status and that it was normally only prescribed after a diagnosis of vitamin D deficiency or a fall – because a lack of the vitamin can cause brittle bones.

Care home staff said they would ‘feel vulnerable to malpractice allegations’ if they gave residents over-the-counter supplements and people also worried about who would bear the cost. 

NHS guidance says the vitamin should not be routinely prescribed because it can be cheaply bought over the counter.

But the researchers – BSMS MSc Public Health graduate Joe Williams and the university’s Principal Lecturer for Health Promotion and Public Health, Carol Williams – said a blood test to confirm low vitamin D levels was more expensive than a year’s supply of the tablets.

Professor Williams said: ‘Recommendations that residents in elderly care homes should take 10mcg vitamin D each day have been around for more than 30 years. 

‘Moving into a care home should not mean an inevitable drift into vitamin D deficiency.’ 

‘The study found that under the current guidance, care homes are only allowed to give residents vitamin supplements that have been prescribed. 

‘But doctors have also been advised by the NHS not to prescribe preventative vitamins because they can be bought cheaply over the counter. 

‘This means that elderly care home residents often do not get the vitamin D they require, leaving them at increased risk of falls.’   

They said the ‘pandemic has brought conditions in care homes into the public eye’.

‘There is an urgent need for action to ensure vitamin D recommendations can be applied,’ researchers said.

‘A paradigm shift is needed so that vitamin D is understood as a protective nutrient as well as a medicine, and a public health as well as a medical responsibility.’ 

Professor Sumantra Ray, executive director of NNEdPro Global Centre for Nutrition and Health, told The Times: ‘This research re-emphasises the role of vitamin D given the evidence that it may help lower the risk of Covid-19 infection and ease the severity of symptoms.’ 

The researchers said there has recently been an interest the possible link between the severity of Covid-19 symptoms and vitamin D deficiency. However, they did not give their own view on the topic.    

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Trial volunteers will receive tablets containing either 800 IU or 3,200 IU a day of the vitamin, which they will be asked to take for six months.

There will also be a control group taking the NHS recommended amount of 400IU a day. 

Although this level is advised for the winter months, experts said taking more wouldn’t pose a risk as the vitamin is harmless and the body simply removes any excess levels.

But there is no group not taking a vitamin supplement in the trial, meaning it is impossible for the experts to accurately compare differences between the groups.

Researchers will track the incidence of doctor-diagnosed or laboratory-confirmed acute respiratory infections in participants during the trial, to see whether the supplements have affected their risk or severity of infection.

Volunteers will also be required to do a finger-prick test to check their vitamin D levels.  

Dr David Jolliffe, from Queen Mary University of London, said the study had the potential to give a ‘definitive answer’ on whether vitamin D could protect against coronavirus. 

‘Vitamin D supplements are low in cost, low in risk and widely accessible; if proven effective, they could significantly aid in our global fight against the virus,’ he said.

Professor Adrian Martineau, who is also involved in the study, said: ‘There is mounting evidence that vitamin D might reduce the risk of respiratory infections, with some recent studies suggesting that people with lower vitamin D levels may be more susceptible to coronavirus.  

‘Vitamin D deficiency is more common in older people, in people who are overweight, and in Black and Asian people – all of the groups who are at increased risk of becoming very ill with COVID-19.

‘The UK government already recommends that people take a low-dose vitamin D supplement over the winter to protect their bone health, but we do not know if this will have effect on COVID-19 or if higher doses might be able to provide protection against the virus.

‘The CORONAVIT trial will test whether higher doses of vitamin D might offer protection against winter respiratory infections including COVID-19.’ 

Arguments on the link between Vitamin D deficiency and its observed link with poor Covid-19 outcomes started to gather pace as early as May. 

The problem lies in the fact there is a lack of gold-standard medical research – the randomised controlled trials which compare people who are given the supplement with those who are not to see which group fares better.

Only one study has done this so far, conducted by the University of Cordoba in Spain and published last month.

Researchers gave high doses of calcifediol – a type of vitamin D supplement – to 50 patients hospitalised with the disease.  

There were no deaths among volunteers receiving the vitamin and all 50 patients were eventually discharged by the end of the study. But two of the 26 patients in a control group, who were not given the tablets, died.

Just one patient given calcifediol felt ill enough to be admitted to intensive care, whereas half of the participants in the control group were taken to ICU and two died.

But many scientists have criticised the study, saying its sample size is too small for any firm conclusions to be drawn about the impact of Vitamin D.

Nonetheless, it was the most promising result for trials of the vitamin so far, and corresponds to earlier research that fixing vitamin deficiency might cut mortality rates by half. 

A Northwestern University study, published in May, found Covid-19 patients with a severe Vitamin D deficiency are twice as likely to experience major complications and die.  

Nearly 99 per cent of Covid-19 patients who are vitamin D deficient die, according to a study from Indonesian researchers who analysed hospital records of 780 people who tested positive for SARS-CoV-2.

Results revealed 98.9 per cent of infected patients defined as vitamin D deficient — below 20ng/ml — died. Yet this fell to just 4.1 per cent for patients who had enough of the nutrient.

Researchers warned the study was not definitive, however, because the patients with high vitamin D levels were healthier and younger.

Another study by Tehran University, in Iran, and Boston University, found hospital Covid-19 patients who had sufficient vitamin D – of at least 30 ng/mL— were 51.5 per cent less likely to die from the disease. 

The study of 235 hospitalized patients with Covid-19 also showed those with enough vitamin D had a significantly lower risk of falling seriously ill or needing ventilation. 

Patients who had plenty of the nutrient also had less inflammation – often a deadly side effect of Covid-19. 

However, there were flaws in these studies, such as a lack of acknowledgement of confounding factors, such as smoking, and social economic status, which were were not recorded for all patients but could have an impact on illness severity.   

Some participants’ underlying health conditions were not defined, despite having a major impact on disease severity. 

A study by Tehran University, in Iran, and Boston University analysed data from 235 hospitalised patients with Covid-19. Patients who had sufficient vitamin D - of at least 30 ng/mL— were 51.5 per cent less likely to die from the disease. Although no one in the study under age 40 died, fatalities  (red) were more  common among vitamin  D deficient people (under the  black  line) of all ages

A study by Tehran University, in Iran, and Boston University analysed data from 235 hospitalised patients with Covid-19. Patients who had sufficient vitamin D – of at least 30 ng/mL— were 51.5 per cent less likely to die from the disease. Although no one in the study under age 40 died, fatalities  (red) were more  common among vitamin  D deficient people (under the  black  line) of all ages

A correlation graph showing the relationship between levels of viamin D (bottom, measured in nmol/l) compared to infection numbers of coronavirus by the University of East Anglia. Countries with low vitamin D levels tend to have the highest case rates per million - but the graph was from a study in May, when outbreaks looked very different to how they do now and testing was patchy in most countries

A correlation graph showing the relationship between levels of viamin D (bottom, measured in nmol/l) compared to infection numbers of coronavirus by the University of East Anglia. Countries with low vitamin D levels tend to have the highest case rates per million – but the graph was from a study in May, when outbreaks looked very different to how they do now and testing was patchy in most countries

University of Chicago researchers studying 500 Americans' vitamin D levels  found 60 per cent higher rates of Covid-19 among people with low levels of the 'sunshine vitamin'

University of Chicago researchers studying 500 Americans’ vitamin D levels  found 60 per cent higher rates of Covid-19 among people with low levels of the ‘sunshine vitamin’

How can I join the trial? 

The researchers are looking for volunteers who do not currently take high doses of vitamin D.

Those involved will take part in the study from their homes, and will not be required to make face-to-face visits as all supplements will be sent in the post.

To register for the trial, people can contact the study team on: coronavit@qmul.ac.uk 

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There have also been at least three studies which have suggested those who have enough vitamin D are less likely to catch the coronavirus in the first place.

But Professor Ian Jones, a virologist at the University of Reading, told MailOnline: ‘My general view is that if there is no clear cut view on vitamin D after six months of debate then there is nothing in it.’  

But given the findings so far, it astonished scientists that Mr Hancock was so quick to throw out the ‘sunshine vitamin’ as a potential treatment.

Matt Hancock wrongly told the House of Commons in September that a Government-funded ‘trial’ investigating vitamin D showed it did not ‘appear to have any impact’. 

He was told to ‘get his facts straight’ in September after shooting down vitamin D as a potential coronavirus treatment despite a growing body of evidence from around the world suggesting it works.  

Liberal Democrat MP Layla Morgan told MailOnline the secretary of state ‘needs to be listening, not dismissing’.

She added: ‘I hope Matt Hancock will take a less flippant approach to potential treatments in future and get his facts straight before making such comments. We’re in a crisis, it’s time for politicians to stop playing science and listen to the experts.’ 

Chris Chapman, chief executive officer of manufacturer YPV, which offers a home vitamin D test kit, said the company was ‘deeply disappointed’ about Mr Hancock’s comments.

He said: ‘We have seen a mountain of evidence that vitamin D has a positive, and at times life-saving, impact on people suffering with severe symptoms of coronavirus. 

‘We fundamentally disagree with the Health Secretary on this matter, his comments display incredible ignorance.

‘We urge him to practice his well-trodden mantra by following the science, which overwhelmingly points to the benefits of vitamin D when it comes tackling coronavirus.’ 

But Matt Hancock told the House of Commons last week he had green-lit a Government-funded 'trial' investigating vitamin D and that it did not 'appear to have any impact'

But Matt Hancock told the House of Commons last week he had green-lit a Government-funded ‘trial’ investigating vitamin D and that it did not ‘appear to have any impact’

The ‘sunshine vitamin’ – nicknamed because it is acquired by spending time in the sun – is postulated to protect against Covid-19.  

A number of studies have suggested the immune-boosting vitamin could protect people from coronavirus after finding adults deficient in the nutrient are more at risk of catching the disease. 

And those who spend more time indoors – such as in a care home – or who have darker skin – those of a Black, Asian or ethnic minority (BAME) background – are also at greater risk of Covid-19.

Officials estimate one in five Britons are deficient in vitamin D — the equivalent of 13million Britons. 

But some people are more at risk than others; the rate is up to 90 per cent in people with darker skin who find it harder to obtain the vitamin from the sun. 

Advice from PHE states: ‘People whose skin has little or no exposure to the sun, like those in institutions such as care homes, or who always cover their skin when outside, risk vitamin D deficiency and need to take a supplement throughout the year.’

But a recent University of Brighton study suggests care home residents are not being given the supplement.

The article was written by BSMS MSc Public Health graduate Joe Williams and the university’s Principal Lecturer for Health Promotion and Public Health, Carol Williams 

The team interviewed four GPs four care home managers, a dietician, a falls specialist, two public health practitioners and a senior doctor in elderly care, The Times reported.

A report from the Academy of Medical Sciences in July said: ‘It has been suggested that low levels of vitamin D — endemic within the UK, exacerbated by lockdown and which worsen over winter — may contribute to susceptibility to Covid-19.’  

MailOnline have contacted PHE for comment.  

What have just some of the DOZENS of studies into vitamin D and Covid-19 shown?

When? September.

By who? Cordoba University in Spain.

What did scientists study? 50 Covid-19 hospital patients with Covid-19 were given vitamin D. Their health outcomes were compared with 26 volunteers in a control group who were not given the tablets.

What did they find? Only one of the 50 patients needed intensive care and none died. Half of 26 virus sufferers who did not take vitamin D were later admitted to intensive care and two died.

What were the study’s limitations? Small pool of volunteers. Patients’ vitamin D levels were not checked before admission. Comorbidities were not taken into consideration.

When? September.

By Who? University of Chicago.

What did scientists study? 500 Americans’ vitamin D levels were tested. Researchers then compared volunteers’ levels with how many caught coronavirus.

What did they find? 60 per cent higher rates of Covid-19 among people with low levels of the ‘sunshine vitamin’.

What were the study’s limitations?  

Researchers did not check for other compounding factors. Unclear whether or not volunteers were vitamin D deficient at the time of their coronavirus tests. People’s age, job and where they lived – factors which greatly increase the chance of contracting the virus – were not considered.

When? September.

By Who? Tehran University, in Iran, and Boston University.

What did scientists study? Analysed data from 235 hospitalized patients with Covid-19.

What did they find? Patients who had sufficient vitamin D – of at least 30 ng/mL— were 51.5 per cent less likely to die from the disease. They also had a significantly lower risk of falling seriously ill or needing ventilation. Patients who had plenty of the nutrient also had less inflammation – often a deadly side effect of Covid-19. 

What were the study’s limitations? Confounding factors, such as smoking, and social economic status were not recorded for all patients and could have an impact on illness severity.  

When? July.

By Who? Tel Aviv University, Israel.

What did scientists study? 782 people who tested positive for coronavirus had their vitamin d levels prior to infection assessed retrospectively and compared to healthy people.

What did they find? People with vitamin D levels below 30 ng/ml – optimal – were 45 per cent more likely to test positive and 95 per cent more likely to be hospitalised.

What were the study’s limitations?  Did not look at underlying health conditions and did not check vitamin D levels at the time of infection.

When? June.

By Who? Brussels Free University.

What did scientists study? Compared vitamin D levels in almost 200 Covid-19 hospital patients with a control group of more than 2,000 healthy people.

What did they find? Men who were hospitalised with the infection were significantly more likely to have a vitamin D deficiency than healthy men of the same age. Deficiency rates were 67 per cent in the COVID-19 patient group, and 49 per cent in the control group. The same was not found for women.

What were the study’s limitations?  Independent scientists say blood vitamin D levels go down when people develop serious illness, which the study did not take into consideration. This suggests that it is the illness that is leading to lower blood vitamin D levels in this study, and not the other way around.

When? June.

By who? Inha University in Incheon, South Korea.

What did scientists study? 50 hospital patients with Covid-19 were checked for levels of all vital vitamins and compared to a control group.

What did they find? 76 per cent of them were deficient in vitamin D, and a severe vitamin D deficiency (<10 ng/dl) was found in 24 per cent of Covid-19 patients and just 7 per cent in the control group.

What were the study’s limitations?  

Small sample size and researchers never accounted for vitamin levels dropping when they fall ill.

When? June.

By Who?. Independent scientists in Indonesia.

What did scientists study? Checked vitamin D levels in 780 Covid-19 hospital patients.

What did they find? Almost 99% of patients who died had vitamin D deficiency. Of patients with vitamin D levels higher than 30 ng/ml  – considered optimal – only  per cent died.

What were the study’s limitations?  It was not peer-reviewed by fellow scientists, a process that often uncovers flaws in studies.

When? May.

By Who? University of Glasgow.

What did scientists study? Vitamin D levels in 449 people from the UK Biobank who had confirmed Covid-19 infection. 

What did they find? Vitamin D deficiency was associated with an increased risk in infection – but not after adjustment for con-founders such as ethnicity. It led to the team to conclude their ‘findings do not support a potential link between vitamin D concentrations and risk of Covid-19 infection.’

What were the study’s limitations?  Vitamin D levels were taken 10 to 14 years beforehand. 

When? May.

By Who? University of East Anglia.

What did scientists study? Average levels of vitamin D in populations of 20 European countries were compared with Covid-19 infection and death rates at the time.

What did they find? The mean level of vitamin D in each country was ‘strongly associated’ with higher levels of Covid-19 cases and deaths. The authors said at the time: ‘The most vulnerable group of population for Covid-19 is also the one that has the most deficit in vitamin D.’

What were the study’s limitations?  The number of cases in each country was affected by the number of tests performed, as well as the different measures taken by each country to prevent the spread of infection. And it only looked at correlation, not causation.

When? May.

By Who? Northwestern University.

What did scientists study? Crunched data from dozens of studies around the world that included vitamin D levels among Covid-19 patients. 

What did they find? Patients with a severe deficiency are twice as likely to experience major complications and die.

What were the study’s limitations?  Cases and deaths in each country was affected by the number of tests performed.

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WHAT ELSE HAS MATT HANCOCK GOT WRONG? 

MASKS

The health secretary was staunchly opposed to face masks as a Covid-19 preventative measure during the first wave of the pandemic.

Mr Hancock described evidence about their effectiveness as ‘extremely weak’ in April, despite Asian nations which fared much better in the battle against the disease routinely wearing them in public spaces.

He reluctantly decided in July – four months into the crisis – that masks in shops were a good idea after Scotland beat him to the punch weeks earlier.

Mr Hancock pushed back against face coverings despite months of research that indicated masks were an effective way of reducing the risk of infection, even if the reduction was only slight.

It’s not clear if the health secretary was truly against face masks or did not want to risk running out of the coverings and leaving health and social care staff without any once again.

Harrowing reports emerged at the peak of the outbreak in April of frontline workers having to make their own masks out of old t shirts and bin bags because the Government failed to keep adequate stockpiles of PPE.

100,000 TESTS A DAY

Matt Hancock was accused of blatantly fiddling testing figures in May to hit his much-vaunted target for 100,000 coronavirus swabs in a day.

The health secretary used postal tests yet to be completed and multiple checks on the same people to hit his six-figure milestone.

He used an appearance at the Downing Street briefing to bullishly claim success after setting the significant a month prior, when tests were running at just 10,000 a day. 

Appearing live on television tonight he emotionally told the watching nation there were 122,347 tests in the 24 hours to 9am, branding it an ‘incredible achievement’ for the whole medical and scientific community.

But he faced a wave of condemnation as it became clear that the number appeared to only tell half the story.

Figures posted online by the Government itself show that his questionable calculation included tens of thousands of tests kits that have been sent out to homes and hospitals – even though they have yet to be used, returned and processed. 

COVID-19 APP

The health secretary promised a ‘world-beating’ coronavirus contact tracing app would launch alongside the NHS Test and Trace programme back in May.

But it turned out to be another empty promise that Mr Hancock could not live up to.

The app failed miserably during a month-long trial on the Isle of Wight, failing to reach a third of people who were at risk of infection.

Officials scrapped the app entirely and approached Google and Apple in June to ask them to help build the technology that they had shunned just months prior. 

Scotland, Northern Ireland and Wales were all able to get their apps up and running quicker than England because they chose to work with the tech giants from the start. 

England finally became the last country in the UK to go live with its app in September, with ministers changing their tune to say it would only ‘compliment’ manual tracing work, which would still have to catch the majority of people.

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