In March, as coronavirus deaths in the UK began to mount, two hospitals in northeast England began taking vitamin D readings from patients and prescribing them with extremely high doses of the nutrient. Studies had suggested that having sufficient levels of vitamin D, which is created in the skin’s lower layers through the absorption of sunlight, plays a central role in immune and metabolic function and reduces the risk of certain community-acquired respiratory illnesses. But the conclusions were disputed, and no official guidance existed.
When the endocrinology and respiratory units at Newcastle upon Tyne Hospitals NHS foundation trust made an informal recommendation to its clinicians to prescribe vitamin D, the decision was considered unusual.
“Our view was that this treatment is so safe and the crisis is so enormous that we don’t have time to debate,” said Richard Quinton, a consultant endocrinologist at the Royal Victoria Infirmary in Newcastle.
Soon clinicians and endocrinologists around the world began arguing about whether sufficient levels of vitamin D might positively impact coronavirus-related mortality rates. Some considered the nutrient an effective treatment hiding in plain sight; others thought of it as a waste of time. In March, the government’s scientific advisers examined existing evidence and decided there wasn’t enough to act upon. But in April, dozens of doctors wrote to the British Medical Journal describing the correction of vitamin D deficiencies as “a safe, simple step” that “convincingly holds out a potential, significant, feasible COVID-19 mitigation remedy.”
In the Newcastle hospitals, patients found to be vitamin D-deficient were given extremely high oral doses of the nutrient, often up to 750 times the daily measure recommended by Public Health England. In July, clinicians wrote to the journal Clinical Endocrinology to share their initial outcomes. Of the first 134 coronavirus patients given vitamin D, 94 had been discharged, 24 were still receiving inpatient care and 16 had died. The clinicians hadn’t clearly associated vitamin D levels with overall death rates, but only three patients with high levels of the nutrient died, and all of them were frail and in their 90s.
Increasingly, others followed the lead of the Newcastle doctors and began taking the vitamin themselves. During the first months of the pandemic, up to 1,000 NHS staff received free wellness packs — including vitamin C, vitamin D and zinc — from a voluntary initiative called the Frontline Immune Support Team, after informal demand from clinicians. And as sales of vitamin D supplements significantly increased, some doctors informally recommended it to patients. In a letter, the British Association of Physicians of Indian Origin advised its members to take the nutrient, though it was not made official policy.
“We believe that vitamin D3 deficiency is a major risk factor for severe coronavirus infection, for which there is accumulating evidence,” the letter said. “People born with darker skin receive less UV light in the deeper layers where D3 is made, and so are prone to more severe D-deficiency at the end of winter in northern latitudes than their fairer-skinned counterparts.”
By April, Public Health England had revised its vitamin D guidelines, wary of people’s reduced exposure to the sun during lockdown. Whereas once it had suggested only taking small doses in the winter, now it advised everyone to take a daily dose all year round, which was the pre-existing advice only for people of colour, those in care homes and children aged one to four. But it didn’t run an information campaign to inform the public of the change, nor tell those at greater risk to increase their intake, and the majority of people remained unaware of the nutrient’s potential effect.
To the former Brexit secretary David Davis, a Conservative who has a molecular science degree, the failure to fortify a wider group of foods seems unacceptable. Like clinicians at the height of the first wave of the pandemic, he couldn’t understand why vitamin D wasn’t being pursued as a viable coronavirus treatment. In May, he urged the health secretary, Matt Hancock, to review the evidence and consider a free supplement scheme to reverse vitamin D deficiencies, citing the letter sent to the BMJ.
The National Institute for Health and Care Excellence (Nice) and Public Health England, having reviewed the potential ability of vitamin D to reduce the risk of coronavirus, continued to announce that there was insufficient evidence to take action. The research was deemed to be of poor quality — not quite enough of it, not quite convincing enough. When the announcements came, Davis grew more frustrated.
“If you’ve got something that could potentially save tens of thousands of lives — worldwide, hundreds of thousands, if not millions — and you say there’s not quite enough evidence, but it’s indicating in a positive direction, then you do something about it, don’t you?”
In October, Davis made an unlikely alliance with Rupa Huq, the remainer Labor MP and a former sociology lecturer, who is also increasingly convinced of the merits of vitamin D, and the pair began to pile pressure on the government.
A month earlier, Davis had written an article for the Telegraph claiming that correcting Britain’s vitamin D deficiency could save thousands of lives. Huq later wrote in the Times that loudly telling people to take supplements should be “an obvious piece of advice.”
She pointed to countries where vitamin D levels are high, such as Finland (which fortifies dairy products with the nutrient) and New Zealand (which, since 2011, has prescribed vitamin D to all-aged care home residents, and where people live a more outdoorsy life), and said it was no coincidence that coronavirus cases and deaths in both countries had been rare. They have both also highlighted how black, Asian and ethnic minority people — who have higher levels of melanin in the skin, which tends to reduce the creation of vitamin D from sunlight — have been disproportionately affected by the virus, including an overwhelming disparity among doctors.
For UK public health experts, perhaps wary of overstated claims of vitamin D’s benefits, the case for downplaying the link to coronavirus initially mostly depended on retrospective studies and there was no official call for more research. One such recent paper considered by Nice, using vitamin D levels measured up to 14 years ago, found no link between vitamin D levels and more severe illness or mortality from COVID-19, but in another paper the lead author called for high-quality trials to ascertain whether vitamin D plays a beneficial role in the prevention of severe coronavirus reactions.
Hancock agreed to meet with Davis and Huq a fortnight after the Spanish study was published. The health secretary had previously claimed, wrongly, that government scientists had run a trial on vitamin D that showed it did not “appear to have any impact,” when in fact no such tests had taken place. In a meeting on Oct. 8, Hancock revealed he was facing resistance from the Department of Health and Social Care (DHSC) clinicians, but that he was nonetheless minded to change government course, later saying publicly there were “no downsides” to vitamin D supplements.
“Hancock had been adamant there was no link for a long time,” Huq says. “But you could see the penny drop and he agreed to do public health messaging recommending vitamin D.” In the meantime, coronavirus deaths continued to rise and, in the US, Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, said vitamin D deficiency impacted people’s susceptibility to coronavirus infection and: “I would not mind recommending — and I do it myself — taking vitamin D supplements.”
At the end of November, the government announced it would offer four months of free vitamin D supplements to all those in care homes and shielders — some 2.7 million people — beginning this month, with the prison service also providing free supplements to all prisoners. Hancock also ordered Nice (which sets NHS clinical guidelines) and Public Health England to produce recommendations on vitamin D for the treatment and prevention of coronavirus. The issue now seems so urgent to the DHSC that it has suggested people purchase their own supplements to ensure they have sufficient levels, ahead of the deliveries of the rations. “A number of studies indicate vitamin D might have a positive impact in protecting against COVID-19,” Hancock said.
However, Nice again ruled there was insufficient evidence to prove a causal relationship between vitamin D deficiency and COVID severity, but, for what is believed to be the first time, PHE’s nutrition committee said vitamin D “may provide some additional benefit in reducing the risk of acute respiratory infections.” While Nice belatedly called for more research.
There remains marked frustration over a relative failure to fund vitamin D studies.
“Our problem has been that major funding bodies haven’t supported clinical trials of vitamin D supplementation to prevent COVID-19, despite the fact that several different research groups in the UK submitted proposals,” says Adrian Martineau, a professor of respiratory infection and immunity at Queen Mary University of London, who was able to launch a charity-funded clinical trial in October to investigate whether vitamin D protects against COVID-19. He was only able to get his own trial off the ground “because charities and philanthropists gave us financial support and stepped in where the government didn’t.”
Davis now believes there will be increasing government focus on immunological health. “Covid kills you if you’ve got a weak immune system,” he says. “That’s why vitamin D has a much more general purpose effect than, let’s say, vaccines. We’re going to win this battle in the long run. I just feel for those who have died unnecessarily.”
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