Vitamin D3 and K2 and their potential contribution to reducing the COVID-19 mortality rate
https://www.ijidonline.com/article/S1201...0624-X/fulltext
Simon Goddek

Open AccessPublished:August 05, 2020DOI:https://doi.org/10.1016/j.ijid.2020.07.080
Vitamin D3 and K2 and their potential contribution to reducing the COVID-19 mortality rate
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Highlights

• Vitamin D serum levels above 35 ng/mL seem to correlate with the mortality rate of COVID-19 patients.
• The majority of the Western population is deficient in Vitamin D.
• Vitamin D3 supplementation also requires additional vitamin K2 intake.
• The immunoregulating function of vitamin D is promising and might decrease the global epidemic mortality.

Abstract
The world is desperately seeking for a sustainable solution to combat the coronavirus strain SARS-CoV-2 (COVID-19). Recent research indicated that optimizing Vitamin D blood levels could offer a solution approach that promises a heavily reduced fatality rate as well as solving the public health problem of counteracting the general vitamin D deficiency. This paper dived into the immunoregulatory effects of supplementing Vitamin D3 by elaborating a causal loop diagram. Together with D3, vitamin K2 and magnesium should be supplemented to prevent long-term health risks. Follow up clinical randomized trials are required to verify the current circumstantial evidence.
Keywords

Vitamin D
COVID-19
Coronavirus
Mortality rate
Immunology

Introduction
The COVID-19 pandemic is a current pandemic of high international interest, caused by the coronavirus strain SARS‑CoV‑2. Up to date, there is no treatment to decrease the virus-caused infection and mortality rates (Cortegiani et al., 2020
). More and more voices are being raised supporting the supplementation of Vitamin D3 to counter the pandemic outbreak with the correlated mortality rates as well as economic and social consequences (Grant et al., 2020
). In a recently published review article, Sharma et al. (2020) have critically discussed the association of vitamin D with viral infections. A recent clinical study from Iran (n = 611) stated that there were no COVID-19 deaths in a hospital if serum 25(OH)D concentrations were higher than 41 ng/mL and patients were younger than 80 (Maghbooli et al., 2020
). Russian hospitals observed that the likelihood to have severe COVID-19 increases by the factor of 5 if vitamin D is deficient (Karonova et al., 2020
). Similar observations have been made by Panagiotou et al., 2020
. Tan et al., 2020
observed a significant reduction in oxygen support for older clients when providing them with a relatively low daily dose of 1000 IU D3 OD, 150 mg magnesium OD, and 500 μg B12 OD upon admission. On the other hand, one retrospective cohort study that investigated the correlation between the mean D3 serum levels of different European countries and the COVID-19 mortality rate was not considered significant (Ali, 2020
). An explanation for this could be that testing conditions differ in each European country, making it difficult to reach a conclusion in such a retrospective study. Also, the mean D3 serum levels do not necessarily apply to people who are especially vulnerable to that virus (e.g. aged and bedridden people). This assumption is supported by De Smet et al., 2020
who documented a significantly lower median D3 value in patients with COVID-19 compared to control subjects.
The obviously correlating vitamin D deficiency is linked to increasing the risk of many common and serious diseases (Holick, 2004
). In a study conducted by Forrest and Stuhldreher, 2011
, vitamin D deficiency was defined as a serum 25(OH)D concentrations ≤20 ng/mL. 41.6% of the test subjects have been considered vitamin D deficient. Of the tested people of color (PoC) and Hispanics, the deficiency rate was even 69.2% and 82.1%, respectively. Similar observations with respect to patients’ ethnicity have been made by Holick, 2002
and Darling et al., 2020
. The latter also states that serum 25(OH)D concentrations were lower in obese people that were tested COVID-positive, which is most likely due to increased relative body volume. Haq et al., 2016
even report that 82.5% of studied patients in the sun-intensive Middle East were vitamin D deficient. These observations with respect to common vitamin D deficiency, together with evidence of several experimental studies (Bendix‐Struve et al., 2010
, Casteels et al., 1998
, Holick, 2005
, Seibert et al., 2013
), indicates that vitamin D is essential in the modulation of immune function (Aranow, 2011
, Sassi et al., 2018
).-- excerpt, rest at link above --

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