Covid-19 and Vitamin D : cases – deaths dissociation in August

Covid-19 and Vitamin D : after six months

The triumph of new technology over common sense and historical perspective

Figure 1. Covid-19

On December 31st 2019 in Wuhan, China, a report was issued concerning a cluster of cases of an unusual form of pneumonia. The cause was found to be a corona virus, similar to the viruses responsible for SARS and MERS. Corona viruses (so called because the profile resembles a crown) were first identified in 1965 by Tyrell and Bynoe, working in the UK Common Cold Research Laboratory.

China released the genetic sequence of the new virus on January 12th 2020. On the following day the first case outside China was recorded in Thailand. By January 30th there were cases reported in another 17 countries.

Europe

The first case of Covid-19 in Europe was in Italy at the end of January By March 1st 2020 Italy had recorded 1694 cases and 34 deaths. Spain was the next European country to experience a large number of Covid-19 cases and deaths. On April 23rd the deaths in Italy had risen to 25,549 (429 per million), in Spain to 22,517 (473 per million). 

UK

The first confirmed Covid-19 case in the UK was in a hotel in York on January 29th. Two Chinese nationals had arrived by air flight from Wuhan. It was later revealed that 5 million people left Wuhan by air during this critical time. On February 6th in Brighton an Englishman was diagnosed with Covid-19 after he had arrived by air from Singapore. The first person to catch Covid-19 in the UK was on February 28th. 

By March 23rd the number of cases in the UK  had reached 19,507 with 289 deaths. At this point ‘lockdown’ was introduced so as to prevent further spread throughout the population. 

Figure 2. UK deaths each day

But the number of cases and deaths continued to increase. Cases and deaths per day reached a peak in early April but then declined. By the end of July there had been in the UK a total of more than 300,000 cases and more than 45,000 deaths.

Reduction of deaths

The rapid increase in the number of deaths during late March and early April was alarming. It led to a demand for many more intensive care beds and ventilators for those critically ill. New hospitals were built in the UK with impressive speed.

But then, as shown in Figure 2, at the end of April there was a steady decline in the number of deaths, from 1,000 per day in April to 100 per day in July and August. This was unexpected and reason for it has not been debated. There was no specific treatment available at that time, but later dexamethasone was given to the critically ill. 

It is no coincidence that the decline in deaths followed the change in the season, from winter to summer. After mid-April in the temperate zones of the northern hemisphere the sun is high enough in the sky and is strong enough to produce vitamin D from 7-DHC in human skin. There is then an improvement in immunity. It is this that was the "game-changer", it was obviously the arrival of the summer months that brought about the decline in deaths.

Africa and Asia

The deaths from Covid-19 in the UK (and in the USA and Sweden) had been disproportionately high among those of black African and Asian ethnicity. It was highest of all in those of African ethnicity. This has been attributed to socio-economic disadvantage, the result of racism. There have also been suggestions of a genetic predisposition to Covid-19 death, without mentioning the glaringly obvious genetic factor of  melanin-rich skin. Melanin in the skin acts as nature's sun factor: it absorbs UVB from sunlight and minimises damage to the skin, but it also diminishes vitamin D production.

We can perhaps understand this better by looking at the experience of black Africans who are living in Africa. The deaths per million, the most important measure of Covid-19, are remarkably low in equatorial African countries, the lowest at 0.3 in Uganda and highest in Liberia with 16 deaths per million. This can be contrasted with 518 in the USA and 613 in the UK. I doubt if the socio-economic disadvantage would be any worse in the UK than in Liberia or Uganda but the different mortality rates could not be more striking.

Dying from Covid-19 in the UK, Africa, and India

In India the number of deaths per million population is 36, and in Pakistan 28. In Africa we have seen that the deaths per million population are much lower.

In the UK (overall 613 deaths per million) the mortality of those of black African and Asian ethnicity is much higher that the white population. It has been assumed to be the result of socio-economic disadvantage. If this were true (which it obviously is not) the immigrants and their descendants must be very disappointed that they have moved from Africa and Asia to the UK only to find themselves far more socio-economically disadvantaged than they were previously. 

The data show clearly that in the UK the high black African and Asian death rate from Covid-19 is geographical and biological. Compared to being close to the equator, melanin-rich skin at a latitude of more than 50 degrees north causes serious and life-threatening vitamin D deficiency. 

It is important to remember that adequate body reserves of vitamin D (a blood level greater than 30ng/ml or 75 nmol/L) is imperative for  optimal defensive immunity  

August increase in cases

In August governments were almost panic-stricken in many European countries. Serious disease and deaths had fallen to very low levels, but cases were stubbornly continuing. Lockdown had been introduced in most countries but of course physical distancing and isolation cannot continue for ever. When lockdown is removed, as in July, the virus will not have "gone away" as viruses cannot do that.

An epidemic such as cholera can be controlled and eradicated by human ingenuity, in this case the purification of drinking water and safe disposal of human waste. But it is different with respiratory viruses such as flu and corona viruses. Humankind cannot control the air we breath, other than chemical pollution. Most people live close together in cities and share the same air.   

When people ultimately come out from lockdown they will begin to socialise, worship, work, and study together, and they will inevitably come into contact with Covid-19. This is what happened: the number of cases increased  leading to fear of a "second wave". This should come as no surprise to governments, but to a government policy based on arithmetic it presents a serious challenges: should lockdown be re-introduced? Should our children be allowed to return to school? Should the singing of hymns now be allowed in our churches? Can weddings and funerals be attended by more than a handful of people? Can workers go back to work?

Figure 3. UK: new cases each day

We can see in Figure 3 the decline of daily cases in UK from the early May peak of 6,000, but a slight and stubborn increase in July and August. There have been a few days on which the number of new cases was not reported on Worldometer, more in several other countries.

We have seen in Figure 2 the decline in deaths each day in the UK.

Cases and deaths divergence in Europe

The increase in the number of cases per day has been much more dramatic in other European countries. We can see below some  examples. Firstly Spain, which was the second European country to receive a serious Covid-19 epidemic.

Figure 4. Spain: new cases each day

 

The peak of almost 6,400 cases on April 25th was the highest in Europe, but it was exceeded on the same day by the USA with17,333 cases, the USA having seven times the population. A rapid decline during May was reassuring, but during the second half of July a second peak occurred, to 5,760 on August 7th. This was almost certainly the result of release of the population from the strict lockdown that occurred during May and June.

However the "second peak" of cases was not accompanied by an increase in the number of deaths.

Figure 5. Spain: deaths each day

The 400 deaths occurring on April 23rd represented a cumulative 460 per million population at that time, second only to Belgium at 560. Deaths from Covid-19 effectively came to an end by the end of May, and this has continued throughout the summer. On August 8th Spain experienced 4507 new cases but only 3 deaths. 

We see the same pattern in Switzerland.

Figure 6. Switzerland: new cases each day

The peak in mid-April was followed by a decline to mid-May, but then steady increase during July and August.  There is again a contrast with deaths.

Figure 7. Switzerland: deaths each day

The peak of deaths at the end of April corresponded to a cumulative 202 per million population. In contrast to cases, there were subsequently very few deaths, 147 between May 5th and August 12th, leading to a total of 230 per million.

Austria has experienced and even greater divergence between cases and deaths.

Figure 8. Austria: new cases each day

The start of the epidemic in Austria was quite modest, but in July and August there has been a remarkable increase in cases, with a far greater number of cases per day than in the early stages of the pandemic. Lockdown helped control the number of cases in May and June, but it cannot continue for ever. 

As with other European nations, the increase in the number of cases has not been matched by deaths.

Figure 9. Austria: deaths each day

We can see in Figure 10 the number of cases per million in a selection of countries. The USA is the only large nations with more than 10,000 cases per million. Austria is well down the list.

 

Figure 10. Covid-19 deaths per million

Government policy

The government is concentrating on the number of cases. Although there has been a recent increase in "cases", there remains a dramatic reduction of deaths. So what should be the government priority, cases or deaths?

It depends on what is "a case". Is it someone with just very minimal or even no symptoms who has tested positive? Such cases are bound to be common with there being "drive-in testing centres". Then we have cases who are defined by illness sufficient to lead to hospital admission, and then those who are so ill that require intensive care and ventilation. 

Previous epidemics came to an end when people stopped being ill, admitted to hospital, or dying. But this one is different: we now have the new technology of antigen testing. The government-directed testing is expanding steadily, and as a consequence more "cases" are discovered. It is government (and WHO) policy that is keeping the epidemic alive. 

Could it be that it keeps up demands for vaccines? In that serious illness, hospital admissions, and deaths are now at an end what help will vaccines be? More cases mean more immunity within the population.

Hospital admissions and ventilation

The daily numbers of cases and deaths are displayed to the public directly, but there is no explanation of the severity of cases. Certain details are, however, available from the website of the UK Office of National Statistics (ONS). We have seen above the decline of cases and deaths. 

From the ONS website we can see the number of patients in hospital suffering from Covid-19. The decline has been remarkable since mid-April, when vitamin D production started.

Figure 11.  UK: Covid-19 patients in hospital each day

In March and early April there was panic that we did not have sufficient ventilators for critical care patients. We can see from the ONS website the decline of the number of ventilated patients. The increase of use of ventilators was dramatic in early April. The decline in ventilator use in the UK was obvious by the end of April, and by the end of May the numbers had declined remarkably, from 3,300 to 1000. There are now very few patients on ventilators.

Figure 12.  UK: Covid-19 patients on ventilators each day

More cases, more immunity

It is clear that in many countries the incidence of Covid-19, the number of new cases per day, is increasing, but this is not being matched by severe disease or the number of deaths. The disease is becoming milder, but this is not due to a change in the virus: it is due to a change for improved immunity in the human host. We are now producing vitamin D in our skin. The vast majority of people developing infection with Covid-19 now are no longer facing serious disease and they are going to become immune.

Government advice

This is important. Government advice has concentrated on the number of cases, an obsession with the virus. The mathematicians in control appear to have no knowledge of biology and medical science. The government has not considered humankind, the people, the "holistic" approach. We can only hope that this will change. Optimism is provided by the news that Public Health England (PHE) is being disbanded because of its failure to have a useful influence over the UK epidemic of Covid-19, but the leadership of the replacement body does not inspire confidence

 It is obvious that:

• As we have moved from winter to summer, the number of deaths declined to a very low level, highly suggestive of a defensive function of the sun and vitamin D.
• It is obviously an advantage to have Covid-19 in the summer than in the winter.
• Vitamin D does not prevent Covid-19 infection or contamination, but it prevents escalation to serious disease and possible death.
• In the UK black African and Asian people have a higher risk of death, and the experience of doctors in the UK and people living in India and equatorial Africa indicate the biological factor of vitamin D deficiency.
• The increase in new cases means an increase in the number of immune people.
• Our increased production of vitamin D since mid-April is likely to last until the end of the year.
• To prevent a second wave of deaths in early 2121 it would be sensible to provide the population with vitamin D supplements.

Vitamin D production depends on latitude

Figure 13 looks at cutaneous vitamin D production in April in the USA. The further south of residence, the greater is the chance of vitamin D production in April, and also in September. Between these months, in the summer, vitamin D production will occur throughout the country, but the further south the longer the summer. It will be the same in Europe, remembering that New York is on the same latitude as Madrid and Florida as North Africa.

Figure 13: Vitamin D production in April in the USA

Simple questions for the government:

"In that we have now experienced more than 46,000 deaths from Covid-19, do you in retrospect think that it might have been an advantage to our population for them to have been issued with vitamin D supplements at the same time as lockdown on March 23rd, when we had experienced only 285 deaths?" 

"In that vitamin D is very safe, very cheap, and has a very strong scientific foundation in optimising immunity, do you think that it would have been worth a try?"

I would not want the word “proof” (or the two words “no proof”) to appear in the answer, as it is unlikely that the government members would be able to define the word “proof”. I would add that there is no such thing as absolute proof, and that proof must always be pragmatic. It is pragmatism that we clearly need at present.

Initiatives

Evidence of the potential of vitamin D to help in the pandemic is increasing and is now overwhelming, but there remains a deafening silence from the government. Despite lack of advice from the centre, the word is getting about via social media that vitamin D is of benefit to immunity, and that immunity is the key to survival from Covid-19 infection and avoidance of serious disease.

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The population seems to understand that now we are in the summer with the sunny weather (and it has been an excellent summer in the UK), the dangers are in the past. People are congregating on the beaches and in the bars. The government is panicking and is warning of great dangers, but what are the present dangers?

The government through its mathematician advisors has not done well. Public Health England (PHE) has performed so badly that is being disbanded, but it will be interesting to see if the replacement body will have among its predicted 10,000 staff someone who will have knowledge of immunity and vitamin D.

The future

We have seen almost the end of deaths from Covid-19 during the summer and the influence of the sun and vitamin D. But what will happen in the coming winter? At the latitude of the UK, we will stop producing vitamin D in September, but vitamin D stores accumulated during the summer should last until towards the end of the year. After that there might be an increase in deaths, as always happens in the winter. The policy should be to protect the population with vitamin D. Vaccines are on the horizon, but vaccines will be more effective if immunity is optimised with vitamin D.

At present every new case is an addition to immunity, but this will not reach everyone. Perhaps there should be encouragement to spread the virus during the summer when we are obviously more resistant than in the winter, but better if we are also protected by the use of vitamin D supplements.

Winter death peaks in England, much greater in early 2020

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