Saturday, 26 September 2020

Covid-19 & Vitamin D – action: accept Pascal's wager


Covid-19 and Vitamin D


Pascal's wager


Blaise Pascal 1623–1662


It is interesting to look at the contribution of the 17th century French philosopher, theologian, and mathematician Blaise Pascal to the present pandemic of Covid-19 and the influence of vitamin D. 


Pascal's Wager

Pascal's wager was originally applied to the decision whether or not to believe in God, knowing that God's existence could neither be proven nor disproven. To believe would cost nothing, or at best a little time spent in devotion, and might result in eternal happiness. But to deny the existence or God would  cost nothing, with no time in devotions, but if wrong it would lead to eternal damnation. The pragmatic wager was to believe in God.

Pascal's wager is illustrated by a two-by-two contingency table, as I was taught in statistics lectures when I was studying medicine at Manchester University. Its message had laid dormant in my mind until a couple of weeks age when it was retrieved by my learned friend Patrick Gavin.

The basic table is as follows, and the results of decisions go into the boxes A,B,C,D.





It is conditional on absolutes. God either does or does not exist, and a person either believes in God or does not believe in God.



We can see that belief in God will lead to eternal happiness if God turns out to exist, but if God does not exist, time will have been wasted in devotions instead of a lie-in on a Sunday morning (or whatever for other religions). But if we choose to reject God, we face the prospect of eternal damnation should God turn out to exist, but no loss if God does not exist. Eternal happiness is better than eternal damnation, irrespective of the odds, and so the pragmatic decision is to believe in God. There is no disadvantage.

We can apply Pascal's wager to the decision whether or not to promote vitamin D in an attempt to prevent deaths from Covid-19. I must acknowledge this application to my good friend Patrick Gavin, who is a retired teacher of physics at nearby Stonyhurst College and a man of considerable intellect. 

The absolutes are that either vitamin D is of considerable benefit or it isn't, and we can either promote it or reject it. There are no alternatives. We can make the decision as individuals on the basis of evidence given to us, and as personal or public health physicians we must do the same, on the basis (hopefully) of much more extensive knowledge. 

The decision whether or not to believe in God is very much a matter of faith, but the decision to promote or reject vitamin D is based on evidence, the strength of which has increased considerably during the past six months. The evidence from Spain and many other countries is overwhelming.



Strong evidence would lead to the promotion of vitamin D. The advantage is that many deaths would be prevented if vitamin D really is effective. If it isn't the disadvantage will just be wasted effort but very little wasted money.

If the advantage of vitamin D is rejected (as is the official government advice at present), and if vitamin D is effective (as the evidence suggests) then there will be many unnecessary deaths. Those officials who reject vitamin D will have blood on their hands.

In September 2020 the weight of evidence in favour of benefit from Vitamin D during the pandemic of Covid-19 is overwhelming. It is thus clear that rejecting vitamin D as a health policy is responsible for many deaths now and in the future. It is a policy that is clearly negligent.

But perhaps there is a reason for the government and its medical advisors rejecting the use of vitamin D. If so it must be a very strong reason, and if so it would appear to have no medical basis. The cost is only about £$€ 10 per year and this is not a valid reason for rejection of vitamin D. There are no side-effects at a dose of maximum 10,000 units daily, with half that being the usual recommendation to optimise immunity. 

But there must be a reason to reject vitamin D.

Vested interests

The UK Health Secretary Matt Hancock told us on the morning radio on September 18th that government policy is to "hold" the pandemic until a vaccine becomes available. On September 22nd, Matt Hancock told parliament that :

"Vitamin D does not appear to have any impact on reducing the incidence of Covid-19"


This is simply not true. It is either a lie or it is ignorance, both being inexcusable with so many lives at stake. Of course as a politician he is lkeiely to be "economical with he truth". He cannot be expected to have read medical papers, but he has medical scientific advisors who we would expect to be up-to-date. Who are they?

Chief Medical Officer Professor Chris Whitty, who is on the board of CEPI, Confederation for Epidemic Preparedness Innovations, "New Vaccines for a Safer World", and he chairs the London branch. It has received funding from several governments, the Bill & Melinda Gates Foundation, the Welcome Trust, and it has received £20 million from the UK National Institute for Health Research, which Whitty co-chairs. We can see from a press release from September 21st that CEPI has expanded investment into vaccine research, but there has been been no documented research into vitamin D.




Chief Scientist is Sir Patrick Vallance, formerly having a high position in GSK (GlaxoSmithKlein), a high profile vaccine manufacturer with an important facility in Barnard Castle (remember?). Press releases (Times and Mail) from September 24th are shown below.





It is interesting to note his previous experience with vaccines.

The vaccine Pandemrix was manufactured by GSK and was introduced in 2009 as vaccine to prevent swine flu, a pandemic that did not materialise. It was given an accelerated provisional licence by the EU but not in the USA. It was given to 6 million people in Europe, many of them young people. In 2010 there were reports in Finland and Sweden of an unusual increase in the frequency of narcolepsy in young people. This is a brain disorder characterised by uncontrollable attacks of sudden deep sleep. It became a small but widespread epidemic and it was identified by the UK Patient Safety Agency (now part of PHE) to be due to Pandemrix. The licence was revoked in 2014 and it was withdrawn from use. 

Sir Patrick Vallance is hardly to blame for this, but It might be thought that this experience would cause hime to be cautious in his approach to vaccines, but not so, Once bitten easily forgotten.

Vaccines and Vitamin D

The very successful vested interests in the heart of government must cause concern. The need during the pandemic is for the population to become immune to the new virus, and this can be achieved in two ways. The one chosen by the government is to produce a vaccine, but this would be active against just one virus, and perhaps not against a mutation of it. Also it would take at least a year to develop and test, and as we have seen the major impact of the epidemic is likely to have been passed by then

The alternative is to optimise the immunity of the population, and this can be achieved issuing vitamin D supplements. Ideally we need to make certain that blood levels of vitamin D are about 40ng/ml (100nmol/L). Blood testing for all might take a few weeks, but vitamin D supplementation would be immediate.

Herein lies the problem: if vitamin D been issued at the same time as lockdown on March 23rd, the pandemic might have been over by now, with work, transport, education, worship, family gatherings, social events etc being once again part of our lives. Had vitamin D been so successful, what would. be the need for a vaccine, if only to prevent a common cold? And what of possible side-effects? 

So silence of vitamin D had to be maintained. No reading of evidence, no speaking of evidence, no listening to evidence. 

The conspiracy of silence and the denial of evidence has been very successful – so far. But one day the truth will be revealed to all.







Vitamin D deficiency and Covid-19 : its vital importance in a world pandemic



https://www.ypdbooks.com/2147-vitamin-d-deficiency-and-covid-19-its-central-role-in-a-world-pandemic-YPD02419.html





Wednesday, 16 September 2020

Covid-19 and Vitamin D. More evidence of benefit: observational studies from Italy, USA, Israel, Iran, Germany.


My previous Blog post was on the subject of "Covid-19 and Vitamin D: randomised controlled trial from Spain". This was the first RCT of vitamin D in Covid-19 and it had been demanded by commentators who were playing down the well-researched role of vitamin D in defensive immunity. 

To repeat: of 26 control patients admitted to hospital with Covid-19 pneumonia (on X-ray or CT scan), 13 (50%) needed admission to intensive care and 2 (8%) died. Of the 50 similar patients randomly allocated to receive vitamin D (initially 20,000 units and 10,000 units on days 3 and 7) only 1 (2%) required admission to intensive care and none died.

What could possibly be more clear and compelling than this? 2% versus 50% requiring intensive care. It is just what we might need in the UK in case of a "winter surge", especially with a vaccine being of unknown impact. Rather than awaiting admission to hospital with Covid-19 pneumonia, the vitamin D could be administered in advance.

But the report from Spain has been completely ignored by the government and its medical-scientific advisors, by the radio and TV news, by the press, and so far even by the medical  and scientific journals. Not even a hint of recognition and enthusiasm.

Why is this? Could it be directed by the Bill Gates and Big Pharma funded WHO? After all vaccines are to be given to the world population. There is big money at stake, and a cheap and safe competitor such as vitamin D is not to be encouraged.

But the evidence for vitamin D being of great benefit in protection of humankind against Covid-19 and future unknown viruses continues to accumulate. Can it be ignored indefinitely? As I have mentioned before, how many of our medical-scientific-political leaders are taking vitamin D? Dr Fauci in the USA has admitted in interview that he has been taking vitamin D. 

Here are more studies, careful observations that make a much stronger case for the role of vitamin D in defensive immunity against Covid-19. 


Observations from Bari, Italy

Bari Polyclinic


http://www.societaitalianadiendocrinologia.it/public/pdf/hypovitaminosis_d_covid19.pdf

Published on August 8th and subsequently viewed 131k times, was a study from the ICU of the Hospital Polyclinic of Bari, in southern Italy. It investigated the vitamin D status of patients with Covid-19 and applied this to the clinical outlook for these patients.

It took as 30ng/ml (75nmol/L) vitamin D as the level above which it is considered to be ideal and below which is deficient, or certainly below ideal. This is reasonable based on previous studies. 

Considering the sunny weather in Bari (compared for example to NW UK where I live) it is perhaps surprising that 81% of those tested had a blood level of vitamin D below 30ng/ml. However this is not an uncommon finding. Residents of Mediterranean holiday resorts usually avoid the strong sun whenever possible. 

The subjects were divided into four groups on the basis of the blood level of vitamin D. The distribution can be seen in Figure1.


The endpoint of the study was death at 10 days, and for the purpose of analysis there were just two groupings:

Vitamin D level <10 ng/ml 50% died

Vitamin D level >=10 ng/ml 5% died

This finding is dramatic and cannot be ignored, or should not be ignored. People with blood vitamin D level <10ng/ml should be identified and treated, as is done for people with high blood pressure or high blood glucose. It is a very important health indicator. 

The result of this study conforms to previous studies. It is unfortunate that the death risk was not recorded separately for all four vitamin D groups. This might have shown a gradient of risk related to vitamin D status, and this would have been a powerful finding.  


Observations from Chicago, USA

University of Chicago Medical Centre


https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157

Researchers at the University of Chicago Medicine investigated 489 out of 4314 patients who had tested positive for Covid-19. The use of the term "patients" implies that these "patients" were ill with respiratory infection rather than being asymptomatic individuals who merely had a positive test. They were among a larger group who had  blood levels of vitamin D tested during the previous year.

Patients deficient in vitamin D during the previous year had a risk of Covid-19 1.77 times greater than those who were sufficient. 

Risk of Covid-19:

Vitamin D deficient = 21.6%

Vitamin D sufficient = 12.2%

This study adds to knowledge that a low level of vitamin D increases the risk of Covid-19 clinical infection (as opposed to just positive testing). This study did not include the risk of death.


Observations from Israel

https://www.medrxiv.org/content/10.1101/2020.09.04.20188268v1.full.pdf

A study was undertaken of the 4.6 million members of the Clalit Health Services, using electronic health records. 

Between the years 2010 and 2019, 1,359, 339 (>30% of the members) had a vitamin D measurement performed and the results were analysed. 

Israel has its general population and within it two special ethnic groups, the Arab people and the ultra-orthodox Jews both of which exhibit modest dress habit with little skin exposure, especially Arab women. Despite the very sunny climate of Israel and its long summer, it is perhaps surprising that vitamin D deficiency is very common. In particular 59.1% of Arab women had seriously low blood levels of vitamin D, less than 12 ng/ml, or 30 nmol/L. The full results are show in the Figure below. 

This is perhaps a complex "rainbow" image, but the red columns represent seriously low levels of vitamin D (<12ng/ml, 30nmol/L) and the blue columns represent very good levels (>30ng/ml, 75nmol/L), more common in the general population than in the ethnic groups.

The same medical records were examined for evidence of Covid-19 infection, and comparisons made each with ten matched controls. The Covid-19 infection rates can be seen in Figure below. It was below 1% in the general population, but above 1% in the Arab groups 1.12 in males, 1.64 in females) and much higher in the ultra-orthodox (3.37 in males, 2,69 in females). 


There was strong correlation between severe vitamin D deficiency and Covid-19 infection. The particularly high Covid-19 incidence in ultra-orthodox men was put down to the dress code of a wide-brimmed hat together with a traditional heavy beard, these minimising sun exposure. This does not entirely correlate with the blood vitamin D levels, but there is another factor.

We can also see in the Figure below that the incidence of Covid-19 infection was lowest in those who had the lowest blood levels of vitamin D. 14.3% of the sample of 18,361 with vitamin D greater than 30ng/ml (75nmol/L) had Covid-19 infection, whereas those with lower vitamin D levels (less than 30ng/ml) had twice the incidence of infection, 28.6%. 



The blood levels of vitamin D had been undertaken as part of normal clinical practice rather than an epidemiological study. Because of this most of those found to have vitamin D deficiency were given a vitamin D supplement, usually as drops. It was observed that prescription of vitamin D was associated with a reduced Covid-19 infection risk.

Here have seen yet another study indicating a protective role of vitamin D in protection against Covid-19. An ideal blood level of vitamin D (>30ng/ml) reduced by half the risk of Covid-19 infection.

In this study the low vitamin D level predated the infection. The low vitamin D level was definitely not the result of Covid-19 infection.


Observations from Iran


Virus Res. 2020 Aug 28;198148. doi: 10.1016/j.virusres.2020.198148 


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7455115/


The study was of 65 male and 58 adult patients admitted to the Behpooyhan Clinic, Tehran, on account of proven Covid-19 pneumonia. They were compared to 63 control Covid-19 patients of similar age.


The average (mean) blood vitamin D level in the Covid-19 patients was 19.25 ng/ml (50 nmol/L), and in the controls it was 30.17 (70). In those who died it was particularly low  at 8.175ng.ml (20nmol/L).



The results were as in several other studies, supporting the strong evidence that vitamin D deficiency is a major factor in clinical Covid-19 infection and death from it.


Observations from Heidelberg, Germany


Medical University Hospital, Heidelberg


https://www.mdpi.com/2072-6643/12/9/2757


A study from the Medical University Hospital, Heidelberg was published on September 1st 2020. It was a prospective study of 185 patient with Covid-19 and a retrospective study of their vitamin D status and its association with outcome.


Of the 185 patients, 92 were managed on home treatment and 93 required admission to hospital so as to maintain oxygenation. Of the 93 admitted, 28 (60% of those admitted, 29.5% of total) required invasive ventilation, and 16 ( 15% of those admitted, 8% of total) died.  All patients had required standard treatment including azithromycin, hydroxychloroquine, prednisolone (steroid). 


Blood samples from all patients were frozen and analysed for vitamin D at the end of the study. 


The average (mean) blood level of vitamin D of the 185 subjects was 16.6ng/ml (41.5nmol/L). Vitamin D deficiency was defined in this study as less than 12ng/ml (30nmol/L). This was observed in 41 of the 185 patients (22%). It is remarkable that this severe deficiency of vitamin D was so common in a prosperous German city, at least in those who were sick with Covid-19, but no doubt less common in the general healthy population that were not included in this study..


The distribution is shown in the Figure (the vertical black line indicates 30ng/ml, above which blood levels of vitamin D are ideal. 




Observations during the Covid-19 pandemic in particular has confirmed previous experience that although a blood vitamin D level of 20ng/ml (50nmol/L) is adequate to avoid rickets and osteomalacia, a minimum level of 30ng/ml (75nmol/L) is necessary for the escalation of defensive immunity at a time of serious infection. Approximately 160 of the 185 patients (86%) were deficient in vitamin D by this definition.


In this study the risk of death was expressed as the "Hazard Ratio", HR, excess risk if those with vitamin D deficiency related to those with ideal blood levels of vitamin D. 


Of the 22% with serious vitamin D deficiency (<12ng/ml):


HR for invasive ventilation  =  6.12

HR for death                         = 14.73



This study took place during  period of three months. The bloods could have been analysed for vitamin D earlier. This might have revealed  similar hazard ratios and on ethical grounds the observational study could have been halted. It could have been converted into a randomised controlled trial, but it would have been much easier to convert it into a longitudinal trial. This would have involved commencing intervention with vitamin D supplements after six weeks, and then comparing outcome before and after this intervention. It would have added to the study and it would probably have resulted in reduced need for invasive ventilation and fewer deaths.


Comments:


  • The study from Bari demonstrated a 10-fold increase in risk of death from Covid-19 in those with serious vitamin D deficiency.
  • The study from Chicago demonstrated a double risk of Covid-19 infection in those deficient of vitamin D.
  • The study from Israel demonstrated a double risk of Covid-19 infection in those deficient of vitamin D, and much increased risk of death.
  • The study from Iran demonstrated a high risk of death from Covid-19  in those deficient of vitamin D.
  • The study from Heidelberg demonstrated an almost 15-fold increase in risk of death from Covid-19 in those with serious vitamin D deficiency. 

How is it that these studied have been ignored by governments and the press? How many more people must die as a result of official inaction? Why are our officials asleep at the wheel? When will inertia be replaced by action?




https://www.ypdbooks.com/2147-vitamin-d-deficiency-and-covid-19-its-central-role-in-a-world-pandemic-YPD02419.html



 
















Monday, 7 September 2020

Covid-19 and Vitamin D: Randomised controlled trial from Spain

Reina Sofía University Hospital, Córdoba, Spain


At the onset of the pandemic of Covid-19, a number of mainly medical scientists suggested to the government in a variety of ways, direct and indirect, that it would be sensible to use vitamin D supplements to diminish the impact of the virus on the population. Such medical scientists knew of the vital importance of vitamin D in optimising defensive immunity. They emphasised that vitamin D was cheap, safe, and available immediately. It was envisaged to prevent the rapid and often fatal escalation of the infection due to the "cytokine storm", that vitamin D is known to "switch off". 

40,000 deaths, perhaps not inevitable

Unfortunately this advice fell upon deaf ears, and we had to sit and watch while more than 40,000 of our citizens died. Those who understood vitamin D and its common deficiency predicted that those who would be hit the hardest would be the elderly in residential care homes and people with melanin-rich skin, people of black African and Asian ethnicity (BAME). These groups had previously been identified as being at particular risk of serious vitamin D deficiency.

Deaths of 26 doctors

And so it came to pass. 26 working doctors died from Covid-19, and 25 of them had ethnic genetically determined melanin-rich skins. Their  chance of dying in the UK was 20 times greater than in India and Pakistan, and 100 times greater than in equatorial Africa. Vitamin D deficiency was the obvious answer, but it was ignored by the government and its advisors, and also by those responsible for public health policies throughout the UK.

What is proof?

There was a refusal to contemplate giving vitamin D to the citizens of the UK. The reason expressed was that it was "not proven to help in Covid-19 infection". Of course not. Covid-19 was new to medical science and there obviously had not been time to conduct the appropriate trials. For the same reason we do not yet have a tested vaccine. 

Those who expressed this opinion had no understanding of the concept of proof. There were demands for randomised controlled clinical trials (RCTs) before it could be used. It was obvious that this would take a considerable time, and so it has. The first RCT result of vitamin D has now become available, but serious illness and deaths have virtually come to an end in Europe.

Official delays

What has been gained by officially delaying the introduction of vitamin D? Nothing whatsoever. What has been lost? The lives of many people, especially those with melanin-rich skin.

But there has been widespread awareness of the potential value of vitamin D. Word has got around and sales of vitamin D in the UK are thought to have increased by a factor of 30. Perhaps our political leaders and public health officials are taking vitamin D on the quiet. I hope so, but I hope even more that they will spread the message.

Now there is evidence of benefit from Vitamin D that politicians will not be able to deny, but which they might choose to ignore. It has not yet been reported in the UK news media.


RCT from Spain

https://www.sciencedirect.com/science/article/pii/S0960076020302764

So here it is, a review of the the study from the Reina Sofía University Hospital, Córdoba, Spain, which came to my attention on September 3rd.

The study was of 76 consecutive patients admitted to hospital on account of serologically proven Covid-19 infection causing pneumonia as demonstrated on chest X-ray. 

All patients were given on admission hydroxychloroquine and azithromycin (antibiotic), together with general support. They were immediately randomised to receive vitamin D or to act as controls and not receive vitamin D. They were allocated electronically in the ratio of two vitamin D recipients to one control

Vitamin D was given as the liver-activated form 25(OH)D, or calcidiol. To become biologically active it must receive within the immune cells (which it ultimately activates) another hydroxyl group to become 1,25(OH)D, or calcitriol.

The initial dose of vitamin D was 532mcg, which is 20,000 units. A second dose of 266 mcg (10,000 units) was given on days 3 and 7, and then weekly until discharge from hospital.

50 patients received vitamin D, and 26 acted as controls. The two groups were reasonably comparable in respect of prognosis indicators. The outcome measures were the need for ICU admission and death. The decision to admit to ICU would be made without the knowledge of whether or not a patient had been allocated to vitamin D.

Results

Of the 26 control patients, 13 (50%) required admission to the ICU, and 2 died.

Of the 50 patients allocated to receive vitamin D, 1 (2%) needed to be admitted to the ICU, and there were no deaths.


Figure 2. Effect of vitamin D on escalation to ICU support

Diversion to Brazil

A report in the Lancet September 8th is that an RCT of azithromycin (included for all in the Spanish study), which was undertaken in Brazil, showed no benefit from the addition of azithromycin to standard care. Unfortunately vitamin D was not used in the Brazil study and death occurred in 42% and 40% of those given or not given azithromycin. It is a disappointment that the Brazil team chose to investigate azithromycin and not vitamin D.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31862-6/fulltext


Conclusion

It can be concluded from the study from Córdoba, together with very large published data supporting vitamin D, that vitamin D is of immense help in the management of Covid-19 infection, reducing the need for ICU support from 50% of the patients to 2%. 

This study confirmed what was confidently expected and which to many was  glaringly obvious. 

Vitamin D must be taken, ideally well in advance (in other words now) to control Covid-19 infection, to diminish the risk of serious illness and death. This must become official policy. But will it? No doubt sceptics in the ivory tower offices, probably taking vitamin D on the quiet, will demand repeat studies before sanctioning official action.

Ethical considerations

This result of this study was confidently predicted as there has been ample evidence to support the use of vitamin D in optimising defensive immunity at a time of infection. An RCT was not necessary, apart from satisfying the academic sceptics. 

As a result of the result of the RCT in C√≥rdoba, 12 patients needed admission to ICU and two died, when they might not have done had they received vitamin D. 

The 26 controls gave consent when entering the study on admission to hospital. Had they been fully informed of the strong potential benefit of the vitamin D that was, with their "consent", withheld from them? Were they aware of their risk of death (ultimately 8% in this study)? If they were too ill to give consent, were their families informed of these risks? 21 of the 26 control patients were younger than 60 and half of them died. Should their relatives and dependents receive financial compensation for their misfortunes that  resulted from this scientific experiment?

I expect that there will be attempts to rubbish this report, and then demand that the study must be repeated. How many human sacrifices will this necessitate?

Will our medical - scientific - political leaders please come clean and tell us whether or not they are taking vitamin D supplements.



https://www.ypdbooks.com/2147-vitamin-d-deficiency-and-covid-19-its-central-role-in-a-world-pandemic-YPD02419.html



 




Thursday, 3 September 2020

Covid-19 and Vitamin D: some questions


Covid-19 and Vitamin D: some questions

The evidence underpinning these questions has been displayed in detail in recent Blog posts.

1.

Since early May there has been a major and sustained reduction in deaths from Covid-19, hospital admissions, and ventilated patients. In that we have no appropriate antiviral therapy, how has this come about? Could it be anything to do with the change of season from winter to summer, and the fact that during April in the UK the sun becomes high enough above the horizon (greater than 45 degrees) to generate vitamin D in our skin?


2.
Why is it that the well-established science of the defensive immune process and its vital activation by vitamin D has been neglected by our medical-scientific leaders and our major medical journals?

3.
Why is it that out of 26 working doctors who have died from Covid-19, 25 had ethnic genetically determined melanin-rich skin, which is well known to to be inefficient at generating vitamin D? Their misfortune has been explained officially as due to socio-economic disadvantage. Is it true that they were socio-economically disadvantaged?

4.
Why is it that in equatorial African countries, the deaths per million are between 0.3 (Uganda) and 16 (Sudan) compared to 615 in the UK and 578 in the USA? Why is it that an ethnic African with melanin-rich skin has about one hundred times the risk of dying from Covid-19 in the UK compared to family members in equatorial Africa? Is socio-economic deprivation so much worse in the UK than in equatorial Africa? Or could it be that a melanin-rich skin has an evolutionary advantage in equatorial Africa but a biological disadvantage in the UK?


5.
Similarly, why is it that India has experienced 32 Covid-19 deaths per million and Pakistan 28, compared to the UK 613? Why is it that people of South Asian ethnicity living in the UK have twenty times the risk of Covid-19 death compared to those living in India and Pakistan? Again, is this the result of much more serious socio-economic deprivation in the UK? Or could it be due to differences in climate and vitamin D production in melanin-rich skin?

6.
The British Medical Journal has published during 2020, obituaries of 18 doctors whose deaths have been reported as due to Covid-19. Why is it that 10 have been in those with melanin-poor (ie white) skin, their ages between 84 and 107 (mean 88), whereas the 8 with melanin-rich skin (BAME) have had an age-range between 46 and 79 (mean 63), with no overlap of the age ranges?



7.
Why have these ethnic disadvantages and deaths not been taken seriously by medical-scientific leaders and major medical journals?

8.
Why is it that in July and August, at least in Europe (for example Belgium), “cases” have been increasing quite dramatically in many if not most countries whereas deaths and hospital admissions due to Covid-19 are equally dramatically now very low?





9.
Is it true that antigen testing does not discriminate between someone who is ill from Covid-19 and someone who is simply an asymptomatic carrier of the virus? Is it true that someone who is immune could carry the virus? Will this not be the case after vaccines are introduced? Is it true that vaccines will not stop the virus from landing on the nasal mucosa of someone vaccinated but will just prevent tissue invasion and disease? 

10.
Will extensive testing mean that the mathematical pandemic fuelled by increasingly extensive antigen testing will take a long time in coming to an end? Will the time come that a medical-political leader will say "Enough is enough, we must now stop testing and reporting so that life and the economy can hopefully return to what used to be normal"?

11.
In that we have now experienced more than 40,000 deaths from Covid-19, do our medical-political leaders 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 medical-political leaders accept that it would have been worth a try?

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