Sunday, 22 November 2020

Covid-19 & Vitamin D : Deaths of doctors from Covid-19

Excess deaths from Black, Asian, and Minority Ethnic Doctors during the Covid-19 Pandemic


I would like to display some information that I have collected during the course of the pandemic this year, and unfortunately finish on a low note.

Most weeks in the British Medical Journal we can read six obituaries to UK doctors who have died. They will not make up a full list of doctors who have died but they are interesting to read. I have recorded for a few years the ages and causes of death, but 2020 is particularly interesting as we can see the personal effects of Covid-19. In recent years the causes of death have been clearly displayed in the BMJ. During 2020 up to November 7th there have been 245 obituaries displayed with cause of death not stated in only 5.

The obituaries are accompanied by names (obviously) but also photographs. It has therefore been possible to assess the ethnicity of those who have died. I have divided them into two groups, White and BAME (Black African and Asian minority Ethnic groups).

They are displayed in Figure 1, a bar chart in which each column represents each of the 25 doctors who have been reported to have died from Covid-19, and the height of the columns represents the ages at death.The youngest death was at the age of 46 years and the oldest at the age of 107 years.


Figure 1. Doctors in the UK who have died from Covid-19

What is most dramatic and disturbing is the complete lack of overlap between the ages at death of the white and BAME groups.

Age range White:  84 to 107

Age range BAME:  46 to  79

Average mean age White:  91

Average mean age BAME:  62

As with the Cigarette Smoking and Lung Cancer study, published in 1950, we are dealing with only doctors, a homogenous group. We can therefore eliminate confounding factors such as income, housing, or socio-economic status.

The only one thing that the two groups do not have in common is skin pigmentation, but it is the one thing that the members of the BAME group do have in common. They might come from a range of nations within Africa, the Middle East, India and Pakistan, and South-east Asia, with different traditions, religions, and inheritance, but they share a melanin-rich skin.

These findings will be very uncomfortable to many people in government, and rightly so. Their advisors have declared that the high death rate of BAME people is due to socio-economic  factors, but this cannot be the case with doctors. The BAME doctors have died 30 years on average younger than their white counterparts. This is a major cause for concern and it must not be dismissed. I can think of no explanation other than skin colour.

The link between skin colour and Covid-19 deaths in the UK is deficiency of vitamin D. Melanin in the skin is a superb sun-shield that blocks 80% or more of the UV light that is incident upon the skin. Vitamin D is produced from the action of UV on 7-dehydrocholesterol which is synthesised within the skin, and this process is reduced by the presence of melanin. UV is diminished not only by absorption by melanin, but also by distance from the equator, the low elevation of the sun in the winter, extensive skin cover by clothes, indoor work, indoor leisure, and sun-avoiding behaviour including excessive use of sunscreens.

The way to reduce the impact of Covid-19 is to correct the widespread vitamin D deficiency which leads to suboptimal defensive immunity. No doubt the 13 BAME doctors recorded here died without knowing their blood level of vitamin D and without any correction of likely deficiency.

Extensive vitamin D deficiency is being ignored. What I have demonstrated will no doubt be dismissed as mere uncontrolled observation. Medical-scientific explanations are unwelcome. No-one listens to clinical doctors but only to mathematicians and sociologists.

One conclusion that can be drawn from this study is that a melanin-rich skin and presumed vitamin D deficiency appears to be much more dangerous than the coronavirus. The virus might have caused death in the very elderly but ethnicity and vitamin D deficiency caused death to be 30 years premature.



To part-counter arguments that my numbers are incomplete, I would like to look at the deaths of BAME doctors in another way, as I have done in a previous Blog post on April 3rd. This information has been known for more than six months but still there is no relevant official action.

Although the deaths of 13 BAME doctors are recorded in the obituaries above, I am aware of 25 BAME working doctors who have died from Covid-19. The 25th death was Dr Krishnan Subramanian, consultant anaesthetist at the University Hospitals of Derby and Burton. He died on November 12th 2020.

Dr Krishnan Subramanian

The first BAME working doctors to die from Covid-19 were Dr Adil El Tatar and Dr Habib Zaidi, both of whom died on March 25th, early in the UK pandemic and just two days after lockdown.

To my knowledge, during the following six weeks a further 22 working doctors died from Covid-19. Only one of the 24 was white, Dr Craig Wakeham, from Dorset. The BAME:White ratio at 23:1 is as dramatic as that above in Figure 1,

The dates of the 23 deaths earlier in the year of BAME working doctors are illustrated in Figure 2.

Figure 2. BAME doctors dying from Covid-19

       
The  deaths seemed to come to a sudden end, the last of the series being the death of Dr Saad Al-Dubbaisi, a general practitioner from Ramsbottom, Bury.

It was obvious that these doctors had just one factor in common, a melanin-rich skin. They would not have experienced socio-economic disadvantage nor small overcrowded houses. They would have almost certainly been deficient in vitamin D, but awareness of this was not general. However it was known by Professor Parag Singhal, endocrinologist and the national secretary of the British Association of Physicians of Indian Origin (BAPIO) and Dr David C Anderson former Professor of Endocrinology and Professor of Medicine. 

The black arrow in Figure 2 indicates April 29th. On this day they sent to all BAME doctors working in England and Wales a communication indicating that they would all be very much at risk from serious or fatal Covid-19 because of likely vitamin D deficiency. They were strongly advised to take take a vitamin D supplement in good dose of about 3,000 units per day, ideally after a single loading dose of 100,000 units, and this was supplied as necessary.

This action was unofficial, but it appears to have been very effective. It was the equivalent Dr John Snow removing the handle of the Broad Street water pump in Soho in 1854 and bringing to an end the epidemic of cholera.  

There was no randomised controlled trial preceding the action of Professors Singhal and Anderson, but we can compare the high mortality before April 29th to the absence of death following May 2nd. 

There has been a very disappointing research activity in the UK during this pandemic, just the study from Tameside having been reported so far. There appears to have been no centrally sponsored research. The Bill & Melinda Gates / Wellcome Foundation consortium, The Covid-19 Therapeutics Accelerator, set aside $20 million to fund research, but research related to vitamin D was excluded.

To prevent BAME doctor deaths was an imperative: they are human beings, not just doctors but husbands, one wife, parents. Their successors need not have become experimental subjects or necessary deaths, but thanks to direct action they continued to live. They were particularly at risk not just because of almost certain serious vitamin D deficiency but also because they were front-line workers.

There has been no national or even professional collation of the doctors who have died from Covid-19. I have brought together this information by reading medical journals, and also national and local newspapers. My evidence is incomplete, but it is powerful.

Apart from individual actions of my friends mentioned above, there does not appear to have been any official national or professional interest in or response to the deaths that I have described. The professional bodies have been silent or asleep.

Perhaps the totality of deaths has been noticed by only three people.


Post script:

Professor Kamlesh Khunti FRCGP FRCP MD PhD FMed Sci professor of primary care diabetes and vascular medicine in Leicester is a member of SAGE, the scientific advisory group for emergencies.

On Saturday November 21st 2020 he addressed a meeting of BAPIO, British association of physicians of Indian origin. 

Being an important person and presumed to be fully up-to-date and knowledgeable, a member of SAGE, his words were anticipated to be a revelation, words that would explain the intentions of the government to acknowledge the high number of deaths of BAME doctors in the UK (described above), and  action to be taken. The audience was to be seriously disappointed.

All members of BAPIO packed into the room would have been well-aware of the importance of vitamin D supplements in correcting wide-spread vitamin D deficiency, and how this can bring deaths from Covid-19 to a halt. There was just one person in the room who was not aware of this: the guest speaker, Professor Kamlesh Khunti. His words can be summarised as:

"The official line is that there is no role for vitamin D.

No discussion, no debate, the words are carved in stone.

This level of ignorance at the centre of government advice is frightening. 

We must be thankful for professors Parag Singhal and David Anderson for their direct well-informed action.



24 comments:

  1. Very compelling analysis. Surely this should be shouted from the rooftops?

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    1. Thanks. I agree and this post is likely to be read by more than 1,000 people, but not enough. What is required is for the message is to picked by a reporter on a national newspape.

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    2. Very compelling reading. A friend of mine has Asian neighbours either side, they've both told him their doctors advised their families to take Vit D supplements years ago. As far as he knows none of them have had covid, yet my friend's wife did, she was unaware and not taking Vit D. My friend, who told me he takes multi-vitamin tablets since a cancer op a few years ago and is diabetic did not catch it. His wife is fully recovered now, but the covid cough did linger a few weeks.

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  2. Hi David
    That letter to BAME physicians was utterly brilliant and so effective. It save countless lives and was medicine at its very best -- what we were trained to do. The signatories should be publicly acclaimed.
    My much more limited action locally went viral and has resulted in death threats that have had a severe effect on my family and employees. But this too shall pass.
    Cheers
    Roger

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    1. What on earth did you do to warrant death threats? Surely if you are advising on vit D you are helping to save lives.

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  3. Scandalous and very depressing that the space for open rational debate of science has been so diminished by a confluence of circumstances, politics, commercial pressures, and human frailties including ego.

    Even more despicable and saddening people should somehow presumably genuinely believe expression of contrary opinion somehow justifies death threats.

    People are at liberty to put up an opposing opinion - surely that is the way debate should be conducted. Historic echoes of witch trials, and similar, fill the mind, and empathy for early proponents of the suggestion the sun did not orbit the earth etc.

    This may be of interest. https://www.bmj.com/content/371/bmj.m3872/rr-5

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  4. Brilliant analysis. There is ample evidence of the role of Vitamin D in the incidence and severity of COVID-19. Evidence has been published from UK, Israel, Iran, USA and other European countries but still there is no official recommendation yet. Disappointing.
    M Siddiqi, Liverpool

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  5. Your memorable presentation some years ago at an all day meeting in London on Vitamin D arranged by Prof Rufus Greenbaum was a comprehensive review of the problem of vitamin D deficiency particularly in the North West with the highest incidence in the populations you mention above. I knew one of the doctors who lost his life to Covid19. At the outset when it became clear that NHS staff of Asian or Black origin were disproportionately affected. The only conclusion to draw from the NHS staff deaths was precisely as you have pointed out. The combination of being dark, living more than 35 degrees latitude beyond the equator, spending much of the day indoors and styles of dress that cover most of the skin predispose to vitamin D deficiency. This starts from an early age and unless investigated for and corrected may well persist with consequences that have been devastatingly exposed by the Covid19 pandemic. As has been pointed out by many observers, among Asian and black populations, the higher incidence of cardiovascular disease or conditions predisposing to vascular damage which start at lower BMIs and younger ages together with vitamin D deficiency with resultant immune system dysfunction may be the perfect setting for the setting for the more severe outcomes following Covid19 infection. The need to ensure that all such populations are screened for deficiency and if proven, regularly take adequate supplements to ensure they are vitamin D replete cannot be overemphasised.

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  6. Do you have a copy of this communication to BAME medics? Because if this was sent by the NHS and the results of VitD supplementation were noted it would seem to be almost criminal negligence on behalf of the Gov. not to roll the advice to other vunerable groups or indeed the whole population.
    How many lives could have been saved?

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  7. It was not an official NHS document, but it should have been. I agree that with all the information available there is serious negligence at the centre.

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  8. Absolutely brilliant analysis.
    I’m an Indian Paediatrician. I preach Vitamin D supplements to all my relatives in India and more so to BAME patients and friends in UK. I was shocked to find that my own Vitamin D level was only 12. It is a hidden killer that people only notice if they have musculoskeletal problems.

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  9. Please, keep this work alive and keep us updated.

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  10. Very interesting article. Seems to me there are a few leaps of logic in there, as skin colour may not be the "only" factor of difference.
    But the basic conclusion on Vit D has seemed pretty clear for some time.
    One thing puzzles me. A layman myself, with a sun allergy, I started taking Vit D several years ago. Couple years later my dermatologists at Guys started checking on it. Yet GPs seem unaware of its importance, and from this article, most doctors, and the medical establishment, also.

    Mb this will get the attention it deserves.

    There was a very interesting article early in the pandemic showing huge statistical gaps between mortality from Covid in those with normal or low Vit D. Even when corrected for age, and many other factors, it showed a doubled mortality. Despite several attempts I have been unable to fnd the study, Google just throws subsequent news articles at me. But its out there, somewhere.

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    1. Send me an email to davidgrimes1@mac.com and I will send you details.

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  11. You are preaching to one already converted. My wife and I both take Vitamin D3 and K2 MK7.

    What is interesting as well as frustrating were the numbers of videos on YouTube from other doctors recommending Vitamin D3. They were taken down, presumably by Google censors and then put up again by people who understand how to do that. Like a strange game of wack-o-mole, it was crazy.

    I don't think there is a concerted conspiracy around this.

    There is though a system in play and I suspect it's this system which drives the behaviour we are seeing.

    Neo-liberalism is all about the self and private enterprise. It thrives on consumption and its consumption which must be maintained at all costs.

    I used to joke with my wife that humans who are part of this system must consume. Consume all the time, food which makes us fat and then consume the drugs to keep us alive from the food which is slowly killing us.

    David Davis - MP has raised the question of vitamin D a while ago, and he has written about it. Whether it will be ignored or not is questionable.

    My frustration is that it wouldn't take that long to prove or disprove the use of Vitamin and yet there's been nothing. Nothing apart from me and others like you suggesting it.

    One thing is for certain. If we accept the premise of neo-liberalism being all about the self and privatization then this particular citizen will happily continue to ask questions of the system.

    I'll leave you with this comment from a reader on Amazon about a book called The Virus and the Vaccine: Contaminated Vaccine, Deadly Cancers, and Government Neglect...

    "The decisions of our health policy makers, even when well intentioned, are not always enlightened. And sometimes those decisions are not even well intentioned. Sometimes they are based on bias or inadequate scientific evidence. Sometimes they are influenced by the close relationship between the pharmaceutical industry and the government health officials who are charged with regulating that industry. Moreover, sometimes even the best scientists can make mistakes. The safest medical products can have unforeseen side effects ... For that reason, individuals, not governments, must maintain the right to control what medical procedures they and their children undergo and what pharmaceuticals they consume."

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  12. Follow the money. Vitamin D has the disadvantage of being very cheap, and so no big profits. The main effect of vaccines will be to transfer money from the poor to the rich through government contracts. Immune protection can be provided by vitamin D, but without big profits.

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  13. Have you seen this paper on benefits of Calfcidiol?

    From Cordoba:

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

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  14. This is brilliant work, thank you so much David.

    I spent hundreds of hours looking at this issue and produced a report which you will find her: King, E. (2020, June 17). The Role of Vitamin D deficiency in COVID-19 related deaths in BAME, Obese and Other High-risk Categories. https://doi.org/10.31232/osf.io/73whx

    I sent it to various newspapers, the PM, Health Secretary, MPs of BAME origin including Kemi Badenock who was tasked with looking into the issue - but there was no interest whatever. The Therapeutic Taskforce promised to take it into consideration and then ignored it. Only Lord Blencathra took it any further until David Davis learned I had been looking at the issue. To his great credit, he was already very knowledgeable about it and put a lot of time into discussing new research with me, particularly re bradykinin, and looking at further information I provided. He has tried his very best to get Matt Hancock to take the issue seriously and met with him (although not necessarily with specific reference to the BAME community but more in general terms of vitamin D reducing CoVID deaths and serious illness). Matt Hancock did shortly afterwards, announce he was going to be looking at vitamin D again and subsequently said he was distributing supplies to care homes but I have heard nothing since. Too little far too late.

    There is some updated information relating to Covid, vitamin D and T-cells which you can find here:
    T-cells really are the superstars in fighting COVID-19 - but why are some of us so poor at making them? 21 September 2020: https://www.bmj.com/content/370/bmj.m3563/rr-6

    Correcting misapprehensions about vitamin D to save lives and reduce hospitalisations https://drive.google.com/file/d/1_Ui-9phytAJe1tW__GZEj_JwAzpulSSY/view?usp=drivesdk

    There is a new RCT from India.
    I am working on finalizing an update now ( although I have been distracted for the past weeks looking into long term immunity to CoVID, which I am almost 100% sure we do develop even after mild CoVID!)
    I have publicised the vitamin D message via other avenues and all our friends and relatives including many in the medical profession are aware.
    Not only is there no money in Vitamin D, it also prevents dozens of other conditions and therefore renders unnecessary, the drugs used to treat them, which is not in the interests of pharmaceutical companies!




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  15. That was Eshani King by the way - it comes up as unknown!

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  16. To add to the above, the first paper I mentioned was sent in draft to MPs etc as early as May but I wrote letters in March/April to the PM and Health Secretary highlighting Vitamin D deficiency as the likely cause of death(ignored of course - he had far more worrying things to deal with then)
    Eshani King

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  17. Thank you for spreading this message about the importance of raising immunity and the vital role of Vit D. The second wave has offered yet another opportunity to organise a simple RCT or even a cohort study. I have suggested this to my colleagues at the health board ( I retired from the NHS just before the pandemic hit the world). I am not sure whether this would be another missed opportunity?????
    Amit Sinha

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    1. There is not really a second wave. It i just that wave was suppressed during the summer by vitamin D being produced. The lack of research is as you say, a huge missed opportunity.

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  18. Hey, David, do you want me to stick this on my blog, with links back. I get about 100,000 hits on some posts, so it may get more widely read.

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