Covid-19 & Vitamin D : How can we avoid looking stupid ?
Scene 1:
A small meeting room in 10 Downing Street, London
Early January 2021
Four sitting around a table.
Boris Johnson, Prime minister of the UK
Good morning to you all and thanks for coming in at short notice. This is an extremely important meeting.
Sir Patrick Vallance, Chief Scientist of the UK
Prime minister, I have not been able to prepare for this meeting as I do not know the purpose of it.
Professor Chris Whitty, Chief Medical Officer of the UK
The same goes for me, Prime Minister.
Boris Johnson
Sorry about this chaps, but it is very hush-hush. I have mentioned it only to Matt Hancock.
Matt Hancock, Secretary of State for Health and Social Care
That was only yesterday when we discussed briefly the problem but not the solution.
Boris Johnson
Matt and I have just realised that we are in great danger.
Professor Chris Whitty
Danger from what? The vaccination programme is going really well. We all thought that you had made a full recovery from your serious Covid-19 illness.
Boris Johnson
It is not danger from the virus this time. It is a much more important and serious danger than that. It is the serious danger of looking stupid. The point is that under the direction of NICE, our so-called National Committee for Care Excellence, we have spent almost a year telling people, including ourselves, that vitamin D has no role in immunity and is of no benefit in the present pandemic.
Matt Hancock
I have been saying this in public and in parliament on many occasions, but in December I realised that it is not true.
Sir Patrick Vallance
You mean to say that vitamin D is important after all?
Matt Hancock
Yes, it is most important. I received a lot of important information to this effect when I was talking to the now-backbencher David Davis MP in the bar. He is extremely well informed.
Sir Patrick Vallance
But I am the chief scientist. You are supposed to hear important information from me, not from an ordinary MP over a drink in the bar.
Boris Johnson
I also heard this from David Davis. And he a scientist by training. I watched his very well-informed speech in the House of Commons on the value of vitamin D. I am told that Jo Churchill, our health minister who had to reply to him, that she agreed with everything he said, but she had been told in advance that she had to read out some drivel that had been written for her, and she was not allowed to express her personal, and if might say so, well-informed opinion.
Sir Patrick Vallance
But David Davis is not the Chief Scientist, and he has not been knighted for services to science. The same goes for Jo Churchill. I am the Chief Scientist and I decide what is true and what is not true.
Professor Chris Whitty
And David Davis is not medically qualified. He is not a proper doctor like I am.
Matt Hancock
But he knows a great deal on the subject of vitamin D. I caught a glimpse of you, Patrick, on Robert Peston's evening television programme on ITV. Patrick had been interviewed and a viewer phoned in and asked him if we should all be taking vitamin D. You replied, Patrick, along the lines of "That is what the government advises", and said nothing more.
Sir Patrick Vallance
There was no more that I wanted to say. I was hoping that such a question would be filtered out. But I managed to avoid saying "vitamin D" or "immunity".
Matt Hancock
I am fed up with dodging the question and counting the big numbers of deaths, now more than 100,000, knowing that vitamin D would have prevented many of these deaths.
Sir Patrick Vallance
It is NICE that we turn to for advice on such as vitamin D.
Boris Johnson
But the point is that during 2020 NICE has been digging us into a hole of vitamin D denial, deeper every time it issues a report. The question I repeat, is how do we get out of this hole without looking like idiots.
Professor Chris Whitty
It would not be very nice to expose the total failure of NICE to assess the potential role of vitamin D in the present pandemic.
Sir Patrick Vallance
The problem has been that no-one in NICE appears to know anything about vitamin D or immunity, and certainly nothing about how they are linked together, or of the value in the present pandemic.
Matt Hancock
It seem to me, from what I have been told, and from what I read on social media, that a large number of credible people within the country do understand about vitamin D and immunity. However NICE is remote and no-one seem to be able to interact with NICE directly. David Davis tells me that NICE might be OK for checking on new medicines with the help of big pharmaceutical companies, but with vitamin D we are dealing with a widespread deficiency state of a vitamin / hormone, and that it is glaringly obvious that vitamin deficiencies and hormone deficiencies must always be corrected. NICE seems to the wrong organisation to assess a vitamin or hormone deficiency. It has never happened before.
Sir Patrick Vallance
I must admit that NICE does not have an executive function. It is a merely an advisory body. It is the UK Medicines and Healthcare products Regulatory Agency that decides on which medicine can and cannot be used. NICE has assumed a role more important than it has. With vaccines, MHRA has given the go-ahead for use, and NICE has had no role in the roll-out.
Boris Johnson
At least we have been able to keep vitamin D out of the headlines of the major newspapers, off the television screens, and off the radio airwaves. To avoid looking stupid it is vital that David Davis, clever and well-informed as he might be, is kept hidden. If he were to become prominent we really would look stupid, and the first rule is that this must not happen.
Professor Chris Whitty
We have also been able to minimise any mention of vitamin D in the medical journals, and public funding for vitamin D research has been refused. Also funding for vitamin D related research has been refused by the Gates-Wellcome Covid-19 Accelerator programme. There has been virtually no vitamin D research in this country, just small projects in Tameside, Birmingham and Newcastle. They have passed virtually unnoticed, and we must be thankful for that.
Matt Hancock
David Davis picked up the Newcastle study. In the Observer and the Guardian on-line there was a very long article from a journalist whose name is I think Mattha Busby on the subject of vitamin D and Covid-19. It was a very good article, by far the best that I have read, and I believe it had 1.5 million views within a week.
Sir Patrick Vallance
But there was no follow-up in the print editions. All seemed to go quiet, thank goodness.
Boris Johnson
But the word is getting about that vitamin D would be very valuable if we were to use it. We must therefore be prepared that at some stage we will need to state that vitamin D is valuable and so people must take it. Denial cannot go on for ever. But how can we do it without looking ignorant or stupid.
Matt Hancock
I thought until recently that vitamin D was all about bones and avoiding rickets. But now I understand its function of activating VDR, which in turn activates a large number of our genes, perhaps 10%. This initiates the escalation of defensive immunity, and it also switches off the damaging cytokine storm. All this was apparently known before the pandemic started.
Sir Patrick Vallance
You are very well-informed, Matt. I assume this is the wisdom of David Davis. Perhaps you could give me a tutorial on the subject after this meeting.
Boris Johnson
The point is that if we had approved the use of vitamin D early in the pandemic, many thousands of deaths might have been prevented. But we obviously cannot let this get into the public domain or there will be riots, or even legal claims of negligence against us. This would be even worse than looking stupid.
Professor Chris Whitty
What we must do is keep the media publicising our highly successful vaccination programme, and so keep vitamin D out of the public eye. This is what we have been doing very successfully. We have also been keeping any ill-effects from the vaccines away from the public. Patrick will be well-aware that we have also kept hidden recent experience of vaccines that have gone wrong.
Sir Patrick Vallance
Enough of that. The present vaccination programme is of the greatest importance. It is good news that keeps bad news out of the headlines, and for us vitamin D would be very bad news.
Matt Hancock
But vaccinations are not going to influence daily deaths, or take pressure off our hospitals and ICUs.
Boris Johnson
I am told that the daily new cases and deaths will go down considerably in late April and May.
Matt Hancock
That is certainly true. It happened in 2020 and it will happen again in 2021. David Davis tells me that it is the effect of the summer, the greater intensity of the sun and the resumption of vitamin D production in the skin. It happens every year. It is nature.
Professor Chris Whitty
But we must not admit that nature is bringing about the cure while the government is locking down the economy, education, worship, family lives, and causing untold misery. We must be patient and when death rates do fall after Easter we can tell the people that the reason is the success is lockdown and our vaccination programme. We must thank the people for their sacrifice and thank the pharmaceutical companies for their brilliance.
Boris Johnson
That would be excellent, but now, at a time of 1,000 deaths per day and as hospitals are like in a war zone, we need something that acts much more quickly than vaccinations. Matt, what else did you learn from David Davis?
Matt Hancock
Thank you prime minister. He told me that vitamin D itself is excellent for the prevention of Covid-19 but when taking it by mouth it takes about a couple of weeks to become fully active in the blood-stream. It must go through a first slow activation stage in the liver. But there is a part-activated form called calcifediol that if taken by mouth is active within a couple of hours. A clinical trial in Córdoba in Spain showed spectacular results from the use of calcifediol in patients admitted to hospital with Covid-19 pneumonia, reducing ICU admissions by 96%.
Boris Johnson
Gosh! That sounds good. Better than vaccines, What did NICE make of it?
Professor Chris Whitty
NICE had already stated at the beginning of the pandemic that vitamin D was of no proven value and should not be used. It had to comment on the study from Spain, but as the results went completely against its previous statements it had to down-play the results. It passed the task to a professor from I think Birmingham, and he was able to write a couple of sentences to suggest procedural problems with the trial, and thus discount it and just recommend waiting for further studies.
Matt Hancock
NICE just kicked the can down the road. I was told by David Davis that a full review of the randomised clinical trial from Spain was undertaken by a team at the Massachusetts Institute of Technology. No procedural error was found and it was concluded that the probability of the 96% efficacy being by chance was less than one in a million, and significant effect from confounding variables less than one in 600,000. It was certainly very detailed study, in striking contrast to the back-of-an-envelope assessment by NICE.
Boris Johnson
Cripes! This is very embarrassing. If it gets out and NICE looks stupid, as it appears to be, we will also look stupid, which we aren't. What has been happening at NICE? Are the members all asleep?
Matt Hancock
Perhaps they have narcolepsy, but Patrick is an expert on that subject. Spain is certainly not asleep. Córdoba is in the southern region of Andalucía, and a public health initiative of vitamin D / calcifediol was initiated there in mid-November. There was a rapid decline of hospital admissions, ICU admissions, and deaths within six weeks.
Boris Johnson
Well, we need to do that here. Are our public health departments awake? Are they going to take action?
Sir Patrick Vallance
Prime Minister, we cannot come out and say that we must give vitamin D to all the population. If we do, as you said at the beginning, we will look stupid for not having said so earlier in the year.
Professor Chris Whitty
Just before Christmas NICE did something rather clever. In a report it stated that: "Although we find that there is not enough evidence to recommend the use of vitamin D in the prevention or treatment of Covid-19, we encourage people to follow government advice and take it".
Boris Johnson
The difference between "recommend" and "encourage" is very subtle. I regard them as having the same meaning. This is a good example of double-speak by a clever word-smith.
Matt Hancock
I must confess that I broke away from NICE misinformation as I regarded it, and I made a statement that all elderly people must receive vitamin D.
Sir Patrick Vallance
NICE was not very pleased. Nor was Public Health England.
Boris Johnson
But can we not build up on Matt's message and get vitamin D out to the people?
Matt Hancock
I have a cunning idea. I mentioned that everyone knows that vitamin D is something to do with bones, and very few people, including the vast majority of doctors, know anything about immunity. What we must do is invent an epidemic of rickets in old people.
Professor Chris Whitty
Rickets is the result of vitamin D deficiency in children. When in adults it is called osteomalacia.
Matt Hancock
Ok. But no-one will have heard of whatever it is that you said. Let's just call it weak bones. We can tell all old people by letter that they are at great risk of weak bones and that they must take vitamin D. In this way we can roll out vitamin D without mentioning immunity or Covid-19.
Boris Johnson
Brilliant Matt, Well done. In this way we can appear to be a caring government and not look stupid.
And so it came to pass.
Late January 2021
"Each '1-A-Day' vitamin D supplant contains 10 micrograms (µg) of vitamin D. This is equivalent to 400 international units (IU) of vitamin D. This is the daily amount recommended for the general population by Government for general health and in particular to protect bone and muscle health."
Scene 2
The same room in 10 Downing Street
Boris Johnson
Good morning.
We have done it. We have given vitamin D to all old people without looking stupid and without acknowledging that vitamin D is valuable in defensive immunity and helpful against Covid-19. There has been no criticism of us, only praise. Success. We deserve champagne today rather than coffee.
Sir Patrick Vallance
And also NICE can continue without looking stupid or negligent.
Professor Chris Whitty
But we need to do something about SACN, our scientific advisory committee for nutrition. I have been looking into it and its recommendations are hopelessly out of date.
Matt Hancock
David Davis tells me that the dose of vitamin D that we were forced by SACN to put into the DHSC document for elderly people gave a dose of 10 micrograms, 400 units. This is far lower than what is recommended by European and North American countries. The dose we recommend is basically locked into rickets prevention in the first half of the 20th century, and it is effectively carved in stone by SACN.
Boris Johnson
So what dose should we recommend?
Matt Hancock
The maximum dose stated by SACN to be safe is 4,000 units each day. At this time of national emergency that is the dose that I would recommend. It is the dose that I have been taking during the past six months.
Boris Johnson
And it is the dose that I have taken since I was in hospital.
Professor Chris Whitty
It is the dose that I take.
Sir Patrick Vallance
I also take 4,000 units a day, as do all my staff.
Matt Hancock
And so it appears that we are all drinking wine (not just Champagne) in the form of vitamin D while preaching water for the masses.
Boris Johnson
Can you explain to me why we are giving vitamin D only to the elderly?
Professor Chris Whitty
The elderly are known to be deficient in vitamin D because they do not go outdoors.
Matt Hancock
And they are at high risk of Covid-19 death because of poor immunity due to vitamin D deficiency.
Sir Patrick Vallance
I have been doing bit of homework, also talking to David Davis and looking at social media.
Boris Johnson
And so Patrick, what have you learned?
Sir Patrick Vallance
It appears that the skin of old people is dry and does not produce the oil that the sun converts into vitamin D, and so they need to take vitamin D all the year round.
Boris Johnson
Does it not appear to be strange, that we have only just realised the problem of vitamin D deficiency in the elderly at this time of a Covid-19 pandemic, when it has always been a problem, but not recognised?
Professor Chris Whitty
It appears that this pandemic has brought out the great dangers of vitamin D deficiency that were previously unsuspected. We must bear this in mind in preparing for a future pandemic.
Boris Johnson
We must definitely inform SAGE, our Sleeping Advisory Group for Emergencies, which failed to prepare us for Covid-19.
Matt Hancock
There is also the issue of dark-skinned people living in the UK, BAME people. Most are vitamin D deficient and as a result they have a very high risk of death from Covid-19.
Boris Johnson
We have had three reports that tell us that this high death rate is due to socio-economic disadvantage and racism. We are looking into this.
Matt Hancock
These reports have been most unfortunate and unhelpful. They all missed the biological explanation of serious vitamin D deficiency, as David Davis has explained to me. The reports all dismissed vitamin D, but the leaders of the BAME communities made no protest and seem to accept the social explanation with great enthusiasm. Now the BAME community leaders are demanding priority for vaccines, but there is no mention of vitamin D. They appear to know nothing about it.
Professor Chris Whitty
I remember that in March and April, 24 working doctors died from Covid-19 and 23 were of Black African or Asian ethnicity. They were obviously not socio-economically disadvantaged.
Boris Johnson
It sounds like vitamin D deficiency.
Professor Chris Whitty
Yes, Prime Minister. The deaths of these doctors came to an abrupt end, the last of the cluster being on May 3rd. I was told last week that on April 29th the imaginative national secretary of BAPIO, the British Association of Physicians of Indian Origin, sent emails to virtually all BAME doctors in the UK telling them to take vitamin D immediately, and a colleague now retired and living in Italy provided them with supplies. This action was amazingly effective and it obviously prevented many deaths.
Boris Johnson
They sound to be real heroes. We could not have achieved that with us having to consult NICE and PHE and many other groups beforehand. The deaths of these doctors seems to have been forgotten about, but we could encourage dark-skinned people to take vitamin D.
Matt Hancock
I have been told that the deaths of 25 doctors were reported in the British Medical Journal. 12 were white with average age at death 92, and 13 were black African or Asian ethnicity with average age at death 62, thirty years younger. This is difficult to explain away, and again, they were not socio-economically disadvantaged. It must have been the result of vitamin D deficiency.
Boris Johnson
I remember being shown a newspaper headline during the summer. If I remember correctly it was a study in Oldham that indicated that ethnic Asian people were seriously ill from Covid-19 at an age thirty years younger than white people.
Matt Hancock
There is still the problem of 1,000 Covid-19 deaths per day. Giving old people vitamin D 400 units per day is not going to stop these deaths. Should we be giving the sick calcifediol as in Córdoba study?
Sir Patrick Vallance
I would recommend restraint. I am told that another controlled trial in Spain has been completed and is to be published shortly. I hear that the results, when published, will be even more spectacular than the Córdoba trial.
Boris Johnson
We must wait for this report to become available. If what you say is true, NICE will look really stupid and responsible for thousands of deaths. We will need to distance ourselves from NICE. NICE has misled us so much that we will let NICE take the blame.
That is all for today. We will leave things for now and go our separate ways. We must keep the problem in our minds and we will meet again as soon as the news from Spain is available.
We will also need to be certain that above all we will not look stupid.
The room empties
Scene 3. To be arranged.
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David Davis MP – the one who will not look stupid |
