Covid-19 & Vitamin D
No sitting on the fence: there is blood on the floor!
|2008. I just managed to get out of the way !
When the pandemic of Covid-19 appeared a year ago there was a great deal of evidence predicting that our known widespread deficiency of vitamin D would cause a serious problem. It would produce a problem of sub-optimal immunity, and thus a high risk of death from critical or fatal infection. And this is what happened. As expected the deaths occurred in excess in communities known to have a high prevalence of vitamin D deficiency: the ethnic Black African and Asian (BAME), the obese, and the elderly in particular.
The early missed opportunity
There could have been community-based blood testing to detect individuals with vitamin D deficiency, but it did not happen and vitamin D testing was discouraged by public health bodies. Vitamin D could have been given to all, on the basis that in a single dose of 100,000 units it would have corrected deficiency of those deficient and would have done no harm to those not deficient. Blood testing within the following three months would identify the need to continue with a supplement. Alternatively a vitamin D supplement dose of 20,000 units each week or 3,000 units each day would have been appropriate and perfectly safe.
But official correction of vitamin D deficiency did not happen. We had to wait for more than 100,000 deaths before vaccines became available.
We have had a large number of "scientists" who have dominated the political agenda. There have been mathematicians, statisticians, epidemiologists, virologists, nutritionalists, sociologists, the chief medical officer and the chief scientists, both of who have enjoyed an academic career. Some of them have mentioned vitamin D with a remarkable lack of enthusiasm, in complete contrast to their embrace of vaccines.
The dead hand of NICE
The reason for the denial of use of vitamin D has never been clear. The large amount of evidence from the forty years preceding the pandemic made little difference to official advice. Reference was always made to the reports by NICE, the National Institute for Health and Care Excellence.
The reason why the correction of a vitamin deficiency had to be referred to NICE is difficult to understand, as it would be an automatic clinical duty to correct a vitamin or hormone deficiency, be it vitamin D, vitamin C, vitamin B12, the prescription of insulin or thyroxine and so on. But NICE has somehow been given the responsibility for the correction of vitamin D deficiency, and a series of its reports failed to approve the use of vitamin D, but always failing to acknowledge deficiency.
NICE informed the nation of a lack of evidence and demanded randomised controlled clinical trials (RCTs).
A report from NICE on June 29th told us that:
"There is no evidence to support taking vitamin D supplements to specifically prevent or treat Covid-19"
This avoided any mention of the fact that research points to the majority of the population being deficient of vitamin D. If NICE is supposed to help doctors in their treatment of ill patients, it failed miserably to do so. The response has been very far from Excellent.
Once again more evidence, randomised controls were demanded. The result of the first RCT, from Córdoba, Spain, appeared on September 3rd. The response of NICE was that the (very positive) result should have no influence on the way in which doctors treat patients (with Covid-19 pneumonia).
"The clinical management of patients with COVID-19 should not be changed based on the results of this study."
On December 18th NICE published a joint report with SACN (Scientific Advisory Group on Nutrition) and PHE (Public Health England) in which Sir Paul Chrisp (director of the centre for guidelines at NICE) stated:
"While there is insufficient evidence to recommend vitamin D for the prevention or treatment of Covid-19 at this time, we encourage people to follow government advice on taking the supplement thought the autumn and winter period."
The reason for this change of direction is that the Health Secretary Matt Hancock had stepped outside NICE advice. He had become aware of the importance of vitamin D in the prevention of Covid-19 and he issued a directive that all elderly people should be issued with a vitamin D supplement. NICE could not disagree with a minister and so it had to use double-speak, taking advantage of the many synonyms in the English language. To "recommend" and to "encourage" are verbs without an obvious difference in meaning.
NICE cannot be regarded as having the best interests of the sick and dying at heart.
NICE denies responsibility
The full NICE report that included the first RCT of vitamin D as 25(OH)D or calcifediol, its natural rapidly-acting form, appeared in December 2020. Although the earlier report carried its "recommendation" that doctors should not have their treatment of patients be influenced by this first RCT, the full report carried an interesting disclaimer:
"The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian."
Government advisors on the Covid-19 pandemic live in offices, ivory towers. They do not live in the emergency areas of hospitals. They never see blood on the floor. They do not know what it is like to make life or death decisions. They do not understand the pressure to do the very best to help an individual patient. But they inhibit rather than help those front-line doctors who need support.
A report in December 2020 from an all-party committee of parliament also managed to find no place for vitamin D. The ignorance is wide-spread.