Wednesday 14 April 2021

Covid-19 & Vitamin D: One year after the onset

We have experienced a year of the Covid-19 pandemic. and now in the UK it is looking very different.

Figure 1. UK: Covid-19 deaths each day, from March 20th 2020

On March 10th 2020 the WHO declared a pandemic of Covid-19. It was on March 20th that the pandemic became real in the UK. Deaths had risen to about 50 per day. On March 23rd there had been a total of 258 deaths, and something had to be done. That something was "lockdown", intended to reduce spread of the respiratory virus. Face masks must be worn in public places, and there was to be social distancing with a minimum of two metres between individuals. People could not visit each other's houses. The residents of homes for the elderly or seriously disabled could not be visited by their families. Public events such as concerts and worship were stopped. Universities were closed and then schools. Holidays were cancelled. Elective admissions to hospital for surgery were cancelled. Many workplaces were closed and air travel virtually came to an end. Public transport was  strongly discouraged and the roads were very quiet.

These were physical methods to try to reduce transmission, but respiratory viruses are notoriously difficult to control. Deaths increased to almost 1,000 per day during the following month. We had no natural immunity and our vitamin D reserves were at the lowest part of the annual cycle. It is much easier to control micro-organisms that are transmitted in contaminated water or food, or contagious diseases that are transmitted by direct contact (touch). Air transmission is not visible and not easily controlled. 

The introduction of lockdown was not based on evidence as it had never been attempted previously, at least not on a large scale. It seemed to be sensible, given the very limited understanding by the government of the nature of the pandemic. We subsequently entered the summer recess of Covid-19 illness and death during the "vitamin D immunity season". Later in the year when we moved into the "vitamin D deficiency season", further lockdown measures were introduced. 

It is easy to say that the deaths would have been even higher without lockdown, but we must remember that the UK had about the highest death rate from Covid-19 at that time. Since then the UK has been overtaken by nine European nations with higher numbers of deaths per million.

Figure 2. Covid-19 deaths per million, in European and American nations

Figure 2 illustrates the 38 nations of the world with more that 1,000 Covid-19 deaths per million. Most are in Europe, with 9 in the Americas. Some of the nations in Europe are very small, Gibraltar, San Marino, and Andorra in particular.

From late April the daily deaths declined in the UK and other northern hemisphere nations, and this coincided with increasing sun energy each day at sea level, and therefore increasing vitamin D production. It can be said that the weather was warmer but humankind is isothermal. We maintain constant body temperature but the average blood level of vitamin D is much greater in the summer than in the winter. The winter–summer pattern of illness is the same in all temperate zone countries, no matter what the ambient temperature. Vitamin D activates defensive immunity and so it is to be expected that the number of deaths from respiratory infections will reduce during the summer, as happens every year. There are in practice two seasons to the year: the vitamin D immunity season, and the vitamin D deficiency season. This is very obvious in Figure 3, which illustrates the effect of the sun and vitamin D production. 

Figure 3. UK: Covid-19 deaths each day, from March 20th 2020

The decline in case and death numbers continued into the summer as vitamin D production increased, and blood levels of 25(OH)D, calcifediol, the reserve supply also increased. And then of course, as reserves fell when we entered the vitamin D deficiency season, deaths form Covid-19 increased again.

It is interesting to note that we were warned early in 2020 that it would become so much worse in the autumn as there would be an additive effect of the influenza virus. This showed a fundamental lack of medical education, a phenomenon that I learned when I was at Manchester University in 1964. Observation (that important scientific process that in 2020 was rejected in respect of vitamin D) demonstrated that simultaneous virus infections generally do not occur. A virus is greedy: it does not want to share the infection with a competitor. Covid-19 had an advantage in 2020 in that the human host had not encountered it previously and therefore humankind had no immunity. Covid-19 rapidly established respiratory infection, and in the usual way it programmed its infected cells to produce Interferon. This prevented infection by other viruses. 

And that is what happened: during the autumn of 2020 the usual  winter viruses failed to appear. There was just Covid-19. 

The increased case and death rate up to the end of 2020 was as expected, but in January there was a sudden peak that has not really been explained. It is shown in Figure 3. Although mutations appear, we were not told of a mutation that would create up to 2,000 deaths per day in January 2021. Many mutations have been described but this is inevitable and there does not seem to have been a rogue mutation. Of course natural immunity optimised by vitamin D would provide defence against all mutations. The reason for the January peak, "the third wave", remains unexplained. 

This phenemenon was seen in some other European countries, but not in all. It was obvious in Ireland and Spain. This peak, or wave, settled rapidly at the end of January in the UK and these other countries. 

Figure 4. Ireland: Covid -19 deaths 2021, showing the January peak (data incomplete).

Figure 5. Spain: Covid -19 deaths 2021, showing the January peak (data incomplete).

Andalucía in Spain is particular interesting. When the second wave of Covid-19 was very active in October and November, the regional government introduced in November a policy of providing vitamin D in the activated form calcifediol, 25(OH)D, to elderly people. This policy was followed by a dramatic reduction of deaths during December, which I referred to as the "Andalucía miracle" whether the result of intervention by vitamin D or by God. At the end of December vaccine provision was added to the vitamin D initiative. 

Figure 6. Andalucía: Covid -19 deaths 2020-21, showing the three peaks.

But as we can seen in Figure 6, in January the decrease in deaths was suddenly reversed. There was a rapid increase in cases, hospital admission, and deaths from Covid-19. A third peak was reached and then a rapid decline, that is very obvious from daily numbers.

After one of the highest Covid-19 death rates in the world, the UK now finds itself in an excellent position.  The UK now appears to be close to the end of the pandemic. 

Figure 7. UK: Covid -19 cases per day March-April 2020 & 2021

The very low number of death each day now, in early April 2021, is very different what was happening this time a year ago. The trajectory is downwards in 2021.

Figure 8. UK: Covid -19 deaths each day March-April, 2020 & 2021

The difference from 2020 to 2021 is the result of a high level of herd immunity within the nation. It is not that the virus has "gone away", as viruses do not go away. The clinical effects of the virus might "go away" but this is because of herd immunity. It has always been the same.

A recent report (March 30th 2021) from the Office of National Statistics (ONS) informs us that more than half the population have antibodies to Covid-19. How many of these had an illness and how many had received the vaccine were not disclosed. About half the population had received a vaccine during the very extensive vaccination programme, and the number taking vitamin D had increased greatly, but without any national counting. It is suggested that vitamin D consumption has increased by a factor of perhaps 13. On the day of the ONS report Morrison's Supermarket had sold out and further supplies were only on order.

There continues with no official mention of vitamin D. There has been the accumulation of a great deal of knowledge concerning the extent of vitamin D deficiency and the great disadvantage of this when ill with Covid-19, with high risk of critical illness or death. But clinical medicine in the UK remains silent. An as yet unpublished study from Tameside, UK, indicates that 70% of individual doctors would take, prescribe, and advise vitamin D, but this was part of a large grass-roots movement, not officially sanctioned and not measured.

There has been a reduction on the number of Covid-19 cases and deaths in many European countries, but none as dramatic as the UK. The UK has a higher rate of vaccinations than other countries. I display in the figures the deaths per day, but the "cases" (less easily defined) show the same patterns but with larger numbers. The nations are not complete but those that have interested me during the past year.

Figure 9. Switzerland: Covid -19 deaths 2021, showing the January peak 
and subsequent decline

Figure 10. Austria: Covid -19 deaths 2021, showing the January peak 
and subsequent but incomplete decline

Figure 11. Germany: Covid -19 deaths 2021, showing the January peak 
and subsequent decline

Figure 12. Netherlands: Covid -19 deaths 2021, showing the January peak 
and subsequent decline

However the decline is not yet apparent in some other European countries. 

Figure 13. France: Covid -19 deaths 2021 (data incomplete)

Figure 14. Belgium: Covid -19 deaths 2021 

Figure 15. Italy: Covid -19 deaths 2021 

Figure 16. Sweden: Covid -19 deaths 2021 (data incomplete, numbers are very low)

Figure 17. Poland: Covid -19 deaths 2021 

These are examples of the experience of several European countries but not all. Some are approaching the end of the pandemic, and it is hoped that the others will follow shortly. 

It can be anticipated that during May 2021, as in May 2020, cases and death numbers will fall thought the vitamin D production season. If there is widespread immunity, the increase in the winter will be minimal.

Deaths have also been falling in North America.

Figure 18, Canada: Covid -19 deaths 2021 

Figure 19. USA: Covid -19 deaths 2021 

What has been happening in tropical countries will be the subject of  future post.


  1. Wonder why a third wave developed in Andalusia despite vitamin D supplementation in nursing home residents. Any indication that nursing home residents who had been supplemented were protected during the third wave? Did supermarkets in Andalusia run out of vitamin D or not?

  2. As far as we can see, Lockdown was basically avoided or too late in most northern hemisphere countries. You need to factor in Australia, Taiwan and New Zealand which had the fastest and most complete lockdowns. Rapid lockdown worked. Australia and New Zealand are free of the virus except for returnees placed in managed isolation. All three of these countries do NOT have even moderate blood levels of vitamin D in the population due to fear of melanoma.

    1. Australia and New Zealand have a much better public health messaging programme regarding vitamin D and New Zealand at least has been supplementing all their care home residents monthly since before Covid 19. They did have outbreaks in care homes but few if any deaths.

    2. Australia? Lockdown ? Where I live in New South Wales the lockdown didn’t last that long and in sny case covid19 was virtually non existent.
      Victoria has avtoigh lockdown
      Beginning July 9 2020 and the slow rise in covid19 from start of July continued throughout the month but mostly in aged care homes, where people are mostly indoors and will be low in vitamin D


    3. Australia locked its borders early and still has them relatively locked.

    4. Those locked borders didn’t prevent 800 old people with comorbidities dying from or with covid19 In aged care homes in Melbourne.
      And infected persons were let off the Ruby Princess by persons unknown to infect people in Sydney

    5. Mistakes were made! The lockdown by Andrews brought it back under control. Sadly lockdowns have a seriously weak link - objectionable people.

  3. My friend worked on covid icu ward and said all patients tested had low serum vit d levels, poor health status was very effident also🙁

  4. Some hopeful news of 3 more completed calcifediol trials in Spain pending publication

    1. This good. However it is an example of Medicalization of nutritional supplements - an ongoing disease.
      excuse my translation:
      "It is a drug that must be used with facultative control and on the studies that are authorized by health institutions"

  5. I have no doubt that vitamin D should have been given to everyone in every country in order to minimize the damage from Covid-19. I feared that it would never happen as there is far too much at stake for the Medical profession (in general) to promote the use of nutritional supplements to prevent illness. I was merely pointing out that Lockdown worked and I would like to see a better public health approach to both coronavirus and influenza outbreaks in future. Sadly I see most people believing that vaccination is the answer.

    1. The pandemic with a new virus has shown how vulnerable we are when we are vitamin D deficient. It is crucial to understand this, that vitamin D deficiency is real, it is widespread, and it is important. It is important to understand that giving vitamin D my mouth is not a "diet supplement" but is correction of vitamin D deficient that results from our lifestyle within a mainly indoor life.
      The problem does not stop with the end of Covid-19 illness (when herd immunity to this specific virus is achieved) as correction of vitamin D deficiency will have many other health advantages.

    2. David: Agree with everything you say except:
      "giving vitamin D my mouth is not a "diet supplement" ". Why the denigration of the term diet supplement? I see this in many medical practitioners. Giving magnesium by mouth is not a diet supplement?? Yet magnesium deficiency is just as wide spread as vitamin D deficiency.. Magnesium supplementation should not be necessary because sufficient magnesium is available from leafy vegetables and other foods but clearly a large number of people do not eat them in sufficient quantities. Similarly people do not get enough sun. Both are lifestyle deficiencies. While you could argue that because vitamin D is hardly available in the diet then it is not a dietary supplement, it is sun supplement. It is NOT a medicine! Medical politics is so strong and omnipresent that calling it a medicine invites medical control ie vitamin D by prescription. We do not need to medicalize people's health anymore than it is. In the U.S. people are very free to decide for themselves if they need or want vitamin D but in the English colony countries the attempt to control this substance is very strong to the point of preventing people from accessing it from health stores and from overseas. The average physician has no clue about vitamin D except that if you take more than the recommended level of 600IU daily you will "send your calcium levels sky high" (as one GP said to me). In NZ and Australia they will not test vitamin D blood levels and even if they did they still argue that 50Nmol/L is adequate. So, to me vitamin D (as it is called) is a supplement and not a medicine.

    3. Ian. I think we are in agreement in that vitamin is not a medicine and should be available to the public. We also agree that the knowledge that physicians have of vitamin D is abysmal. The important thing about the pandemic is that it has brought to attention the vulnerability of humankind to a new infections. We have been able to see that the greatest vulnerability is the winter-time, the obese, the elderly, living in temperate zones as opposed to the tropics, ethnic African and Asian people who now live closer to the North Pole than to the equator. The common factor, and science always looks for common factors, is deficiency of vitamin D, which can be corrected very easily and very safely.
      I have seen and treated a few people with magnesium deficiency following serious intestinal disease, usually with extensive resection. As when taken by mouth will cause diarrhoea, it needs to be given by regular intravenous infusion. I have no idea of the general frequency of magnesium deficiency as I did not see it, perhaps because I did not look for it. Should a "supplement" of magnesium be given without awareness of deficiency?
      I think that ideally we should give vitamin D, and magnesium, as with insulin and iron, that is my monitoring blood results.

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  7. Yes totally: "The common factor, and science always looks for common factors, is deficiency of vitamin D, which can be corrected very easily and very safely." Do you think that there is a medico-political aversion to recommend vitamin D for respiratory infections, particularly Covid-19? I do hope the data showing that vitamin D deficiency is a strong risk factor for severe symptoms and death will be widely accepted. I also hope that this leads to stronger recommendation for taking vitamin D at a meaningful dose.

    1. Ian. Is there a conspiracy against vitamin D? I don't know, but.... The pharmaceutical industry depends on people being ill. If vitamin D reduces the incidence and severity not just of respiratory infections, but also of several cancers, heart disease, several "auto-immune" diseases, depression and several neurological disease, and more, the necessity for medications will diminish substantially. Would the pharmaceutical industry be better with or without vitamin D?