So that seems to be settled then

The gold standard of medical research is the randomised controlled trial. Back in May, we had no such test for vitamin D and Covid-19. Now we do. The world’s first randomised control trial on vitamin D and Covid has just been published. The results are clear-cut. The trial, which took place in Spain at the Reina Sofía University Hospital, involved 76 patients suffering from Covid-19. Fifty of those patients were given vitamin D. The remaining 26 were not. Half of those not given Vitamin D became so sick that they needed to be put on intensive care. By comparison, only one person who was given Vitamin D requiring ICU admission.
Put another way, the use of Vitamin D reduced a patient’s risk of needing intensive care 25-fold. Two patients who did not receive Vitamin D died. And while the sample is too small to conclude that Vitamin D abolishes the risk of death in Covid patients, it is nonetheless an astonishing result, and corresponds with Prof Backman’s assertion that correcting vitamin deficiency might cut mortality by half. The Government should now act on this latest evidence.

The medical side is interesting, of course it is. But it’s the political side that’s of more importance. For now we’ve got our explanation of why the BAME peeps have been so hard hit. Which also means that we don;t need to overturn capitalist free marketry to reduce the BAME death rate for Covid – as so much of the Guardian has been claiming – instead we treat the actual cause. Some Vit D tablets.

Being wholly and entirely fair about this. Yes, the higher BAME death rate could have been due to structural inequality. But it ain’t and claims that it is, from now on, will be lies.

55 thoughts on “So that seems to be settled then”

  1. My beloved GP has decided that I need chalk pills. Reading the stuff in your blog, I decided to buy the pills with added vitamin D, even though they /horrors// cost more.

    Not sure of their effectiveness yet. Perhaps my going mad with the machete and chopping down most of the pollen producing plant outside my window was more effective.

  2. In related news, you don’t actually have to wait for the government to act, you can buy it in the supermarket. All this was known and widely publicised back in the early spring. Supermarkets ran out of the stuff, so obviously lots of folks were aware.

    The NHS recommended dose “to avoid rickets” is 10 micrograms a day. You probably need maybe ten times that, but do your own research, Rhoda is not a doctor. Or a biochemist, come to that.

    As far as government action is concerned, why would they need to see a proper trial, there being no logical validity behind anything they done so far?

  3. “…you don’t actually have to wait for the government to act, you can buy it in the supermarket. ”

    Can’t expect those BAMEs to buy it for themselves as their vitamin D deficiency is clearly caused by white privilege.

  4. Bloke in North Dorset

    I don’t suppose I’ll get an apology from the twat who accused me of spreading fake news when I suggested people should be getting outside to raise their Vit D levels.

    Anyway, for those thinking of taking supplements my prescription is 800 IU per day (equivalent to 20 micrograms Vit D3) and since I was prescribed it about 4 years ago I haven’t had a cold or other respiratory infections.

    Like Rhoda I’m not a medical professional so do your own DD.

  5. Seeing as this government has pretty much ignored every bit of proper scientific evidence and advice from day one, what makes you think they’ll take any notice of this?

  6. I thought it was already common sense/practice that anyone working in an environment promoting The Sniffles™ starts supplementing when October hits?

    I sure as hell do.. Only way to survive the Miasma excuding from a homeless ward without getting a cold every other week… Hunt for the preggers multivits.. They got all the Good Stuff for elevated resistance, and for some reason the hoarders leave them in the shelves.. 😉

  7. Most of the variation in deaths can be explained by the fact that huge urban areas were hit much harder than country towns and villages. The percentage of BAME in London and Birmingham isn’t far off the death rate. You barely saw this fact reported in the media.

    Anyway, this can never be the solution as these pills are about 2p each. The NHS will need to sell them for at least £5 before it becomes viable.

  8. “now we’ve got our explanation of why the BAME peeps have been so hard hit.”

    Now we have one possible explanation. I recently read a medical paper that suggests that people with type O blood are less likely to get severe effects if infected. Many BAME people tend to be A, B or AB blood type. That’s another possible explanation.

  9. To be clear here, the scientific evidence, as published in the paper itself, is that:

    “Calcifediol seems to be able to reduce severity of the disease, but larger trials with groups properly matched will be required to show a definitive answer.”
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/

    The article in the Telegraph appears to be overselling it, which is hardly unusual for MSM reporting of science. It’s certainly a promising result, and I personally will be badgering the people I care about to start/keep taking a multivitamin*, but it’s not settled to the gold standard.

    * put them in your fridge, then you’ll see them and remember

  10. That is interesting. So what I thought was a rather savage cold for a couple days back in February could have been Covid. Especially as I don’t often succumb to the common cold. It had been 3 or 4 years since the previous & that only a sniffle. Currently this once blonde Brit is slightly darker than his mulata girlfriend. And she’s been tanning all summer. Wasn’t much paler at the start of the year. I must have vitamin D coming out my ears.

  11. Many BAME people tend to be A, B or AB blood type. That’s another possible explanation.

    Tony Hancock was AB negative, rhesus positive. He’d be a goner.

  12. Bloke in North Dorset

    “* put them in your fridge, then you’ll see them and remember”

    We keep ours next to the kettle, but I also have a daily alert on my iKit.

  13. “Can’t expect those BAMEs to buy it for themselves as their vitamin D deficiency is clearly caused by white privilege.”

    Nor will they conclude that they aren’t adapted to living in temperate climates. The various sub-species of homo sapiens should generally live in their natural habitats.

  14. “Being wholly and entirely fair about this. Yes, the higher BAME death rate could have been due to structural inequality. But it ain’t and claims that it is, from now on, will be lies.”

    Nah, this is massively overreaching. As the paper makes clear, this was only a pilot study with an absolutely tiny sample size, and the BAME thing was not studied at all in it. The results are interesting but not known with sufficient precision to compare them to what we know about differences in vitamin D between ethnic groups and then compare that to observed differences in COVID fatality rates to see how much it explains.

    You know if you saw an ignorant leftie pundit jump on evidence from a small-scale pilot study to claim that one factor they were very keen on was the sole driver of a complex, multifactorial problem that you’d jump on it. Trying to think of a good analogy but let’s try “using the results of a modelling study that suggests Cali wildfires were more intense recently due to climate change, to claim the fires were entirely the fault of climate change, we all need to give up our cars immediately even though the study said nothing about the effect of giving up cars, and claiming that since another factor had been identified, therefore poor forest management could not possibly have been a factor.” Not a perfect analogy but roughly similar logical error.

    There are a variety of competing explanations for why there were higher death rates among BAME people, as others have pointed out. Too early to say which are most important but I think it’s highly unlikely structural factors played absolutely no role at all, bearing in mind certain known risk factors (high-risk jobs and overcrowded housing – partly a cultural thing due to multigenerational living but also affected by the size of property that can be afforded) vary between ethnic groups.

  15. Rob has it right.

    NHS and PHE procurement will scour the globe for the most expensive sources of Vitamin D and subject the pills to rigorous testing before they issue it in prescription form at a mark up of thousands of %. Cheap supermarket pills will not be approved for general use.

  16. The role of vitD3 in maintaining frontline immunity ie intrinsic non antibodymediated immunity )been known since . It was not enthusiastically promoted probably because it’s cheap and non patentable. The Med School of East Virginia developed a very successful and cheap treatment for sepsis based on IV hydrocortisone, rather than dexamethasone, and IV vits C&D which they adapted for severe covid on the basis that both conditions are characterized by a cytokine storm. The vits displace the cytokines from cell receptors for corticosteroid which reduces inflammation.

    Please note that vitD3, the active form, is fat soluble so should be taken with meals for any absorption. It is naturally low in the obese, elderly and dark skinned living at high latitudes. I started taking it in winter years ago while living in the UK to reduce the gloom I felt in the dark part of the year. Its chemistry resembles that of steroid hormones so it is unsurprising that it affects multiple systems.

    The skin cancer panic has a lot to answer for. There is an Oz srudy that correlate longterm solid tumour survival positively with a history of squamous and basal cell skin cancer ie sun exposure.

  17. It was also pointed out that commercial Vit D is an animal product so unsuitable for vegans which I consider to be a crying shame. And so, “something must be done”.

  18. @Theo

    The idea that there are different sub-species of anatomically modern humans is a ship that has long since sailed, get over it. The main debate over human subspecies these days, as far as I’m aware, is whether us modern lot (of all skin colours and geographical ancestry) should be designated Homo sapiens sapiens to differentiate us from ancestors judged to be within the same species but arguably distinct enough to form a different subspecies, like Homo sapiens idaltu, and whether you then place e.g. Neanderthals as Homo neanderthalensis (different species) or Homo sapiens neanderthalensis (same species, different subspecies).

    The idea of H. s. americanus, H. s. europaeus, H. s. asiaticus and H. s. After is long long gone because it lacked any convincing biological basis.

  19. Blokein.. “But a **very** small study.”

    For a given metabolism that’s proven to be relatively universal for a given organism, you can use small samples to predict effects in the larger population. Important thing in biology and medicine, as it saves tons of test subjects.
    Barring anomalies, the human immune system *is* such a metabolism.. It’s pretty much the same +/- couple niggles across all humans in function and effect.
    So very small samples can be used if you’re not trying to prove the anomalies. Which isn’t the case here.. They were studying general efficacy.

    Given the rather extreme result of the outcome, the difference is huge, all it takes is another couple of small tests to confirm the findings.
    Worthwile, given that if this works, the potential worst result shifts from “lethal in risk groups” to “lethal only in extreme cases” , at which point you’ve reached the happy situation where CoVid19 is simply less dangerous than the common flu, and we can be done with all this panic-stuff.

  20. Most of the variation in deaths can be explained by the fact that huge urban areas were hit much harder than country towns and villages. The percentage of BAME in London and Birmingham isn’t far off the death rate. You barely saw this fact reported in the media.

    The rumour going round at the beginning of the panic that blacks were immune from covid seems to have been memoryholed.

  21. Didn’t we have a muslims are less vvulnerable story here at the beginning? Are figures by race of the current casedemic available?

  22. “Given the rather extreme result of the outcome, the difference is huge, all it takes is another couple of small tests to confirm the findings.”

    Bah! We know nothing of the conditions surrounding the study. The study is suggestive. That is all.

  23. From the quotes it seems that vitD aids recovery. Nothing in the above says it’s a preventative.

    Incidentally, while the govt obsesses about cases and the slightly wiser look at hospitalisation rates, here’s another measurement. Are patients now being cured faster? If beds are being liberated at twice the rate of April that is even better news.

  24. I know none of us like experts these days but Grikath is one such. Works in the medical testing field I think…..

  25. Mushrooms and fortified bread is a natural and cheap source of vitamin D. Some years ago when I needed to lose some weight I followed a vegan diet for about four months, and specifically checked for vitamin D and B sources in food.

    Vitamin D is one of those dietary components that it’s difficult to overdose on, the body natually expells any it doesn’t use, so taking too much will just give you enhanced urine.

  26. Igh: vit D is stored in fat. It is not water soluble. We evolved to get fat in summer and live off our fat stores in winter when vit D is released as we use the fat. Too much gives you Ca++ deposits in inconvenient places like kidneys, joints, arteries..

  27. I’m not disputing that this study adds to the evidence about the role of Vit D re COVID, and moreover that this fits with what is already known about the role of Vit D in the immune system.

    Nevertheless, the sample size is very low compared to what you’d usually use to inform a large-scale pharmaceutical intervention, and you generally don’t want to draw too many conclusions from a single study, particularly a small one. It can be hard to tell how well-conducted an individual trial is – a study claiming it is “double-masked” or “placebo-controlled” can still hide a multitude of sins. It’s unfortunate that this kind of trial doesn’t get money ploughed into it by big pharmaceutical companies because there’s no highly profitable patentable drug in play here – it’s why it was important that government and other funders put some effort into the RECOVERY trial (https://www.recoverytrial.net) that found dexamethasone was a cheap and effective off-patent treatment – though found no clinical benefit from hydroxychloroquine (https://www.recoverytrial.net/news/statement-from-the-chief-investigators-of-the-randomised-evaluation-of-covid-19-therapy-recovery-trial-on-hydroxychloroquine-5-june-2020-no-clinical-benefit-from-use-of-hydroxychloroquine-in-hospitalised-patients-with-covid-19). I don’t think RECOVERY looked at Vitamin D.

    The point stands that this wasn’t an investigation of the effect of COVID among ethnic minorities, the sample size is only capable of low precision (even if it’s strongly statistically significant), and it was looking at the effect as a treatment rather than as a preventative. It’s therefore an unjustifiable leap to claim that all other factors bar skin colour’s effect on Vit D levels (something the study didn’t even look at – in fact it didn’t look at patients’ prior Vit D levels at all), including socioeconomic/structural factors which have other evidence in their favour, can be entirely ruled out as contributing to COVID deaths, based on this one small study. That is overreaching.

  28. @Tim.. Expert? Gods forbid…
    I’m just a generalist who has *not* forgotten the important stuff they teach you at Uni and retained the ability to Read Up On Stuff. It does help that I have a good selection of people who do work in the field. Something, something, access to actual scientific articles.

    Ljh: You do realise that to overdose on D3 ( and bugger up your calcium homeostasis) you have to have a structural intake of 100’s of times the recommended daily dose?
    Not something you can do accidentally..

  29. “the sample size is very low compared to what you’d usually use to inform a large-scale pharmaceutical intervention, ”

    The large sample sizes are to ascertain there’s no hidden (side)effects that crop up in the <0.1% of the population..

    The actual efficacy of a medicine is already established by the time it hits large-scale testing.
    In small scale tests that determine this ( + any obvious side effects).

    This is “How To Set Up Your Experiment” 101, available at every Freshman course worldwide.

  30. I’ve been taking 3,000 IU daily for months. The upside is attractive, the downside almost non-existent, the cost negligible. That’s the sort of gamble I enjoy.

    I also eat a Brazil nut at breakfast – all that lovely selenium. I looked into multivitamins – the idea is attractive and remarkably cheap but there’s one vitamin I need to avoid so it would make for a lot of tiresome studying of labels. I opted instead for a Vitamin C/Zinc pill every morning before breakfast.

    P.S. I am not a medical man – this is an anecdote, not advice.

  31. But now that the over 80 and already very ill groupings have been thinned out (apologies to anyone offended by the above) exactly how many people are actually getting ill from it these days let alone dying?

    Bbbbbbut look at all the positive test results!

    Still I suppose the prospect of giving the entire population their “daily dose of D” might appeal to our mindless nanny state and give Boris a way of crawling away from the disaster he has created.

  32. @MBE
    Wouldn’t normally support Theo. Mostly he spouts bollocks. But. No doubt you’re technically correct according to the science. Although what the science is on a subject where any divergence from the dominant paradigm is unlikely to go unpunished isn’t exactly transparent.
    Humans, as an animal, were clearly on the path to speciation. Why wouldn’t we be? That’s what happens to all creatures with a wide geographical dispersion when populations become isolated. Except you have technology pulling in two directions. Early tech enabled dispersion. Later tech enables convergence. So it really depends on how far down the road to speciation populations were when the changeover happened. Certainly some distance. Lighter skins in high latitudes. Lactase persistence into adulthood. Cold resistance in the Arctic. Sickle celling. OK, all humans can interbreed. But opportunity’s an important factor. There’s a lot of closely related species of animals could interbreed. But don’t because of geographical separation or differing mating patterns. Lions & tigers? Then there’s the neanderthal factor. Europeans (only?) are reckoned to have neanderthal DNA. Humans & neanderthals are accepted as being different (sub?) species. So what does that make Europeans?
    It seems pretty obvious humans have evolved somewhat for differing environments. So it makes sense to say some humans are less optimal for environments they haven’t evolved for.

  33. Bloke in North Dorset

    We know the products safe and although this is a small trial would it ethical to run a other double blind trial given the wide discrepancy in the results?

  34. Grikath: if you are enthusiastic consumer of supplements od’ing on it is possible even if extremely unusual. I have sat in on a case conference of one such, who was also yellow from beta carotene.

  35. @Grikath

    “The large sample sizes are to ascertain there’s no hidden (side)effects that crop up in the <0.1% of the population.. The actual efficacy of a medicine is already established by the time it hits large-scale testing. In small scale tests that determine this ( + any obvious side effects)."

    If it were as simple as that, then wouldn't you expect most failures in Phase II trials to be due to lack of efficacy, and most failures in the larger, later Phase III trials to be due to problems with safety?

    In fact there are failures at both phases for both reasons (as well as commercial issues) but in recent years safety has accounted for more failures than efficacy at Phase II whereas efficacy has accounted for more failures than safety at Phase III: https://www.parexel.com/application/files_previous/5014/7274/5573/ACT_Article.pdf and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6609997

    It's also interesting that large-scale Phase III results can unexpectedly diverge from Phase II results, with failures in both safety and efficacy occurring even when the Phase II trial was relatively large or the product was already in use for other conditions: https://www.fda.gov/media/102332/download

    Quite a lot of ink has been spilled on the forthcoming death of the Phase III trial due to new statistical techniques and the rise of personalised medicine. But results like those above help explain why it ain't dead yet, and we're unlikely to see large-scale policy changes based on a single-site trial that compared 50 versus 26 patients.

    @BIS

    Not just Europeans actually, the interbreeding seems to have influenced Eurasians in general and hence on to Oceanians and Native Americans. And not just with Neanderthals, also with Denisovans (who seem to have particularly affected some Oceanian groups). There's also some evidence for breeding with other, unknown archaic humans in Africa. But it's wrong to think of sub-Saharan Africans as having been completely cut off from Eurasians – they weren't an isolated population, and the Neanderthal genes actually seem to have flowed back to themm, just as a lower proportion of their DNA than what you'd find in a European. We're all hybrids but you get a different mixture in different places. Rather than thinking of humanity like a tree that's split out into different branches, each of which has diverged further into separate twigs, the current paradigm is more like a "braided stream".

  36. @ Ljh : There is *always* bog-standard stupidity… Doesn’t mean it’s the norm…
    Although you now have me curious about *how much* said idiot interesting case ingested to get the fake spray tan effect. That’s ..impressive… in a Darwin Award sense..

    I’ve seen pics in books, but there’s always been some kind of disorder involved in those… I never imagined someone would do this to themselves voluntarily..

  37. Tony Heller has a video up where the CDC director spouts a load of unscientific bollocks in order to get at Trump. And people wonder why our trust in the pontificating classes in general and scientific experts in particular is through the floor.

    One side effect of the ‘march through the institutions’ is that these institutions have become risible imitations of their former self which cannot be respected by anyone, just used as political weapons.

  38. Looks pretty bloody convincing, for the ICU admission endpoint at least. Small sample size not a concern given the magnitude of effect. One more trial of similar size and you can put it on the product label, not that anyone will pay for that.

    Phase 3 trials are being killed off by Joe Biden’s “cancer moonshot”. I kid you not we are now licensing stuff on the basis of ongoing uncontrolled dose escalation studies. It’s a bad joke.

    20,000 IU every week to 10 days is commonly prescribed in severe deficiency, including moderate to severe renal failure.

  39. The sample size may be small but if I remember correctly the chance the results were by chance was less than 0.1% so significant.

    Vitamin D deficiency (at least in the US) is race related with an average 40% deficient but hispanics around 70% and blacks around 80%

    Also interesting to note Dr Fauci takes 150 micrograms of vitamin D and 2 – 3 grams of vitamin C per day

  40. “Are patients now being cured faster?“
    I did see somewhere that survival rates for ICU admissions had massively improved due to better understanding of effective treatments, though not surprisingly this piece of positive news isn’t mentioned in the media. Also likely one of the reasons the death rate is down despite more cases.

  41. OK there is also the caveat that we haven’t had similar studies with “negative” and thus unpublishable results. But I don’t think that is the case. The medics grapevine is doing a good job of spreading news about effective and counterproductive treatment protocols.

    So, um, ummmmm, yes, patients sick enough to need treatment are also now being discharged to primary care more and to the morgue less now.

  42. @MBE
    “Rather than thinking of humanity like a tree that’s split out into different branches, each of which has diverged further into separate twigs, the current paradigm is more like a “braided stream”.
    Well, yes.
    But it depends on when & how much, doesn’t it? Can’t be very braided or a long time ago or that’d be the route to coffee coloured people by the score. So it obviously wasn’t. How prevalent is neanderthal DNA in sub-Saharan Africans? Enough to account for large scale movements or a few individuals once? How reliable is the “science” on this, anyway? There’s a great deal invested in the all-one-people paradigm & scientists are proven liars.

  43. Vitamin D has the same problem as hydroxychloroquine: Drumpf said take it. Ipso facto, it has to be bad. Any fewl knows Drumpf is trying to kill Americans.

    Don’t get too carried away taking vitamin D. At higher concentration, cholecalciferol is rat poison. Cirrusly. Hmmm, maybe some blacks think whitey is trying to poison him.

  44. re: The vitamin D paradox in Black Americans

    [quote]
    According to the U.S. National Institutes of Health, a paradox exists in which, despite markedly low (or “deficient”) measures of vitamin D status in Black Americans, the incidence of falls, fractures, or osteopenia are significantly lower compared to White American counterparts with similar vitamin D status. An expert panel meeting report published in BMC Proceedings presents a panelist discussion regarding this issue.
    [end quote]

    It is explained here:

    [quote]
    The 25-hydroxy form is tightly bound to a protein, and as a result, bone cells, immune cells and other tissues that need vitamin D can’t take it up. It has to be converted by the kidneys into a form called 1,25-dihydroxyvitamin D.

    For Caucasians, blood levels of 25-hydroxyvitamin D are a pretty good proxy for how much of the bioavailable vitamin they have. But not for blacks.

    That’s because blacks have only a quarter to a third as much of the binding protein, Thadhani says. So the blood test for the 25-hydroxy form is misleading. His study finds that because of those lower levels of the protein, blacks still have enough of the bioavailable vitamin, which explains why their bones look strong even though the usual blood tests say they shouldn’t.
    [end quote]

    Some links:

    https://blogs.biomedcentral.com/bmcseriesblog/2018/05/15/vitamin-d-paradox-black-americans/

    https://www.npr.org/sections/health-shots/2013/11/20/246393329/how-a-vitamin-d-test-misdiagnosed-african-americans

    https://bmcproc.biomedcentral.com/articles/10.1186/s12919-018-0102-4/figures/1

  45. Uhhmmm.. Ahmed.. Those peeps have got it ass-backwards…

    Africans (or peeps of mainly african descent) are the “wild” form when it comes to D3 metabolism. It’s the Caucasians who are adapted to low levels of sunlight, by having developed a higher expression of that lovely little proteïn.
    The pathway of D2/3 to its bioactive form is exactly the same otherwise, it’s just the level of expression of the binding protein that is different.
    Which makes sense, since Caucasians cannot afford to waste the stuff, whereas africans in their “natural environment” can to an extent.
    And like you’d expect from such a relatively novel mutation, the Caucasian mutation is (mostly) recessive, so the “black” (wild form) genes tend to “win” in mixed-race offspring, just as our white skin ( another adaptation..) is (mostly) recessive.

    As far as the sturdyness of the bones is concerned.. The caucasian skeletal phenotype is more “gracile” than the african phenotype. Which is in and of itself another adaptation to a different calcium regimen.
    The most extreme natural examples of this are actually the viking-era scandinavians: Their skeletons were generally so “gracile” quite a number of burial sites were mistaken for female, giving rise to the 19th/early 20thC notion of the Female Viking Warrior. ( oh those Romantics, so droll, so much pulled ut of their arse…)
    But the simple truth is that africans have bones that are simply more sturdy, with a slightly different muscle insertion. Which is why they do excel in the althletic fields, and are less prone to bone fractures.
    Even under D3 deficiency… Their scaffolding is simply better’n ours.

    But a lovely example of how “experts” can get it wrong.. Simply by picking the wrong phenotype as the archetype. Something called Data Bias, which can trip up even the best of us..

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