
The First Randomized Controlled Trial on Vitamin D and Covid-19 - wavepruner
https://www.sciencedirect.com/science/article/pii/S0960076020302764
======
maxander
From the results:

“Of 50 patients treated with calcifediol, one required admission to the ICU
(2%), while of 26 untreated patients, 13 required admission (50%) p value X2
Fischer test p < 0.001.”

Which sounds like as strong a signal as a study of this scale could hope to
show.

~~~
ellyagg
It's useful to note that this study doesn't need to stand on its own as
evidence. It contributes to a growing body.

As most of you may have already seen, there is a lot of observational evidence
that people with low vitamin D have the worst C19 outcomes. Obviously,
correlation by itself doesn't mean causation. But it is a hint.

On top of the hint, we already have dozens of RCTs that vitamin D supplements
suppress respiratory infections.

[https://www.bmj.com/content/356/bmj.i6583](https://www.bmj.com/content/356/bmj.i6583)

And now we have this study. Every study and line of evidence has flaws, which
is why you look at the totality of the evidence.

From the evidence I've seen, low vitamin D is a bigger problem in modern
societies than vitamin D toxicity. Vitamin D is available OTC and many people
use it apparently responsibly. I would expect that to continue with
appropriate messaging.

It would be great if we could pursue a consensus on this while it can still
make a difference, even in the absence of perfect data. It was a mistake in
the early US messaging to downplay the importance of masks even though we
didn't have perfect data on it.

~~~
mattmanser
We actually have an expert on this comment here quite often, too high Vit D
dose can cause problems with calcium:

[https://news.ycombinator.com/user?id=devaboone](https://news.ycombinator.com/user?id=devaboone)

And she's done a series on it:

[https://www.devaboone.com/post/vitamin-d-part-1-back-to-
basi...](https://www.devaboone.com/post/vitamin-d-part-1-back-to-basics)

~~~
mrslave
IIRC, calcium toxicity is serious, but only a consequence of sustained Vitamin
D supplementation.

Also there's some Joe Rogan-esque "just take the 5000 IU bro" even though 4000
is the recommended supplement upper bound. And devaboone warns against even
using that much.

~~~
me_me_me
Taking more than recommended is ok, your body will flush it out.

It is basically wasteful, only in extreme cases you could 'overdose' vitamins.

[https://en.wikipedia.org/wiki/Vitamin_D_toxicity](https://en.wikipedia.org/wiki/Vitamin_D_toxicity)

~~~
curryst
> Taking more than recommended is ok, your body will flush it out.

This is not true. Vitamin D is fat-soluble, not water-soluble. Your kidneys
can only filter out water-soluble vitamins. B vitamins are water-soluble;
that's why there's practically no upper limit to how much you can take. Your
kidneys will filter out the extra (assuming you aren't eating buckets full of
the stuff).

Vitamin D toxicity occurs specifically because your body can't remove the
excess vitamin D stored in your fat.

That's also why severe overdose happens over time, as opposed to instantly.
You have to take a huge amount of Vitamin D at once to overdose (like millions
of IUs) but you can cause toxicity using smaller doses over longer periods of
time. If your body could flush it out, that wouldn't be true. Any excess would
be removed and you would start each day "fresh".

------
asah
Non-white skinned people: sunlight may not be enough to increase your vitamin
D.

[https://www.google.com/search?q=dark+skin+vitamin+d+minutes](https://www.google.com/search?q=dark+skin+vitamin+d+minutes)

~~~
kyleee
Is there a scientific classification system for evaluating how light vs. dark
a person's skin is? I'd like to know how much my relatively darker skin is
preventing vit D uptake / creation in the body

~~~
philsnow
There is
[https://en.wikipedia.org/wiki/Fitzpatrick_scale](https://en.wikipedia.org/wiki/Fitzpatrick_scale)
which I learned about from the apple health app, no idea how widespread it is
or how useful it is as a model.

~~~
briankelly
I learned about this from a dermatologist who specializes in skin cancer care.
He says it is a very strong indicator for skin damage and cancer risk (sounded
stronger than genetic/family history factors), but how it relates to vitamin D
deficiency was not really in his domain.

------
dilippkumar
Previously on HN, a physician shared some thoughts on treating Vitamin D as a
medication and not as a dietary supplement:

Part 1:
[https://news.ycombinator.com/item?id=24138590](https://news.ycombinator.com/item?id=24138590)

Part 2:
[https://news.ycombinator.com/item?id=24261948](https://news.ycombinator.com/item?id=24261948)

To summarize - popping in large doses of Vitamin D is not exactly safe.

~~~
conorh
Deva is deep into writing part 3 at the moment (the physicians husband here)
where she reviews these trials, what they mean and how they should be
interpreted. I think she will be finished soon.

~~~
pvsukale3
Thanks for the update, would love her opinion on this paper's outcome.

------
lrem
Can someone tell what is the equivalent dose of said calcifedol in regular D3?
The article claims 0.532 mg have been used, which seems too large. From [1] I
gather it's about 3x more potent, meaning we are talking about equivalent of
1.596mg of D3. Or, 10000% of RDA according to [2]. Is that right?

[1]:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460735/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460735/)
[2]: [https://ods.od.nih.gov/factsheets/VitaminD-
HealthProfessiona...](https://ods.od.nih.gov/factsheets/VitaminD-
HealthProfessional/)

~~~
graeme
That’s about 60,000 IU? Not necessarily out of line for such interventions. In
cases of deficiency doctors will often prescribe weekly doses of 50,000 I
believe. Have also seen RCT on vitamin d and the flu where groups where given
250,000-500,000 IU’s in one shot.

....obviously nobody reading this should take anything near those doses
without consulting a doctor and without knowing your current blood level, to
be clear.

~~~
lrem
Yup, 60kIU from my understanding. And here I am wondering if the 2kIU I'm
doing would have any effect...

~~~
ac29
The amount used as an interventional or short term treatment can greatly
exceed what is a prudent amount to take daily. Taking 50k/day long term is
probably a bad idea.

~~~
graeme
No probably about it, it’s a disastrous idea.

------
sradman
> Serum 25OHD concentrations at baseline or during treatment are not
> available.

This is mind boggling. These 76 patients had extensive blood work done so why
did the study design not include serum concentration testing before and after
treatment?

~~~
blithedale
Welcome to every Vitamin D study done ever. I follow some PHD/RD combination
researchers on Twitter and they all get together each time one of these
studies is done and bang their heads against a wall.

------
gshotwell
This follows quite a lot of observational evidence. There are currently 11
studies that have found an association between serum vitamin D and Covid
severity. These are listed here:

[https://github.com/GShotwell/vitamin_d_covid](https://github.com/GShotwell/vitamin_d_covid)

------
bdamm
Noteworthy that this is in combination with anti-viral drugs at hospital
admission: hydroxychloroquine (400 mg every 12 hours on the first day, and 200
mg every 12 hours for the following 5 days), azithromycin (500 mg orally for 5
days). Regardless, I'm going to assume this means being outside and getting
sun is good for me.

~~~
DenisM
Except for all the skin cancer, right?

FWIW, I was told that when the Sun is above 45 degrees over the horizon you
will accrue DNA damage, and it stacks up over your entire lifetime. There is
no "reset" or "heal", it just adds up.

For that reason I'm doing my darnest best to stay in the shade between 9am and
3pm. Or covering clothing.

~~~
eholk
I'd be really interested to see a comparison of the relative risks between
skin cancer and vitamin D deficiency.

A lot of what I've read lately suggests we're discovering a lot of benefits of
vitamin D that were previously unknown, and some evidence that the recommended
vitamin D levels should be higher than they are.

For a generation or so we've told people the sun is dangerous because of skin
cancer, and obviously skin cancer is really bad. But I wonder if we have a
case of need to weight risks that are high cost, low probability (skin cancer)
compared with low cost, high probability (low vitamins D complications). What
is the overall effect of these two things?

~~~
agarden
This article gets into that: [https://www.outsideonline.com/2380751/sunscreen-
sun-exposure...](https://www.outsideonline.com/2380751/sunscreen-sun-exposure-
skin-cancer-science)

Short excerpt: People don’t realize this because several different diseases
are lumped together under the term “skin cancer.” The most common by far are
basal-cell carcinomas and squamous-cell carcinomas, which are almost never
fatal. In fact, says Weller, “When I diagnose a basal-cell skin cancer in a
patient, the first thing I say is congratulations, because you’re walking out
of my office with a longer life expectancy than when you walked in.” That’s
probably because people who get carcinomas, which are strongly linked to sun
exposure, tend to be healthy types that are outside getting plenty of exercise
and sunlight.

~~~
function_seven
> _The most common by far are basal-cell carcinomas and squamous-cell
> carcinomas, which are almost never fatal._

My grandpa died due to complications from a basal-cell skin cancer. He was
almost 90 years old. The cancer itself was a few decades old. He served in the
Navy during WWII, and likely got it from years of tropical sun exposure with
no sunscreen.*

So, yeah, as far as cancers go, that's one you'd rather get if given a choice.

* (Well, and the additional years of fishing and other outdoor activities. Obviously the cause can't be pinpointed like that, but it must have contributed)

------
natcombs
> parallel pilot randomized open label, double-masked clinical trial.

Dumb questions: What is a parallel pilot | what is open label? And Is double-
masked the same as double-blind?

~~~
legerdemain
"Parallel" generally means that different groups of patients receive different
treatments. The opposite is a within-patient study, where all patients get all
treatments over time (possibly varying the order to prevent order effects).

"Open-label" generally means "not blind at all." Basically, the patient knows
what treatment is being administered.

"Double-masked" is usually synonymous with "double-blind," because "masking"
sounds less violent than "blinding."

What did they actually do in the study? Well, §2.2.1 says the following:

    
    
      > 2.2.1. Randomization and Masking
      > 
      > An electronically generated randomization 2:1 list was prepared by
      > independent statisticians. The list was accessible only to nonmasked
      > specialists in the study in an attempt to minimize observation bias.
      > The patients' data were recorded in the hospital's electronic
      > medical record, with blind access by the technical data collectors
      > and the statistician who carried out the study.
    

My takeaway is that... the authors don't do a great job of describing who had
access to what information.

It sounds like those who analyzed the data didn't know which group was which,
but in the case of unequal 2:1 group allocation it is typical for the larger
group to be the treatment group. Why was unequal assignment used in the first
place?

The descriptor "open-label" suggests that _someone_ knew which patients were
in which groups: was it the people who administered the treatment, or the
patients, or both? Unclear.

The authors themselves write: "This pilot study has several limitations as it
is not double-blind placebo controlled."

~~~
gruez
>"Double-masked" is usually synonymous with "double-blind," because "masking"
sounds less violent than "blinding."

This is literally the first time I've heard of "double-blind" being
interpreted this way.

~~~
legerdemain
I think it's a common euphemism, similar to referring to "subjects" as
"participants" and so on.

\-
[https://link.springer.com/referenceworkentry/10.1007%2F978-3...](https://link.springer.com/referenceworkentry/10.1007%2F978-3-540-68706-1_1425)

\- [https://az.research.umich.edu/medschool/glossary/double-
mask...](https://az.research.umich.edu/medschool/glossary/double-masked-
design)

\- [https://aidsinfo.nih.gov/understanding-hiv-
aids/glossary/211...](https://aidsinfo.nih.gov/understanding-hiv-
aids/glossary/211/double-blind-study)

------
jonplackett
Surly now it's time to just start giving everyone some free vitamin D.

Best case scenario: Less dead people.

Worst case scenario: We all have healthier bones.

~~~
sokoloff
Vitamin D pills look to be 3-5¢ per day. Hardly seems like something I’d be
supportive of creating a “free” supply chain for.

~~~
shajznnckfke
If the costs are low, then the free supply chain won’t cost much to create. If
the public health savings are greater than the costs, it may be better to just
mail free supplements to people than mail them postcards advising they go out
and purchase them (advice most people will ignore, no matter how low the
cost).

~~~
sokoloff
How many people will need to be paid to operate this free supply chain to
provide a good that is perfectly well-supplied inexpensively privately now?
How many to answer questions, field calls about missed shipments, lost pills,
changes of address, etc?

The answer to every problem shouldn’t be “create a new government-funded
agency to make this happen ‘for free’”. Mr Market isn’t the answer for every
single thing, but sometimes it’s fine to let existing private supply chains
operate. Supplying cheap dietary supplements seems to me like an area where
that’s the case.

It may need to be added to SNAP/WIC; that’s a reasonable task for government
to busy itself supporting this.

------
stjohnswarts
Very small scale but sounds promising. I've been taking 2000UI/day for few
years now since my doc found my vitamin D was pretty low, it's now far up in
the normal range now. I didn't let him give me the massive doses that they
want to give you for low vitamin D, and opted for just starting to take the
supplement, when I went back in 3 months later everything was in the normal
range. I don't actually get much sunlight as a den dwelling programmer so it's
the next best thing.

~~~
neuronic
Sounds great. What's important to understand with high vitamin D doses is that
overdoses can occur unregulated by the body.

The regulation of vitamin D usually occurs before its synthesis after sunlight
exposure. Supplementing synthesized vitamin D circumvents the regulation and
allows vitaminosis to happen.

I have read wildly different recommendations for the dose. Typical package is
1000 IU, you take 2000 IU, others recommend upwards of 8000 IU due to possible
issues with earlier studies leading to FDA/regulatory agencies
recommendations. Again, rather stay below 5000 IU unless explicitly told
otherwise by a doc. Always get blood work done to REALLY figure out your
levels and how to fix them.

Again, why we can overdose with supplements but too much sunlight won't cause
an overdose:

Sunlight + components ---> X (regulation) <\---> Vitamin D ---> effect in body

Supplements start _behind_ the regulation step...

------
woeirua
Looks promising, but I would want to see a true double blinded RCT on a few
thousand people before we say that Vitamin D is an effective treatment.

Also, there's going to be a confounding question based on this study: is it
just Vitamin D, or is it Vitamin D in combination with HCQ / Azithromyacin?

That said, it probably wouldn't hurt you to supplement with Vitamin D this
winter, even if it doesn't treat Covid.

~~~
cameldrv
It's difficult to imagine how the placebo effect could produce this result.
Both arms of the trial were receiving HCQ and Azithromycin, so to the extent
that there is a placebo effect, you'd think that adding a vitamin wouldn't
change the result very much.

~~~
woeirua
I’m not saying it’s a placebo effect. Instead there could be unknown
interactions between Vitamin D and HCQ/Az that could be the causal effect.

------
ReflectedImage
And that's why I've been taking Vitamin D pills for the past 6 months. (It's
been suspected for some time to have an effect)

This doesn't mean go outside and get covid.

~~~
arkitaip
I've been taking Vitamin D3 5000 IU and Vitamin K2 MK-7 100 mcg daily since
February to boost my immune system, and I've noticed a radical difference in
my colds.

I used to get a major cold every 2-3 month and they were really bad lasting
two weeks with fever, fatigue, coughs, colds, really stuffy nose, etc. Now?
The two colds I've had were over in a week and the symptoms were so incredibly
mild - mostly a light runny nose - that I'm legit grateful when I get a cold.

Regardless of vitamin D's effect on covid-19, the supplement has already paid
off big time as far as I'm concerned. I've started to take 1g of vitamin C for
the same reason, i.e. to boost my immune system. I should add that I live in a
Nordic country with long dark winters and that I can't/don't go outside as
much as I should.

~~~
JabavuAdams
Are you sure you just aren't getting colds because of better hygiene, and less
contact with others? Without controlling for social distancing, you can't
reasonably conclude that it was the vitamin D.

I haven't had a cold since we initially locked-down in April, which is very
unusual for me, but completely explained by social distancing.

~~~
arkitaip
Oh I absolutely believe that social distancing and better hygiene are the
reasons why I've gotten so few colds this year but those actions can't fully
explain the decrease in severity. My colds have gone from being absolutely
miserable to barely noticeable and are over in a week or less. I could be
totally wrong but I'm not willing to remove vitamin d/k/c from my diet just to
validate the hypothesis.

------
ptest1
The problem I see with this trial is that it’s open-label, small n, and has
subjective endpoints (ICU admission as the primary outcome). The study is
underpowered to detect mortality. Given the open-label nature of the trial,
the subjective outcome with the small n makes this result less strong.

Why is this the case? Well, for this trial the physicians treating patients
knew who got the Vitamin D and who didn’t, and thus they may have been more
likely to admit those who didn’t to the ICU (subjective). Something like
mortality is not as subjective, but there are too few study participants to
detect a mortality signal in this trial.

If I had been conducting this small open label trial I would have picked some
less subjective outcomes, like maybe P/F Ratio.

------
autokad
when i was doing the covid19 kaggle competitions in march and april, someone
asked me what I learned.

I was like I dont know, the data is messy but the sun seems to have something
to do with reducing fatalities. (I used weather data as additional covariates)

~~~
dcolkitt
In general, the segment of the population that avoids sun exposure has _twice_
as high an all-cause mortality rate as the segment that actively seeks sun
exposure.[1] To put that in context that's on par with the health difference
found between smokers and non-smokers.

[1][https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12251](https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12251)

~~~
amelius
Maybe also because staying inside makes it easier for the virus to spread.

~~~
briankelly
That study is from 2014.

------
IAmNotBatman_
Yeah we wear too much sunscreen, a significant number of people are vitamin D
deficient. From the UltraMind Solution book, you need the active form
cholecalciferol in your supplements. You can safely take 5000-10000 IU a day
for 3 months to get up to the optimal levels, then 2000 IU a day for
maintenance. The Ideal range is 50 to 80 ng/ml in your blood tests. Also just
minimal outdoor sun exposure is the best way to get it, no sunscreen. 15
minutes if you're light skinned, 35 if you're really dark.

~~~
kardos
> Also just minimal outdoor sun exposure is the best way to get it, no
> sunscreen. 15 minutes if you're light skinned, 35 if you're really dark.

These prescriptions seem to always lack the amount of exposed skin. Is exposed
hands enough or should one be naked?

~~~
IAmNotBatman_
Yeah the time is dependent, I just try to think of like our evolutionary
history, pre clothes and where your ancestors are from. So I try to sunbathe
by the pool during the summer. But if you work indoors, cholecalciferol is
useful and you can get the blood tests for your levels.

------
jamesfisher
> open label, double-masked clinical trial

Aren't "open label" and "double-masked" contradictory?

"An open-label trial, or open trial, is a type of clinical trial in which
information is not withheld from trial participants. In particular, both the
researchers and participants know which treatment is being administered."
(Wikipedia)

"Double-Masked Study. A type of clinical trial in which neither the
participants nor the research team know which treatment a specific participant
is receiving." (NIH)

------
Emphere
This is not a strong signal. The adjusted odds ratio is 0.03 (95% CI: 0.003 -
0.25). For randomised trials, it makes no sense to say that the difference in
baseline is not significant because we have already observed the outcomes. It
is better to use ASDs and in such small trials, small differences in baseline
matter a lot. In this case it's pretty obvious the effect of vitamin D would
easily be non significant if you shift around some variables. Reeks of p
hacking imo

~~~
mlyle
> This is not a strong signal. The adjusted odds ratio is 0.03 (95% CI: 0.003
> - 0.25)

Are you for real? Smallest effect in the 95% CI is a 4x reduction in ICU
admission. Yes, it's probably closer to the bottom end of this range, but this
is a fantastically different.

> For randomised trials, it makes no sense to say that the difference in
> baseline is not significant

For randomized trials, the baselines are not likely to be massively different.
And, of course, the authors compared risk factors and ages to rule out some of
the ways that the trial could be ridiculously tilted from the outset.

> In this case it's pretty obvious the effect of vitamin D would easily be non
> significant if you shift around some variables.

...??? The endpoint was pre-declared, and we're just comparing two pre-
randomized groups. Exactly what variables would you shift around?

> Reeks of p hacking imo

If you're going to cast aspersions, be a little more concrete.

~~~
Emphere
I...had such an epic brain fart, I don't even know what to say. Please
disregard my entire comment.

------
amai
Dai (2018): Magnesium status and supplementation influence vitamin D status
and metabolism: results from a randomized trial
[https://pubmed.ncbi.nlm.nih.gov/30541089/](https://pubmed.ncbi.nlm.nih.gov/30541089/)

"Our findings suggest that optimal magnesium status may be important for
optimizing 25(OH)D status. "

------
mikenew
There's a handful of blood-test-by-mail sites you can use to do a vitamin D
test. Cost is around $50.

------
epmaybe
You know, at this point, I'm basically over debating the merits of vitamin d.
Take it, don't take it, I don't really care, just please tell your doctor
you're taking it.

To pharmaceutical companies or supplement companies, or the NIH: fund a well
powered study, pretty please?

------
gumby
This seems pretty promising, though small n, result. Vitamin D is so ably
we’ll well attested as a prophylaxis for pulmonary infections — in fact there
was a large UK study published in January on this very facto.

Starting in February I went on a prophylactic supplement of Vit D, Vit C and
aspirin because of the then-unnamed Covid-19 virus. The aspirin (actually
started that in april) is because of the pervasive excess clotting and sudden
strokes in young people showing up in ERs (less attested in the US than some
other countries for reasons I’m not sure about). I’d never taken supplements
before.

I’m immuno compromised so with my doctor we worked out the regime above plus
some prescription drugs I won’t mention.

So far, so good, but I’m isolating' so this could be a case where I’m also
preventing tiger attacks.

~~~
ellyagg
N can be small when the effect size is huge.

~~~
gumby
It can be, depending on the protocol. This was a double blind yet open label
(?) study. I’ve never done an open label study so don’t know how they have to
be powered (and I’m not a biostatistician so won’t render a guess)

------
longtimegoogler
As someone with low vitamin D this kinda sucks. Does anyone know how effective
OTC vitamin D is at raising vitamin D levels and what kind of doses to take?

~~~
amai
Dai (2018): Magnesium status and supplementation influence vitamin D status
and metabolism: results from a randomized trial
[https://pubmed.ncbi.nlm.nih.gov/30541089/](https://pubmed.ncbi.nlm.nih.gov/30541089/)

"Our findings suggest that optimal magnesium status may be important for
optimizing 25(OH)D status. "

------
koboll
Can anyone here help demystify how "oral calcifediol (0.532 mg)" maps to an
equivalent amount of Vitamin D in the form you can buy in a drugstore?

~~~
delecti
I take 5000 IU pills, and they're labeled as 125 mcg. The 0.532mg pills they
were getting would thus be around 4.25x as much, or a bit over 21,000 IU based
on how D3 is usually labeled for over-the-counter purchase.

Though my pills are "cholecalciferol" not "calcifediol", so there's not a
perfect 1:1 correspondance, but your body converts cholecalciferol into
calcifediol, so based on nothing else my above calculation is probably not far
off.

------
meiraleal
Meat (vitamin B) and sun (vitamin D) are the bane of COVID. We definitely have
not been fighting this pandemic with the right tools.

------
BiteCode_dev
It this gets confirmed, we'll have a dilemna: confined people will become
deficient in D vitamin by lack of sun exposure.

------
mucinoab
Anyone knows what rol sunscreen plays in vitamin D intake/generation by
sunlight?

~~~
graeme
This is not a direct answer, but:

1\. Uva is the cause of most skin cancer

2\. Uvb generates vitamin d and sunburns

3\. When uvb is present, you can make sufficient vitamin d quite quickly

This would suggest you would want sunscreen for longer exposures, or with much
uva exposure. And could get vitamin d from a briefer exposure pre sunscreen.

I can’t say how completely sunscreen blocks vitamin d however.

~~~
dralley
Given that sunburn is a response to cellular damage of your skin cells, why
would it be the case that the two are de-coupled w/r/t UVA and UVB?

~~~
graeme
Actually, it seems I was wrong. I thought it was just UVA, but uvb also causes
melanoma.

I’d delete the above comment if I could. The main point that you can get
vitamin d from short exposure without sunburn is correct, but I was incorrect
on the risk. But he fact I was wrong about uvb and melanoma also makes me
think I may be incorrect on the risk of uva during periods without uvb.

[https://en.wikipedia.org/wiki/Melanoma#UV_radiation](https://en.wikipedia.org/wiki/Melanoma#UV_radiation)

------
ilaksh
In the future we may decide on windows that permit some UV B.

------
akimball
(db)RCTs are good. Fetishizing them is bad.

------
afrojack123
Every year they issue a winter influenza vaccine instead of making vitamin D
pills and artificial sunlight available. Young people never take the winter
flu vaccine and are fine.

------
fithisux
GPT-3 ?

------
tus88
Vaccine or bust.

------
MivLives
Is there a trustable authority that measures the actual contents of
supplements in the US? When I try to search it, it's pretty heavily SEO'd.

~~~
sk0g
LabDoor [0] maybe? Use them for their protein rankings mainly, but they have a
Vitamin D section too.

[0]
[https://labdoor.com/rankings/vitamin-d](https://labdoor.com/rankings/vitamin-d)

------
scott_paul
Anyone else notice that Calcifediol is the most expensive vitamin-D analogue
on the market? What a huge surprise that the study chose that form of
vitamin-D specifically.

~~~
JabavuAdams
That's quite a leap. Also, this study was done in Spain, so US intuitions
probably don't apply without further study.

D3 takes 7 days to be fully metabolised to calcifediol. When Drs measure your
D levels, they're actually measuring calcifediol.

------
sagebird
It would be tragic if taking vitamin D supplements had a negative effect on
Covid survivability.

I think that it is extremely unlikely, though possible unless a specific study
has ruled this out.

EG: Perhaps vitamin D supplementation upon Covid-19 diagnoses is only
effective if you have not been supplimenting.

Like: Maybe drinking alcohol at a party is helpful to court a new partner,
unless you are an alcoholic already. Not the best analogy but I hope you'll
take my point in good faith.

------
robertofmoria
This test really doesn't hold a lot of useful data. It doesn't calculate any
of the statistics of those that died which is kinda of important when age and
previous health conditions are important. It doesn't gather BMI, physical
activity levels, ethnicity, secondary/multiple infections, cause of death,
type 1 or 2 diabetes, etc. Medical trials are hard because of all the
variables. I think it actually works against this trial having it randomized
especially when there is no placebo group.

------
tboyd47
Good on you, Spain. A study like this could never take place in the USA :(

Too many powerful people are heavily invested in the belief that there is no
treatment for it.

~~~
vore
Seems like a ridiculous claim when I'm sure almost absolutely everyone would
like to get out of this mess.

~~~
jerf
It shouldn't be hard to sit for a moment and think of some people who would
certainly like for there not to be a treatment consisting of ~$3-5 worth of
off-the-shelf, completely unpatentable medicines and vitamins.

There are absolutely some powerful vested interests in not seeing an easy
treatment for this disease, or, by the same logic, pretty much any other
disease either since there's nothing special about this one. (A not infrequent
complaint on Hacker News.) I can't prove they're driving the discourse on
treatment for COVID-19, but it sure isn't disproved by what I see happening
out there.

~~~
vore
The original claim said "invested in the belief that there is no treatment for
it", not "no inexpensive treatments".

What you are rebutting is not against what OP is claiming.

------
nautilus12
"Don't go outside, you'll get COVID", sounds more and more like horrible
advice. Before knowing the virus died in sunlight, I still couldn't fathom why
people were avoiding going out to parks and stuff. It was totally non
sequitor.

~~~
extremeMath
I got one that is still in effect in Michigan-

"Gyms are closed" (but bars and casinos are open)

A virus that kills old and _obese_ people, and you are shutting down the gym?

If anything I hope Coronavirus shifts politicians from business leaders to
scientists.

~~~
notadoc
Weight gain and loss is simple physics. If you want to reduce obesity, focus
on the dietary input. Virtually nobody is active enough to burn the extreme
number of excess calories consumed that leads to obesity and the maintenance
of obesity.

~~~
inetsee
I have always thought that diet and exercise are both needed. If you can cut
your caloric intake by 250 calories a day, and increase your aerobic exercise
to burn 250 more calories a day, you should be able to lose a pound a week,
without going to extremes of diet or exercise.

Of course, someone who is obese will take a long time to get to a healthy
weight if they are only losing a pound a week, but most people would have a
hard time maintaining extremes of diet or exercise for a long period of time.

------
notadoc
>All hospitalized patients received as best available therapy the same
standard care, (per hospital protocol), of a combination of hydroxychloroquine
(400 mg every 12 hours on the first day, and 200 mg every 12 hours for the
following 5 days), azithromycin (500 mg orally for 5 days.

Fascinating how hydroxychloroquine is routinely used and considered standard
of care in most countries where the drug has not been politicized.

~~~
notatoad
>The best available treatment that at the beginning of the outbreak in our
hospital, included the use of hydroxychloroquine/azithromycin therapy
[23,24,26]. However, taking into consideration more recent data on the safety
and efficacy of chloroquine and hydroxychloroquine in small randomized
clinical trials, case series, and observational studies this treatment is no
longer considered effective [32] in treating COVID-19.

calling it the "standard of care" in the present tense is very disingenuous.
it was briefly considered to be effective at the beginning of the outbreak. it
was determined relatively quickly that it was not actually an effective
treatment. this has nothing to do with politics.

------
doublekill
Experts and health authorities were adament to tell us that vitamins have zero
effect against COVID. Not: we don't know and taking a Vitamin C can't hurt,
unless you count an upset stomach. But: stop sharing fake health information,
this is an infodemic! Just wash your hands.

So to add to the infodemic: selenium and iodine deficiency also increases
severity. Take some iodized salt and Brazil nuts now, or wait 5 months for the
authorities to understand that absence of evidence is not evidence of absence.
And no matter what Youtube bans you for going against the WHO: tumeric is an
efficient antiviral.

~~~
sbelskie
Any examples of the CDC, FDA, or NIH statements telling us that vitamins have
zero effect on COVID? I’d also be interested in statements from the WHO, but
that one I wouldn’t be at all surprised by.

~~~
doublekill
Vitamin C is listed as fake news on WHO. Fact checker sites listed vitamin D
as false, then switched to correct after research. Doctors, journalists, and
health experts in Brazil and the Netherlands chided social media for not
removing "fake" info on vitamin supplements.

I'll check some CDC sources later to contextualize these claims to the US.

~~~
BickNowstrom
Mayo Clinic: Debunking COVID-19 (coronavirus) myths. Extremely unlikely to
work and might cause serious harm. [...] Supplements. Many people take vitamin
C, vitamin D, zinc, green tea or echinacea to boost their immune systems.
While these supplements might affect your immune function, research hasn't
shown that they can prevent you from getting sick.

Notice the weird mind crinkle: Got to debunk it, and use "prevent you from
getting sick" as the reason for it not working (and the subtle differences
between: "No research has shown", "research hasn't shown", and "research has
shown that it can't prevent you"). Even though plenty of research shows it
prevents you from getting severely sick, when you do get sick. Willing to bet
that garlic (a famous folk knowledge cure for the flu, smashed boiled garlic
with hot water) is actually effective in recovery and severity, but the fact
checkers present it as a "COVID cure" and of course that can be debunked. But
it is a debunking based on a weird strawman we saw with masks: Masks are not
protective to COVID because the eyes can catch it too. As if protectiveness
and immune health is binary and anything else than 0 or 1 has to be a lie.

Could not find anything about the CDC, just
[https://www.cdc.gov/nutrition/infantandtoddlernutrition/vita...](https://www.cdc.gov/nutrition/infantandtoddlernutrition/vitamins-
minerals/vitamin-d.html) where they recommend Vitamin D for children under 2
years old, to prevent deficiency, but no where mention a recommendation for
using it during a pandemic to keep your immune system healthy.

As for selenium deficiency and iodine deficiency, the research is slowly
catching up:

> Certain micronutrients are seen as supportive for the treatment of and
> protection against viral diseases with some vitamins (A, B6, B12, C, D, and
> E) and essential trace elements (zinc, iron, selenium (Se), magnesium, or
> copper) discussed as particularly promising .

> However, the data base is very small and it is unknown whether certain
> vitamins or trace elements are deficient in patients with COVID-19, and
> whether the concentrations are related to disease severity or mortality
> risk.

> The collaborative research team from Germany hypothesised that Se may be of
> relevance for infection with SARS-CoV-2 and disease course of COVID-19 and
> that severe Se deficiency is prevalent among the patients and associates
> with poor survival odds in COVID-19.

As for turmeric, mentioned in relation to COVID a bannable offense on Youtube:
It inhibits and suppresses Zika, Hepatitis, HIV, Noro, coxsackie, HBV, herpes,
influenza, encephalitis, dengue, corona, and chikunya. It also suppresses
cytokine signalling. But experts warn that it may interfere with the immune
system when fighting COVID, and that it is neither a cure nor a treatment nor
a helpful supplement. WHO lists it under hoaxes (except when discussing
Chinese traditional medicine). And you are a bad person if you share this
potential online, because you don't have a randomized trial to back up that it
works against SARS-CoV-2.

MedicalNewsToday: In a rapid review of the evidence published on May 1, 2020,
researchers from the Centre for Evidence-Based Medicine at the University of
Oxford in the United Kingdom unequivocally conclude: “We found no clinical
evidence on vitamin D in [the prevention or treatment of] COVID-19.” They also
write that “[t]here was no evidence related to vitamin D deficiency
predisposing to COVID-19, nor were there studies of supplementation for
preventing or treating COVID-19.”

Potential Effect of Curcumin Treatment of COVID-19: Curcumin may have
beneficial effects against COVID‐19 infection via its ability to modulate the
various molecular targets that contribute to the attachment and
internalization of SARS‐CoV‐2 in many organs, including the liver,
cardiovascular system, and kidney. Curcumin could also modulate cellular
signaling pathways such as inflammation, apoptosis, and RNA replication.
Curcumin may also suppress pulmonary edema and fibrosis‐associated pathways in
COVID‐19 infection.

WHO Fact or Fiction: There is no scientific evidence that lemon/turmeric
prevents COVID-19.

