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Tuesday, June 16, 2020

The Sun Killed COVID

The Sun Killed COVID

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 Image result for vitamin d
 June 16/2020
  • Deaths from COVID-19 dropped rapidly from a peak in late April to a low in May
  • A number of studies have suggested COVID-19 may taper off during the summer, due to higher humidity and other factors
  • A 1% decrease in humidity was predicted to increase the number of COVID-19 cases by 6.11%
  • COVID-19 disease severity is associated with vitamin D levels, with lower levels linked to more severe disease
  • If COVID-19 is seasonal, a resurgence is likely come fall, which is why the time for optimizing your vitamin D level is now
The U.S. Centers for Disease Control and Prevention’s provisional death counts for COVID-19 show a striking change. While starting at zero in February 2020 and spiking up to more than 5,000 deaths per week for the oldest age range (85 and over) and 111 among 25- to 34-year-olds in late April, they’ve plummeted.
There were 199 COVID-19 deaths for the week ending May 30, 2020, among those 85 and over, while only one death was reported among 25- to 34-year-olds — an extremely rapid decline from April to May.1 What happened to make the deaths come to a standstill, according to some experts, might be the same seasonal ebb and flow that happens with many respiratory infections: Summer may have killed it.
COVID-19 provisional death counts

Many Respiratory Infections Decline in the Summer

While it’s possible to get respiratory infections like influenza any time of year, influenza is more common during the fall and winter, hence the “flu season” during those months. Respiratory syncytial virus (RSV), a leading cause of severe respiratory illness in young children and those aged 65 and over, is also more common in the fall and winter.
At least four common coronaviruses are also highly seasonal with transmission similar to influenza.2 Although these aren’t related to SARS-CoV-2, the virus that causes COVID-19, it is genetically related to the coronavirus responsible for the severe acute respiratory syndrome (SARS) outbreak of 2003.
This is notable because, as noted by professor Paul Hunter from the University of East Anglia in England, “Sars largely spread in hospitals but still died out in the summer in the Northern Hemisphere.”3 There are a number of reasons why SARS was quickly contained in about eight months, but the summer, with its higher temperature and humidity level, is among them.

What Makes Summer Less Conducive to Respiratory Infection?

Winter’s dry, cold air is favorable to the spread of flu transmission, and influenza spread is known to be affected by both temperature and humidity.4 During the winter, people also spend more time indoors, in enclosed spaces with less ventilation and less personal space compared to being outdoors in the summer.5
School is usually in session during the fall and winter, with students at home over the summer. School terms have been associated with higher transmission of respiratory viruses, while holidays lead to a 20% to 29% reduction in the rate at which influenza is transmitted in children.6 So, just the fact that children are in school in the winter may raise transmission rates.
What’s more, as noted by Marc Lipsitch, professor of epidemiology and director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health:7
“It is possible that the condition of the average person’s immune system is systematically worse in winter than summer. One hypothesis has focused on melatonin which has some immune effects and is modulated by the photoperiod, which varies seasonally. Another with more evidence is that vitamin D levels, which depend in part on ultraviolet light exposure (higher in summer) modulate our immune system in a positive way.”
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Studies Suggest COVID-19 May Be Seasonal

A number of studies have suggested COVID-19 may, in fact, taper off during the summer. One preprint study tracked the seasonality of influenza viruses and endemic human coronaviruses over an eight-year period. The activity of human coronaviruses peaked the first week of January, with transmission facilitated by low indoor relative humidity (RH) of 20% to 30%.8
The researchers cited previous studies that found an increase in relative humidity to 50% reduced the transmission of both influenza and animal coronaviruses. What’s more, the study found a decrease in disease incidence by 50% in early March, 75% in early April and greater than 99% at the end of April. According to the study:9
“As a lipid-bound, enveloped virus with similar size characteristics to endemic human coronaviruses, SARS-CoV-2 should be subject to the same dynamics of reduced viability and transmission with increased humidity. In addition to the major role of social distancing, the transition from lower to higher indoor RH with increasing outdoor temperatures could have an additive effect on the decrease in SARS-CoV-2 cases in May.
Over the 8-year period of this study, human coronavirus activity was either zero or >99% reduction in the months of June through September, and the implication would be that SARS-Cov-2 may follow a similar pattern.”

Humidity May Be a Major Factor

A study conducted in Sydney, Australia, found a similar connection between humidity and COVID-19. A 1% decrease in humidity was predicted to increase the number of cases by 6.11%,10 with researchers stating, “During periods of low relative humidity, the public health system should anticipate an increased number of COVID‐19 cases.”11
Professor Michael Ward, an epidemiologist in the Sydney School of Veterinary Science at the University of Sydney, said in a news release that humidity appeared to be a major factor:12
"When it comes to climate, we found that lower humidity is the main driver here, rather than colder temperatures. It means we may see an increased risk in winter here, when we have a drop in humidity. But in the northern hemisphere, in areas with lower humidity or during periods when humidity drops, there might be a risk even during the summer months.
… When the humidity is lower, the air is drier and it makes the aerosols smaller. When you sneeze and cough those smaller infectious aerosols can stay suspended in the air for longer. That increases the exposure for other people. When the air is humid and the aerosols are larger and heavier, they fall and hit surfaces quicker."
Aside from affecting transmission rates, humidity may also affect the survival of viruses. The addition of a portable humidifier with an output of 0.16 kilograms of water per hour in the bedroom increased absolute humidity 11% and relative humidity 19% during sleeping hours compared to having no humidifier present, according to one study. Along with the increases in humidity came a decrease in the survival of influenza virus, by 17.5% to 31.6%.13
Humidity even influences innate immune defenses against viral infections. In an animal study, dry air compromised the mice’s resistance to infection, and those housed at lower humidity levels had impaired mucociliary clearance, innate antiviral defense and tissue repair function, the study found.14

The Vitamin D Connection

The other reason why summer may slash COVID-19 deaths is because summer equals greater exposure to sunlight, which boosts vitamin D levels. There is strong scientific evidence vitamin D plays a central role in your immune response and your ability to fight infections. It’s been shown in an analysis of 212 people with lab-confirmed COVID-19 that disease severity is associated with vitamin D levels, with lower levels linked to more severe disease.15
A review published in the journal Nutrients also concluded that not only could vitamin D be useful to reduce the risk of infection with COVID-19, but also could be helpful for treatment:16
“Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) [vitamin D] concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration.”
If COVID-19 is seasonal, a resurgence is likely come fall, which is why the time for optimizing your vitamin D level is now. To improve your immune function and lower your risk of viral infections, you’ll want to raise your vitamin D to a level between 60 nanograms per milliliter (ng/mL) and 80 ng/mL by fall. In Europe, the measurements you’re looking for are 150 nanomoles per liter (nmol/L) and 200 nmol/L.

Why Do so Many Experts Get It Wrong?

Harvard professor Lipsitch is among those who said COVID-19 would “probably not” go away on its own in warmer weather. “The short answer is that while we may expect modest declines in the contagiousness of SARS-CoV-2 in warmer, wetter weather and perhaps with the closing of schools in temperate regions of the Northern Hemisphere, it is not reasonable to expect these declines alone to slow transmission enough to make a big dent,” he said.17
CDC’s provisional death counts appear to suggest otherwise, but some have cautioned that COVID-19 is too new to be seasonal. In other words, because fewer people have established immunity, a new virus has an advantage in that it can thrive even in less-than-optimal conditions for a virus, i.e., the summer.
“Old viruses,” Lipsitch said, “which have been in the population for longer, operate on a thinner margin — most individuals are immune, and they have to make do with transmitting among the few who aren’t.”18
Likewise, a study in Science used a computer model to suggest that while COVID-19 may fall into seasonal patterns eventually, this may not occur until more people develop immunity, noting that “susceptible supply” is limiting the role of climate in the early COVID-19 pandemic.19
The drastic decline in COVID-19 deaths that occurred from April to May do suggest a seasonal component, but what’s driving the drop is not completely understood. It’s likely a combination of humidity, heat, human behaviors, vitamin D levels and, likely, other aspects of sunlight exposure that are culminating in this decline.
With summer upon us in the U.S., you can use it to your advantage to spend time outdoors, optimize your vitamin D levels and get sensible sun exposure, all of which can help you support health and reduce your susceptibility to viral infections.

Tuesday, June 9, 2020

17 Benefits of Omega-3 Fatty Acids


17 Benefits of Omega-3 Fatty Acids
Image result for omega 3
 

October 15, 2018

Omega-3 fatty acids are incredibly important.

They have many powerful health benefits for your body and brain.

In fact, few nutrients have been studied as thoroughly as omega-3 fatty acids.

Here are 17 health benefits of omega-3 fatty acids that are supported by science.

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Depression is one of the most common mental disorders in the world.

Symptoms include sadness, lethargy and a general loss of interest in life.

Anxiety, also a common disorder, is characterized by constant worry and nervousness

Interestingly, studies indicate that people who consume omega-3s regularly are less likely to be depressed.

What's more, when people with depression or anxiety start taking omega-3 supplements, their symptoms improved.

There are  fatty acids: ALA, EPA and DHA. Of the three, EPA appears to be the best at fighting depression.

One study even found EPA as effective against depression as a common antidepressant drug.

Summary Omega-3 supplements may help prevent and treat depression and anxiety. EPA seems to be the most effective at fighting depression.


DHA, a type of omega-3, is a major structural component of the retina of your eye.

When you don't get enough DHA, vision problems may arise.

Interestingly, getting enough omega-3 is linked to a reduced risk of macular degeneration, one of the world's leading causes of permanent eye damage and blindness.

Summary An omega-3 fatty acid called DHA is a major structural component of your eyes’ retinas. It may help prevent macular degeneration, which can cause vision impairment and blindness.


Omega-3s are crucial for brain growth and development in infants.

DHA accounts for 40% of the polyunsaturated fatty acids in your brain and 60% in the retina of your eye.

Therefore, it's no surprise that infants fed a DHA-fortified formula have better eyesight than infants fed a formula without it.

Getting enough omega-3s during pregnancy is associated with numerous benefits for your child, including:

*       Higher intelligence

*       Better communication and social skills

*       Fewer behavioral problems

*       Decreased risk of developmental delay

*       Decreased risk of ADHD, autism and cerebral palsy

Summary Getting enough omega-3s during pregnancy and early life is crucial for your child’s development. Supplementing is linked to higher intelligence and a lower risk of several diseases.


Heart attacks and strokes are the world's leading causes of death.

Decades ago, researchers observed that fish-eating communities had very low rates of these diseases. This was later linked to omega-3 consumption.

Since then, omega-3 fatty acids have been tied to numerous benefits for heart health

These benefits address:

*       Triglycerides: Omega-3s can cause a major reduction in triglycerides, usually in the range of 15–30% .

*       Blood pressure: Omega-3s can reduce blood pressure levels in people with high blood pressure.

*       “Good” HDL cholesterol: Omega-3s can raise “good” HDL cholesterol levels.

*       Blood clots: Omega-3s can keep blood platelets from clumping together. This helps prevent the formation of harmful blood clots.

*       Plaque: By keeping your arteries smooth and free from damage, omega-3s help prevent the plaque that can restrict and harden your arteries.

*       Inflammation: Omega-3s reduce the production of some substances released during your body’s inflammatory response.

For some people, omega-3s can also lower “bad” LDL cholesterol. However, evidence is mixed — some studies find increases in LDL.

Despite these beneficial effects on heart disease risk factors, there is no convincing evidence that omega-3 supplements can prevent heart attacks or strokes. Many studies find no benefit.

Summary Omega-3s improve numerous heart disease risk factors. However, omega-3 supplements do not seem to reduce your risk of heart attacks or strokes.


Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder characterized by inattention, hyperactivity and impulsivity.

Several studies note that children with ADHD have lower blood levels of omega-3 fatty acids than their healthy peers.

What's more, numerous studies observe that omega-3 supplements can reduce the symptoms of ADHD.

Omega-3s help improve inattention and task completion. They also decrease hyperactivity, impulsiveness, restlessness and aggression.

Recently, researchers observed that fish oil supplements were one of the most promising treatments for ADHD .

Summary Omega-3 supplements can reduce the symptoms of ADHD in children. They improve attention and reduce hyperactivity, impulsiveness and aggression.


Metabolic syndrome is a collection of conditions.

It includes central obesity — also known as belly fat — as well as high blood pressure, insulin resistance, high triglycerides and low “good” HDL cholesterol levels.

It is a major public health concern because it increases your risk of many other illnesses, including heart disease and diabetes.

Omega-3 fatty acids can improve insulin resistance, inflammation and heart disease risk factors in people with metabolic syndrome .

Summary Omega-3s can have numerous benefits for people with metabolic syndrome. They can reduce insulin resistance, fight inflammation and improve several heart disease risk factors.


Inflammation is a natural response to infections and damage in your body. Therefore, it is vital for your health.

However, inflammation sometimes persists for a long time, even without an infection or injury. This is called chronic — or long-term — inflammation.

Long-term inflammation can contribute to almost every chronic Western illness, including heart disease and cancer .

Notably, omega-3 fatty acids can reduce the production of molecules and substances linked to inflammation, such as inflammatory eicosanoids and cytokines .

Studies have consistently observed a connection between higher omega-3 intake and reduced inflammation .

Summary Omega-3s can reduce chronic inflammation, which can contribute to heart disease, cancer and various other diseases.


In autoimmune diseases, your immune system mistakes healthy cells for foreign cells and starts attacking them.

Type 1 diabetes is one prime example, in which your immune system attacks the insulin-producing cells in your pancreas.

Omega-3s can combat some of these diseases and may be especially important during early life.

Studies show that getting enough omega-3s during your first year of life is linked to a reduced risk of many autoimmune diseases, including type 1 diabetes, autoimmune diabetes and multiple sclerosis .

Omega-3s also help treat lupus, rheumatoid arthritis, ulcerative colitis, Crohn's disease and psoriasis .

Summary Omega-3 fatty acids can help fight several autoimmune diseases, including type 1 diabetes, rheumatoid arthritis, ulcerative colitis, Crohn's disease and psoriasis.


Low omega-3 levels have been reported in people with psychiatric disorders .

Studies suggest that omega-3 supplements can reduce the frequency of mood swings and relapses in people with both schizophrenia and bipolar disorder .

Supplementing with omega-3 fatty acids may also decrease violent behavior .

Summary People with mental disorders often have low blood levels of omega-3 fats. Improving omega-3 status seems to improve symptoms.


A decline in brain function is one of the unavoidable consequences of aging.

Several studies link higher omega-3 intake to decreased age-related mental decline and a reduced risk of Alzheimer's disease .

One review of controlled studies suggests that omega-3 supplements may be beneficial at disease onset, when the symptoms of AD are very mild

Keep in mind that more research is needed on omega-3s and brain health.

Summary Omega-3 fats may help prevent age-related mental decline and Alzheimer's disease, but more research is needed.


Cancer is one of the leading causes of death in the Western world, and omega-3 fatty acids have long been claimed to reduce the risk of certain cancers.

Interestingly, studies show that people who consume the most omega-3s have up to a 55% lower risk of colon cancer .

Additionally, omega-3 consumption is linked to a reduced risk of prostate cancer in men and breast cancer in women. However, not all studies give the same results .

Summary Omega-3 intake may decrease the risk of some types of cancer, including colon, prostate and breast cancer.


Asthma is a chronic lung disease with symptoms like coughing, shortness of breath and wheezing.

Severe asthma attacks can be very dangerous. They are caused by inflammation and swelling in the airways of your lungs.

What's more, asthma rates in the US have been rising over the past few decades .

Several studies associate omega-3 consumption with a lower risk of asthma in children and young adults .

Summary Omega-3 intake has been associated with a lower risk of asthma in both children and young adults.


Non-alcoholic fatty liver disease (NAFLD) is more common than you think.

It has increased with the obesity epidemic to become the most common cause of chronic liver disease in the Western world .

However, supplementing with omega-3 fatty acids effectively reduces liver fat and inflammation in people with NAFLD .

Summary Omega-3 fatty acids reduce liver fat in people with non-alcoholic fatty liver disease.


Osteoporosis and arthritis are two common disorders that affect your skeletal system.

Studies indicate that omega-3s can improve bone strength by boosting the amount of calcium in your bones, which should lead to a reduced risk of osteoporosis

Omega-3s may also treat arthritis. Patients taking omega-3 supplements have reported reduced joint pain and increased grip strength .

Summary Omega-3s may improve bone strength and joint health, potentially reducing your risk of osteoporosis and arthritis.


Menstrual pain occurs in your lower abdomen and pelvis and often radiates to your lower back

14. Omega-3s May Improve Bone and Joint Health

Osteoporosis and arthritis are two common disorders that affect your skeletal system.

Studies indicate that omega-3s can improve bone strength by boosting the amount of calcium in your bones, which should lead to a reduced risk of osteoporosis .

Omega-3s may also treat arthritis. Patients taking omega-3 supplements have reported reduced joint pain and increased grip strength .

Summary Omega-3s may improve bone strength and joint health, potentially reducing your risk of osteoporosis and arthritis.

15. Omega-3s Can Alleviate Menstrual Pain

Menstrual pain occurs in your lower abdomen and pelvis and often radiates to your lower back and thighs.

It can significantly affect your quality of life.

However, studies repeatedly prove that women who consume the most omega-3s have milder menstrual pain .

One study even determined that an omega-3 supplement was more effective than ibuprofen in treating severe pain during menstruation .

Summary Omega-3 fatty acids can reduce menstrual pain and may even be more effective than ibuprofen, an anti-inflammatory drug.


Good sleep is one of the foundations of optimal health.

Studies tie sleep deprivation to many diseases, including obesity, diabetes and depression .

Low levels of omega-3 fatty acids are associated with sleep problems in children and obstructive sleep apnea in adults .

Low levels of DHA are also linked to lower levels of the hormone melatonin, which helps you fall asleep .

Studies in both children and adults reveal that supplementing with omega-3 increases the length and quality of sleep .

Summary Omega-3 fatty acids — especially DHA — may improve the length and quality of your sleep.


DHA is a structural component of your skin. It is responsible for the health of cell membranes, which make up a large part of your skin.

A healthy cell membrane results in soft, moist, supple and wrinkle-free skin.

EPA also benefits your skin in several ways, including .

*       Managing oil production and hydration of your skin.

*       Preventing hyperkeratinization of hair follicles, which appears as the little red bumps often seen on upper arms.

*       Reducing premature aging of your skin.

*       Reducing the risk of acne.

Omega-3s can also protect your skin from sun damage. EPA helps block the release of substances that eat away at the collagen in your skin after sun exposure.

Summary Omega-3s can help keep your skin healthy, preventing premature aging and safeguarding against sun damage.

 

Friday, June 5, 2020

Magnesium L-Threonate for Depression and Anxiety

In summary, depressed mood may simply be a sign of magnesium deficiency in the brain. Boosting brain magnesium levels, particularly with the use of magnesium L-threonate, may have profound benefits on mood.
Importantly, magnesium is needed to make the three primary neurotransmitters in the brain, i.e., serotonin, dopamine and noradrenaline and melatonin which is important for sleep.
magnesium for serotonin and melatonin
magnesium for dopamine and norepinephrine

Friday, May 29, 2020

25-Hydroxyvitamin D Concentrations Are Lower in

Patients with Positive PCR for SARS-CoV-2
Antonio D’Avolio 1,* , Valeria Avataneo 1, Alessandra Manca 1, Jessica Cusato 1 ,
Amedeo De Nicolò 1, Renzo Lucchini 2, Franco Keller 2 and Marco Cantù 2

1 Laboratory of Clinical Pharmacology and Pharmacogenetics, Amedeo di Savoia Hospital,


Department of Medical Sciences, University of Turin, 10126 Turin, Italy; valeria.avataneo@unito.it (V.A.);

alessandra.manca@unito.it (A.M.); jessica.cusato@unito.it (J.C.); amedeo.denicolo@unito.it (A.D.N.)
2 Department of Laboratory Medicine EOLAB, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland,


Renzo.Lucchini@eoc.ch (R.L.); Franco.Keller@eoc.ch (F.K.); Marco.Cantu@eoc.ch (M.C.)

* Correspondence: antonio.davolio@unito.it; Tel.: +39-011-4393867; Fax: +39-011-4393996
Received: 20 April 2020; Accepted: 7 May 2020; Published: 9 May 2020

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease



2019 (COVID-19), with a clinical outcome ranging from mild to severe, including death. To date,
it is unclear why some patients develop severe symptoms. Many authors have suggested the
involvement of vitamin D in reducing the risk of infections; thus, we retrospectively investigated the
25-hydroxyvitamin D (25(OH)D) concentrations in plasma obtained from a cohort of patients from

Switzerland. In this cohort, significantly lower 25(OH)D levels (p = 0.004) were found in PCR-positive
for SARS-CoV-2 (median value 11.1 ng/mL) patients compared with negative patients (24.6 ng/mL);
his was also confirmed by stratifying patients according to age >70 years. On the basis of this
preliminary observation, vitamin D supplementation might be a useful measure to reduce the risk of
infection. Randomized controlled trials and large population studies should be conducted to evaluate
these recommendations and to confirm our preliminary observation.


Keywords: vitamin D; SARS-CoV-2; concentrations; COVID-19; coronavirus; deficiency




1. Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019

(COVID-19), with clinical outcomes ranging from mild to severe, including death. To date, there is
no specific recommended treatment, with COVID-19- and SARS-COV-2-a
ected patients targeted to


receive supportive care to help relieve symptoms.

However, only a fraction of infected people show clinical symptoms, and an even lower percentage

require medical attention [1,2]. To date, it is not yet known why some patients develop more



severe symptoms.

Recently, some articles have suggested the possible involvement of vitamin D in reducing the risk

of respiratory tract infections, especially in the influenza and COVID-19 context. Furthermore, the

role of vitamin D supplementation in reducing the risk of infection [36] is still under investigation,



however, no clinical evidence has been reported yet.

For these reasons, we retrospectively described the 25-hydroxyvitamin D (25(OH)D) plasma

concentrations in a cohort of patients from Switzerland.

Nutrients 2020, 12, 1359; doi:10.3390/nu12051359 www.mdpi.com/journal/nutrients

Nutrients 2020, 12, 1359 2 of 7




2. Methods
2.1. Data Collection
We retrospectively evaluated the repository data for patients who underwent a nasopharyngeal

swab PCR analysis for SARS-CoV-2 and a 25(OH)D measurement at “Ente Ospedaliero Cantonale”

(Canton of Tessin, Switzerland), during the period from 1 March to 14 April 2020.

According to the Swiss federal o ce for public health’s (Bundesamt für Gesundheit (BAG)) rules,



patients selected for the SARS-CoV-2 PCR analysis had to have symptoms of an acute airway disease

(e.g., cough, sore throat, breathing di culties), with or without fever, feeling of fever, muscle pain,



or sudden anosmia or ageusia.

The vitamin D analysis was required to be conducted within seven weeks of the SARS-CoV-2 PCR

result. As an additional control cohort, all patients with a 25(OH)D measurement during the same

period (1 March to 14 April) of 2019 were evaluated.

The duration of sunshine, expressed as total sun hours, into the analyzed period (1 March

to 14 April) were compared between 2019 and 2020. Data were provided by the federal o ce of



meteorology and climatology MeteoSwiss. Reported data refer to the Locarno-Monti measuring station.
2.2. Sample Processing for Vitamin D Quantitation

Sampleswere processedwithMassChrom® 25-OH-Vitamin D3/D2 in serum/plasma (Chromsystems,



Germany) on a MassStar liquid handler (Hamilton, Switzerland) according to the manual’s procedures.

The extracted samples analysis was carried out with a liquid chromatography coupled with a tandem

mass spectrometry (LC-MS/MS) instrument G6490A (Agilent Technologies, Santa Clara, CA, USA)



equipped with a 1290 Infinity LC Systems UHPLC.
2.3. PCR Analysis for COVID-19 Identification

Samples were collected using the Copan® FLOQSwabs® UTM® Nasopharyngeal Sample

Collection Kit composed of the Flexible Minitip Flock Swab + 3 mL UTM® Viral Transport Medium

(COPAN, Italy). An amount of 200 L of media was extracted with the MagPurix® Viral/Pathogen



Nucleic Acid Extraction Kit B using an Automated Nucleic Acid Purification System MagPurix 12s

(Zinexts, Taiwan) and amplified with a Sars-COV (COVID19) E-gene and RdRp Gene kit (TIB MOLBIOL,

Germany). Data acquisition was performed with an ABI 7500 Fast Real-Time PCR (Applied Biosystems,

Foster City, CA, USA).
2.4. Statistical Analysis
For the descriptive statistics, the continuous variables are summarized as the median (25th–75th

percentile, interquartile range (IQR)). The categorical variables are described as frequencies and

percentages. All data were assessed for normality using a Shapiro–Wilk test and the categorical data

were compared using Mann–Whitney or Kruskal–Wallis statistical tests.

Spearman’s rank correlation was utilized to determine the continuous data.

Statistical analyses were carried out using the SPSS software package, version 26.0 (IBM, Armonk,

NY, USA).
3. Results

The 2020 cohort of 107 total patients (male = 54.2%; median age = 73 years (IQR 63–81); median

25(OH)D = 22.0 ng/mL (IQR 8.9–30.5)) included 27 SARS-CoV-2 PCR-positive (male = 70.4%; median

age = 74 years (IQR 65–81) with median 25(OH)D = 11.1 ng/mL (IQR 8.2–21.0)), and 80 SARS-CoV-2

PCR-negative (male = 48.8%; median age = 73 years (IQR 61–82) with median 25(OH)D = 24.6 ng/mL



(IQR 8.9–30.5)) patients. The measurement of 25(OH)D was generally performed three days after the

molecular PCR test (overall median days away = ô€€€3.0 (IQR ô€€€7.0–0.0)), and a not statistically significant

Nutrients 2020, 12, 1359 3 of 7

di
erence in days away was found: ô€€€2.0 days (IQR ô€€€7.0–1.75) vs. ô€€€3.0 (IQR ô€€€6.0 to ô€€€1.0) (p = 0.119)



within the PCR-negative and PCR-positive patients, respectively.

As an additional control cohort, without a SARS-CoV-2 PCR test, all patients with at least one

measurement for 25(OH)D in the corresponding period (1 March to 14 April) of 2019 (before Covid-19

pandemic) were evaluated, with a total of 1377 patients (male = 45.3%; median age = 63 years

(IQR 46–76); median 25(OH)D = 24.6 ng/mL (IQR 16.2–33.0)). The total sun hours in the analyzed



period (1 March to 14 April) are 333.4 h and 349.4 h in 2019 and 2020, respectively, with a total increment

of 16 h in 2020 (+4.8%).

As depicted in Figure 1, we observed statistically significant (p = 0.004) lower 25(OH)D levels

(11.1 ng/mL) in patients positive for the SARS-CoV-2 PCR compared with the negative patients

(24.6 ng/mL). By comparing the 2020 and 2019 cohorts, we observed an even stronger statistically

significant di
erence (p < 0.001) in 25(OH)D levels in patients with a positive PCR for SARS-CoV-2

compared with the 2019 patients (24.6 ng/mL); however, no significant di
erence (p = 0.076) between



the 2019 and 2020 negative PCR cohorts was observed.

Nutrients 2020, 12, x FOR PEER REVIEW 4 of 7

Figure 1. 25-hydroxyvitamin D concentrations in the three evaluated groups (patients from 1 March



to 14 April of 2019 and 2020 with a negative PCR, and of 2020 with a positive PCR for SARS-CoV-2.

*: significant results.

Figure 1. 25-hydroxyvitamin D concentrations in the three evaluated groups (patients from 1 March



to 14 April of 2019 and 2020 with a negative PCR, and of 2020 with a positive PCR for SARS-CoV-2.

*: significant results.

As depicted in Figure 2A, when dividing the 2020 cohort according to gender and PCR result,

a non-statistically significant di
erence in vitamin D concentrations was found: 24.8 ng/mL (IQR

14.5–30.9) vs. 9.3 ng/mL (IQR 7.3–20.5) (p = 0.062) and 23.8 ng/mL (IQR 7.13–32.7) vs. 11.4 ng/mL

(IQR 8.9–23.6) (p = 0.131) within women (41 vs. 8) and men (39 vs. 19), respectively. Nevertheless,

vitamin D concentrations were significantly di
erent when comparing patients from the 2019 and 2020

PCR-positive cohorts, stratified by gender: 25.6 ng/mL (IQR 17.3–33.3) vs. 9.3 ng/mL (IQR 7.3–20.5)

(p = 0.019) in women (n = 753 vs. n = 8) and 22.9 ng/mL (IQR 14.7–33.1) vs. 11.4 ng/mL (IQR 8.9–23.6)

(p = 0.005) in men (n = 624 vs. n = 19).

Nutrients 2020, 12, 1359 4 of 7

Figure 1. 25-hydroxyvitamin D concentrations in the three evaluated groups (patients from 1 March



to 14 April of 2019 and 2020 with a negative PCR, and of 2020 with a positive PCR for SARS-CoV-2.

*: significant results.

(A)

Nutrients 2020, 12, x FOR PEER REVIEW 5 of 7

(B)

Figure 2. (A) 25-hydroxyvitamin D concentrations in the three evaluated groups divided by gender



(patients from 1 March to 14 April of 2019 and 2020 with a negative PCR, and of 2020 with a positive

PCR to SARS-CoV-2; (B) 25-hydroxyvitamin D concentrations in the three evaluated groups divided



by age (0–70 years vs. >70 years) (patients from 1 March to 14 April of 2019 and 2020 with a negative

PCR, and of 2020 with a positive PCR for SARS-CoV-2. *: significant results.
4. Discussion
The world is in the grip of the COVID-19 pandemic. Public health measures to reduce the risk

of infection and death, in addition to quarantines, are desperately needed. In this paper, we describe

for the first time that the 25(OH)D level is significantly lower in SARS-CoV-2 PCR-positive patients

than in PCR-negative patients (Figure 1).

Figure 2. (A) 25-hydroxyvitamin D concentrations in the three evaluated groups divided by gender



(patients from 1 March to 14 April of 2019 and 2020 with a negative PCR, and of 2020 with a positive

PCR to SARS-CoV-2; (B) 25-hydroxyvitamin D concentrations in the three evaluated groups divided by

age (0–70 years vs. >70 years) (patients from 1 March to 14 April of 2019 and 2020 with a negative PCR,



and of 2020 with a positive PCR for SARS-CoV-2. *: significant results.

Nutrients 2020, 12, 1359 5 of 7

As depicted in Figure 2B, when stratifying the 2020 patients by age (0–70 years and >70 years)

and PCR positivity, the vitamin D concentrations are not significantly di
erent (p = 0.277) among

the two groups (n = 37 vs. n = 9), with median values of 25.9 ng/mL (IQR 15.9–32.1) vs. 17.2 ng/mL

(IQR 11.7–31.6), respectively. Nevertheless, when considering only patients with age >70 years (n = 43

vs. n = 18), the vitamin D concentrations are significantly di
erent (p = 0.037), with median values

of 23.1 ng/mL (IQR 8.5–31.7) in PCR-negative patients vs. 9.3 ng/mL (IQR 8.1–19.9) in PCR-positive



patients. Moreover, when comparing patients enrolled in 2019 with the 2020 PCR-positive patients,

the vitamin D concentrations are even more significantly di
erent (p < 0.001): in patients with age

>70 years (n = 501 vs. n = 18), the median was 26.4 ng/mL (IQR 15.7–36.4) in the 2019 cohort vs.

9.3 ng/mL (IQR 8.1–19.9) in the 2020 cohort. The same di
erence was not observed when comparing

patients with an age lower than 70 years (n = 876 vs. n = 9), with median values of 23.9 ng/mL (IQR

16.4–31.6) vs. 17.2 ng/mL (IQR 11.7–31.6) (p = 0.287), respectively.




4. Discussion
The world is in the grip of the COVID-19 pandemic. Public health measures to reduce the risk of

infection and death, in addition to quarantines, are desperately needed. In this paper, we describe for

the first time that the 25(OH)D level is significantly lower in SARS-CoV-2 PCR-positive patients than

in PCR-negative patients (Figure 1).



Despite the relatively low numbers, this evidence is particularly strong, since the group of

PCR-negative patients had a risk of infection and symptoms of respiratory tract infections as indications

for the PCR testing. Since the risk of symptomatic upper respiratory tract infection is suggested to be

associated with low 25(OH)D levels [7], its concentration is expected to be quite low in PCR-negative

patients (partially confirmed by the trend of a di
erence with the 2019 cohort, p = 0.076), making this



control group even more stringent. Therefore, the significantly lower 25(OH)D concentrations in the

PCR-positive group could indicate that the risk of SARS-CoV-2 infection has a stronger relationship

with the 25(OH)D concentration, rather than other respiratory tract infections.

Nevertheless, no precise information regarding the clinical conditions of the PCR-negative patients

was available in this study, making further stratification impossible.

On the other hand, when stratifying the 2020 patients by gender and PCR positivity, the vitamin

D concentrations were di
erent, with a clear trend, but were not statistically significant, probably



due to the low number in each cluster. In fact, when we consider the 2019 patients, the vitamin D

concentrations were significantly di
erent for both the 2020 PCR-positive women (753 vs. 8) and men

(624 vs. 19), respectively (Figure 2A).



In our cohort, the 25(OH)D concentrations were significantly lower in patients with a positive

SARS-CoV-2 PCR assay when compared with the PCR-negative patients and patients from the 2019

cohort, when the age was >70 years (Figure 2B). There were no di
erences when we compared patients

with an age <70 years. These data may be important if we consider that age is a well-known predictor



of disease severity in COVID-19. Based on this evidence, we could hypothesize that higher 25(OH)D

levels (perhaps around 30 ng/mL as a possible target) could reduce the risk if severe disease in the

elderly (>70 years).



Our data have several possible biases: the data represented a relatively low number of patients from

a single hospital center, no clinical information was available about the severity of COVID-19 symptoms

for PCR-positive patients, no clinical information was available about symptoms in PCR-negative

patients (without a possible clinical stratification), etc. Moreover, other potential confounding variables

linking SARS-CoV-2 PCR positivity and lower vitamin D levels could be diet or possible vitamin D

supplementation (data not available). Finally, the PCR for SARS-CoV-2 and the 25(OH)D quantification

could be performed on di
erent days, but the median days away were close in both the PCR-positive

and PCR-negative groups, with no statistical di
erence between them. Therefore, the half-life of



25(OH)D (approximately 2–3 weeks) should not influence our results.

Nutrients 2020, 12, 1359 6 of 7



The exposure to the sun could be important. The total sun hours in the analyzed period (1 March

to 14 April) were 333.4 h and 349.4 h in 2019 and 2020, respectively. The di
erence in sunshine was



4.8% and it seems to be not significant. Eating behavior and the possible vitamin D supplementation

are more likely to be important factors to consider [3]. Another critical issue that we could consider



is the possible reverse causality, where patients with COVID-19 could have a drop in their 25(OH)D

levels due to the SARS-CoV-2 infection. However, with a relatively short disease, this issue can be

considered unlikely and no data are available. In conclusion, this study represents a preliminary

observation justified by several described mechanisms through which 25(OH)D can reduce the risk of

infections [3]. These mechanisms include the induction or transcription of cathelicidins and defensins



that can reduce viral replication rates and concentrations of pro-inflammatory cytokines responsible

for producing inflammation and injuring the lining of lungs, leading to pneumonia, as well as the

capability of vitamin D to increase the concentrations of anti-inflammatory cytokines. Several pieces

of evidence support the role of vitamin D in reducing the risk of COVID-19, including, as indicated

by other authors, that the outbreak occurred in winter, a time when 25(OH)D concentrations are low;

that the number of cases in the Southern Hemisphere near the end of summer is low; that vitamin

D deficiency has been found to contribute to acute respiratory distress syndrome [3]; and that case

fatality rates increase with age (>70 years) and with chronic disease comorbidity, both of which are

associated with a lower 25(OH)D concentration [3].



As suggested by Grant et al., it is recommended that people at risk of COVID-19 consider taking

10,000 IU/day of vitamin D3 for a few weeks to rapidly increase their 25(OH)D concentrations, followed

by 5000 IU/day to reduce the risk of infection. The goal should be to raise 25(OH)D concentrations

above 40–60 ng/mL (100–150 nmol/L) [3], or at least 30 ng/mL, considering our preliminary data.



It is probable that vitamin D3 supplementation would be useful in the treatment of COVID-19

infection, in preventing a more severe symptomatology and/or in reducing the presence of the virus in



the upper respiratory tract and making the patients less infectious (justifying negative PCR in people

with higher 25(OH)D). Randomized controlled trials and large population studies should be conducted

to evaluate these recommendations and to confirm our preliminary observations and hypothesis.

Author Contributions: Conceptualization, A.D., and M.C.; methodology, A.D. and M.C.; statistical analysis, A.D.,



M.C., and A.D.N.; resources, M.C., R.L., and F.K.; data curation, M.C., writing—original draft preparation, A.D.,

V.A., A.D.N. and M.C.; writing—review and editing, A.D., V.A., A.M., J.C., A.D.N., R.L., F.K. and M.C. All authors

have read and agreed to the published version of the manuscript.

Funding: This research received no external funding.

Conflicts of Interest: The authors declare that they have no conflict of interest and no competing financial interests.

Disclaimer: PHASE I AIFA, UNI EN ISO 9001 and 13485 Certificate Laboratory; Certificate No. IT-64386 and

DM/17/154/S; Certification for: “Design, development and application of determination methods for clinical



analytes and drugs, also with reference to in vitro dyagnostics. pharmacogenetic analyses.” and “Design and

development and application of quantification and detection methods of clinical analytes and drugs, finalized to

the production of in vitro diagnostics” www.tdm-torino.org.




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