Association Between Population Vitamin D Status and SARS-CoV-2 Related Serious-Critical Illness and Deaths

Background: Vitamin-D population status may have possible unappreciated consequences to the COVID-19 pandemic Α significant association between vitamin-D sufficiency and reduction in clinical severity and inpatient mortality from COVID-19 disease was recently shown while a recent study has claimed lower COVID-19 cases in European countries with a better vitamin D status Aims: To further elucidate the possible role of vitamin D population status in the COVID-19 pandemic, we examined the associations between published representative and standardized population vitamin D data on European population vitamin D status and the Worldometer COVID-19 data Methods: Data from the Worldometer on 26 European countries populated g4 million (M) were analyzed Results: On 19-June-2020, linear regression found no correlation between published representative-standardized population vitamin-D concentrations and the total cases-recovered/M, but negative correlations predicting a reduction of 47-64-80% in serious-critical illnesses/M and of 61-82-102 4% in deaths/M, further enhanced when adapting for life expectancy by 133-177-221% if 25(OH)D concentrations reach 100-125-150 nmol/L On 15-August-2020 these correlations were sustained indicating a truthful association, yet not proving causality Weighted ANOVA was performed to evaluate serious-critical/M (R2=0 22) by the vitamin-D population status (deficient-D l50, insufficient-IN 50–62 5, mildly insufficient-MIN g62 5–75 and sufficient-S g75 nmol/L) and ANCOVA the deaths/M (R2=0 629) after controlling for life expectancy (R2=0 47) Serious-critical showed a decreasing trend (pl0 001) from population status D (pl0 001) to IN: 9 2%, pl0 001, MIN: 47 6%, pl0 044 and S: 100% (reference) For deaths/M the respective decreasing trend (pl0 001) was 62 9% from D (pl0 001) to IN (pl0 001), 65 15% to MIN (pl0 001) and 78 8% to S (p=0 041) Conclusions: Following the Endocrine Society’s expert committee recommendations, without previous testing being necessary, reaching and maintaining a serum 25(OH)D of 100–150 nmol/L (40–60 ng/ml) could be achieved by an initial supplementation with the upper tolerable daily intake doses (IU/day) for up to two months: l1yr 2000, 1-18yrs 4000 and all adults 10,000 (obese x 2–3 times more) and then with the maintenance proposed doses that do not require medical supervision, practically identical with the IOM’s upper tolerable limits: 1000 l6m, 1500 6m-1yr, 2500 1-3yrs, 3000 4-8yrs, and 4000 g8yrs, with adults and adolescents requiring 4000–5000 (obese x 2) Vitamin D may not prevent SARS-CoV-2 from spreading but may protect, without any risk of toxicity, from serious-critical illness and death from COVID-19 disease While awaiting well-designed prospective studies, following the proposed approach, the gain for global public health and not only against SARS-CoV-2 may just prove invaluable