What are the patterns of Vitamin D use in long-term care (LTC) facilities in Canada and what are their outcomes

Posted on July 31, 2020 by Madalon Burnett

Summary

There is evidence to suggest that there is a correlation between vitamin D deficiency and increased rates and severity of COVID-19 infection. Though the evidence is limited and lacks causation, some sources recommend vitamin D supplementation for prevention and as part of treatment for COVID-19, since supplementation is safe, inexpensive and can have benefits for prevention of other diseases. There is no specific published information about vitamin D and COVID-19 in Canada. 

I.   COVID-19 and Vitamin D

  • One article shows that there is a correlation between low vitamin D levels in the blood and rates of COVID-19 infection and mortality (1)
    • The study reviewed European countries and found paradoxically that areas of lower latitude such as Italy and Spain had lower levels of vitamin D. These areas experienced the highest rates of COVID-19 infection and mortality
    • Countries such as Norway, Finland, and Sweden actually had higher levels of vitamin D and experienced lower rates of COVID-19 infection and mortality
  • Another (non-peer reviewed) article shows that there is a correlation between vitamin D deficiency and the severity of COVID-19 infection. The researchers suggest a mechanism in that vitamin D prevents cytokine storm, which causes many of the complications of COVID-19 (2)
  • A subsequent review article suggests hypotheses for why having adequate stores of vitamin D may be important in COVID-19 infection, though the authors caution that the evidence for the role of vitamin D in COVID-19 remains low quality and should be studied further (3)
  • There are peer-review papers that recommend vitamin D supplementation for patients with COVID-19 or patients at high risk of COVID-19 if circulating levels are measured to be low, even though we do not have any direct evidence to suggest that vitamin D supplementation prevents COVID-19 infection or improves mortality rates. This recommendation is based on the fact that it is known to be a safe and inexpensive intervention and it is also known to be beneficial for the prevention of diseases other than COVID-19 (4, 5)

II.   Canadian Context

  • There is no published information available on what percentage of any type of care facilities are prescribing or investigating vitamin D use in the context of COVID-19
  • There is an ongoing study at the University of Alberta examining the role of vitamin D in improving outcomes of COVID-19 in Canadians. No data have been published yet (6)
  • In the context of COVID-19 Osteoporosis Canada recommends “individuals with osteoporosis or with risk factors for fractures receive adequate vitamin D, as recommended at 800-2000 IU per day. This would also be important for those at higher risk of developing vitamin D deficiency. High dose vitamin D supplementation should be avoided due to potential harms” (7)

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. Laird E, Rhodes J, Kenny R. Vitamin D and Inflammation: Potential Implications for Severity of Covid-19. Ir Med J [Internet]. 113(5):81. Available from: http://www.imj.ie/wp-content/uploads/2020/05/Vitamin-D-and-Inflammation-Potential-Implications-for-Severity-of-Covid-19.pdf
  2. Daneshkhah A, Agrawal V, Eshein A, Subramanian H, Roy HK, Backman V. The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients. 2020 Apr 10 [cited 2020 Jul 31]; Available from: https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4
  3. Biesalski HK. Vitamin D deficiency and co-morbidities in COVID-19 patients – A fatal relationship? NFS Journal [Internet]. 2020 Aug [cited 2020 Jul 31];20:10–21. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276229/
  4. Ebadi M, Montano-Loza AJ. Perspective: improving vitamin D status in the management of COVID-19. European Journal of Clinical Nutrition [Internet]. 2020 May 12 [cited 2020 Jul 31];74(6):856–9. Available from: https://www.nature.com/articles/s41430-020-0661-0?fbclid=IwAR3yo41dvfU1HWVX_Y6z7iXFNL3X2C06A5gIfC4LcNmXzCA48A7ViMAf7N8
  5. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, et al. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients [Internet]. 2020 Apr 2 [cited 2020 Jul 31];12(4):988. Available from: https://www.mdpi.com/2072-6643/12/4/988
  6. Favaro A, Elizabeth St. Philip, Cousins B. Alberta researchers part of rush to learn vitamin D’s role in COVID-19 prevention [Internet]. Coronavirus. CTV News; 2020 [cited 2020 Jul 31]. Available from: https://www.ctvnews.ca/health/coronavirus/alberta-researchers-part-of-rush-to-learn-vitamin-d-s-role-in-covid-19-prevention-1.4949729
  7. Vitamin D and Potential Impact on the Severity of COVID | Osteoporosis Canada [Internet]. Osteoporosis.ca. 2020 [cited 2020 Jul 31]. Available from: https://osteoporosis.ca/vitamin-d-and-potential-impact-on-the-severity-of-covid/

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.