Vitamin D deficiency in the BAME community is associated with a high risk of severe disease and mortality by SARS-CoV-2
– by Dr Mohammed Kamara
COVID-19 infection results in an elevated risk of pulmonary complications and mortality in the hypertensive, diabetic, and old age individuals and patients with cardiovascular or pulmonary diseases. This situation is critical in the BAME population. As a paradigmatic representation of the state is of interest, mentioning that the morbidity and mortality rates by COVID-19 in the BAME are the highest among many other populations, as well as the mortality rate is 6-fold higher compared with white people.
There are many health disparities in BAME groups, like high incidence rates of obesity, diabetes, high blood pressure, cardiovascular and renal diseases, among others. The usual explanation for these differences is the low socioeconomic status and educational levels, the social environment, lifestyle habits, and less access to health care services. However, there are pieces of evidence that these non-favourable conditions are not enough, and there are other influential factors that may help to a better approach to the real problem, like some genetic polymorphism and epigenetic-driven changes. In this sense, of medical relevance are the differences in renin-angiotensin-aldosterone systems (RAAS), renal sodium manages and -of interest for this letter-, the low levels of serum vitamin D. Complementary, there is an association between high serum vitamin D levels and benefits on many aspects of health, including viral infection. Most of the BAME people lack normal serum levels of vitamin D, and the average of their serum levels is considerably lower than other populations.
Additionally, low serum vitamin D levels are associated with a higher number and severity of respiratory infections than people with normal levels. Clinical trials have shown that vitamin D administration reduces respiratory infections in healthy people, as well as in patients with chronic respiratory diseases, including cases with viral infection by COVID-19. It is known that vitamin D exerts this protective effect on respiratory tract mainly through three mechanisms: the preservation of tight junctions to avoid the immune cells infiltration of into the lungs and other respiratory organs, the destruction of enveloped viruses by the stimulation of cathelicidin and defensins, and the decrease in pro-inflammatory cytokines synthesis by the immune system modulation. Moreover, vitamin D has been suggested as a natural antioxidant and anti-inflammatory able to enhance the prognosis of lung pathologies. Additionally, the combined actions of vitamin D and other endogenous molecules with strong antioxidant properties such as melatonin may provide a synergistic effect against COVID-19 infection and it’s lethal consequences.
Consequently, we aim to generate discussion addressing plausible use of high doses of vitamin D in the BAME population as a protective strategy in COVID-19 against both virus entrance, inflammatory storm, and inclusive, the death. As was proposed for other high-risk populations, and currently are ongoing at list ten randomized controlled trials, it is necessary to know whether vitamin D supplementation could be useful in the prevention and treatment of COVID-19 in the BAME population.
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