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Different ways of the patients receiving vitamin D supplements and of conducting possible studies

Posted by mbhattarai391 on 10 Feb 2022 at 17:50 GMT

I read the paper with interest. I see two issues raised by the paper. One is different ways the patients may receive vitamin D supplement and the other is about the possible approaches to be considered in further studies. The authors have explained in the method and limitation sections that they did not have access to data regarding whether patients had been treated for vitamin D deficiency and patients’ supplementation history was not obtained or analyzed as part of their research. There are different ways the patients may receive vitamin D supplement. One group of the patients may have clear documented vitamin D deficiency and its treatment appropriately by their physicians. The other group of patients may have taken some doses vitamin D supplementation for some time during the epidemic on their own or as advised by their physicians. The dose and duration received may need to be considered in the study. Then there may be third groups of patients who may be taking regular over the counter multivitamin supplements that contain recommended dose of vitamin D. Unless specifically enquired and checked the dose of vitamin D, the third type of vitamin D supplementation is likely to be missed in a retrospective or prospective study. It may be useful to consider the proportions and results of the three groups of patients in mild, moderate, severe, and critical categories of COVID-19 disease severity in any vitamin D study.

The authors concluded that pre-infection deficiency of vitamin D was associated with increased disease severity and mortality and raised questions whether and when vitamin D supplementation among vitamin D deficient individuals in the community impacts the outcome of an eventual COVID-19 episode. One possible approach in the future may be to check the vitamin D deficiency of the population regularly and treat them fully. However for such approach to develop, clear evidences are needed in various aspect of testing and of other health effects of vitamin D and it may not be feasible to approach in this way in the near future at least in the non-industrialized countries. The other possible approach in the ongoing COVID-19 epidemic for the future studies is to give therapeutic dose of vitamin D, for example 50,000 to 60,0000 units, daily for a few days in the first week of infection to the patients irrespective of the vitamin D level and see the outcome. In the studies, the initial and final vitamin D levels and other tests need to be checked to see the adverse effects of such therapeutic dose of vitamin D in the people with normal level of vitamin D.

Dr. Madhur Dev Bhattarai
Professor
Department of Medicine
Chitwan Medical College
Nepal

No competing interests declared.
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