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I have read a bunch of articles/papers that support the idea that people that recover will have some immunity and that one or more vaccines will prove to be effective. Whether we can make enough vaccine to immunize the whole planet in a timely manner is another question. What nobody knows yet is how long that immunity will last (weeks, moths years ?). I am also concerned that rushing to a vaccine will produce something that is effective against the virus but has some other issue like a leg falling off so I'm not sure that I will be first in line.

Stan

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3 hours ago, Motorsport Mickey said:

Yes, I think that's the tongue in cheek point Iain.

But as the cartoon points out everybody knows the system and as Peter pointed out adhering to it will likely cost many thousands and maybe millions of extra lives lost whilst "the system" grinds exceeding slow and an "approved sausage" ever so slowly emerges from the other end.

Many people like myself without a doctorate or science background would opine that expanding the amount recommended of IU units that D3 should be taken and absorbed by the entire population is a safe course of action that would have minimal if any impact upon public safety( D3 and it's affects is very well known and even the US has stated a IU recommendation many many times that of ours and regards it as safe). The benefits that the increased consumption of D3 would promote in the boosting of the publics immune system would hopefully mitigate any COVID virus affects (not to underplay any other benefits that the D3 may also promote) and help reduce any death toll without a prohibitive financial or societal cost.

In the meantime the established system of trials and confirming science would hopefully establish an inoculation (if possible) that would prove to be long term preventative measure.

I think that's what's referred to as a "belt and braces" or if not a "no cost" a very little cost ongoing method of mitigating the virus affects.

Mick Richards   

About £30 million per month for UK population.

In 3 monthe we have lost 50,000 "excess lives". If most of those could have been saved the cost would be 90M/50k or about £2000 per life.

I fail to see a downside. The contra-indication of raising 25(OH_D3  are known ( eg sarcoidosis, kidney stones, etc ) and nations with D3- fortified foods that have around 100 nmol/L mean 25(OH)D3 seeem to have mastered that issue. Finland does that and has the lowest COVID deaths in europe.

However to SAGE epidemiologists who have decided that contact tracing is the way forward, having a population in which D3-replete infected peopleare symptomless destrooys their approach. That IoW app becomes useless if D3-replete people dont know that have COVID.  Worse still, awkward souls liek myself who supplement , if there are enough in the population, will impair "contact tracing".  It means that Boris, if he is now aware of D3;s potentil has to decide on everyone being given D3 (with GPs identifying those at risk from that) or no-one. He could ban supplements form sale. BUT the natural way to get D3 is form sunlight, so he would have to ban sunbathing too.  So SAGE have a tricky position, contact tracing will not work well if we have a sunny summer and we all takein the rays,

Peter

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8 minutes ago, foster461 said:

I have read a bunch of articles/papers that support the idea that people that recover will have some immunity and that one or more vaccines will prove to be effective. Whether we can make enough vaccine to immunize the whole planet in a timely manner is another question. What nobody knows yet is how long that immunity will last (weeks, moths years ?). I am also concerned that rushing to a vaccine will produce something that is effective against the virus but has some other issue like a leg falling off so I'm not sure that I will be first in line.

Stan

Stan,  There are  reports that sero-positive recovered pts can be re-infected. If our own antibodies can be defeated by the virus what chance does an artificial approach have ?

RNA viruses have nasty habit of mutatung , so we need anew flu vaacine evry winter. The corona virus has  no need at present to evoleve as it has 6 billion souls to infect, But once the population that has recovered and has its own antibodies the selelctive pressure on the virus will lead to new variants that skirt around that immuniity. The same applies to a vaccine, it may work at first but if it workd too well, the virus will evolve to cirumvent it. Studies that report the virus not mutating much are undoubtedly correct, but it may well be a fools paradise to assume that will persist.

About 100  vaccines are in development, but most will fail. And those that work at first if administered globally may have very brief utility, I doubt COVID can be defeated by a one-off vaccine, it will like seasonal flu need a new one annually.

I think the answer lies in determining why only 1% of the popualtion get bad COVID. That is big clue. And  a big threat to those who seek to make billions form a vaccine or drug. 99% of us have it for free. I wonder waht it can be ??

Peter

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15 hours ago, Bleednipple said:

We are I think increasingly at risk of not being 'allowed' to hold political leaders to account, and expecting them to be fully responsible for the decisions made by the governments they lead, without it being assumed that is an attempt to assign partisan blame. I would say that has become more problematic because politics has become more heated and polarised by the 2016 referendum and its aftermath.

When you accept the job of prime minister, surely you must then accept fully your accountability for all the actions of the government you lead, and their consequences. That's "Leadership 101". And, because our prime ministers are also the leaders of their respective political parties, they also have to accept primary responsibility to the public for the actions of their party in parliament and outside it.

Nigel

We have no problem waiting for a D3 reports or even vaccine / test to be checked and rechecked before allowing it to be released. Yet the media have jumped on Deaths in care home as being BJ responsibility.

We have a variety of residential / care homes here being a popular retirement area. I’d like to say I have visited many of both. I believe it’s fair to say, not all these homes had the same standards or practice.

It’s easy for Sir Keir Starmer and journalists to ask questions or make reference in part of a past report,  referring or implying whats going on in these premises is solely down Government. Really, responsible for what occurs in a individual Care homes, or a GP surgery or any other organisation, this is where I have a problem.

A figure mentioned today 20,000 deaths in care homes, if this figure is correct I’d want more information before I proportion blame.

It interesting a care home with a large number of deaths has had a visit, practices have now  been put in place although the authorities would not wish to jump to conclusions before a full report is produced. 

Wouldn’t it be nice if that was a standard practice. 

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3 hours ago, foster461 said:

I have read a bunch of articles/papers that support the idea that people that recover will have some immunity and that one or more vaccines will prove to be effective. Whether we can make enough vaccine to immunize the whole planet in a timely manner is another question. What nobody knows yet is how long that immunity will last (weeks, moths years ?). I am also concerned that rushing to a vaccine will produce something that is effective against the virus but has some other issue like a leg falling off so I'm not sure that I will be first in line.

Stan

You're quite right to be concerned about side effects, Stan.    Much work on a covid vaccines is looking at a DNA version.     Ordinary vaccines consist of part of a virus or bacterium - the spikes that stud its surface and connect to receptors on our cells to let them in are a favourite - but the DNA version deliberately 'infects our cells with another virus, thought to be harmless (!) that will do the same as any virus, take over the normal protein synthesis mechanism and force it to make viral protein.      Usually these are assembled into complete viruses, but the vaccine version only makes spikes.  For example.    Which the cell then releases so that they alarm the immune mechanism and set off an immune response.      

But early attempts at this instead triggered the "Cytokine storm" that makes a few covid patients deathly ill.  So vaccines are tested progressively on humans after lab and animal testing.   Phase 1 on a few volunteers, who are intensively studied to ensure that it is safe.     Phase 2 will include many hundreds of volunteers,  to see if there is a protective immune response.    In this situation, it could include a viral challenge, infection with the disease, to confirm that, but this has strong ethical problems.   Phase 3 is the use of the vaccine in a limited population, to confirm the safety incidence of side effects and efficacy - if it works or not!     Only then will a vaccine receive a licence.  These precautions inevitably take time and mean that a vaccine that works and is discovered today won't be available until next year    There are suggestions that the global need for an effective vaccine should be short-circuited.  You choose!     

JOhn

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it takes abrave person to enrol for a  trial based upon DNA/ademovirus technology. In 20 yjears progress will have been made but this falure reminds us that new tech carries unforeseen risk. https://en.wikipedia.org/wiki/Jesse_Gelsinger

There are careers to be made, and $billions, with a succesful vaccine. Hype is part of that game.

Peter

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9 hours ago, Motorsport Mickey said:

Yes, I think that's the tongue in cheek point Iain.

But as the cartoon points out everybody knows the system and as Peter pointed out adhering to it will likely cost many thousands and maybe millions of extra lives lost whilst "the system" grinds exceeding slow and an "approved sausage" ever so slowly emerges from the other end.

Many people like myself without a doctorate or science background would opine that expanding the amount recommended of IU units that D3 should be taken and absorbed by the entire population is a safe course of action that would have minimal if any impact upon public safety( D3 and it's affects is very well known and even the US has stated a IU recommendation many many times that of ours and regards it as safe). The benefits that the increased consumption of D3 would promote in the boosting of the publics immune system would hopefully mitigate any COVID virus affects (not to underplay any other benefits that the D3 may also promote) and help reduce any death toll without a prohibitive financial or societal cost.

In the meantime the established system of trials and confirming science would hopefully establish an inoculation (if possible) that would prove to be long term preventative measure.

I think that's what's referred to as a "belt and braces" or if not a "no cost" a very little cost ongoing method of mitigating the virus affects.

Mick Richards   

Agreed, but its the best process we have. The alternative is Q"(£%£$y....often dangerous. 

Nobody will question the role in the  immune system. If someone is deficient sure correct the levels. Cant harm, but first are they deficient? If not why are you treating...?

Safe........not a word used in Medicine or the Pharmaceutical Industry. Having an established low side effect profile may be, but Safe...never. 

Some perspective is required for the non-medical.

REF: https://www.webmd.com/vitamins/ai/ingredientmono-929/vitamin-d

 

Side Effects & Safety

When taken by mouth: Vitamin D is LIKELY SAFE when taken by mouth in recommended amounts. Most people do not commonly experience side effects with vitamin D, unless too much is taken. Some side effects of taking too much vitamin D include weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting, and others. Taking vitamin D for long periods of time in doses higher than 4000 units daily is POSSIBLY UNSAFE and may cause excessively high levels of calcium in the blood. However, much higher doses are often needed for the short-term treatment of vitamin D deficiency. This type of treatment should be done under the supervision of a healthcare provider.

When given as a shot: Vitamin D is LIKELY SAFE when given as a shot into the muscle in recommended amounts. Most people do not commonly experience side effects with vitamin D, unless too much is taken. Some side effects of taking too much vitamin D include weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting, and others.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Vitamin D is LIKELY SAFE during pregnancy and breast-feeding when used in daily amounts below 4000 units. Do not use higher doses unless instructed by your healthcare provider. Vitamin D is POSSIBLY UNSAFE when used in higher amounts during pregnancy or while breast-feeding. Using higher doses might cause serious harm to the infant.

Children: Vitamin D is LIKELY SAFE in children when taken by mouth in recommended amounts. But it is POSSIBLY UNSAFE to take vitamin D in higher doses, long-term. Infants from 0-6 months should not take more than 1000 IU daily. Infants aged 6-12 months should not take more than 1500 IU daily. Children aged 1-3 years should not take more than 2500 IU daily. Children aged 4-8 years should not take more than 3000 IU daily. Children aged 9 years and older should not take more than 4000 IU daily.

Hardening of the arteries (atherosclerosis): Taking vitamin D could make this condition worse, especially in people with kidney disease.

A type of fungal infection called histoplasmosis: Vitamin D may increase calcium levels in people with histoplasmosis. This could lead to kidney stones and other problems. Use vitamin D cautiously.

High levels of calcium in the blood: Taking vitamin D could make this condition worse.

Over-active parathyroid gland (hyperparathyroidism): Vitamin D may increase calcium levels in people with hyperparathyroidism. Use vitamin D cautiously.

Lymphoma: Vitamin D may increase calcium levels in people with lymphoma. This could lead to kidney stones and other problems. Use vitamin D cautiously.

Kidney disease: Vitamin D may increase calcium levels and increase the risk of "hardening of the arteries" in people with serious kidney disease. This must be balanced with the need to prevent renal osteodystrophy, a bone disease that occurs when the kidneys fail to maintain the proper levels of calcium and phosphorus in the blood. Calcium levels should be monitored carefully in people with kidney disease.

A disease that causes swelling (inflammation) in body organs, usually the lungs or lymph nodes (sarcoidosis): Vitamin D may increase calcium levels in people with sarcoidosis. This could lead to kidney stones and other problems. Use vitamin D cautiously.

Tuberculosis: Vitamin D might increase calcium levels in people with tuberculosis. This might result in complications such as kidney stones.

 

Interactions?

Moderate Interaction

Be cautious with this combination !

Aluminum interacts with VITAMIN D

Aluminum is found in most antacids. Vitamin D can increase how much aluminum the body absorbs. This interaction might be a problem for people with kidney disease. Take vitamin D two hours before, or four hours after antacids.

Calcipotriene (Dovonex) interacts with VITAMIN D

Calcipotriene is a drug that is similar to vitamin D. Taking vitamin D along with calcipotriene (Dovonex) might increase the effects and side effects of calcipotriene (Dovonex). Avoid taking vitamin D supplements if you are taking calcipotriene (Dovonex).

Digoxin (Lanoxin) interacts with VITAMIN D

Vitamin D helps your body absorb calcium. Calcium can affect the heart. Digoxin (Lanoxin) is used to help your heart beat stronger. Taking vitamin D along with digoxin (Lanoxin) might increase the effects of digoxin (Lanoxin) and lead to an irregular heartbeat. If you are taking digoxin (Lanoxin), talk to your doctor before taking vitamin D supplements.

Diltiazem (Cardizem, Dilacor, Tiazac) interacts with VITAMIN D

Vitamin D helps your body absorb calcium. Calcium can affect your heart. Diltiazem (Cardizem, Dilacor, Tiazac) can also affect your heart. Taking large amounts of vitamin D along with diltiazem (Cardizem, Dilacor, Tiazac) might decrease the effectiveness of diltiazem.

Verapamil (Calan, Covera, Isoptin, Verelan) interacts with VITAMIN D

Vitamin D helps your body absorb calcium. Calcium can affect the heart. Verapamil (Calan, Covera, Isoptin, Verelan) can also affect the heart. Do not take large amounts of vitamin D if you are taking verapamil (Calan, Covera, Isoptin, Verelan).

Water pills (Thiazide diuretics) interacts with VITAMIN D

Vitamin D helps your body absorb calcium. Some "water pills" increase the amount of calcium in the body. Taking large amounts of vitamin D along with some "water pills" might cause to be too much calcium in the body. This could cause serious side effects including kidney problems.<br /><br /> Some of these "water pills" include chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL, Esidrix), indapamide (Lozol), metolazone (Zaroxolyn), and chlorthalidone (Hygroton).

Minor Interaction

Be watchful with this combination

!

Cimetidine (Tagamet) interacts with VITAMIN D

The body changes vitamin D into a form that it can use. Cimetidine might decrease how well the body changes vitamin D. This might decrease how well vitamin D works. But this interaction probably isn't important for most people.

Heparin interacts with VITAMIN D

Heparin slows blood clotting and can increase the risk of breaking a bone when used for a long period of time. People taking these medications should eat a diet rich in calcium and vitamin D.

Low molecular weight heparins (LMWHS) interacts with VITAMIN D

Some medications called low molecular weight heparins can increase the risk of breaking a bone when used for a long periods of time. People taking these medications should eat a diet rich in calcium and vitamin D.<br /><br /> These drugs include enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep).

 

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1 hour ago, iain said:

Agreed, but its the best process we have. The alternative is Q"(£%£$y....often dangerous. 

Nobody will question the role in the  immune system. If someone is deficient sure correct the levels. Cant harm, but first are they deficient? If not why are you treating...?

Safe........not a word used in Medicine or the Pharmaceutical Industry. Having an established low side effect profile may be, but Safe...never. 

Some perspective is required for the non-medical.

REF: https://www.webmd.com/vitamins/ai/ingredientmono-929/vitamin-d

 

Side Effects & Safety

When taken by mouth: Vitamin D is LIKELY SAFE when taken by mouth in recommended amounts. Most people do not commonly experience side effects with vitamin D, unless too much is taken. Some side effects of taking too much vitamin D include weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting, and others. Taking vitamin D for long periods of time in doses higher than 4000 units daily is POSSIBLY UNSAFE and may cause excessively high levels of calcium in the blood. However, much higher doses are often needed for the short-term treatment of vitamin D deficiency. This type of treatment should be done under the supervision of a healthcare provider.

When given as a shot: Vitamin D is LIKELY SAFE when given as a shot into the muscle in recommended amounts. Most people do not commonly experience side effects with vitamin D, unless too much is taken. Some side effects of taking too much vitamin D include weakness, fatigue, sleepiness, headache, loss of appetite, dry mouth, metallic taste, nausea, vomiting, and others.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Vitamin D is LIKELY SAFE during pregnancy and breast-feeding when used in daily amounts below 4000 units. Do not use higher doses unless instructed by your healthcare provider. Vitamin D is POSSIBLY UNSAFE when used in higher amounts during pregnancy or while breast-feeding. Using higher doses might cause serious harm to the infant.

Children: Vitamin D is LIKELY SAFE in children when taken by mouth in recommended amounts. But it is POSSIBLY UNSAFE to take vitamin D in higher doses, long-term. Infants from 0-6 months should not take more than 1000 IU daily. Infants aged 6-12 months should not take more than 1500 IU daily. Children aged 1-3 years should not take more than 2500 IU daily. Children aged 4-8 years should not take more than 3000 IU daily. Children aged 9 years and older should not take more than 4000 IU daily.

Hardening of the arteries (atherosclerosis): Taking vitamin D could make this condition worse, especially in people with kidney disease.

A type of fungal infection called histoplasmosis: Vitamin D may increase calcium levels in people with histoplasmosis. This could lead to kidney stones and other problems. Use vitamin D cautiously.

High levels of calcium in the blood: Taking vitamin D could make this condition worse.

Over-active parathyroid gland (hyperparathyroidism): Vitamin D may increase calcium levels in people with hyperparathyroidism. Use vitamin D cautiously.

Lymphoma: Vitamin D may increase calcium levels in people with lymphoma. This could lead to kidney stones and other problems. Use vitamin D cautiously.

Kidney disease: Vitamin D may increase calcium levels and increase the risk of "hardening of the arteries" in people with serious kidney disease. This must be balanced with the need to prevent renal osteodystrophy, a bone disease that occurs when the kidneys fail to maintain the proper levels of calcium and phosphorus in the blood. Calcium levels should be monitored carefully in people with kidney disease.

A disease that causes swelling (inflammation) in body organs, usually the lungs or lymph nodes (sarcoidosis): Vitamin D may increase calcium levels in people with sarcoidosis. This could lead to kidney stones and other problems. Use vitamin D cautiously.

Tuberculosis: Vitamin D might increase calcium levels in people with tuberculosis. This might result in complications such as kidney stones.

 

Interactions?

Moderate Interaction

Be cautious with this combination !

Aluminum interacts with VITAMIN D

Aluminum is found in most antacids. Vitamin D can increase how much aluminum the body absorbs. This interaction might be a problem for people with kidney disease. Take vitamin D two hours before, or four hours after antacids.

Calcipotriene (Dovonex) interacts with VITAMIN D

Calcipotriene is a drug that is similar to vitamin D. Taking vitamin D along with calcipotriene (Dovonex) might increase the effects and side effects of calcipotriene (Dovonex). Avoid taking vitamin D supplements if you are taking calcipotriene (Dovonex).

Digoxin (Lanoxin) interacts with VITAMIN D

Vitamin D helps your body absorb calcium. Calcium can affect the heart. Digoxin (Lanoxin) is used to help your heart beat stronger. Taking vitamin D along with digoxin (Lanoxin) might increase the effects of digoxin (Lanoxin) and lead to an irregular heartbeat. If you are taking digoxin (Lanoxin), talk to your doctor before taking vitamin D supplements.

Diltiazem (Cardizem, Dilacor, Tiazac) interacts with VITAMIN D

Vitamin D helps your body absorb calcium. Calcium can affect your heart. Diltiazem (Cardizem, Dilacor, Tiazac) can also affect your heart. Taking large amounts of vitamin D along with diltiazem (Cardizem, Dilacor, Tiazac) might decrease the effectiveness of diltiazem.

Verapamil (Calan, Covera, Isoptin, Verelan) interacts with VITAMIN D

Vitamin D helps your body absorb calcium. Calcium can affect the heart. Verapamil (Calan, Covera, Isoptin, Verelan) can also affect the heart. Do not take large amounts of vitamin D if you are taking verapamil (Calan, Covera, Isoptin, Verelan).

Water pills (Thiazide diuretics) interacts with VITAMIN D

Vitamin D helps your body absorb calcium. Some "water pills" increase the amount of calcium in the body. Taking large amounts of vitamin D along with some "water pills" might cause to be too much calcium in the body. This could cause serious side effects including kidney problems.<br /><br /> Some of these "water pills" include chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL, Esidrix), indapamide (Lozol), metolazone (Zaroxolyn), and chlorthalidone (Hygroton).

Minor Interaction

Be watchful with this combination

!

Cimetidine (Tagamet) interacts with VITAMIN D

The body changes vitamin D into a form that it can use. Cimetidine might decrease how well the body changes vitamin D. This might decrease how well vitamin D works. But this interaction probably isn't important for most people.

Heparin interacts with VITAMIN D

Heparin slows blood clotting and can increase the risk of breaking a bone when used for a long period of time. People taking these medications should eat a diet rich in calcium and vitamin D.

Low molecular weight heparins (LMWHS) interacts with VITAMIN D

Some medications called low molecular weight heparins can increase the risk of breaking a bone when used for a long periods of time. People taking these medications should eat a diet rich in calcium and vitamin D.<br /><br /> These drugs include enoxaparin (Lovenox), dalteparin (Fragmin), and tinzaparin (Innohep).

 

Tks Ian, anyone taking above NICE or PHE D3 doses should read through that.

Reading that, It is a wonder anyone is left alive in Finland: they supplement, and their milk, margerine and cornflakes are enriched with D and they have a serum  25(OH) that is double Scotlands. And far less COVID

And reading that, where is sunbathing warned against ? that can in 1/4 hour generate 10,000 IU, Which raises the question baout how large " large amounts: cited above are.

Finally that is a USA site where Inst Med advise < 50 nmol/L as insufficient, Inst Endoc defines >75 as adequate, while our NICE defines <25 as defiicient but  has nto defined adequate.  So we dont have populations with a consistent baseline 25(OH) and hence calcium metabolism to judge the risks of those interactions

If UK implements nation wide supplementation the interactions decribed above can be circulated to GPs and affected pts warned and plasma Ca and PTH etc monitored

There is a wealth of info on D3 in the book by Prof Michael Holick, an eminent proponent in D3 clinical research https://www.bumc.bu.edu/busm/profile/michael-holick/  In it he tells us how much D3 he takes and his serum 25(OH)D3. No surprise both are very close to mine, And within PHE max 4000 IU od

image.png.31423b9b7205fc1ad5b604869243e576.png

Get your D3 information from a world  expert !!

Peter

 

 

 

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26 minutes ago, Peter Cobbold said:

Reading that, It is a wonder anyone is left alive in Finland: they supplement, and their milk, margerine and cornflakes are enriched with D and they have a serum  25(OH) that is double Scotlands. And far less COVID

Nobody lives there and with 6 months  of serious daylight deprivation, not surprising they need VitD3 supplements 

Population density 15 per sq kilometre.....UK 259 per sq kilometre would mean they are permanently socially isolated as well.


 

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6 minutes ago, iain said:

Nobody lives there and with 6 months  of serious daylight deprivation, not surprising they need VitD3 supplements 

Population density 15 per sq kilometre.....UK 259 per sq kilometre would mean they are permanently socially isolated as well.


 

Scandinavian nations are much more clued up on D3 than UK, because of long winters.-they are markedly higher than other european nations even those that get lots more sun

http://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/

I take your point about population density. However we would need to compare city by city to do a better comparison, say Helsinki vs Madrid

Peter

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I think overall country population density is a significant factor affecting transmission. Yes there would be interest in comparing similar sized cities individually but the overall population and distance between significant centres of population must also be factors.

Our centres of population are closer together and so transmission between those centres is more likely here than in many other countries.

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I think the points being made throughout this thread is  that an Epidemic, its spread, its incidence in different populations and demographics, its variance with ethnicity and geography, genomics and many other factors clearly make the point "this is very complex". Its very difficult to point a finger and say......here is the cause. Its undeniably multi factorial. 

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43 minutes ago, iain said:

I think the points being made throughout this thread is  that an Epidemic, its spread, its incidence in different populations and demographics, its variance with ethnicity and geography, genomics and many other factors clearly make the point "this is very complex". Its very difficult to point a finger and say......here is the cause. Its undeniably multi factorial. 

It certainly is. I am intrigued by the Vit D role in C19 discourse, but it does seem really hard to analyse because the data is so messy and so many of the factors apparently co-vary. For example: in Scandinavia I see, from a skim through a couple of the (pre-Covid) literature, that there's often a "reverse gradient" of population Vit D observations - ie people in the south have lower D than in the north. That's been attributed to the fact that more of the southern populations have urban lifestyles.  But (/and!) of course, high density living can also be expected to increase transmission of almost any infectious disease, including Covid. A lot of the factors seem to go together in those kinds of ways, that muddy any causality analysis. Also, the data standards between country studies for Vit D seem to be pretty inconsistent, and national boundaries aren't anyway necessarily a good sampling frame. 

At the same time, the argument in favour of Vit D supplementation on a precautionary principle, if the potential harms are indeed as low as is reported, seems to me a pretty strong one in the current circumstances. Aside from C19, longer term, I'm also struck by the general public health arguments in the same direction and it does seem remarkable how the 'deficiency' level (even that not attained by a large percentage of many populations) in many countries still seems to be set at the level below which kids tend to get rickets. Even if Vit D role in C19 remains un-demonstrated for the time being, if it helps to push some more joined-up-thinking on whether Vit D insufficiency is genuinely the public health issue that many scientists are suggesting, then that at least would be a good thing.

Just my 2p worth as a non-medic.

Nigel

 

 

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3 hours ago, iain said:

I think the points being made throughout this thread is  that an Epidemic, its spread, its incidence in different populations and demographics, its variance with ethnicity and geography, genomics and many other factors clearly make the point "this is very complex". Its very difficult to point a finger and say......here is the cause. Its undeniably multi factorial.

 Clutching at straws Iain, hiding  behind "multifactorilal" wont wash  when there is an elephant in the room. You may ingore him but science has long seen him.

COVID is nabove all a failure of our immune systems, both innate and adaptive. D3 is known form extensice work to promote both. We know from Indonsia, Philippines, India. Belgium. Switzerland that serim 25(OH)D3 below 50 nmol/L is correlated with severe covid and death while aboe 75 it is mosityl mild. Most of western populaiton i/c/UK are weel below 75. RTIs  a re several fold less frequent when D3 > 100 nmol/L ( Yale). COVIID strikes epxecially hard on the elderyl in nurisng home who are mch lower in 25(OH) than the wider populaiton. BAME also, and they sufffer from being less repsonisve to 25(OH) than caucasians. Seaonality in serum 25(OH) is a feature of all devloped nations, and seasoanlity of flu is associated with low D3 at winters end. COVID  is less serious in he antipodes.  Most importnat of all, we know the physiological lelve of 25(OH) is 100 to 150 nmol/L and most nations fail to get more than a tiny percentage to that level. Put all that together and we ahve inderstanding based upon a wide  range of knowledge bases: that is what science does.

Now we  turn to your expectation thet there must be RCTs for D3, treating it as if it were a drug detrmining its minimal effective dose. Lets get it quite clear -that D3 is not a drug NOR IS D3 A VITAMIN that humens volved to extraxt form their diet. This is not an acdemic point it is fundamental  to understandind NICEls catastrophic errror. Humand evolved in Africa in year round sun and derived all thier D3 from sunlight. Diet was and is an  inadequate source, Hiumns did nto eat oily marine fish in  Africa, their D3 all cmae from sunlight on the skin. And gave them aserum25(OH)D3 of  100 -150 nmol/L, whoch is reported today form natural lving tribes eg Maasai, Hazda. When in recent itmes man migrted out nof africa to less suunt climes melainin pigmentaion was lost to try to correct lower skin synthesis. The take home mesage is D3 IS A HIORMONE with a PHYSIOLOGIAL LEVEL. For any committee to seek to ignore that is hubristic beyond belief. And dangerous.

The lsit of disease states that are now known to be infuelced by deficiency of D3 is long. Many are chronic, all are a signifcnat bureden on health services and patients.  Diabetes,  hypertension, many cancers i/c colon and prostate, dementias, depression,,,etc etc etc. And NICE expects a large, expensive RCT trial for  each one independmetly. It is nonsense. RCTs d esigned to test drugsaare hugely expensive and D3  earns no profits so  there are no RCTs that NICE accpts in that long list of diseases.( colon cancers is the only one)

Gradually evidence for the importnace of D3 deficincy is determining the severity.leathlaity of COVID is emerging. And the fallacy that a committe rahter than physiology can determine supplementation will be exposed. COVID we will regard in reotrospect as a blessing that put D3 centre stage in our health services, wiht lifelong benefits of being at a physiological level. And the RCT nonsense killed off once and for all. Meanwhiel this RCT abuse of science is being allowed to keep killling us.

Peter

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VitaminDwiki is collating COVID-D3 research papers, updated daily, with synopsis and links to the paper

https://vitamindwiki.com/

================

The list of diseases in which D3 deficiency is implicated is in the left hand solumn; " Heallth  problems and D". The bigger the number or papers collated is a rough indication of importnace of D3

They use USA units for serum  25(OH)D3 of ng/ml, often sloppily just ng. Multiply this number by 2.5 to get eutopean units of nmol/L

Peter

 

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5 hours ago, Peter Cobbold said:

 Clutching at straws Iain, hiding  behind "multifactorilal" wont wash  when there is an elephant in the room. You may ingore him but science has long seen him.

COVID is nabove all a failure of our immune systems, both innate and adaptive. D3 is known form extensice work to promote both. We know from Indonsia, Philippines, India. Belgium. Switzerland that serim 25(OH)D3 below 50 nmol/L is correlated with severe covid and death while aboe 75 it is mosityl mild. Most of western populaiton i/c/UK are weel below 75. RTIs  a re several fold less frequent when D3 > 100 nmol/L ( Yale). COVIID strikes epxecially hard on the elderyl in nurisng home who are mch lower in 25(OH) than the wider populaiton. BAME also, and they sufffer from being less repsonisve to 25(OH) than caucasians. Seaonality in serum 25(OH) is a feature of all devloped nations, and seasoanlity of flu is associated with low D3 at winters end. COVID  is less serious in he antipodes.  Most importnat of all, we know the physiological lelve of 25(OH) is 100 to 150 nmol/L and most nations fail to get more than a tiny percentage to that level. Put all that together and we ahve inderstanding based upon a wide  range of knowledge bases: that is what science does.

Now we  turn to your expectation thet there must be RCTs for D3, treating it as if it were a drug detrmining its minimal effective dose. Lets get it quite clear -that D3 is not a drug NOR IS D3 A VITAMIN that humens volved to extraxt form their diet. This is not an acdemic point it is fundamental  to understandind NICEls catastrophic errror. Humand evolved in Africa in year round sun and derived all thier D3 from sunlight. Diet was and is an  inadequate source, Hiumns did nto eat oily marine fish in  Africa, their D3 all cmae from sunlight on the skin. And gave them aserum25(OH)D3 of  100 -150 nmol/L, whoch is reported today form natural lving tribes eg Maasai, Hazda. When in recent itmes man migrted out nof africa to less suunt climes melainin pigmentaion was lost to try to correct lower skin synthesis. The take home mesage is D3 IS A HIORMONE with a PHYSIOLOGIAL LEVEL. For any committee to seek to ignore that is hubristic beyond belief. And dangerous.

The lsit of disease states that are now known to be infuelced by deficiency of D3 is long. Many are chronic, all are a signifcnat bureden on health services and patients.  Diabetes,  hypertension, many cancers i/c colon and prostate, dementias, depression,,,etc etc etc. And NICE expects a large, expensive RCT trial for  each one independmetly. It is nonsense. RCTs d esigned to test drugsaare hugely expensive and D3  earns no profits so  there are no RCTs that NICE accpts in that long list of diseases.( colon cancers is the only one)

Gradually evidence for the importnace of D3 deficincy is determining the severity.leathlaity of COVID is emerging. And the fallacy that a committe rahter than physiology can determine supplementation will be exposed. COVID we will regard in reotrospect as a blessing that put D3 centre stage in our health services, wiht lifelong benefits of being at a physiological level. And the RCT nonsense killed off once and for all. Meanwhiel this RCT abuse of science is being allowed to keep killling us.

Peter

Peter, we have had this discussion on here and in private, so why is the data that you passionately believe in being  being ignored? I don't believe there are are prejudices or hidden agendas anywhere, if  Vit D3, (strictly a pro-drug) converted by the liver to the hormone 25(OH) ( your abbreviation not mine) which conveys the benefits. 

Surely if the data was compelling, any Government would want to take advantage of this "cheap, effective remedy", that would restore the Countries economy fast and reduce the catastrophic effects on the economy that we are seeing? 

 

Iain

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39 minutes ago, iain said:

Peter, we have had this discussion on here and in private, so why is the data that you passionately believe in being  being ignored? I don't believe there are are prejudices or hidden agendas anywhere, if  Vit D3, (strictly a pro-drug) converted by the liver to the hormone 25(OH) ( your abbreviation not mine) which conveys the benefits. 

Surely if the data was compelling, any Government would want to take advantage of this "cheap, effective remedy", that would restore the Countries economy fast and reduce the catastrophic effects on the economy that we are seeing? 

 

Iain

Ian, 

That’s the definition of a a “sucker bet,” or to paraphrase Runyon, “ One day a man will offer you a bet that a Tapping the Jack of Diamonds in the card deck will see the Jack sit up and squirt Cider in your ear”. Do not take this bet or you will end up with an ear full of cider”. !

Peter and his family “ have got skin in this game” a powerful interest?, Maybe a different view from “experts” who don’t Want to be the one to exclaim, “ The King isn’t wearing any clothes” !

Mick Richards

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Mick 

I understand Peters enthusiasm and believe it or not I think he has a very valid point, but, those in a position of major influence don't seem to want to bite. Why? I started this dialogue with Peter to try and help as someone with 25 years experience of the hurdles the Pharma Industry have to jump to make medical progress. I  have experience of sitting on a Nice Stakeholder Group as an industry representative. ( Ironically for Parkinsons in which I had skin with my Grandmother and Father both being sufferers and eventually dying of the complications) . In conclusion there is an issue, the data is either poor, in a format that is unacceptable or some other valid reason, poor study design, not peer reviewed, in pay for publication journals,etc etc . To blatantly ignore good data would be a crime. 

Peter has not addressed these issues when asked, he has just pointed accusatory fingers and called them incompetent. In my experience this is not a way to win friends and influence people.

Iain

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https://www.nice.org.uk/process/pmg20/chapter/reviewing-research-evidence#assessing-quality-of-evidence-critical-appraisal-analysis-and-certainty-in-the-findings
 

Section 6.2 onwards describes the robust methodology used to assess data, for those with an interest. 

Please  remember NICE does not grant licences for products it evaluates the evidence and decides on that interventions “value “ in terms of Cost Benefit or Qualy or other recognised Health Economic outcome.
The MHRA grants licences based on safety and efficacy. VitD3 is not recognised as a pharmaceutical. It’s is currently a borderline substance, there are no regulations applying to its manufacture or distribution. Perhaps this is the issue. If it were manufactured and distributed as a POM or P product or even GSL it would have to have a pharmaceutical dossier supporting it. Manufacturing process, quality control, safety, etc and the Company manufacturing it would have a legal obligation to provide pharmacovigilance. 

Iain
 

 

Iain

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Until a proper study is done we are just going to go around in circles. There is more than enough evidence in the role that vit D plays, why being deficient is bad and i'm ok with saying people in the northern hemisphere will probably not hurt themselves taking 1000 or 2000 IU a day in winter.

the recent studies show high correlation between covid19 outcomes and vit D levels but that just fuels the conjecture.

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8 hours ago, iain said:

https://www.nice.org.uk/process/pmg20/chapter/reviewing-research-evidence#assessing-quality-of-evidence-critical-appraisal-analysis-and-certainty-in-the-findings
 

Section 6.2 onwards describes the robust methodology used to assess data, for those with an interest. 

Please  remember NICE does not grant licences for products it evaluates the evidence and decides on that interventions “value “ in terms of Cost Benefit or Qualy or other recognised Health Economic outcome.
The MHRA grants licences based on safety and efficacy. VitD3 is not recognised as a pharmaceutical. It’s is currently a borderline substance, there are no regulations applying to its manufacture or distribution. Perhaps this is the issue. If it were manufactured and distributed as a POM or P product or even GSL it would have to have a pharmaceutical dossier supporting it. Manufacturing process, quality control, safety, etc and the Company manufacturing it would have a legal obligation to provide pharmacovigilance. 

Iain
 

 

Iain

Iain, D3 should never have been witihn NICE responsibity to determine dose. Thats strictly a job for science, and the science on that has been ignored by NICE.The protocl denies its inclusion.

I have no issues with committees looking at cost-benefit, However when D3 is under that scrtiny it is essential that the phama industry has no input whatsoever, A population that is replete with D3 is an enormous threat to pharmas profits. On a cost-benefit basis D3, at around £10 pa ( or free form the sun) , is without any doubt the most efffective multi-puprose defensive hormone we  have been denied- denied by NICE, Why? We need to look at who determined that the same protocol for evaluaitng drugs was to be applied to a  hormone.If pharmas had  input to that  then there may be smoking gun,:the motivation to impair the efficacy of D3 is there in spades. The panel itself carries a burden of guilt by continuing its deliberation using what must have become obvious to its scientists, was an inappropriate protocol.

I have no objection to quality control, providing the cost increase is marginal. Imposing quality control on the sun might present a challenge.

Peter

 

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Peter ......the regulatory process came about and has been refined to what has been acknowledged as the best in the World as a result of the Thalidomide tragedy. I’m sure no one would argue that this is not necessary.

To argue that Pharma has such influence over NICE is frankly ridiculous. Stakeholders included in every assessment include physicians, researchers, patient groups, nurses, gps, charities,.........anyone with a genuine need to be included in the “ cross functional team. Pharma are only involved if they have a therapeutic agent for the disease being assessed and can only draw attention to the published data they have.....their is no discussion on its merit. It’s just to ensure it is included in the evidence case.

Perhaps you could review the 2014 stakeholder document for VitD and gain an insight to the process resulting in the current guidelines and its deficiencies. 

https://www.nice.org.uk/guidance/ph56/documents/implementing-vitamin-d-guidance-draft-guideline-stakeholder-comments-and-responses-table2

 

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Well.....started coughing on Thursday, headache , sore throat....Being tested today. 

Fingers crossed its just a summer cold/flu. 

Worse case scenario is that it's "man flu" and we all know that's more leathal than C-19 !!

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