key: cord-0895009-luxjxf9i
authors: Lewiecki, E. Michael
title: Vitamin D and COVID-19: Is something better than nothing?
date: 2020-09-03
journal: Osteoporos Sarcopenia
DOI: 10.1016/j.afos.2020.08.005
sha: ae6726cbde99a1edd9b8a8e13d20d25244bfe423
doc_id: 895009
cord_uid: luxjxf9i

There is no abstract.

than none." This was purportedly the view of Gottlieb Burckhardt, the "father" of psychosurgery, in reference to brain surgery for patients with schizophrenia [2] . When Dr. Burckhardt reported surgical outcomes for 6 of his patients, the results were unimpressive, but that was in 1891, when there was no known treatment for schizophrenia. Now that psychopharmaceuticals are widely available, approaches to the treatment of schizophrenia are vastly different. There are certainly instances when dangerous remedies are not better than none. They may simply be dangerous.

Some proposed but unproven treatments for COVID-19 have been followed by harmful outcomes (eg, adverse effects of hydroxychloroquine) and even death (eg, ingestion of disinfectants). When recommendations from governments and public health experts are inconsistent or late in coming, rumors and misinformation are likely to influence behavior of many individuals, resulting in panic buying and treatments that may be ineffective or dangerous [3] . For non-COVID disorders, sometimes doing nothing is better than doing something, such as not prescribing an antibiotic for viral pharyngitis, the use of which could ultimately result in emergence of antibiotic-resistant microorganisms, or not doing a prostate biopsy in an elderly man with borderline high prostate specific antigen, which would expose the patient to potential adverse effects of surgery with minimal benefit [4] . In some situations, doing "nothing" is actually an active beneficial process, as when a patient with osteoporosis who does not want drug therapy is monitored periodically to reassess fracture risk and treatment strategies. Adaptive immunity is the process by which immunological memory to a specific antigen is established with a timeline that is slower than innate immunity. It is mediated through two types of lymphocytes, B cells that are responsible for humoral immunity and T cells for cell- There is no evidence that vitamin D is effective at treating these diseases.

"Cytokine storm" is a term used to describe a hyperactive immune response to COVID-19. Although much yet to learned about the pathophysiology of cytokine storm, it appears to be mediated by chronic activation of the innate immune system with an overly exuberant release of pro-inflammatory cytokines and chemokines, leading to excessive activation of adaptive immunity [7, 10] . The clinical manifestations include acute lung injury, wide-spread tissue damage, multi-organ failure, and death. It has been postulated by some that vitamin D might help to mitigate the severity of cytokine storm by downregulating toll-like receptors and diminishing activation of mediators of inflammation.

In the spectrum of translations of anceps, where should we place vitamin D and COVID-19? Considering the best available evidence at this time, maintaining an adequate level of vitamin D is "something" that should be recommended for all of us, especially those at risk for vitamin D deficiency. It is an "uncertain" remedy for the treatment of COVID-19, but with further investigation we may soon know more. It is important to learn whether adequacy of vitamin D is simply a marker of good health that is associated with lower risk and better outcomes with COVID-19, or a useful medication for prevention and treatment of the disease.

Vitamin D is clearly not a "dangerous" remedy for COVID-19 and is unlikely to cause harm.

The author has no conflict of interest relevant to the content of this editorial.

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Controversies in Vitamin D: Summary Statement From an International Conference

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