Part 10 COVID-19 Knowledge Update Part III
In part 3 of the COVID-19 knowledge update, I will focus on the various risk factors for severe cases of COVID-19. Some of these risk factors can be managed through lifestyle changes, while others unfortunately cannot. Knowing the factors for which we can mitigate our risk of serious complications is an important piece of the puzzle in avoiding the potentially dangerous consequences of this disease. By diminishing the negative impact of the virus on our health, we can shift the society back towards the old “normal.” Hopefully, for many people, positive lifestyle changes motivated by avoiding serious consequences from COVID-19 will be permanent. In that case, the overall health span for the population could potentially improve.
Risk Factors for Severe COVID-19 Illness
Many have been trumpeting the figure that 94% of COVID-19 deaths are associated with underlying conditions. Those utilizing this statistic to undervalue the threat of COVID-19 are either ignorant of the prevalence of underlying conditions or flat-out dishonest.
I would even go as far as to say they are criminally dishonest. For instance, obesity is one of the many listed underlying conditions by the CDC, and obesity is present in over 42% of those living in the United States. Diabetes, for which obesity is often (but not always) a contributing factor, is another underlying condition that affects 10.5% of all people living in the United States. What about other underlying conditions? There is also heart disease, which is the leading cause of death in the United States and afflicts about 23% of those living in the United States. There are several other risk factors of severe COVID-19 illness at play in the CDC report, including chronic obstructive pulmonary disease and chronic kidney disease. It is safe to say that over 50% of those living in the United States would be considered to have underlying conditions, and therefore could be at increased risk. However, these risk factors do not include age, even though the vast majority of those at an advanced age will likely have one of the other underlying conditions present.
It is incredibly easy to dismiss a risk when you believe that the numbers are skewed to include only those individuals with underlying conditions. Moreover, it complicates the emotional response in knowing that over 50% of people in the country have underlying conditions, particularly, if you are part of this 50% or are close to someone who is, which is highly likely.
Risk Factors Not Reported in the CDC Evaluation
Sickle Cell Disease
A new at-risk category has recently emerged — sickle cell disease, an abnormality in the oxygen-carrying protein hemoglobin found in red blood cells. Roughly 100,000 Americans have sickle cell disease, while an estimated 2 million others carry the gene responsible for causing this disease. Questions linger regarding whether merely carrying the gene increases risk. Evidence points to having sickle cell disease is associated with higher risk of COVID-19 complications, and research suggests that individuals with sickle cell disease have a 7% case fatality rate, which is also alarming due to the average age at death being below 40 years.1
Moreover, sickle cell disease disproportionately affects those of African descent, with 1 in 13 African Americans being born with sickle cell traits, and 1 in 365 having sickle cell disease,2 which is a rate of roughly 10 times that of the average U.S. resident.
A study that included over 1 million people has found that having the blood type “O” significantly lowers the risk of infection with COVID-19, as reported in Technology Networks.
Unfortunately for men, simply being a male seems to increase the risk of serious complications from contracting COVID-19. Researchers from Turkey have determined that sharp declines in testosterone levels seen due to being sick with COVID-19 can lead to significantly higher rates of patients needing hospitalization.3 This could be a causative factor in helping to explain why men are twice as likely to die from COVID-19 infection, as published in Frontiers in Public Health,4 with the gap in rate of death depending on gender and increasing with age, as reported in an article published in Nature.
We have a lot more information to sift through and study in regard to genetic risk factors at play and COVID-19. To date, it has been reported that a cluster of genes we have inherited from the Neanderthals that are carried by approximately 50% of people from South Asia and approximately 16% of Europeans may play a role in contributing to severe COVID-19 cases. These genes play a role in how the angiotensin-converting enzyme 2 (ACE2) receptor is expressed in the body, according to an article written for Business Insider. This is not surprising or new information, with researchers at the very beginning of the pandemic talking about the importance of ACE2, such as from this article in ScienceMag.
“It’s hard to predict what will pop out from these gene hunts, some researchers say.But there are obvious suspects, such as the gene coding for the cell surface protein angiotensin-converting enzyme 2 (ACE2), which the coronavirus uses to enter airway cells. Variations in theACE2gene that alter the receptor could make it easieror harder for the virus to get into cells, says immunologist Philip Murphy of the National Institute of Allergy and Infectious Diseases, whose lab identified a relatively common mutation in another human cell surface protein, CCR5, that makes some people highly resistant to HIV.”
This cluster of genes inherited from Neanderthals may significantly increase the risk of respiratory failure in South Asians compared to Europeans, according to Biorxiv.5 This single gene cluster is not the “end all” of risk factors. Another report links a combination of genes also connected to ACE2 expression — more frequent in those of African (39%) and non-Finnish European descent (54%), as compared to those of South Asian, Latin American, and Finnish descent (2–10%) —with a significantly higher risk of cardiac and pulmonary issues.6
So far, the data suggests that non-Hispanic Black individuals/African Americans are at the greatest risk of death from COVID-19 in the USA, which is approximately 2.1 times higher than average. However, there are numerous factors that would need to be investigated other than genetics, such as access to the same quality of care, which could be considered as confounding variables. This is further posited by another article and study7 that suggest that the genetic risk factors for the viral entry via ACE2 receptors are unlikely to increase morbidity, as the differences between function and across ethnic groups is negligible. Rather, it is variability from other risk factors from various groups, such as pre-existing conditions and access to healthcare, that has led to the large disparity in fatalities.
What is important is the knowledge that different genes may lead to different symptoms and severity of COVID-19 illness (and in general for many other illness’s and risks). Increasing knowledge on this front can help practitioners prescribe personalized treatment plans and medication, which I believe to be the future of healthcare.
Sleep apnea has been reported as a significant risk factor for severe cases of COVID-19,8 but this should not be shocking in any way, shape, or form. In fact, the paper in question, which was reported in a major science-based news source, admits that the factors associated with obstructive sleep apnea are known to increase the risk of severe cases and death from COVID-19, and it is unknown whether sleep apnea further increases that risk! Basically, it is an admittance that their systematic review is utterly worthless, providing no new insights. Here is a quote from the review:
“It is associated with increased prevalence of hypertension (39%), obesity (34%), depression (19%), gastroesophageal reflux disease (GERD) (18%), diabetes mellitus(15%), hypercholesterolemia (10%), asthma (4%) . Many of these factors have also been identified as risk factors for poor COVID-19 outcomes . It is unclear whether the virus might pose an increased risk for patients with OSA.”
There is a good basis to presume sleep apnea would create a further risk factor above the associated risk factors with the sleep apnea, simply by reducing sleep quality. We know that sleep quality plays an important role in immune system function, both in terms of contracting a virus as well as in the associated outcomes once a viral infection occurs. While there is currently no published research detailing sleep quality and COVID-19, research suggests that individuals getting less than 7 hours of sleep a night are three times as likely to be infected by the common cold.9 Further, a large prospective study carried out on over 50,000 women found that women who slept less than 5 hours a night were 70% more likely to develop pneumonia,10 which of course can occur with COVID-19.11 According to the results of another study, mice that were deprived of sleep at specific sleep stages, such as REM sleep, and then exposed to malaria had a significantly increased risk of death compared to well-rested mice.12
Poor sleep quality can even play a role in developing immunity. One study looked at the response to flu vaccines and found that insufficient sleep in the week leading up to vaccination yielded less than 50% of the normal antibody response.13 Having an adequate antibody response is critical for acquired immunity, and decreased antibody production in response to the flu vaccine would lead to the vaccine being less effective.
Vitamin D Deficiency
I first mentioned a potential correlation between Vitamin D and severe cases of COVID-19 in an opinion piece I wrote in April titled “COVID-19, the Aversion of AgingScience, and the Psychology of Fear.” The position that Vitamin D could protect against COVID-19, while labeled as “ridiculous” by many in the mainstream media, was not random. Here is a quote from a letter published in the British Medical Journal earlier in February:
“There is reasonable evidence that higher 25-hydroxyvitamin D [25(OH)D] concentrations reduce the risk of respiratory tract infections. A meta-analysis of vitamin D supplementation trials found an inverse relationship between vitamin D supplementation and incidence of acute respiratory tract infections, especially for those with 25(OH)D concentrations below 25 nmol/l . Several mechanisms by which vitamin D reduces risk of respiratory tract infections have been identified. One is that cathelicidins and defensins are induced that have antimicrobial and antiendotoxin properties . Another is that vitamin D reduces the production of pro-inflammatory cytokines and increases production of anti-inflammatory cytokines 2. The innate immune system often goes into overdrive during respiratorytract infections, resulting in the cytokine storm that can damage the lining of the lungs . Serum 25(OH)D concentrations have been found to be inversely correlated with development of acute respiratory distress syndrome .”
Another letter published in The Lancet stated the following, in advance of the results of clinical research:
“Pending results of such trials, it would seem uncontroversial to enthusiastically promote efforts to achieve reference nutrient intakes of vitamin D, which range from 400 IU/day in the UK to 600–800 IU/day in the USA. These are predicated on benefits of vitamin D for bone and muscle health, but there is a chance that their implementation might also reduce the impact of COVID-19 in populations where vitamin D deficiency is prevalent; there is nothing to lose from their implementation, and potentially much to gain.” (my emphasis)
This is a key reason why during the tail-end of winter, while many of us were locked down in quarantine, I made the decision to give away free bottles of vitamin D with every purchase of Rejuvenation (while also giving away profits to food banks). In fact, we intend to start giving away vitamin D to our customers shortly, as we gradually ease into fall and lose more daylight hours.
Despite evidence trickling in since early on in the pandemic that there may be a correlation between vitamin D deficiency and mortality due to COVID-19,14 and that vitamin D levels play a role in mortality rates, many articles in the mainstream media — and even more Facebook posts from self-proclaimed skeptics — advised against taking vitamin D supplements. Notably, Dr. Fauci, whom many in the alt health space unfairly malign, is on record advising to supplement with vitamin D (and vitamin C), stating he takes them himself.
I’d expect nothing else from the Facebook “skeptic” crowd, as they need to parrot this refutation to maintain their own image and appeal to their base. Unfortunately, the motivations from media are similar; negative stories trend far more than positive stories, and positive stories on subjects without clear consensus may seriously impact their Google rankings. This is a critical point that I have an entire article dedicated to, so stay tuned. So, what exactly are some of the publications saying? Here are some of the top-ranking queries:
From The Toronto Star
“Before we go any further, though, there is absolutely no evidence to support the idea that vitamin D has therapeutic value for people infected with or exposed to the virus.”
From The Conversation
“Does vitamin D ward off coronavirus? Don’t reach for the supplements yet.”
The date on this TIME article, September 17, was after more evidence emerged regarding the highly significant correlation between Vitamin D levels and serious COVID-19 cases and has been widely reported. Note the sensational wording with “No Evidence” in the title, and that they are considered to be a “trusted source” by News Guard.
In fact, as reported in Forbes, adequate vitamin D levels halves the risk of dying from COVID-19, according to a new study published15 on September 25.Prior to this article, on September 10, Dr. Fauci stated the following:
“If you are deficient in vitamin D, that does have an impact on your susceptibility to infection. So I would not mind recommending, and I do it myself, taking vitamin D supplements.”
In fact, evidence is emerging that adequate vitamin D levels may also play a role in reducing the risk of becoming infected with the novel coronavirus, as reported in Science Daily. This is from a study published September 3 that was widely reported in the media, which was 2 weeks before the TIME article came out.
“The research team looked at 489 UChicago Medicine patients whose vitamin D level was measured within a year before being tested for COVID-19. Patients who had vitaminD deficiency (< 20ng/ml) that was not treated were almost twice as likely to test positive for the COVID-19 coronavirus compared to patients who had sufficient levels of the vitamin.”
Can any of the above evidence be considered conclusive that vitamin D supplementation can protect against COVID-19? Absolutely not. There is also no evidence that supplementing with vitamin D in excess, as in above recommended levels, confers any health benefit. In fact, I wrote about vitamin D supplementation in general, and the false belief that “more is better,” in one of my first articles. The number of individuals deficient in vitamin D will dramatically rise in the coming months, and the benefits of taking it as a supplement could be quite substantial. To once again quote the opinion piece published in The Lancet:
“There is a chance that their implementation might also reduce the impact of COVID-19 in populations where vitamin D deficiency is prevalent; there is nothing to lose from their implementation, and potentially much to gain.” (my emphasis)