Quote from RobertBryant

"Indonesian study: Low Vitamin D patients ten times more likely to die of Coronavirus

"If this is confirmed, Coronavirus is almost a disease of Vitamin D deficiency

preprint via http://joannenova.com.au/

http://joannenova.com.au/2020/…to-help-beat-coronavirus/

"After controlling for known risk like being old, or male or having high blood pressure, a Vitamin D level described as deficient (less than 20ng/ml) was associated with a 10 fold greater risk of death. These are quite extraordinary numbers. In most medical studies an OR (odds ratio) as low as 1.3 is notable enough to get published. But these are OR’s of 10."

The devil as always is in the detail. A lot of the COVID studies suffer this same issue that makes the results worthless:

To determine the association of Vitamin D status and mortality outcome, all ORs were adjusted for age, sex, and comorbidity using a generalized linear model. A p-value less than 0.05 was considered statistically significant.

The deconfounding of the very strong age dependence will not work if dependence is treated linearly, because the dependence on age is:

(a) highly nonlinear

(b) very strong

And Vit D will correlate very strongly (and inversely) with age.

So, without checking the maths, or being sensible about what the maths means, you get garbage results.

They could take this data, generate age balanced buckets, look at the correlation with each bucket between vit D and mortality (doing the same linear deconfounding per bucket). Combine results. Within each bucket the dependence on age would be linear (if buckets were small enough - say 3 years). That would give more believable results.

Notwithstanding that it is a good call to make sure Vitamin D levels are high, not proven to help but mild evidence supporting the possibility:

https://www.mdpi.com/2072-6643/12/4/988

Several observational studies and clinical trials reported that vitamin D supplementation reduced the risk of influenza, whereas others did not. Evidence supporting the role of vitamin D in reducing risk of COVID-19 includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest; that the number of cases in the Southern Hemisphere near the end of summer are low; that vitamin D deficiency has been found to contribute to acute respiratory distress syndrome; and that case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration. To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40-60 ng/mL (100-150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.

That is why it is a pity that observational studies are on this topic are not more carefully conducted! Having said that, the above (v poor) study is not on any of the main preprint servers, and published on a fringe site known for unreliablescience reporting.

if it gets posted on a preprint server it will get commented on severely. I guarantee.

THH

Well after all that molecular biological work in the Nature paper hydroxychloroquine still checks out as the most easily obtainable and effective biochemical agent against COVID. Note no mention in either intro or discussion, perhaps avoiding the political problem, whilst remdesivir is highlighted in both (even as clinical trials have failed). So we can carry on using HCQ until PB28 becomes availiable, providing it doesn't make your hair fall out, induce heart attacks or give you cancer.

.......and no mention of our other wonderdrugs ivermectin or the antiviral properties of azithromycin or doxycycline. None of these understandably are of any commercial interest so why bother studying them?

Given (looking at the above review) a lot of the vit D observational studies are weak, maybe the strongest evidence for benefits comes from

https://www.sciencedaily.com/r…/2017/02/170216110002.htm

Vitamin D supplements protect against acute respiratory infections including colds and flu, according to a study led by Queen Mary University of London (QMUL).

The study provides the most robust evidence yet that vitamin D has benefits beyond bone and muscle health, and could have major implications for public health policy, including the fortification of foods with vitamin D to tackle high levels of deficiency in the UK.

The results, published in The BMJ, are based on a new analysis of raw data from around 11,000 participants in 25 clinical trials conducted in 14 countries including the UK, USA, Japan, India, Afghanistan, Belgium, Italy, Australia and Canada. Individually, these trials yielded conflicting results, with some reporting that vitamin D protected against respiratory infections, and others showing no effect.

Lead researcher Professor Adrian Martineau from QMUL said: "This major collaborative research effort has yielded the first definitive evidence that vitamin D really does protect against respiratory infections. Our analysis of pooled raw data from each of the 10,933 trial participants allowed us to address the thorny question of why vitamin D 'worked' in some trials, but not in others.

"The bottom line is that the protective effects of vitamin D supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly rather than in more widely spaced doses.

"Vitamin D fortification of foods provides a steady, low-level intake of vitamin D that has virtually eliminated profound vitamin D deficiency in several countries. By demonstrating this new benefit of vitamin D, our study strengthens the case for introducing food fortification to improve vitamin D levels in countries such as the UK where profound vitamin D deficiency is common."

The plot however thickens.

Look at the responses to this paper (and replies to those responses) and make up your own mind.

https://www.bmj.com/content/356/bmj.i6583/rapid-responses

Correction, they did do an antiviral assay on azithromycin which looks slightly effective above 100 uM. Pretty useless, perhaps doxycycline would be a better alternative after all, although as yet untested has antiviral properties and less cardiac and renal toxicity.

https://www.cebm.net/covid-19/…or-prevention-in-covid-19

Clinicians should treat patients with vitamin D deficiency irrespective of any link with respiratory infection.

Policymakers should attend to public health measures to ensure the population has adequate vitamin D intake.

In the UK, 25 nmol/L (1ng/ml) is used as the cut off for deficiency, .

Vitamin D deficiency is very common, particularly in winter.

In January to March in the UK, 30% of people aged 65 years

and over and 40% of people aged 19–64 years had serum vitamin D concentrations below 25 nmol/L.[6]

The UK government’s SACN report identifies people at high risk of deficiency [4]:

• Infants and children aged under four years old;
• Pregnant and breastfeeding women, particularly teenagers and young women;
• People over 65;
• People who have low or no exposure to the sun,
• and those who are housebound or confined indoors for long periods;
• People with darker skin,
• for example people of African, African-Caribbean, or South Asian family origin.

Quote from RobertBryant

https://www.cebm.net/covid-19/…or-prevention-in-covid-19

Clinicians should treat patients with vitamin D deficiency irrespective of any link with respiratory infection.

Policymakers should attend to public health measures to ensure the population has adequate vitamin D intake.

In the UK, 25 nmol/L (1ng/ml) is used as the cut off for deficiency, .

Vitamin D deficiency is very common, particularly in winter.

In January to March in the UK, 30% of people aged 65 years

and over and 40% of people aged 19–64 years had serum vitamin D concentrations below 25 nmol/L.[6]

The UK government’s SACN report identifies people at high risk of deficiency [4]:

• Infants and children aged under four years old;
• Pregnant and breastfeeding women, particularly teenagers and young women;
• People over 65;
• People who have low or no exposure to the sun,
• and those who are housebound or confined indoors for long periods;
• People with darker skin,
• for example people of African, African-Caribbean, or South Asian family origin.

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In the Uk pretty well everyone has low or no exposure to sun in winter, and likely also in Summer if they pay attention to skin cancer protection.

So some supplementation to deal with deficiency is worth it - unless you have been tested and know at end of winter you are not deficient.

My preferred suggestion for stopping lockdown. It needs political will and time to prepare, but is possible and would be highly cost-effective:

https://www.medrxiv.org/conten…101/2020.04.27.20078329v1

We propose an additional intervention that would contribute to the control of the COVID-19 pandemic, offer more protection for people working in essential jobs, and help guide an eventual reopening of society. The intervention is based on: (1) testing every individual (2) repeatedly, and (3) self-quarantine of infected individuals. Using a standard epidemiological model (SIR), we show here that by identification and isolation of the majority of infectious individuals, including those who may be asymptomatic, the reproduction number R0 of SARS-CoV-2 would be reduced well below 1.0, and the epidemic would collapse.

Quote from THHuxleynew

I think this is based on ignoring the incredible advances in research on genomics and vaccine-related tech in the last few years, and the enormous stried made by the international Coalition for Epidemic Preparedness Innovations (CEPI) funded of course by Gates

What are you talking about ?? The total failure of providing an AIDS vaccine ? The total failure of providing a MERS vaccine or any corona virus vaccine, Malaria vaccine....??

You simply are a dreamer or a paid (Gates ?) poster that ignores any safety rules we installed for the last 20 years.

Vaccines can be as harmful as the disease or even worse. That's why the test-base is increased stepwise from e.g. 10 to 100 to 1000 people.

We here in Switzerland name the people that are a member of the 10 to 100 test-set trials Pharma hustlers, because they get between 1000 -5000$ for one trial.

This 1 mio$ first round payment is often circumvented by many companies, that simply do ask the Indian/Chinese pharma mafia to organize black market trials telling people they just try flu or something simple instead these victims do get an experimental drug.

If your so called progress in vaccination is based on Chinese/India slave tests, then may be it has some base...

(China has a large > 1 mio. test base of jailed Uyghurs and Falun gong members that quite often also are used as an instant organ supply.)

Quote from oldguy

yes may of the young "recover" but I understand that most end up with damaged lungs. I makes me wonder what will happen to them in the future. Will they have a shortened life expectancy do to the damage and any future stresses on their lung/heart?

I do not know if "most" end up with damaged lungs, but of the 20% that are hospitalized, reports say that many have damaged lungs. I do not know what percent. There are reports of young people who still cough up blood weeks after recovering, and are out of breath after climbing stairs. I read that it is too soon to know whether they will fully recover. However, after the 1918 epidemic, many people had similar problems for life, and many died young.

One doctor wrote recently that much of the lung tissue ends up stiff, a bit like stale marshmallow, and there is no recovering from it.

There are other reports of blood clots, especially in young people. These can lead to sudden death by strokes, or to amputations. There are many other grim outcomes.

In any case, this is a very serious illness. For about 20% of young patients, it is much worse than seasonal flu. When I was young, I had seasonal flu that developed into pneumonia. It was serious. I was in the hospital for a week, and it took me a month to recover, but there was no long term damage, and the doctors were never worried about that. I had pleurisy for a week after I got home, which was painful. As in "take 4 Ibuprofen several times a day" painful (doctor's suggestion).

Quote from seven_of_twenty

I don't want to go too far OT here but reducing obesity is currently impossible.

How can it be impossible? Obesity was rare in the U.S. until the late 1970s, and it is rare in other countries such as Italy and Japan. We Americans have not changed since 1970. I haven't. I weigh the same as I did back then, and the same as my parents, siblings and friends. None of us are obese. I do not know any obese Japanese people, and I know lots of Japanese people. I saw one obese women in Sapporo a few years ago at a donut store. She stood out from the crowd.

All we have to do is go back to living and eating the way we did then. There is no need to exercise intensely. My father never did much exercise after getting out of the army in WWII. Neither did most of the men of his generation. They drove around in cars rather than walking, more than I do. Yet few of them become obese.

Quote from seven_of_twenty

Most medications and commercial diets (like where they supply your food) don't and can't work for most people. And there is a very simple, mostly ignored reason although several papers and books document it. The only way to reduce someone's obesity for the long run is to modify appetite.

That's true, but a common sense diet and living the way we did in 1970 solves the problem. Living the way everyone does in Japan solves the problem. Just eat reasonable quantities of delicious food and the problem goes away for nearly everyone. It does not seem like rocket science to me. I realize that people who are obese already have difficulty losing weight, but tens of thousands have done it quite successfully. The success rate is much higher when patients get professional help from doctors who specialize in this. See the research papers here: http://www.nwcr.ws/

My dad said that many fat men drafted into the army in WWII got thin practically overnight with Basic Training, and many of them stayed that way for life. So we might recommend joining the army as way to get thin. Just a suggestion.

Quote from seven_of_twenty

When you say to a fat person to reduce their food intake, it's like asking someone to breathe less or sleep less.

It does not seem that way to me. About 20 years ago my doctor told me I was getting fat at ~190 lbs. (I am around 5' 11', so that is a high BMI.) I ate less, lost 20 lb in about 2 months, and I have not changed since then. I hardly noticed. I get lots of exercise, and I always have, so that helps. I still eat pie and ice cream on Sundays. Why not?

Maybe it is just me, but losing weight takes little willpower compared to other things I have done, such as learning Japanese kanji, writing 100,000-line programs, or copy-editing a dozen papers by Russian scientists. You get a little more hungry by 5 p.m. You are supposed to get hungry every day. That's normal. One thing I have noticed in comments by people who suffer from obesity is that they think you should never be hungry during the day. They think they are suffering when their stomach growls and they feel seriously hungry. Whereas that seems normal to me. Pleasurable, even, when I have supper. Hunger is the best sauce, as they say in France.

It is a cultural thing. People can always change their culture. We are remarkably flexible. Japanese people changed their culture radically in 1868 and again in 1945. Americans have changed a lot since the 1950s, with regard to things like sexual morality and race relations. (Not me, but other Americans changed.)

Shane D. The biochemistry speaks for itself, I have always been a socialist but support your President because his instincts however bizarre in this respect are correct. If he can sweep these idiots who are objecting to using a life saving remedy to one side and so save thousands of lives then good luck to him and his fellow Republicans.

Quote from THHuxleynew

My preferred suggestion for stopping lockdown. It needs political will and time to prepare, but is possible and would be highly cost-effective:

https://www.medrxiv.org/conten…101/2020.04.27.20078329v1

We propose an additional intervention that would contribute to the control of the COVID-19 pandemic, offer more protection for people working in essential jobs, and help guide an eventual reopening of society. The intervention is based on: (1) testing every individual (2) repeatedly, and (3) self-quarantine of infected individuals. Using a standard epidemiological model (SIR), we show here that by identification and isolation of the majority of infectious individuals, including those who may be asymptomatic, the reproduction number R0 of SARS-CoV-2 would be reduced well below 1.0, and the epidemic would collapse.

This is what has been done in Korea and Japan, where the epidemic has indeed collapsed. Yesterday, Gov. Cuomo of New York announced a program like this. It will be directed by Blumberg. Blumberg is a good choice because the project requires internet and big data resources, which he pioneered, and public health, which he has made large philanthropic donations to at Johns Hopkins and elsewhere. Johns Hopkins experts will direct the medical and public health aspects of the project. They have an online examination for people who want to apply to the case tracing jobs. I think they said that most of the case tracing "army" will be people presently employed by the state of New York. Most of people assigned to case tracing in Japan are local government employees. That's a good choice. They have access to address records; they are used to bothering members of the public on the telephone; and they have nothing better to do at present. I do not know who the cyber experts will be, but I expect Blumberg is well connected to that business. A company such as Google or Microsoft could handle it.

In New York, they mainly want to trace cases forward. That is, instead of asking patients, "who infected you?" they will ask: "Who have you been in contact with in the past two weeks? We will contact them and recommend they come in for a test."

This is definitely cost effective. It is thousands of times cheaper than letting 60% of the population get infected (the herd immunity approach). It also saves millions of lives compared to that approach.

The governor of Georgia seems determined to kill as many Georgia citizens as he can. See:

Georgia Drops Driving Test Requirement for License Due to Pandemic

https://www.complex.com/life/2020/04/georgia-drops-driving-test-requirement-for-license-due-to-pandemic

Quote from THHuxleynew

https://www.medrxiv.org/conten…101/2020.04.27.20078329v1

Here is a really important aspect of this proposal:

"Our model also indicates that unlike sampling-based tests, population-scale testing does not need to be very accurate: false negative rates up to 15% could be tolerated if 80% comply with testing every ten days, and false positives can be almost arbitrarily high when a high fraction of the population is already effectively quarantined."

Even when your methods of measuring are inaccurate, or crude, or unreliable, you can still make good use of them. You can adapt the project to work with the limitations of the method. This is often done in natural science, where researchers can only make very rough estimates. I was once involved in a project with naturalists to observe and estimate the number of fish in the Inland Sea around Okayama. It was extremely crude. We went out on motorboats and looked around. We really had no idea. It resembled the annual Audubon society Great Backyard Bird Count. Which is to say, it was better than nothing.

Quote from JedRothwell

Obesity was rare in the U.S. until the late 1970s, and it is rare in other countries such as Italy and Japan. We Americans have not changed since 1970. I haven't. I weigh the same as I did back then, and the same as my parents, siblings and friends. None of us are obese. I do not know any obese Japanese people, and I know lots of Japanese people

Let me emphasize that I am not bragging about how virtuous my friends and I are. We are normal! This is how nearly everyone in the U.S. used to be. Look at photos of crowds of people in 1970. You see few obese people.

I am not saying we have some extra measure of discipline, and those fat people should darn well shape up. (Many people do say that, but not me.) There was nothing special about being at a healthy weight in 1970. No one thought twice about it. We just went about our lives eating ordinary food. Such as a peanut butter and jelly sandwich and an apple for lunch. It was no more praiseworthy than going to work every day, or brushing your teeth. Everyone did it.

What has changed since then is readily apparent to me. I can see the changes everywhere. For example, food portions in restaurants and fast food places were much smaller. See:

https://www.dailymail.co.uk/he…s-20-years-ballooned.html

Gas stations did not sell food. There were no soft drink machines or candy machines in middle schools or high schools. That would have been unkinkable! Grocery stores today have all kinds of packaged and prepared foods, frozen foods, snack foods and so on that did not exist back then. Food is much cheaper as a percent of income. So, people eat a lot more than they used to. Eating huge amounts has become normalized. No one sees anything unusual about it, or wrong about it. Apparently, they do not realize it is unhealthy. I see examples of that when I go to an all-you-can-eat buffet when driving from Atlanta to Washington. If I ate as much as the people I see there, I would throw up.

Changes are everywhere. I see no reason why we cannot change things right back to where they were. The problem will gradually go away. Perhaps I am simple minded or literal minded, but when I see a critical problem with a simple solution, I cannot imagine why we don't all do it. The same with this coronavirus epidemic. We now see how entire nations such as Korea have dealt with it effectively. They have had little loss of life, not much suffering, no curtailment of their rights, no lock-down, and it cost them a tiny fraction of the money we have been forced to spend. So why don't we do what they did?!? If they can do it, of course we can. What is stopping us??? Fortunately, Cuomo the other governors in the northeast plan to do what the Koreans did. Unfortunately, the governors in Georgia and other southern states seem to have no plans to do anything like this. Yesterday the governor's office said the stay-home restrictions would end at midnight, and the governor would announce additional measures today. Which is doing things backwards. I have not seen an announcement but the local experts at Georgia Tech and places like that say the governor never consulted with them and the whole thing is a fiasco. See:

"Georgia Went First. And It Screwed Up.

Here’s what other states can learn from our inept reopening."

https://www.nytimes.com/2020/0…oronavirus-reopening.html

The notion that Americans are unwilling to imitate Asian people, and Japanese in particular, is absurd. Japanese popular culture has had a pervasive influence on the U.S. since the 1970s. In good ways and bad. In 1975, there were probably not more a hundred Americans who knew what the word "manga" meant. I should know; there were four at Cornell, including me and two professors. Now, manga are everywhere, along with sushi, Mari Kondo, tentacle porn (don't ask) and much else from Japan. U.S. culture has had a huge impact on Japan, as well.

Here is an article about what proponents do not say, and what I have been saying. Not original to me! I am just reporting what most experts say.

What the Proponents of ‘Natural’ Herd Immunity Don’t Say

Try to reach it without a vaccine, and millions will die.

By Carl T. Bergstrom and Natalie Dean

Dr. Bergstrom is a professor of biology at the University of Washington. Dr. Dean is an assistant professor of biostatistics at the University of Florida.

https://www.nytimes.com/2020/0…avirus-herd-immunity.html

Quote from Shane D.

I think we could use a little more blunt talk about obese Americans. As you said, it used to be unusual, but somehow it is now politically incorrect to be publicly critical about it.

I agree that the "politically incorrect" part is an abomination. That is like saying it is politically incorrect to say that smoking causes cancer. Or that neglecting to brush your teeth causes cavities. Obesity is a health problem!

I am fully on board with the idea that we should sympathize with people who have health problems. Even self-induced problems such as cancer from smoking, or diabetes from eating too much, or drug addiction. It does no good to accuse the patients of immorality. Ridicule does no good. Don't tell them they should shape up. They know that. Most of them feel terrible about themselves already. We should try to help them. But we should never say: "Don't try to get better. You probably can't anyway. You will slide right back into your addiction [to over-eating / alcohol / opioids]." That's the message I hear when people say we need body acceptance, and you can be healthy even if you are obese. No, that's not healthy, by definition. It's like saying you can be healthy even if you have cancer.

This is part of the anti-science, anti-fact, reality-is-what-you-choose zeitgeist of the modern era. It is the reason cold fusion was rejected, vaccines are rejected, and the reason Americans are sick and dying in numbers 100 times higher per capita than in Japan and Korea.

Quote from Shane D.

Maybe a silver lining to this virus is that overweight people will be more motivated to get back to an ideal BMI,

I hope so. But I would prefer a more positive motivation. Like telling people that a healthy BMI improves your sex life. Which is true!

It sounds strange to say this, but people should be taught to stay thin in primary school. You wouldn't think people need to be told this, but apparently they do. They used to teach about "balanced diets" in grade school. I think it did a lot of good. They still do teach this in Japan. As I said, in many parts of U.S. society, being overweight or obese has become normalized, even among children. I find that horrifying. It is like telling kids it is okay to smoke.

Quote from Shane D.

it is a shameful state we have eaten our way into, and it is embarrassing to me when I go out and see what has become of us as a nation. I love going to Waikiki, but I cringe when I see all these trim, energetic Asian tourists walking everywhere, and here come the fat, lumbering out of shape Americans, who have to stop and rest every few minutes. I can only guess how bad an impression the Asians take home about us.

They do get a bad impression. The ones I know are cosmopolitan and quite familiar with U.S. and European culture. They don't like to criticise Americans in conversation with me. I suppose I am less inclined to say nasty things about Japanese culture in conversation with them. But they sure do see it. I have the impression they feel pity more than contempt. But again, that is what you expect from cosmopolitan bilingual scientists and geeks. Like me, I think they see it more as a health problem to be solved than a moral failure to be punished. The Japanese government definitely sees it as health problem. It was a big issue around 2008, with a national campaign to reduce obesity and the metabolic syndrome. It was played up in the mass media and Sunday morning talk shows by the usual crowd of Distinguished Experts that NHK trots out. They are big on having university professors advise the public. In the U.S. it is sort of the opposite. Our public and our leaders ignore professors. You can see where that leads to. It leads to the governor of Georgia ignoring every medical expert in the state, and doing things they warn will trigger a resurgence of exponential growth.