talk about preparation from a prevention standpoint here we have our Johns

Hopkins dashboard at ninety four thousand total confirmed cases total

deaths thirty two hundred total recovered fifty one thousand South Korea

has the most confirmed outside of China and we're talking about aggressive

testing in South Korea Iran quickly shot up we can see here that's a pretty large

red dot we go to the world ometer website active cases are actually on the

decline probably because we are leaving a epidemic in China but there are small

epidemics relatively outside of China that are rapidly growing and that's why

this is not continuing to go down if we look at total cases we can see that the

inflection point has started to turn upwards let's look at the latest updates

a number of countries are reporting single digits cases and in some cases

some deaths interestingly here there's 586 new cases in Iran but they're also

starting the show recoveries as well we knew there would be recoveries but we're

just not seeing a lot at this point we see that there are 10 new cases in

Belgium nine of which came from northern Italy and that seems to be a hotspot of

spread throughout Europe remember that in Europe there are free borders because

of the European Union so it's not as if this is unregulated constrain travel at

least as of a couple of weeks ago four new cases in the United States all of

them being in California which is a hot spot there's one in Los Angeles County

two who had recently traveled to countries that have had cava 19 and

there's one new case in Contra Costa County in Northern California that

second case of corona virus in Los Angeles was reported by Fox 11 News that

patient is being taken care of at home in self isolation and being treated on

an outpatient basis the purpose of May cram and what we're doing here is to

talk about the data the raw numbers to talk about the medical aspects of this

virus and what we know is going but of course there are things that are

out there that are emerging that seemed to have evidence but don't quite fit

with coronavirus at this point because we don't have the data at this point

let's face it we have no randomized controlled trials for coronavirus Cove

at 19 they just haven't been performed so we're forced to look at things that

may work vitamin D is one of those things we don't have any randomized

control trials that show that supplement with vitamin D works in kovat 19 but we

do have data about vitamin D specifically and so I think it's

interesting to go over I've gotten a lot of comments from people about vitamin D

and the potential use for the corona virus and even though this paper here is

for the influenza virus vitamin D is not actually having an effect on the virus

itself as far as we know it's affecting the hosts us our bodies our immune

system and how they deal with the virus so potentially might be something that

is applicable to other viruses and in this case the corona virus and if you've

thought about this you'll notice that there's a lot of talk about what will

happen in the summertime to the virus and a lot of the talk has been about

heat and humidity versus dryness and I'm wondering if there's another angle on

this because vitamin D could be acknowledged as a quote seasonal

stimulus as defined by our Edgar Hope Simpson it would be crucial to prove it

from a potential easy and cheap prophylaxis or therapy support

perspective as far as influenza infections are concerned now this paper

talks about how first of all vitamin D is absorbed into the body and how it is

metabolized the fact that it is a vitamin you have to understand that we

cannot generate or make vitamin D in our own body but in fact we need ultraviolet

radiation from the Sun to convert the inactive form to the active form I've

always had a special place in my heart for vitamin D because that's what I did

in terms of my undergraduate research working in organic chemistry and so

you'll know that vitamin D for those of you studied the structure is a lipid

soluble vitamin and so it's possible to overdose on vitamin D so you have to be

very careful with it because it is fat soluble now there's a lot of talk about

vitamin D in the immune system and how it bolsters it but something that's also

very in interesting about vitamin D is its

possible role in infections and also it has a suppressive anti-inflammatory

process so in other words vitamin D can turn things on and it can also turn

things off it's not unimodal and that is something that could be very helpful

especially in the immune response that we see in kovat 19 remember that it's

the immune system that is going to suppress the virus which is good but

it's also the immune system that could cause this storm of cytokines that put

your lungs into a RDS and could potentially kill so what we want is a

smart immune system an immune system that takes care of the virus but doesn't

put us into an inflammatory condition that could put us on a ventilator

so is vitamin D the answer I have no financial relationships with any

pharmaceutical companies or companies that make nutritional supplements in any

way this study that was talked about here in the Harvard Gazette may be what

we are looking for here it says a new global collaborative study has confirmed

that vitamin D supplementation can help protect against acute respiratory

infections the study our participant data meta analysis so a meta analysis is

simply a study that looks at a whole bunch of other studies breaks down the

components and makes a super study out of it so they took actually 25

randomized controlled trials with an N number of 11,000 participants that's a

pretty sizable number this was published in the British Medical Journal I will

give you a link to that journal will actually look through that most people

understand that vitamin D is critical for bone and muscle health Cisco's

Camargo of the Department of Emergency Medicine at Mass General our analysis

has also found that it helps the body fight acute respiratory infection which

is responsible for millions of deaths globally each year

remember this article was published before coronavirus several observational

studies with track participants over time without assessing the specific

treatment have associated low vitamin D levels with greater susceptibility to

acute respiratory infections I don't have to tell you that living in high

latitudes especially in the wintertime exposes you to the least amount of

sunlight if you have the least amount of sunlight you would conclude a

corporately that your vitamin D levels are generally going to be on the lower

side while it's possible that the seasonal variation in the virus may

still have something to do with the survival of the virus outside the body

but it may have more than we think to do with the survival of the virus inside

the body it is a postulate but it's interesting the meta-analysis of these

trials which aggregate data from several studies that may have different designs

or participant qualifications also had conflicting results and this really has

been the issue for some period of time some studies showed that there is a

connection that makes vitamin D look good in terms of preventing infections

others not so good so to resolve these discrepancies this research team out of

Queen Mary University of London conducted an individual participant data

meta-analysis so what does that mean they grouped all of these studies

together and then they stripped it down to each particular individual and that

is very powerful producing what could be considered a higher resolution analysis

of the data from all the studies the investigators found that daily or weekly

supplementation had the greatest benefit for individuals number one there was a

benefit and number two it was the turtle not the hare what I mean by that is it

was the daily supplementation not the huge doses of vitamin D if you got sick

this makes sense the people who have the lowest levels are going to have the best

effect from supplementation and it cut their risk of respiratory infection get

this in half that is a significant number and could reduce the Arnott or

the replication number in viruses and maybe the reason why we see these

viruses disappear in the summer I say May don't have proof of that yet but

it's interesting all participants experience some beneficial effects from

regular vitamin D supplementation administering a high doses of vitamin C

did not produce significant benefits this study was not funded by some

nutraceutical company but was funded in fact by the British National Institute

of Health Research so let's actually go to that study it's open access we'll put

the link in the description below this is from the British Medical Journal

that's a very prestigious publication in the conclusion vitamin

supplementation was safe and it protected against acute respiratory

tract infection overall patients who were very vitamin D deficient and those

not receiving bolus doses experienced the most benefit so if you go down to

the raw data they have to come up with cutoff points and for those of you who

don't know how to read studies let me show you here a little bit what they're

looking at is how many respiratory tract infections they receive so one step'

individual participant data men analysis proportion of partisans experiencing at

least one acute respiratory tract infection first thing to do is to look

at the very top one and that's overall how many trials twenty-five proportion

with greater than one acute respiratory tract infection and proportion with

greater than one acute respiratory tract infection in the intervention group and

you can see that there was a difference and what was that difference the

adjusted odds ratio is where you want to look

there's another way of looking at to looking at p-values to see if there's a

difference between these two groups those in the control group those in the

intervention group and any p-value of less than point zero five is considered

to be statistically significant so you can see here that a bolus dose of

greater than thirty thousand international units given had a p-value

of 0.67 that's greater than point zero five therefore not statistically

significant in other words a bolus dose is not going to be helpful if the bolus

dose wasn't given you can see that was very statistically significant so the

question is how much should I take on a daily dose well here it is daily dose

equivalent if it was less than twenty micrograms highly statistically

significant if it was 2250 still statistically significant however if you

took more than 50 micrograms there was no difference between that group

indicating that a modest dose of vitamin D every single day would be the best

here's more research in the study showing all of the different individual

studies and the proportion with greater than one acute respiratory tract

infection and you can see here where they lined up relative to number one

remember one being no difference if it was less than number one with a 95%

confidence interval less than one then you could say that that was

statistically significant and it was weighted based on the number of patients

in that study and finally we come to the overall which is down here at the bottom

p-value a point zero zero one you can see that it lands less than one so if

you scroll down to the discussion it says vitamin D supplementation reduce

the risk of experiencing at least one acute respiratory tract infection and it

talks about the grade of the data which was very good the question though is why

would a bolus dose of vitamin D be ineffective and they talked about how

the wide fluctuations of circulating 25 hydroxy vitamin D concentrations which

is the starting material for the active form in the body could this right

activity of enzymes responsible for the synthesis and degradation of the active

vitamin D metabolite which is 125 dihydroxy vitamin d so my recommendation

based on this data would be take a small supplement of vitamin D every day and

again we'll put the links to these articles in the description below