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Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study) https://pmj.bmj.com/content/early/2020/11/12/postgradmedj-2020-139065.full It has been observed that vitamin D-deficient individuals have increased COVID-19 risk and mortality Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review. JAMA 2020;323:1824–36. doi: 10.1001/jama.2020.6019 The role of vitamin D in the prevention of coronavirus disease infection and mortality. Aging Clin Exp Res 2020;32:1195–8. doi: 10.1007/s40520-020-01570-8 Association of vitamin D status and other clinical characteristics with COVID-19 test results. JAMA Netw Open 2020;3:e2019722. (Published 3 Sep 2020).doi: 10.1001/jamanetworkopen.2020.19722 Immunomodulatory role and protective effect of vitamin D against other viral infections Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017;15:356:i6583. doi: 10.1136/bmj.i6583 An intervention study with calcifediol noticed a reduction in requirement for intensive care among hospitalised patients for COVID19 Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: a pilot randomized clinical study. J Steroid Biochem Mol Biol 2020;203:105751. doi: 10.1016/j.jsbmb.2020.105751 50 patients treated with calcifediol, one required admission to the ICU (2%), no deaths 26 untreated patients, 13 required admission (50 %) to the ICU, 2 deaths Immune-modulatory effect of vitamin D is likely to be observed at 25(OH)D levels, which are considered higher than that required for its skeletal effects Vitamin D to prevent COVID-19: recommendations for the design of clinical trials. Febs J2020;287:3689–92. doi: 10.1111/febs.15534 Positive correlation between circulating cathelicidin antimicrobial peptide (hCAP18/LL-37) and 25-hydroxyvitamin D levels in healthy adults. BMC Res Notes 2012;5:575. doi: 10.1186/1756-0500-5-575 Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PLoS One 2020;15:e0239799.doi: 10.1371/journal.pone.0239799 Aim https://pmj.bmj.com/content/early/2020/11/12/postgradmedj-2020-139065.full Effect of high dose, oral cholecalciferol supplementation on SARS-CoV-2 viral clearance First cholecalciferol intervention study for asymptomatic and mildly symptomatic SARS-CoV-2 positive individuals Design Randomised, placebo-controlled. Participants Asymptomatic or mildly symptomatic SARS-CoV-2 RNA positive vitamin D deficient (25(OH) D less than 20 ng/ml) Calcifediol, calcidiol, 25-hydroxycholecalciferol, or 25-hydroxyvitamin D3 Pre intervention baseline serum 25(OH) D Intervention group, 8.6 ng/ml Control group, 9.54 ng/ml (p=0.730) 10 out of 16 patients could achieve 25(OH)D more than 50 ng/ml by day-7 Another two by day-14 Outcome measure Proportion of patients with SARS-CoV-2 RNA negative before day-21 Change in inflammatory markers Intervention group (n=16) 60 000 IU of cholecalciferol (oral nano-liquid droplets) for 7 days Therapeutic target 25(OH)D more than 50 ng/ml Cholecalciferol supplementation was continued for those with 25(OH)D less than 50 ng/ml Fibrinogen levels significantly decreased with cholecalciferol supplementation 10 (62.5%) participants became SARS-CoV-2 RNA negative Control group (n=24) Placebo 5 (20.8%) participants became SARS-CoV-2 RNA negative (p less than 0.018) Both groups Patients requiring invasive ventilation or with significant comorbidities were excluded 25(OH)D levels were assessed at day 7 Regular measurements of: SARS-CoV-2 RNA, fibrinogen, D-dimer, procalcitonin, CRP, ferritin Improvements Calcifediol would have been better Little and often for prevention

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