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Scientific Advisory Committee on Nutrition (SACN) https://www.gov.uk/government/groups/scientific-advisory-committee-on-nutrition SACN vitamin D and health report https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report A reference nutrient intake (RNI) of 10 micrograms (400 units) of vitamin D per day, throughout the year, for everyone in the general population aged 4 years and older The RNI and safe intakes were developed to ensure that the majority of the UK population has enough vitamin D to protect musculoskeletal health, all year round. SACN did not take account of sunlight exposure in making recommendations because of the number and complexity of factors that affect skin synthesis of vitamin D. Vitamin D Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline (2011) The Endocrine Society https://www.endocrine.org Journal of Clinical Endocrinology https://pubmed.ncbi.nlm.nih.gov/21646368/ Vitamin D deficiency is very common in all age groups Few foods contain vitamin D Task Force recommended supplementation, depending on age and clinical circumstances Measurement of serum 25-hydroxyvitamin D level, in patients at risk for deficiency Treatment with supplement recommended for deficient patients https://www.healthline.com/nutrition/how-much-vitamin-d-to-take#How-Common-Is-Vitamin-D-Deficiency About 42% of the US population is vitamin D deficient 82% in black people 70% in Hispanics Nutrients, 15 July 2020 https://www.mdpi.com/2072-6643/12/7/2097 Immunologic Effects of Vitamin D on Human Health and Disease Calcium and phosphate metabolism, bones 1,25-dihydroxyvitamin D, active form of vitamin D Immunomodulatory hormone Innate and adaptive immune systems Vitamin D receptor and enzymes in; Lymphocytes NKs T lymphocytes B lymphocytes Monocytes Macrophages Dendritic cells Vascular endothelial membrane stability Association with low blood levels of 25-hydroxyvitamin D Several immune-related diseases and disorders Psoriasis, Type 1 diabetes Multiple sclerosis Rheumatoid arthritis Tuberculosis Sepsis Respiratory infection COVID-19 Optimal Serum 25-hydroxyvitamin D It is advisable to increase vitamin D intake and have sensible sunlight exposure Maintain serum 25-hydroxyvitamin D at least, 30 ng/mL (75 nmol/L) and preferably 40–60 ng/mL (100–150 nmol/L) Recommended dosage for vitamin D intake in individuals who are at risk for vitamin D Deficiency (1,000 iu = 25 mcg) Age, years Daily requirement Upper limit Years Requirement 0 – 1 400 – 1,000 2,000 1 – 18 600 – 1,000 4,000 18 + 1500- 2000 10,000 Obese 4,000 – 6000 10,000 For deficiency 0 – 1 year 2000 IU/day or 50,000 IU/week of vitamin D2 or D3 for at least 6 weeks to achieve serum 25(OH)D more than 30 ng/mL (75 nmol/L) maintenance therapy of 400–1000 IU/d For deficiency 1 – 18 years 2000 IU/day or 50,000 IU/week of vitamin D2 or D3 for at least 6 weeks to achieve serum 25(OH)D more than 30 ng/mL (75 nmol/L) maintenance therapy of 600–1000 IU/d For deficiency after 18 years 6000 IU/day or 50,000 IU/week of vitamin D2 or D3 for 8 weeks to achieve serum 25(OH)D more than 30 ng/mL (75 nmol/L) maintenance therapy of 1500 –2000 IU/d Obese and malabsorptive patients Dosage should be increased by 2–3 times Respiratory Viral Infection and COVID-19 Outbreak of influenza infection is periodic and usually occurs during the wintertime at higher latitudes but is sporadic throughout the year in the tropical area Association between low level of serum 25(OH)D and incidence and severity of respiratory tract infection in children and adults A recent meta-analysis of 25 RCTs showed that supplementation of vitamin D2 or D3 can protect against the development of acute respiratory tract infection compared with placebo https://www.bmj.com/content/356/bmj.i6583 COVID Rate of symptomatic infection, morbidity and mortality observed African American Obesity Worldwide on average approximately 40% of children and adults have circulating levels of 25(OH)D less than 20 ng/mL (50 nmol/L) It is therefore reasonable to institute as a standard of care to give at least one single dose of 50,000 of vitamin D to all COVID-19 patients as soon as possible after being hospitalized

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