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that low levels of vitamin D patients do much worse than high levels of vitamin D patients. Vitamin D deficiency prevalence and cardiovascular risk in Israel https://pubmed.ncbi.nlm.nih.gov/20955219/ N = 34,874 Vit D levels, women, 22.7 ng mL Vit D levels, men, 23.2 ng mL Prevalence of vitamin D deficiency or insufficiency (vitamin D levels less than 30 ng mL) Women, 77·5%, Men, 79·2% Only little variation when stratified by age Prevalence of deficiency in Israel, similar to less sunny regions Two groups Group with vitamin D less than 15 ng mL Group with vitamin D levels more than 30 ng mL less than 0·031 age-adjusted odds ratios for the presence of, Hypertension Diabetes mellitus Dyslipidemia Obesity Peripheral vascular disease Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263069 https://www.webmd.com/lung/news/20220208/vitamin-d-deficiency-tied-to-severe-covid Potential correlation, low vitamin D and increased risk of infection with SARS-CoV-2, and poorer clinical outcomes This study examines Any relationship exists between, pre-infection serum 25-hydroxyvitamin D (25(OH)D) level, With disease severity and mortality due to SARS-CoV-2. April 7th, 2020 and February 4th, 2021 Positive polymerase chain reaction tests for SARS-CoV-2, searched for historical 25(OH)D levels measured 14 to 730 days prior Design Patients admitted were categorized, disease severity and level of 25(OH)D Deficient, less than 20 ng/mL (n = 133) Insufficient, 20 to 30 ng/mL (n = 36) Adequate, 30 to less than 40 ng/mL (n = 30) High-normal, 40 ng/mL or greater (n = 40) Accounted for changes throughout the year Results 1,176 patients admitted 253 had records of a 25(OH)D level prior to infection A lower vitamin D status was more common in patients with the severe or critical disease In patients with severe or critical disease 87.4% had less than 20 ng/mL In patients with mild or moderate disease 34.3% had Less than 20 ng/mL P less than 0.001 Patients with vitamin D deficiency (less than 20 ng/mL) 14 times more likely to have severe or critical disease, Odds ratio 14 (95% confidence interval 4 to 51) p less than 0.001 Mortality, patients with sufficient vitamin D levels 2.3% Mortality, patients with deficient vitamin D levels 25.6% mortality rate (p less than 0.001) Conclusions Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality. Low vitamin D status has been associated with a range of autoimmune, cardiovascular, and infectious diseases Essential immunologic mediator Inhibitory effects on pro-inflammatory cytokines, TNF-alpha and IL-6 Epidemiological risk factors for vitamin D deficiency Darker skin pigmentation Low sun exposure Skin-covering clothes Sun creams Diet low in fish and dairy products An association between low 25-hydroxyvitamin D (25(OH)D) levels and an increased risk of acquiring influenza and respiratory viruses Meta-analyses of randomized controlled trials, 2007 and 2020 Vitamin D supplementation reduced the risk of acute respiratory infection as compared with placebos Factors associated with poorer COVID-19 prognoses Geographic location in northern countries Older age Black and minority ethnic groups Obesity Preexisting conditions, diabetes and hypertension these risk factors are also independently associated with vitamin D deficiency Difficult to ascertain a definitive causative effect of baseline vitamin D status on a clinical presentation during active COVID-19 infection A cosinor model, to account for the cycles of serum vitamin D values across the seasons Vitamin D levels below less than 20 ng/mL Israeli Arabs 64.3% Israeli non-Arabs 35.7%

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