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Vitamin C Cuts COVID Deaths by Two-Thirds

Commentary by Patrick Holford

 

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The world’s first randomized placebo controlled trial designed to test high dose intravenous vitamin C for treatment of COVID-19 has reduced mortality in the most critically ill patients by two thirds. [1] The study, headed by Professor Zhiyong Peng at Wuhan’s Zhongnan University Hospital, started in February and gave every other critically ill COVID-19 patient on ventilators either 12,000 milligrams (mg) of vitamin C twice daily or sterile water in their drip. Neither the patient nor the doctors knew who was getting vitamin C or placebo so the trial was "double blind." This is the ‘gold standard’ of research design.

Overall, 5 out 26 people (19%) died in the vitamin C group while 10 out of 28 (36%) receiving the placebo died. That means that vitamin C almost halved the number of deaths. Those on vitamin C were 60% more likely to survive.

The key measure of the severity of symptoms is called the SOFA oxygenation index. Those with a SOFA score greater than 3 are most critically ill. Of those most critically ill, 4 people (18%) in the vitamin C group died, compared to 10 (50%) in the placebo group. That’s two-thirds less deaths. Statistically this meant that of those most critically ill who were given vitamin C, they were 80% less likely to die. This result, backed up with a clear reduction in inflammatory markers in the blood, was statistically significant – beyond doubt. This level of benefit is much greater than the benefit seen in the randomized controlled trial on dexamethasone, the anti-inflammatory steroid drug that hit the headlines as the "only proven treatment" for COVID-19. [2] In this drug trial 23% of patients on the steroid drug died compared to 26% on placebo. However, there were over 6,000 people in the trial so the results were statistically significant.

But now there is another proven treatment – vitamin C. The Wuhan trial needed 140 patients to be sufficiently "powered" for the statistics but they ran out of COVID cases during March, a month after 50 tons of vitamin C, which is 50 million one gram doses, was shipped into Wuhan and given to hospitalised patients and also hospital workers. New admissions into Intensive Care Units (ICUs) plummeted. Professor Peng ended up with a third as many as the trial was designed to include. But, even though the resulting overall statistic showing almost half as many deaths was not significant, the results from the SOFA oxygenation score and other markers were significant.

These results are especially important when case reports in American ICUs using 12,000 mg of vitamin C show almost no deaths in anyone without a pre-existing end stage disease already and also over 85, [3] and a British ICU using 2,000 mg of vitamin C have reported the lowest mortality of all ICUs in the UK, cutting deaths by a quarter. [4]

The best results are being reported in ICUs using vitamin C, steroids and anti-coagulant drugs combined, which has been standard treatment protocol in China since April. China’s mortality rate from COVID is 3 persons per million compared to the UK’s 624 per million, according to Worldometer data. [5]

On top of this, reports are coming in from ICUs that are testing the blood vitamin C levels, that the majority of their critically ill patients are vitamin C deficient, many with undetectable levels of vitamin C that would diagnose scurvy. One ICU in Barcelona found 17 out of 18 patients had ‘undetectable’ vitamin C levels, akin to scurvy. [6] Another, in the US, found almost all their patients were vitamin C deficient but those who didn’t survive had much lower levels than those who did. [3]

Scurvy killed two million sailors around the world between 1500 and 1800. In 1747 James Lind worked out the cure - vitamin C in limes, but it took fifty years before the Navy took it seriously. So dramatic was the life-saving effect that sailors became known as "limeys."

Will the same thing happen with COVID-19? With over a million deaths worldwide and the potential of vitamin C to more than halve the death toll, every day our governments, digital ringmasters and doctors fail to take vitamin C seriously in another day of unnecessary deaths due to ignoring the evidence. This is not fake news.

It’s not the coronavirus that kills people with COVID; it is usually the immune system over-reacting against dead virus particles, once the viral infection is over, which triggers a "cytokine storm, " something like an inflammatory fire out of control. That’s when very high doses of both steroids and vitamin C are needed. Normally, the adrenal glands, which contain a hundred times more vitamin C than other organs, release both the body’s most powerful steroid hormone cortisol as well as vitamin C, when in a state of emergency. The steroid helps the vitamin C get inside cells and calm down the fire. Vitamin C is both an anti-inflammatory and anti-oxidant, mopping up the "oxidant" fumes of the cytokine storm. Without vitamin C the steroid hormone cortisol can’t work so well. That’s why ICU doctors administer both extra vitamin C and steroids to get a patient out of the danger zone.

But even better is to prevent a person ever getting into this critical phase of COVID-19. That’s why early intervention, taking 1,000 mg of vitamin C an hour upon first signs of infection, is likely to save even more lives. This reduces duration and severity of symptoms, with most people becoming symptom-free within 24 hours. It takes on average, two weeks of being sick with COVID-19 to trigger the ‘cytokine storm’ phase. During that time, the patient is at risk of becoming vitamin C deficient and then developing acute "induced scurvy." If you can beat the infection within 48 hours you’ll be out of the woods. You can lower your risk even further by taking vitamin D (5000 IU/d, or more: 20,000 IU/d for several days if you already have symptoms), magnesium (400 mg/d in malate, citrate, or chloride form), and zinc (20 mg/d) [7-11] Prevention is better than cure.

Pauling put the C in Colds and COVID

Much like Lind’s limes, twice Nobel Prize winner Dr Linus Pauling proved the power of high dose vitamin C in the 1970’s. [12-18] It is thanks to him we know about the benefits of high dose vitamin C. The cover of his landmark book Vitamin C and the Common Cold has a statement that reads, in relation to a predicted swine flu epidemic at that time "it is especially important that everyone know that he can protect himself to a considerable extent against the disease, and its consequences, with this important nutrient, vitamin C." [19] It’s been 50 years since Pauling proved the anti-viral power of vitamin C. Isn’t it time we took this seriously?

About Patrick Holford

Patrick Holford is author of over 30 books including Flu Fighters https://www.patrickholford.com/flu-fighters and The Optimum Nutrition Bible. He is a member of the Orthomolecular Medicine Hall of Fame.

References

1. Zhang J, Rao X, Li Y, Zhu Y, Liu F, Guo F, Luo G, Meng Z, De Backer D, Xiang H, Peng Z-Y. (2020) High-dose vitamin C infusion for the treatment of critically ill COVID-19. Pulmonology, preprint. https://doi.org/10.21203/rs.3.rs-52778/v2

2. RECOVERY Collaborative Group, Horby P, Lim WS, Emberson JR, et al. (2020) Dexamethasone in Hospitalized Patients with Covid-19 - Preliminary Report. N Engl J Med., NEJMoa2021436. https://pubmed.ncbi.nlm.nih.gov/32678530

3. Arvinte C, Singh M, Marik PE. (2020) Serum Levels of Vitamin C and Vitamin D in a Cohort of Critically Ill COVID-19 Patients of a North American Community Hospital Intensive Care Unit in May 2020: A Pilot Study. Medicine in Drug Discovery, 100064. In press, available online 18 September 2020, https://pubmed.ncbi.nlm.nih.gov/32964205 https://www.sciencedirect.com/science/article/pii/S2590098620300518

4. Vizcaychipi MP, Shovlin CL, McCarthy A, et al., (2020) Development and implementation of a COVID-19 near real-time traffic light system in an acute hospital setting. Emerg Med J. 37:630-636. https://pubmed.ncbi.nlm.nih.gov/32948623

5. Worldometer (2020) https://www.worldometers.info/coronavirus/#countries

6. Chiscano-Camón L, Ruiz-Rodriguez JC, Ruiz-Sanmartin A, Roca O, Ferrer R. (2020) Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome. Critical Care, 24:522. https://pubmed.ncbi.nlm.nih.gov/32847620

7. Rasmussen MPF (2020) Vitamin C Evidence for Treating Complications of COVID-19 and other Viral Infections. Orthomolecular Medicine News Service, http://orthomolecular.org/resources/omns/v16n25.shtml

8. Downing D (2020) How we can fix this pandemic in a month (Revised edition). Orthomolecular Medicine News Service, http://orthomolecular.org/resources/omns/v16n49.shtml

9. Castillo ME, Costa LME, Barriosa JMV et al., (2020) 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 and Molec Biol. 203, 105751. https://pubmed.ncbi.nlm.nih.gov/32871238

10. Holford P. (2020) Vitamin C for the Prevention and Treatment of Coronavirus. Orthomolecular Medicine News Service, http://orthomolecular.org/resources/omns/v16n36.shtml

11. Gonzalez MJ (2020) Personalize Your COVID-19 Prevention: An Orthomolecular Protocol. Orthomolecular Medicine News Service, http://orthomolecular.org/resources/omns/v16n31.shtml

12. Pauling L. (1974) Are recommended daily allowances for vitamin C adequate? Proc Natl Acad Sci USA. 71:4442-4446. https://pubmed.ncbi.nlm.nih.gov/4612519

13. Pauling L. (1973) Ascorbic acid and the common cold. Scott Med J. 18:1-2. https://pubmed.ncbi.nlm.nih.gov/4577802

14. Pauling L. (1972) Vitamin C. Science. 177:1152. https://pubmed.ncbi.nlm.nih.gov/17847190

15. Pauling L. (1971) The significance of the evidence about ascorbic acid and the common cold. Proc Natl Acad Sci U S A. 68:2678-2681. https://pubmed.ncbi.nlm.nih.gov/4941984

16. Pauling L. (1971) Ascorbic acid and the common cold. Am J Clin Nutr. 24:1294-1299. https://pubmed.ncbi.nlm.nih.gov/4940368

17. Pauling L. (1971) Vitamin C and common cold. JAMA. 216:332. https://pubmed.ncbi.nlm.nih.gov/5107925

18. Pauling L. (1970) Evolution and the need for ascorbic acid. Proc Natl Acad Sci USA. 67:1643-1648. https://pubmed.ncbi.nlm.nih.gov/5275366

19. Pauling L. (1970) Vitamin C and the Common Cold. W.H.Freeman & Co. ISBN-13:978-0425048535

 

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The views expressed in this article are the author's and not necessarily that of all members of the Orthomolecular Medicine News Service Editorial Review Board. Readers should consult and work with their own personal physician on any medical matter. OMNS welcomes discussion on a variety of subjects. Readers may submit their own article drafts to the Editor at the contact email below.

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Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

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Andrew W. Saul, Ph.D. (USA), Editor-In-Chief
Associate Editor: Robert G. Smith, Ph.D. (USA)
Editor, Japanese Edition: Atsuo Yanagisawa, M.D., Ph.D. (Japan)
Editor, Chinese Edition: Richard Cheng, M.D., Ph.D. (USA)
Editor, French Edition: Vladimir Arianoff, M.D. (Belgium)
Editor, Norwegian Edition: Dag Viljen Poleszynski, Ph.D. (Norway)
Editor, Arabic Edition: Moustafa Kamel, R.Ph, P.G.C.M (Egypt)
Editor, Korean Edition: Hyoungjoo Shin, M.D. (South Korea)
Assistant Editor: Helen Saul Case, M.S. (USA)
Technology Editor: Michael S. Stewart, B.Sc.C.S. (USA)
Legal Consultant: Jason M. Saul, JD (USA)

 

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How We Can Fix this Pandemic in a Month (Revised Edition)

Commentary by Damien Downing MBBS MRSB

 

Republished from orthomolecular.activehosted.com

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The Orthomolecular Medicine News Service has been publicizing the importance of vitamins D and C, and the minerals zinc and magnesium, in this pandemic since January [1]. I have been writing about vitamin D and sunlight for over 30 years [2], and it has never been more relevant.

If you caught the COVID19 virus right now, having a good vitamin D status (from already having taken a supplement) would greatly reduce your risk of contracting the infection, of the disease becoming severe, and of dying. Vitamin D enhances innate immunity while reducing the severity of inflammatory responses and supporting antioxidant activity [3]. Vitamin D deficiency correlates with risk of ARDS, sepsis and death from these [4]. You can even get some protection from living somewhere sunny [5] - or better still somewhere where people generally have good vitamin D status, probably from dietary sources [6].

For countries in Europe, the probability of developing COVID-19, and of dying from it, is negatively correlated with mean population vitamin D status, with both probabilities reaching zero above about 75nmol/L, as clearly shown here [7]. The chart is redrawn from the original data, and also shows, at the top, the significantly lower vitamin D levels for the elderly in Spain and Italy. 

Intervention!

We now also know that hitting the virus hard when you get infected can also work. Well, we already knew that vitamin C, zinc and magnesium worked (see any number of OMNS releases over the years). Recommended preventive adult doses are vitamin C, 3000 mg/day (in divided doses, to bowel tolerance), magnesium, 400 mg (in malate, citrate, or chloride form), zinc, 20 mg. [1]

What's new is that vitamin D also works in the acute context. You want magic bullets? We got a handful now!

5 years ago a GP in Edmonton reported dramatic effects on influenza - "complete resolution of symptoms in 48 to 72 hours" from giving 50-60,000 IU of vitamin D3 [8]. Now a new study reports a similar effect on Covid-19.

The new study, from Cordoba in Spain [9], looked at 76 patients admitted to hospital with signs of both Covid-19 and an acute respiratory infection. 26 patients had only the hospital's standard care; 50 of them were given vitamin D as well. The form used was the 25-hydroxy D3, the more active form and the one that is usually measured in blood tests. The dose, given on days 1, 3 and 7, so over one week in effect, was equivalent to 128,000 IU in a week or 18,000 units every day of ordinary vitamin D3. This was a big dose, but not dangerous - see below.

What was the outcome? Here's the graph. In the control group 50% of patients needed transfer to intensive care units; in the 25 (OH) D group only 2% - one patient out of 50.

 

Dosage is Important and Generally Misunderstood

We have powerful tools here that could be employed right now to save lives; why are we not doing so? One reason is a widespread misunderstanding about dosage - of both vitamins D and C. In the UK this all seems to be down to one governmental committee.

The epidemiological paper cited above [7] shows that a vitamin D3 blood level of at least 75 nmol/L (30 ng/ml) is needed for protection against COVID-19. An adult will need to take 4000 IU/day of vitamin D3 for 3 months to reliably achieve a 75 nmol/L level [10]. Persons of colour may need twice as much [11]. These doses can prevent, i.e. they can greatly reduce the risk of severe illness, but they are not enough for treatment of an acute viral infection - that takes the 60,000 to 120,000 IU dose acute intervention.

But governmental recommendations for vitamin D intake - 400 IU/day for the UK and 600 IU/day for the USA (800 IU for >70 years) and the EU - are based primarily on bone health and are woefully inadequate in the pandemic context. Several recently published papers have suggested that more than 4000 IU per day of vitamin D3 may carry a risk of harm, often citing the UK Scientific Advisory Committee on Nutrition (SACN) report of 2016 which set the recommended Upper Level (UL) intakes at 2000IU (50mcg) per day [12]. That report says; "Excessive vitamin D intakes have, however, been shown to have toxic effects (Vieth, 2006)".

However this is misleading, as the 2006 Vieth paper [13] states: "Published reports suggest toxicity may occur with 25(OH)D concentrations beyond 500 nmol/L." This leaves a wide margin of safety because 4000 IU per day will get you to about 75nmol/L - you would need to take more than 30,000 IU per day for three months to reach a 500 nmol/L blood level of vitamin D, to even run the risk of toxic effects.

What Can we Do?

If we had given everybody enough vitamin D six months ago when this all started - in March when the Northern hemisphere was not quite out of winter, and vitamin D levels were at their lowest - what would have happened? Well, I definitely believe that a couple of hundred black and Asian healthcare workers would still be alive (that's just in the UK), along with a lot of people's gramps and grandmas who had to die alone in their care homes.

Two decades ago Richard Horton, editor of The Lancet wrote [14]; 'When the state of the health of the people is at stake, we should be prepared to take action to diminish these risks even when the scientific knowledge is not conclusive.' There is no good reason to wait for placebo-controlled trials to be conclusive here; we know that Vitamin D, vitamin C, zinc and magnesium will help and will do no harm.

So what would happen if we gave everybody enough vitamin D right now? In a population it would greatly reduce the risk of people contracting the infection, of the disease becoming severe, and of dying. Is that a 100% guarantee of your safety? Of course not, you're not people; population studies can't tell you about individuals - for a start they don't know your vitamin D status now, or what else may be wrong with you.

For a government, though, it's a far safer, and cheaper, bet than a vaccine that might never happen - you'd think. And the downside is negligible; if it simply didn't work, we in the UK would have lost about what the Prime Minister just spent respraying his plane. And it would have made precisely nobody sick. The risk from not acting is much greater than the risk from acting.

Strike Now

Strike now and we save lives. But I wouldn't hold your breath until any of our governments takes appropriate action; you may have to do it yourself.

Michael Holick's (he is one of the greats of vitamin D research) new app, D*minder, is a good place to start; it does a pretty good job on your D status, and it’s a free download. And buy some high strength vitamin D3 (no, fish won't do it, and Cod Liver Oil has too much vitamin A).

Since our PM likes short pithy slogans, here's one for all of us;

GET YOUR "D" UP!

Author's note: I originally wrote this in June, basing the first part on two papers that were in pre-publication then. We have now been informed that the data in those two papers cannot be verified. We have no alternative but to withdraw that section. This release has now been rewritten to take account of that, and also of a new paper that considers vitamin D therapy in Coronavirus infection.

Correction

There was a typographical error in the Orthomolecular Medicine News Service release of October 2, 2020, titled "It is Time to Flatten the Fear of COVID." The author's view of prophylaxis for COVID is 40 mg/day, not 400. I apologize for this error.
A. Saul, Editor.

References

1. Saul AW. (2020) Vitamin C Protects Against Coronavirus. Orthomolecular Medicine News Service. http://orthomolecular.org/resources/omns/v16n04.shtml

2. Downing D. (1988) Day Light Robbery. Arrow Books, London. ISBN-13: 978-0099567400

3. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JA, Bhattoa HP. (2020). Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients, 12, 988. https://www.mdpi.com/2072-6643/12/4/988

4. Dancer, R. C. A., Parekh, D., Lax, S., et al (2015). Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax, 70(7), 617-624. https://doi.org/10.1136/thoraxjnl-2014-206680

5. Tang, L., Liu, M., Ren, B., Wu, Z., Yu, X., Peng, C., & Tian, J. (2020). Sunlight ultraviolet radiation dose is negatively correlated with the percent positive of SARS-CoV-2 and four others common human coronaviruses in the U.S. Science of The Total Environment, 751, 141816. https://doi.org/10.1016/j.scitotenv.2020.141816

6. Laird, E., Rhodes, J., & Kenny, R. (2020). Vitamin d and inflammation - potential implications for severity of COVID-19. Irish Medical Journal, 113:81-87. https://pubmed.ncbi.nlm.nih.gov/32603576 http://orthomolecular.org/resources/omns/v16n04.shtml

7. Ilie, P., Stefanescu, S., Smith, L. (2020) The role of Vitamin D in the prevention of Coronavirus Disease 2019 infection and mortality. Aging Clinical and Experimental Research, 32:1195-1198 https://link.springer.com/content/pdf/10.1007/s40520-020-01570-8.pdf

8. Schwalfenberg, G. (2015). Vitamin D for influenza. Canadian Family Physician, 61: 507. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890

9. Castillo, M. E., Entrenas Costa, L. M., Vaquero Barrios, J. M., Alcalá Díaz, J. F., Miranda, J. L., Bouillon, R., & Quesada Gomez, J. M. (2020). "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". The Journal of Steroid Biochemistry and Molecular Biology, 105751. https://doi.org/10.1016/j.jsbmb.2020.105751

10. Vieth R, Chan PC, MacFarlane GD. (2001) Efficacy and safety of vitamin D(3) intake exceeding the lowest observed adverse effect level. Am J Clin Nutr, 73:288-294. https://pubmed.ncbi.nlm.nih.gov/11157326

11. Cashman KD, Ritz C, Adebayo FA, et al. (2019) Differences in the dietary requirement for vitamin D among Caucasian and East African women at Northern latitude. Eur J Nutr. 58:2281-2291. https://pubmed.ncbi.nlm.nih.gov/30022296

12. UK Scientific Advisory Committee on Nutrition (SACN) (2016) Vitamin D and Health. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf

13. Vieth R (2006) Critique of the considerations for establishing the tolerable upper intake level for vitamin D: critical need for revision upwards. J Nutr, 136:1117-1122. https://pubmed.ncbi.nlm.nih.gov/16549491

14. Horton R. (1998) The new new public health of risk and radical engagement. Lancet. 352:251-252. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)60254-1/fulltext

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

Find a Doctor

To locate an orthomolecular physician near you: http://orthomolecular.org/resources/omns/v06n09.shtml

The peer-reviewed Orthomolecular Medicine News Service is a non-profit and non-commercial informational resource.

Editorial Review Board:

Seth Ayettey, M.B., Ch.B., Ph.D. (Ghana)
Ilyès Baghli, M.D. (Algeria)
Ian Brighthope, MBBS, FACNEM (Australia)
Gilbert Henri Crussol, D.M.D. (Spain)
Carolyn Dean, M.D., N.D. (USA)
Ian Dettman, Ph.D. (Australia)
Damien Downing, M.B.B.S., M.R.S.B. (United Kingdom)
Ron Erlich, B.D.S. (Australia)
Hugo Galindo, M.D. (Colombia)
Martin P. Gallagher, M.D., D.C. (USA)
Michael J. Gonzalez, N.M.D., D.Sc., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Tonya S. Heyman, M.D. (USA)
Suzanne Humphries, M.D. (USA)
Ron Hunninghake, M.D. (USA)
Robert E. Jenkins, D.C. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Felix I. D. Konotey-Ahulu, MD, FRCP, DTMH (Ghana)
Jeffrey J. Kotulski, D.O. (USA)
Peter H. Lauda, M.D. (Austria)
Thomas Levy, M.D., J.D. (USA)
Alan Lien, Ph.D. (Taiwan)
Homer Lim, M.D. (Philippines)
Stuart Lindsey, Pharm.D. (USA)
Victor A. Marcial-Vega, M.D. (Puerto Rico)
Charles C. Mary, Jr., M.D. (USA)
Mignonne Mary, M.D. (USA)
Jun Matsuyama, M.D., Ph.D. (Japan)
Joseph Mercola, D.O. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Karin Munsterhjelm-Ahumada, M.D. (Finland)
Tahar Naili, M.D. (Algeria)
W. Todd Penberthy, Ph.D. (USA)
Selvam Rengasamy, MBBS, FRCOG (Malaysia)
Jeffrey A. Ruterbusch, D.O. (USA)
Gert E. Schuitemaker, Ph.D. (Netherlands)
T.E. Gabriel Stewart, M.B.B.CH. (Ireland)
Thomas L. Taxman, M.D. (USA)
Jagan Nathan Vamanan, M.D. (India)
Garry Vickar, M.D. (USA)
Ken Walker, M.D. (Canada)
Raymond Yuen, MBBS, MMed (Singapore)
Anne Zauderer, D.C. (USA)
Andrew W. Saul, Ph.D. (USA), Editor-In-Chief
Associate Editor: Robert G. Smith, Ph.D. (USA)
Editor, Japanese Edition: Atsuo Yanagisawa, M.D., Ph.D. (Japan)
Editor, Chinese Edition: Richard Cheng, M.D., Ph.D. (USA)
Editor, French Edition: Vladimir Arianoff, M.D. (Belgium)
Editor, Norwegian Edition: Dag Viljen Poleszynski, Ph.D. (Norway)
Editor, Arabic Edition: Moustafa Kamel, R.Ph, P.G.C.M (Egypt)
Editor, Korean Edition: Hyoungjoo Shin, M.D. (South Korea)
Assistant Editor: Helen Saul Case, M.S. (USA)
Technology Editor: Michael S. Stewart, B.Sc.C.S. (USA)
Legal Consultant: Jason M. Saul, JD (USA)

Comments and media contact: drsaul@doctoryourself.com OMNS welcomes but is unable to respond to individual reader emails. Reader comments become the property of OMNS and may or may not be used for publication.

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Republished from orthomolecular.activehosted.com

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Viral Cultures for COVID-19 Infectivity Assessment. Systematic Review

Tom Jefferson, Elizabeth Spencer, Jon Brassey, Carl Heneghan

 

doi: https://doi.org/10.1101/2020.08.04.20167932  

https://www.medrxiv.org/content/10.1101/2020.08.04.20167932v4

 

This article is a preprint and has not been peer-reviewed [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

 

Objective: To review the evidence from studies comparing SARS-CoV-2 culture, with the results of reverse transcriptase polymerase chain reaction (RT-PCR).

Methodology: We searched LitCovid, medRxiv, Google Scholar and the WHO Covid-19 database for Covid-19 using the terms viral culture or viral replication and associated synonyms up to 10 September 2020. We carried out citation matching and included studies reporting attempts to culture or observe SARS-CoV-2 matching with cutoffs for RT-PCR positivity. One reviewer extracted data for each study and a second reviewer checked end edited the extraction and summarised the narratively by sample: faecal, respiratory, environment, blood or mixed. Where necessary we wrote to corresponding authors of the included or background papers for additional information. We assessed quality using a modified QUADAS 2 risk of bias tool. This is the fourth version of this review that was first published on the 4th of August and updated on the 21t of August, on the 3rd and 10th of September.

Results: We included 29 studies reporting culturing or observing tissue invasion by SARS-CoV in sputum, naso or oropharyngeal, urine, stool, blood and environmental samples from patients diagnosed with Covid-19. The data are suggestive of a relation between the time from collection of a specimen to test, cycle threshold and symptom severity. The quality of the studies was moderate with lack of standardised reporting. Twelve studies reported that Ct values were significantly lower and log copies higher in samples producing live virus culture. Five studies reported no growth in samples based on a Ct cut-off value. These values ranged from CT > 24 for no growth to Ct > 34 or more. Two studies report a strong relationship between Ct value and ability to recover infectious virus and that the odds of live virus culture reduced by 33% for every one unit increase in Ct. A cut-off RT-PCR Ct > 30 was associated with non-infectious samples. One study that analysed the NSP, N and E gene fragments of the PCR result reported different cut-off thresholds depending on the gene fragment analysed. The duration of RNA shedding detected by PCR was far longer compared to detection of live culture. Six out of eight studies reported RNA shedding for longer than 14 days. Yet, infectivity declines after day 8 even among cases with ongoing high viral loads. A very small proportion of people re-testing positive after hospital discharge or with high Ct are likely to be infectious.

Conclusion: Prospective routine testing of reference and culture specimens are necessary for each country involved in the pandemic to establish the usefulness and reliability of PCR for Covid-19 and its relation to patient factors. Infectivity is related to the date of onset of symptoms and cycle threshold level. A binary Yes / No approach to the interpretation RT-PCR unvalidated against viral culture will result in false positives with possible segregation of large numbers of people who are no longer infectious and hence not a threat to public health. 

doi: https://doi.org/10.1101/2020.08.04.20167932  

https://www.medrxiv.org/content/10.1101/2020.08.04.20167932v4

 

 

Counting COVID-19 'Cases' is Misleading Everybody – Lockdown Sceptics

by Professor Norman Fenton, Dr Scott McLachlan, Professor Martin Neil and Dr Magda Osman – 8 October 2020

 

Republished from lockdownsceptics.org

https://lockdownsceptics.org/counting-covid-19-cases-is-misleading-everybody/

 

The focus of almost all current reporting on COVID-19 is on the sharp increase in number of ‘new cases’ – as shown in the above graph – and the accompanying narrative that we are in the midst of an exponential ‘second wave’ increase. For example, there were 12,000 ‘new cases’ on October 2nd compared to just 3,000 on September 2nd – a four-fold increase in four weeks, and more than double the new cases per day now than we had at the peak of the pandemic in March.

This looks frightening. But the massive increase in ‘new cases’ is almost completely explained by factors that have nothing to do with an increasing population health risk. New cases are simply the count of those who get a positive test result. But almost all of those – as can be seen from the university student ‘cases’ – are either asymptomatic or false positives., i.e. they do not – and will not – show any symptoms of a ‘COVID-19 illness’. Nor will they ‘spread the virus’ to others.

Also, contrary to widely believed assumptions, there is no ‘gold standard’ test for COVID-19. A diagnostic process, namely PCR, has been used, but since the outbreak there has been no attempt to determine its accuracy. It might be shocking to find that research on lab grown ‘live’ cultures of the virus, taken from patients, had not been published until early August – eight months after the virus outbreak. These have been used to assess the accuracy of PCR and the results are not good. It has been shown it is possible to return a positive PCR test where a sample taken from the same patient never grows a viral culture – meaning the patient does not have an active COVID-19 infection despite the positive PCR test. The implications of this for the false positive rate of PCR tests are obvious and significant.

The other obvious explanation for the increase in number of ‘cases’ is that far more people are being tested – 280,000 per day now compared to 10,000 at the peak in March. So, while there are twice the number of ‘new cases’ per day now compared to the March peak, the number of ‘new cases’ per 1000 people tested now is actually only ONE-TENTH of that in the March peak (45 compared to 450). See graph below.

Much of this is borne out by simply looking at the more important trend of “COVID-19” hospital admissions and deaths (see graph below). For both we see increases – but at much slower rates than ‘cases’, and not beyond what we would expect at the beginning of any flu season. But, critically, these counts of ‘COVID-19’ admissions and deaths are inevitably ALSO inflated for the same reason that ‘cases’ are: anybody admitted to hospital – or dying – with a positive test is classified as ‘COVID-19’ irrespective of the actual reason for admission or cause of death AND regardless of whether they showed any symptoms of a ‘COVID-19 illness’. The analogous situation would be assigning the cause of hospitalisation or death to ’a cold’ if a patient harboured a cold virus without showing any symptoms of

 

 

Professor Norman Fenton is the Professor of Risk and Information Management, School of Electronic and Electrical Engineering, Queen Mary University of London

Dr Scott McLachlan is a Postdoctoral Research Assistant, School of Electronic and Electrical Engineering, Queen Mary University of London

Professor Martin Neil is the Professor of Computer Science and Statistics, School of Electronic and Electrical Engineering, Queen Mary University of London

Dr Magda Osman is a Reader in Experimental Cognitive Psychology, School of Biological and Chemical Sciences, Queen Mary University of London

 

Republished from lockdownsceptics.org

https://lockdownsceptics.org/counting-covid-19-cases-is-misleading-everybody/

 

 

Why your Positive Test Result is Likely Wrong

by Rob Verkerk PhD Founder, Executive & Scientific Director Alliance Natural Health Int’l

 

Republished from anhinternational.org

https://www.anhinternational.org/news/why-your-positive-test-result-is-likely-wrong/

 

You’ve just got the news from your coronavirus test centre that your test was positive. You now have to self-isolate. If you don’t, you could face a fine up to £10,000, in the UK at least.

When it comes to health, we’re all for monitoring. It’s a central plank of our blueprint for health system sustainability. But there has to be some caveats. Here are a few:

• That the test must be accurate;
• If there’s a chance your test result might be wrong, you should be told;
• Any actions that follow from the test result must have been subjected to a careful balancing of risk and benefit – taking into account not only health-related factors, but also social and economic ones.

On all three of these caveats, testing as rolled out in most countries – including the UK’s Test & Trace initiative – fails spectacularly.

We’re going to explain here why positive test results from RT-PCR tests are more than likely to be wrong – and why, if you’ve had a positive test result, you should make sure you’re re-tested. If compulsory self-isolation following a positive test result has a major negative impact on your work or other aspect of your life, you should think about demanding multiple re-tests.

Testing for a Virus not a Disease

By definition, someone who’s got Covid-19 has to be diseased and present with symptoms, such as a continuous cough, shortness of breath, fever, chills, fatigue, nausea, runny nose, loss of sense of taste or smell, and so on. But we know that the vast majority of people who’re found to be positive from a PCR test don’t have the disease. Most people have come to think of these people as asymptomatic, but the majority of these might not even be infected with SARS-CoV-2 (the virus that causes Covid-19). They therefore can’t infect others.

 

https://www.youtube.com/watch?v=ah1ADk2r2Jg&feature=emb_logo

 

In our video above, we show you why it is wrong to consider positive test results as a measure of infection. Recently deceased inventor of PCR, Dr Kary Mullis, was always clear that PCR should be used for biomedical research and forensics, and not for diagnosis of disease.Echoing Mullis’ sentiments, Dr David Rasnick, biochemist and protease developer proferred, “I’m skeptical that a PCR test is ever true. It’s a great scientific research tool. It’s a horrible tool for clinical medicine.”

Accuracy, Sensitivity and Specificity aren’t the Same

Manufacturers of PCR tests that measure whether or not you’re supposed to be infected claim values expressed as percentages for two metrics. One is sensitivity that measures the ability of the test to detect true positives, the other is specificity, which reflects the ability of the test to detect true negatives. For so-called Covid-19 RT-PCR tests, they’re often very high values close to 100%, as you’ll see in the table below: 

But these analytical values are based on tests evaluated under perfect conditions using reference samples of synthetic gene sequences. There is no proper gold standard that confirms the infection or the presence of disease, and we also know that real world accuracy of the tests varies according to the timing of the swab sample, the viral load on the specimen, and even things like whether or not someone smokes.

“A test with good analytical sensitivity and specificity does not necessarily have good clinical sensitivity and specificity. The overall performance of SARS-CoV-2 RT-PCR tests cannot be known until we understand who is truly infected and who isn’t.”
- Andrea Prinzi, American Society for Microbiology

To put it in different terms, the analytical sensitivity, under ideal lab conditions, is the proportion (percentage) of people who will have a positive result when exposed to the virus. Conversely, the specificity is the proportion that should get a negative result when there’s no disease around. When specificity for example is less than 100%, say 99%, you’d expect 1% false positives i.e. people testing positive when they should have been negative because they are not infected. A 1% error rate sounds pretty good to most people – but that 99% specificity will only give you a 99% chance of having true negative if you’re guaranteed to be infected. That just doesn’t happen when there’s not much virus around and a lot of infected people around you.

Bayes’ Re-entry

When there’s not much disease around, probability theory comes into play. This general idea was first mooted posthumously by Reverend Thomas Bayes in 1763 in the form of what we know today as Bayes’ theorem or law. It took a while for medics and researchers to recognize the importance of Bayesian probability theory in clinical diagnostic and screening and Bayes’ theorem wasn’t applied to diagnostic or screening tests until the 1950s. It’s been thoroughly studied in diseases like TB.

What Bayesian probability tells us in relation to our current pandemic is that if we have information about the prior risk of infection – in other words, if we know what proportion of people in the communities we live in are infected (= disease prevalence) – we can more accurately predict the accuracy of a given test result, whether positive or negative.

High False Positive Rate when Disease is at Low Ebb

Here’s the real cough drop: as the disease prevalence declines, the chances of a positive result from an RT-PCR test being a true positive declines, dramatically so at very low levels of prevalence. The converse is also true, although, fortunately, is much less relevant. When the prevalence of infection is very high, the chances that a negative test result is a true result also declines substantially.

Modelled daily rates of positive tests in different regions of the UK range from 0.04% (West Midlands) to 0.21% (North West) according to UK government stats which are themselves based on the rate of positive tests.

To understand how prevalence affects the likelihood of a test result being true, you need to calculate another statistic that includes Bayes’ theorem, the Positive Predictive Value (PPV) and the Negative predictive Value (NPV). Here, one of the world’s greatest medical statisticians, the late Doug Altman from Oxford University needs to be credited for his application of Bayesian probability to diagnostic and screening tests.

DIY PPV

You can use many a website diagnostic calculator to compute the PPV and NPV, but remember it’s the PPV that is particularly affected by low prevalence. You can also use Altman and Bland’s 1994 formulas yourself if you want to do it the hard way, but the MedCalc is an easier option.

If you take real-world sensitivity and specificity at 95% i.e. you assume that a combination of errors in the test themselves and the way the tests perform in the real world contribute to a 5% error rate which is realistic, you get the following percentage probabilities for a positive test result being a true positive.

At 10% prevalence, PPV = 68%
At 5% = 50%
At 2% = 28%
At 1% = 16%
At 0.5% = 9%
At 0.05% = 1%

In this final scenario, which may be in line with the real world prevalence in the least infected parts of the UK, that means if you got a positive result in a test, there’s only a 1% chance it’s correct. Yes, a 1% chance.

Just Tell Us – We’re not Stupid!

It’s not statistical trickery – it’s actually common sense. To try to understand why the false positive rate of RT-PCR tests go up when the prevalence of SARS-CoV-2 is low, let’s use the analogy of looking for a needle in a haystack; the PCR test has been designed to detect real needles. But because the test isn’t 100% accurate, especially when used in different barns and fields by different people, it sometimes picks up things that look like needles but aren’t real ones. As real needles are so few and far between, the chances of finding things that look like needles but aren’t increases. OK?

The big question we have is: Why is the Public not being Told about the Probability of their Test being Incorrect?

Don’t tell us the public isn’t clever enough to understand probability. The public deals with probability all the time. The probability of market prices rising or falling according to national or global events. The probability of a plane falling out of the sky when you decide to travel by air. The risk of something going seriously wrong when you consent to a given surgical procedure. Why not now?

Could False Positives Explain the Apparent Rise in Infections?

The short answer is: partially. The non-intuitive answer is: not because the rate of true positives becomes less reliable because the prevalence is low. Especially not where there is evidence of higher infections. Primarily because there has been increased testing. In the figure below, relying on official UK government data, we present the number of tests (in Pillars 1 and 2), the number of positive tests by specimen date, and by published date, as well as the positivity rate for each method (7-day averages). The positivity rate is simply the number of positive tests as a proportion of those tested. As you will see (Fig. 1) total tests increased and this will likely account for some of the apparent increase in cases that has got everyone deeply concerned. The trouble is in the mix of the slight upward trend is a genuine rise of true positives and the effect of increased testing frequency.

You'll also notice that the way the UK Government chooses to illustrate the rise in case numbers (Fig. 2) is at odds with a more scientifically rational representation of the data, as we show in Fig. 1, which eliminates confounding by testing frequency. Unfortunately, another clear case of Government deception. As we said last week, the World Health Organization (WHO) has advised governments that before reopening economies and removing restrictions, the positivity rate should be below 5% for at least 14 days. The real positivity rate in the UK has been way below 5% for months now.

 
Figure 1: UK government data on number of tests, daily positive tests (by specimen and published date)
and positivity rates for each (7-day averages).

 

Figure 2. The way the UK Government presents the current rise in cases. [Source: GOV.UK]

 

Watchful waiting and protection of the most vulnerable may have been a more proportionate response than life-changing fines for those who don’t self-isolate when they’ve been delivered a positive result for a RT-PCR test.

Especially when the chances are it was wrong.

Acknowledgement Citation

Republished from anhinternational.org

https://www.anhinternational.org/news/why-your-positive-test-result-is-likely-wrong/

Source and Contact:

Rob Verkerk PhD  ANH-Intl info@anhinternational.org
Alliance for Natural Health International

 

 

Discovery of Druggable Pocket in SARS-CoV-2 Spike Protein could Stop Virus 

A druggable pocket in the SARS-CoV-2 Spike protein that could be used to stop the virus from infecting human cells has been discovered by an international team of scientists led by the University of Bristol.  The researchers say their findings, published today 21 Sep in the journal Science,[1] are a potential ‘game changer’ in defeating the current pandemic and add that small molecule anti-viral drugs developed to target the pocket they discovered could help eliminate COVID-19.

SARS-CoV-2 is decorated by multiple copies of a glycoprotein, known as the ‘Spike protein’, which plays an essential role in viral infectivity. Spike binds to the human cell surface, allowing the virus to penetrate the cells and start replicating, causing widespread damage.

In this ground-breaking study, the team headed by Professor Christiane Schaffitzel from Bristol’s School of Biochemistry and Professor Imre Berger from the Max Planck-Bristol Centre for Minimal Biology, used a powerful imaging technique, electron cryo-microscopy (cryo-EM), to analyse SARS-CoV-2 Spike at near atomic resolution. Enabled by Oracle high-performance cloud computing, a 3D structure of SARS CoV-2 Spike protein was generated allowing the researchers to peer deep inside the Spike identifying its molecular composition.
Unexpectedly, the research team’s analysis revealed the presence of a small molecule, linoleic acid (LA), buried in a tailor-made pocket within the Spike protein.  LA is a free fatty acid, which is indispensable for many cellular functions. The human body cannot produce LA. Instead, the body absorbs this essential molecule through diet. Intriguingly, LA plays a vital role in inflammation and immune modulation, which are both key elements of COVID-19 disease progression. LA is also needed to maintain cell membranes in the lungs so that we can breathe properly.

Professor Berger said: “We were truly puzzled by our discovery, and its implications. So here we have LA, a molecule which is at the centre of those functions that go haywire in COVID-19 patients, with terrible consequences. And the virus that is causing all this chaos, according to our data, grabs and holds on to exactly this molecule – basically disarming much of the body’s defences.”

Professor Schaffitzel explained: “From other diseases we know that tinkering with LA metabolic pathways can trigger systemic inflammation, acute respiratory distress syndrome and pneumonia. These pathologies are all observed in patients suffering from severe COVID-19.  A recent study of COVID-19 patients showed markedly reduced LA levels in their sera.”

Professor Berger adds: “Our discovery provides the first direct link between LA, COVID-19 pathological manifestations and the virus itself. The question now is how to turn this new knowledge against the virus itself and defeat the pandemic.”

There is reason for hope. In rhinovirus, a virus causing the common cold, a similar pocket was exploited to develop potent small molecules that bound tightly to the pocket distorting the structure of the rhinovirus, stopping its infectivity. These small molecules were successfully used as anti-viral drugs in human trials, defeating rhinovirus in the clinic. The Bristol team, based on their data, is optimistic that a similar strategy can now be pursued to develop small molecule anti-viral drugs against SARS-CoV-2.

Professor Schaffitzel said: “COVID-19 continues to cause widespread devastation and in the absence of a proven vaccine, it is vital that we also look at other ways to combat the disease. If we look at HIV, after 30 years of research what worked in the end is a cocktail of small molecule anti-viral drugs that keeps the virus at bay. Our discovery of a druggable pocket within the SARS-CoV-2 Spike protein could lead to new anti-viral drugs to shut down and eliminate the virus before it entered human cells, stopping it firmly in its tracks.”

Alison Derbenwick Miller, Vice President, Oracle for Research, added: "Oracle for Research unites researchers and cloud computing to help bring about beneficial change for our planet and its people. SARS-CoV-2 and COVID-19 are causing global devastation, and research efforts to find vaccines and treatments cannot move quickly enough. We are so pleased that Oracle's high-performance cloud infrastructure enabled Professors Berger and Schaffitzel to examine the molecular structures of the coronavirus spike protein and make this powerful  and unexpected new discovery that could help curb the pandemic and save lives."

The team included experts from Bristol UNCOVER Group, Bristol biotech Imophoron Ltd, the Max Planck Institute for Biomedical Research in Heidelberg, Germany and Geneva Biotech Sàrl, Switzerland. The study was supported by funds from the Elizabeth Blackwell Institute with additional support from Oracle high-performance cloud computing and Genscript. We are very grateful to the University of Bristol's alumni and friends for their generous philanthropic support of this research.

Reference

1. C Toelzer et al Free fatty acid binding pocket in the locked structure of SARS CoV-2 spike protein Science DOI: 10.1126/science.abd3255. 21 Sep 2020. https://science.sciencemag.org/content/early/2020/09/18/science.abd3255

Further Information

Webinar

A webinar explaining the team’s discovery of a druggable pocket in the SARS-CoV-2 Spike, is available on SelectScience.

About Professor Christiane Schaffitzel

Christiane Schaffitzel is also a Wellcome Trust Investigator and Academic Lead of the Wellcome Trust/BBSRC-funded GW4 Cryo-EM Facility at the University of Bristol.

About Professor Imre Berger

Imre Berger is also Director of BrisSynBio, a BBSRC/EPSRC Research Centre for Synthetic Biology in Bristol and a partner in the Wellcome Trust COVID-19 Protein Portal Consortium CPPC. BrisSynBio is part of the Bristol BioDesign Institute.

Study collaborators

University of Bristol collaborators on the project include: Professor Adrian Mulholland in the School of Chemistry, who worked on the molecular dynamics simulations and Dr Andrew Davidson, Reader in Systems Virology at Bristol, who in partnership with the team showed that LA works in synergy with the drug remdesivir to reduce virus replication, suggesting that supplementation of LA might be beneficial during treatment of SARS-CoV-2 infection.

In addition to Oracle cloud resources, this work used ARCHER (Advanced Research Computing High End Resource) High Performance Computing (HPC) through EPSRC, and the University of Bristol’s HPC resources.

About coronavirus (SARS-CoV-2)

The surface of the coronavirus particle has proteins sticking out of it known as Spike proteins which are embedded in a membrane.  They have the appearance of tiny little crowns, giving the virus its name (corona). Inside the membrane is the viral genome wrapped up in other proteins. The genome contains all the genetic instruction to mass produce the virus. Once the virus attaches to the outside of a human cell, its membrane fuses with the human cell membrane and its genetic information into the human cell.  Next, the virus instructs the cell to start replicating its genome and produce its proteins. These are then assembled into many new copies of the virus which, upon release, can infect many more cells. The viral proteins play diverse further roles in coronavirus pathology.

Bristol UNCOVER Group

In response to the COVID-19 crisis, researchers at the University of Bristol formed the Bristol COVID Emergency Research Group (UNCOVER) to pool resources, capacities and research efforts to combat this infection. Bristol UNCOVER includes clinicians, immunologists, virologists, synthetic biologists, aerosol scientists, epidemiologists and mathematical modellers and has links to behavioural and social scientists, ethicists and lawyers.

Follow Bristol UNCOVER on Twitter at: twitter.com/BristolUncover

For more information about the University of Bristol’s coronavirus (COVID-19) research priorities visit: www.bristol.ac.uk/research/impact/coronavirus/research-priorities/

Bristol UNCOVER is supported by the Elizabeth Blackwell Institute

Find out more about the Institute’s COVID-19 research looking into five key areas: virus natural history, therapeutics and diagnostics research; epidemiology; clinical management; vaccines; and ethics and social science.

About Oracle for Research

Oracle for Research is a global community that is working to address complex problems and drive meaningful change in the world. The program provides scientists, researchers, and university innovators with high-value, cost-effective Cloud technologies, participation in Oracle research user community, and access to Oracle’s technical support network. Through the program’s free cloud credits, users can leverage Oracle’s proven technology and infrastructure while keeping research-developed IP private and secure.

Further Information and Contact

For further information or to interview Professor Christiane Schaffitzel or Professor Imre Berger, please contact Joanne Fryer [Mon to Wed] joanne.fryer@bristol.ac.uk; Mob:: +44 (0)7747 768805 or Caroline Clancy [Wed to Fri], caroline.clancy@bristol.ac.uk, Mob: +44 (0)7776 170238 at the University of Bristol.

 

 

COVID-19 patients with sleep apnoea could be at additional risk

• Relationship between obstructive sleep apnoea and poorer outcomes from COVID-19 identified in systematic review of studies by University of Warwick;
• Researchers advise that people with obstructive sleep apnoea should take the necessary precautions to reduce their exposure and follow their treatment plan diligently ;
• 1.5 million people in the UK currently diagnosed with the condition, but up to 85% of people could be undiagnosed;
• Researchers call for better recording and more data on the condition.

People who have been diagnosed with obstructive sleep apnoea could be at increased risk of adverse outcomes from COVID-19 according to a new study from the University of Warwick.

The conclusion is drawn from a systematic review of studies that reported outcomes for COVID-19 patients that were also diagnosed with obstructive sleep apnoea. Published in the journal Sleep Medicine Reviews,[1] the review highlights the need to further investigate the impact of the virus on those with the sleep condition and to better identify those currently undiagnosed with it.

 Obstructive sleep apnoea is a condition characterised by complete or partial blockage of the airways during sleep when the muscles there become weaker. It is commonly diagnosed in people who snore or appear to stop breathing or make choking sounds during sleep, and those who are obese in particular are more likely to experience it. If you are told that you make strange noises when you sleep or seem to stop breathing during sleep, you should speak to their GP about being referred to a sleep service to be checked for the condition. You can also find more information about the condition here: http://www.sleep-apnoea-trust.org and https://www.hope2sleep.co.uk

Many of the risk factors and comorbidities associated with sleep apnoea, such as diabetes, obesity and hypertension, are similar to those associated with poor COVID-19 outcomes. However, the researchers wanted to investigate whether being diagnosed with obstructive sleep apnoea conferred an additional risk on top of those factors.

The systematic review looked at eighteen studies up to June 2020 with regards to obstructive sleep apnoea and COVID-19, of these eight were mainly related to the risk of death from COVID-19 and ten were related to diagnosis, treatment and management of sleep apnoea.  Although few studies of obstructive sleep apnoea in COVID-19 had been performed at the time, there is evidence to suggest that many patients who presented to intensive care had obstructive sleep apnoea and in diabetic patients it may confer an increased risk that is independent of other risk factors. In one large study in patients that had diabetes, who were hospitalised for COVID-19, those being treated for obstructive sleep apnoea were at 2.8 times greater risk of dying on the seventh day after hospital admission.

Researchers believe that in the UK up to 85% of obstructive sleep apnoea disorders are undetected, suggesting that the 1.5 million people in the UK currently diagnosed with the condition may be just the tip of the iceberg. With obesity rates and other related risk factors on the increase, the researchers also believe that rates of obstructive sleep apnoea are also increasing. The review highlights that the pandemic has also had worldwide effects on the ongoing diagnosis, management and treatment of patients with this and other sleep conditions. Moving forward it may be necessary to explore new diagnosis and treatment pathways for these individuals.

Lead author of the study Dr Michelle Miller of Warwick Medical School said: “Without a clear picture of how many people have obstructive sleep apnoea it is difficult to determine exactly how many people with the condition may have experienced worse outcomes due to COVID-19.

“This condition is greatly underdiagnosed, and we don’t know whether undiagnosed sleep apnoea confers an even greater risk or not.

“It is likely that COVID-19 increases oxidative stress and inflammation and has effects on the bradykinin pathways, all of which are also affected in obstructive sleep apnoea patients. When you have individuals in which these mechanisms are already affected, it wouldn’t be surprising that COVID-19 affects them more strongly.”

Treatment for obstructive sleep apnoea with continuous positive airway pressure (CPAP) has been shown to have some beneficial effects on these mechanisms and it is important that treatment is optimised for these individuals.  In the UK, the British Sleep Society with the OSA alliance has released guidelines with regards to the use of CPAP during the pandemic.

The researchers feel it is important that those diagnosed with obstructive sleep apnoea are aware of the potential additional risk and are taking appropriate precautions to reduce their exposure to the virus. Further research is required to determine whether these individuals need to be added to the list of vulnerable groups that may need to shield if transmission of virus increases.

Dr Miller adds: “This is a group of patients that should be more aware that obstructive sleep apnoea could be an additional risk if they get COVID-19. Make sure you are compliant with your treatment and take as many precautions as you can to reduce your risk, such as wearing a mask, social distancing and getting tested as soon as you notice any symptoms. Now more than ever is the time to follow your treatment plan as diligently as possible.

“Hospitals and doctors should also be recording whether their patients have obstructive sleep apnoea as a potential risk factor, and it should be included in studies and outcomes data for COVID-19. We need more data to determine whether this is something we should be more concerned about.”

Reference

1. Michelle A Miller, Francesco P. and Cappuccio. A systematic review of COVID-19 and obstructive sleep apnoea Sleep Medicine Reviews  55: 101382. February 2021. DOI: 10.1016/j.smrv.2020.101382

Further Information

Please contact Peter Thorley, Media Relations Manager (Warwick Medical School and Department of Physics) | Press & Media Relations via Mob: +44 (0) 7824 540863; peter.thorley@warwick.ac.uk     University of Warwick

 

 

Oral Health Foundation Alarmed by Dangerous DIY Dental Hacks

The Oral Health Foundation is becoming extremely concerned for the safety of some users, following a rise in the number of influencers posting on sites such as TikTok dangerous DIY dental advice. The charity estimate that bogus health advice has been seen by more than 20 million people on TikTok and if replicated, could cause severe and long-term damage for a person’s mouth. Some of the most harmful videos sharing DIY dental hacks have been liked by more than 3 million TikTok users, leading the charity to be alarmed by the potential effect influencers may be having on their audience.  

Here are four of the most ill-advised dental hacks posted and why you should not try them yourself.

1. Taking a Shot of Apple Cider Vinegar every Day

To kick things off we start with a video, which has over 6 million views and 1.1 million likes, she claims to have taken a shot of apple cider vinegar every day for two weeks. This resulted, she claims, in losing six pounds of weight. The promotion of apple cider vinegar for weight loss is not new but it is still just as harmful to teeth as it’s always been.

As Dr Nigel Carter OBE, Chief Executive of the Oral Health Foundation points out:

“Undiluted apple cider vinegar is acidic enough to weaken the enamel on your teeth. Weakened enamel increases your vulnerability to tooth decay and cavities. It can also lead to increased tooth sensitivity. Individuals with a particularly heavy consumption of undiluted apple cider vinegar also may experience swelling or burns inside their mouths.”

2. Rinsing with Hydrogen Peroxide

This one you may have heard of as it hit the headlines last month. In the video, which has just over 20 million views, a user demonstrates how to mix a solution of water and 3% hydrogen peroxide, brought online for £4 on Ebay, and apply it to your teeth.  The video recommends a course of treatment every day for four days. Concerningly, the influencer starts the video by saying: “if you’re a dentist don’t tell me this is wrong, just save me the grief, the damage has already been done”.

Dentist and President of the Oral Health Foundation, Dr Ben Atkins advises against the home use of any ingredient containing hydrogen peroxide. Dr Atkins says: “The legal limit of over-the-counter hydrogen peroxide in cosmetic products in the UK is 0.1%, and for good reason.  For somebody not trained in dentistry, applying hydrogen peroxide can cause chemical burns and has the potential to cause serious and permanent damage to the teeth and gums. 

“The chemical in its pure form, is not designed for dental use and should be avoided.”

3. Rubbing Banana Skin on your Teeth

This one, made by a user is in a similar vein to our first on the list and is also just as ineffective and damaging.  The claim is that by rubbing the under-skin of a banana on your teeth, you can whiten them. Just like the other claims made before, they are being made by people with no medical or dental training.

Dr Carter adds: “Banana skins contain fructose which is a sugar and when it comes into contact with plaque on the teeth can form acid and lead to the softening of tooth enamel.

“Despite the user’s claims, there is no evidence that the properties of banana skin will have any whitening effect on the teeth and will probably just result in several trips to the dentist.”

4. Filing down Uneven Teeth

This shocking video is just one of a handful seen on TikTok in recent weeks of users using nail files on their teeth saying “I’m going to file my teeth with a nail file because they are not perfect”.

Dr Atkins says: “Using a nail file on your teeth will permanently remove the enamel.  This enamel does not ‘grow’ back, so this could lead to expensive restorative work being necessary to re-build the teeth.

“Another danger is that you’ll expose the nerve of the tooth which would lead to both pain and sensitivity.”

The Oral Health Foundation is concerned by the trend of DIY dentistry across social media. Social media is an area of special concern because of the age of the majority of users, and especially on TikTok. The latest figures show that the majority of TikTok users (32%) fall into the 10 – 19 years old age bracket. This is such a young, impressionable age and one where you are not going to be as aware of the risks associated with these videos.The charity believes many influencers pressure young people to prioritise aesthetics and appearance over their health.

“In an attempt to save money, many young people are drawn in by ‘hack’ videos on social media that seemingly allow you to cut corners and achieve results similar to that of going to the dentist,” adds Dr Carter.

“This is a false and irresponsible message. Such shortcuts come with added danger and can lead to permanent damage to your oral health and will not give you the results you are looking for.”

The charity advises that people looking to improve the appearance of their smile talk with their dentist before embarking on any kind of oral health treatment.

Your dentist will be able to tell you what is and isn’t safe and what is and isn’t legal.

Further Information

The Oral Health Foundation has a Dental Helpline on 01788 539780. The Dental Helpline is staffed by fully trained dental professionals ready and willing to offer you free and independent oral health advice. It is open from Monday to Friday from 9am – 5pm.

For more information contact: Stephen Loat   stephen@dentalhealth.org   on Tel: +44 (0)1788 539 795   https://www.dentalhealth.org/