Vitamin D status and seroconversion for COVID-19 in UK healthcare workers who isolated for COVID-19 like symptoms during the 2020 pandemic
Aduragbemi A Faniyi, Sebastian T Lugg, Sian E Faustini, Craig Webster, Joanne E Duffy, Martin Hewison, Adrian Shields, Peter Nightingale, Alex G Richter, Prof David R Thickett
doi:10.1101/2020.10.05.20206706
Background: It is clear that in UK healthcare workers, COVID-19 infections and deaths were more likely to be in staff who were of BAME origin. This has led to much speculation about the role of vitamin D in healthcare worker COVID-19 infections. We aimed to determine the prevalence of vitamin D deficiency in NHS staff who have isolated with symptoms suggestive of COVID-19 and relate this to vitamin D status.
Methods: We recruited NHS healthcare workers between 12 th to 22 nd May 2020 as part of the COVID-19 convalescent immunity study (COCO). We measured anti-SARS-Cov-2 antibodies using a combined IgG, IgA and IgM ELISA (The Binding Site). Vitamin D status was determined by measurement of serum 25(OH)D 3 using the AB SCIEX Triple Quad 4500 mass spectrometry system. Findings: Of the 392 NHS healthcare workers, 214 (55%) had seroconverted for COVID-19. A total of 61 (15.6%) members of staff were vitamin D deficient (<30 nmol/l) with significantly more staff from BAME backgrounds or in a junior doctor role being deficient. Vitamin D levels were lower in those who were younger, had a higher BMI (>30 kg/m 2 ), and were male. Multivariate analysis revealed that BAME and COVID-19 seroconversion were independent predictors of vitamin D deficiency. Staff who were vitamin D deficient were more likely to self-report symptoms of body aches and pains but importantly not the respiratory symptoms of cough and breathlessness. Vitamin D levels were lower in those COVID-19 positive staff who reported fever, but this did not reach statistical significance. Within the whole cohort there was an increase in seroconversion in staff with vitamin D deficiency compared to those without vitamin D deficiency (n=44/61, 72% vs n=170/331, 51%; p=0•003); this was particularly marked in the proportion of BAME males who were vitamin D deficient compared to non-vitamin D deficient BAME males (n=17/18, 94% vs n=12/23, 52%; p=0•005). Multivariate analysis revealed that vitamin D deficiency was an independent risk factor for seroconversion (OR 2•6, 95%CI 1•41-4•80; p=0•002). Interpretation: In those healthcare workers who have isolated due to symptoms of COVID-19, those of BAME ethnicity are at the highest risk of vitamin D deficiency. Vitamin D deficiency is a risk factor for COVID-19 seroconversion for NHS healthcare workers especially in BAME male staff.
References
Aspray, Bowring, Fraser, National Osteoporosis Society vitamin D guideline summary, Age Ageing
Baktash, Hosack, Patel, Vitamin D status and outcomes for hospitalised older patients with COVID-19, Postgrad Med J
Carpagnano, Lecce, Quaranta, Vitamin D deficiency as a predictor of poor prognosis in patients with acute respiratory failure due to COVID-19, J Endocrinol Invest
Castillo, Costa, Barrios, 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
Chen, Zhou, Dong, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Lancet
Dancer, Parekh, Lax, Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS), Thorax
Faustini, Jossi, Perez-Toledo, Detection of antibodies to the SARS-CoV-2 spike glycoprotein in both serum and saliva enhances detection of infection, medRxiv
Ford, Graham, Wall, Berg, Vitamin D concentrations in an UK inner-city multicultural outpatient population, Ann Clin Biochem
Greiller, Martineau, Modulation of the immune response to respiratory viruses by vitamin D, Nutrients
Hastie, Mackay, Ho, Vitamin D concentrations and COVID-19 infection in UK Biobank, Diabetes Metab Syndr
Im, Je, Baek, Chung, Kwon et al., Nutritional status of patients with coronavirus disease 2019 (COVID-19), Int J Infect Dis
Kaufman, Niles, Kroll, Bi, Holick, SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels, PLoS One
Mahida, Chotalia, Alderman, Characterization and Outcomes of ARDS secondary to pneumonia in patients with and without SARS-CoV-2: A single center experience
Martineau, Jolliffe, Hooper, Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data, Bmj
Merzon, Tworowski, Gorohovski, Low plasma 25(OH) vitamin D level is associated with increased risk of COVID-19 infection: an Israeli population-based study, Febs j
Mitchell, Vitamin-D and COVID-19: do deficient risk a poorer outcome?, Lancet Diabetes Endocrinol
Panagiotou, Tee, Ihsan, Low serum 25-hydroxyvitamin D (25[OH]D) levels in patients hospitalized with COVID-19 are associated with greater disease severity, Clin Endocrinol
Parekh, Dancer, Scott, Vitamin D to Prevent Lung Injury Following Esophagectomy-A Randomized, Placebo-Controlled Trial, Crit Care Med
Parekh, Patel, Scott, Vitamin D Deficiency in Human and Murine Sepsis, Crit Care Med
Parekh, Thickett, Turner, Vitamin D deficiency and acute lung injury, Allergy Drug Targets
Rhodes, Dunstan, Laird, Subramanian, Kenny, COVID-19 mortality increases with northerly latitude after adjustment for age suggesting a link with ultraviolet and vitamin D, BMJ Nutrition, Prevention & Health
Shields, Faustini, Perez-Toledo, SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study, Thorax
Sowah, Fan, Dennett, Hagtvedt, Straube, Vitamin D levels and deficiency with different occupations: a systematic review, BMC Public Health
Watanabe, Allen, Wrapp, Mclellan, Crispin, Site-specific glycan analysis of the SARS-CoV-2 spike, Science
Webster, Relationship of total 25-OH vitamin D concentrations to Indices of Multiple Deprivation: geoanalysis of laboratory results, Ann Clin Biochem
Wrapp, Wang, Corbett, Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation, Science