Myeloma Crowd published a post a few days ago about the impact and importance of adequate Vitamin D levels on the survival statistics of myeloma patients. We would like to add to that today with the pre-print publication of a research study that studied links between Vitamin D deficiencies and COVID-19 severity and mortality. Let’s first explain what a pre-print article is. Pre-print means that the article in question has not yet been peer reviewed for journal publication. Still, in this case the article in question was (a) published by a well-known, well-established, credible organization (Northwestern University, Illinois, USA); and (b) was co-authored by a well-established researcher (Vadim Backman, Walter Dill Scott Professor of Biomedical Engineering at Northwestern's McCormick School of Engineering).

The research in question is not specifically related to myeloma and/or myeloma treatment, but we feel that is important for myeloma patients to be aware of, especially in light of the Myeloma Crowd post referenced above. Let me give you two links to refer to :

• The ‘easy’ summary of the research can be found in the press release by Northwestern University. This summary provides a nice overview of the source document and is a quick read.
• The actual article that provides the full details of the study. This article is written in fairly plain English and may take you have an hour to go through but is well worth the effort. 

‘Backman and his team were inspired to examine vitamin D levels after noticing unexplained differences in COVID-19 mortality rates from country to country. Some people hypothesized that differences in healthcare quality, age distributions in population, testing rates or different strains of the coronavirus might be responsible. But Backman remained skeptical. "None of these factors appears to play a significant role," Backman said. "The healthcare system in northern Italy is one of the best in the world. Differences in mortality exist even if one looks across the same age group. And, while the restrictions on testing do indeed vary, the disparities in mortality still exist even when we looked at countries or populations for which similar testing rates apply. "Instead, we saw a significant correlation with vitamin D deficiency," he said.’

The research team studied data from a large group of patients from 10 different countries, each with large numbers of Covid-19 patients. You will learn about C-reactive proteins (CRP), that ‘are produced by the liver in response to inflammation to minimize damage to arteries, cells, and tissue from autoimmunity, infection, and other causes. The inflammatory cells’ ability to convert Vit D metabolites into calcitriol (the active form of Vit D) … suggests a potential inverse association between CRP and Vit D.’ Or to put it simply : for a patient, having high levels of CRP is not a good thing and there is a relationship between low levels of Vitamin D and high levels of CRP.

The study resulted in several interesting observations :

• ‘… , patients with severe COVID-19 have a higher percentage of cases with CRP ≥ 10 mg (81.5%, 110 cases out of 135) than those with a mild form of the disease (56.5%, 371 cases out of 658). Conversely, patients with high CRP have a higher risk of severe COVID-19 (23%) than their counterparts with low CRP (8%). This trend also persists in the cases of mild COVID-19.’ [Emphasis added] In other words, patients with high levels of CRP tend to end up with more severe COVID-19.
• ‘The relationship between CRP and Vit D has been investigated in multiple clinical studies. Laboratory data from 1,873 participants (NHANES, 2007-2008) and analyzed by Li et al. shows a strong relationship between severe deficiency of Vit D and high levels of CRP.’ [Emphasis added]
• ‘Because high CRP (a surrogate of cytokine storm) levels are associated with severe COVID-19 and severe Vit D deficiency is associated with high CRP, we can estimate the extent to which eliminating Vit D deficiency may lower the risk of severe COVID-19.’ [emphasis added].
• ‘Vit D plays a role in enhancing the innate immune system while, at the same time, partially suppressing adaptive immunity and some of its complications such as the induction of cytokine storm. In turn, cytokine storm … may instigate further complications such as ARDS, exacerbation of the effects of pneumonia, acute kidney failure, acute heart failure, and rhabdomyolysis … that in some cases may become fatal. Even moderate lung damage due to a weak cytokine storm could lead to hypoxemia that in turn results in mortality due to underlying conditions.’
• ‘Our preliminary analysis of COVID-19 patient data … combined with a Vit D research study …  suggests that Vit D may reduce COVID-19 fatality by suppressing cytokine storm.’ [Emphasis added]

The authors caution that more research needs to be done, In specific, they recommend a double blind study that uses specific patient data to quantify the more exact relationship between Vitamin-D levels and severity (and mortality) of COVID-10 patients that does not rely on the population data bases from the 10 countries their current data set. 

What does it all mean for the myeloma patient ? A few days ago, we learned that Vitamin D deficiency has an adverse effect on us. Now we learn that Vitamin D sufficiency will not protect us from COVID-19 infection, but it may well lessen the clinical severity of the infection, especially for the older ones among us.