COVID-19 in Indonesia - suspected data fraud - May 2020

 

Covid-19: More deaths? More lockdown? More suffering?

Vitamin D deficiency causes a 10 times higher death rate in Covid-19 patients, according to recent studies.
What can we do to get the Covid-19 pandemic under control and avoid another lockdown
Lorenz Borsche borsche@gmx.de / Dr. Bernd Glauner
 PDF extracted to this page - from authors in Germany
Extraction of tables was poor - please see PDF

 Original Indonesia preprint

web site of the authors: Does vitamin D (and C) help with Covid-19 - May 2020

Introduction

The authors see sufficient scientific plausibility that with a good vitamin D level, many corona deaths could still be alive today.<span style="color:<span style="color">#000000">The studies listed wrt the course of the disease, and the death rate in Covid-19 infections dependent on vitamin D level are evident, among others, in a study with 780 participants. That may be a factor of 12 smaller than a placebo-controlled double-blind study with 10,000 participants. The study is still significant because it shows that infections in groups with deficient vitamin D levels are 10 times more likely to end in death. With a vitamin D supplementation to levels known from nature (East Africa: Massai/Hadza, Central Africa: wild chimpanzees) of 45 ng/ml, there is a good chance that Covid-19 would not have any worse effects than a severe wave of influenza. A lockdown would then be just as unnecessary as the justified fear of our elderly fellow citizens and the risk groups, which imposes an abnormal life on all of us. Quite independently of Corona, it has been known and published for many years that vitamin D deficiency promotes the development of pneumonia - technically correct from ARDS (Acute Respiratory Distress Symptom) - as a result of viral infections. In addition, vitamin D stimulates the body's own synthesis of antiviral substances, which specifically block the spike protein necessary for the docking mechanism of covid-19 to the receptor protein ACE2. All this is well-researched, published information that clearly shows us that vitamin D deficiency patients are at high risk of getting pneumonia. In today's society, many people suffer from a massive vitamin D deficiency - especially in winter (see chapter: What else you should know [WHO vs. D-A- CH limits]). Statistics often assume that blood values of 20ng/ml are sufficient for vitamin D function. But these limits date back to the time when vitamin D was only studied for its effect on bone metabolism. The fact is - and studies in many European countries show this - that depending on the country, 20-40% of people do not even reach this value (20 ng/ml) even in summer. One reason for this is the recommendations for vitamin D substitution. It has been published for years that the official recommendations of 400-800 units of vitamin D per day are based on a calculation error by a factor of 10. Unfortunately, this has still not been included in the official recommendations, as they should be in the range of 5,000 international units per day. Necessary for a stable immune system are blood values of 40- 50ng/ml. But only a few people have reached this level.

The data presented in this article show that up to 90% of deaths could be avoided. This means that the current situation could also be symbolically described as a "vitamin D deficiency pandemic." Unfortunately, in Germany, neither the family doctor nor hospitalized patients routinely measure the blood level of vitamin D, even though all relevant organisati­ons, such as the DGE, BfR, RKI, and WHO, repeatedly report that our population suffers from vitamin D deficiency that also causes other health problems. The present study from Indonesia shows exactly the result that must be expected based on the scientific background described above. At vitamin D concentrations below 20 ng/ml, a very large number of patients succumb to pneumonia triggered by Covid-19, whereas at vitamin D concentrations >30 ng/ml, the majority of patients survive, and this with a statistically very good correlation. Large medical studies are very expensive. Someone has to raise the necessary funds in the hope that there will be revenue if the results are positive. Given the low market price of vitamin D, this simple economic constraint explains why there are relatively few studies on vitamin D. Lorenz Borsche has been trying for a few weeks now to find partners in the medical field in Germany who, with his financial support, carry out purely observational ex-post studies (vitamin D testing of infected persons/course of the disease), unfortunately without any success so far. The three studies presented here were initiated by ordinary doctors (MD/GP) and financed from their own resources and with considerable personal commitment⁽[1]^}. One must, therefore, not apply the same standard as in large-scale double-blind studies. Nevertheless, the results are so overwhelmingly clear that they should be examined. The rapid increase of vitamin D levels in covid-19 infected patients with vitamin D deficiency (< 30ng/ml), as well as vitamin D supplementation in doctors, nursing staff, and risk patients to a healthy blood level of 40-50ng/ml, is - in the authors' view - the only conceivable solution to effectively contain the corona pandemic. One then could most likely allow the SARS-CoV-2 virus to spread, and people could survive the infection like a wave of influenza. Apart from the social and economic benefits, this would also be much more economical than any other measure and might cost a fraction of what the lockdown has cost and will cost us - in money and in human lives.#000000:__''

The latest studies on Covid-19 and vitamin D

2 May, the authors received a [https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3585561| publication from Indonesia]. Prabowo Raharusuna and his team examined 780 covid-19 patients for their vitamin D levels. This study is neutral and independent; it was neither sponsored nor has any other conflicts of interest. Depressingly clear!
After correction for age, sex, and previous illnesses, the risk of death is 10 times higher for people with vitamin D deficiency. Insufficient vitamin D status is still 7 times higher than sufficient, good vitamin D levels. In order to make the evaluation transparent and easy to interpret even for non-scientists, Sadiah Priambada, a statistician in the team, prepared the data in such a way that the three comparison groups with vitamin D levels of <20, 20-30, and >30 ng/ml can be assessed on the basis of an equal age average and an equal number of cases. This more easily readable evaluation leads to practically the same results as the original data, which proves not only the stability of the data but also the correctness of the previously chosen statistical approach to the calculation of the influencing factors of age, sex, and previous fluctuations.

1	Vitamin D < 20 ng/ml (18.2 ± 0.6)	Vitamin D 20-30 ng/ml(26.6 ± 1.4)	Vitamin D > 30 ng/ml(32.1 ± 1.3)
Overall, N	60	60	60
Mean age	61.5 ±4.9	61.2 ±3.5	61.3 ± 1.6
Comorbidity, %	85.0	76.7	10.0
Death, %	100.0	88.3	3.3
Active,, %	0.0	11.7	96.7

 The authors could not standardize the comorbidity (pre-existing conditions); too few cases would have remained. One should, therefore, not compare the percentage of deaths and attribute everything to vitamin D, as this would result in too high a ratio, here about 30:1 instead of 10:1. Every simplification has its limits. The data show that pre-existing conditions have an influence on the course of infections. It is not possible to say with certainty to what extent the Covid-19 infection or the previous illness is responsible for the occurrence of death. However, the available data suggest that the mortality rate is significantly lower even in the presence of pre-existing conditions when vitamin D levels are sufficient. Whether pre-existing conditions may also result from decades of vitamin D deficiency will have to be proven in future studies. The original data (table, 780 cases) is available[https://borsche.de/res/Indo_1.pdf| here as PDF ]with detailed explanations of the data reduction and comments by Sadiah Priambada. There is also the contact of the zero line below at approx. 34 ng/ml is explained, what it is based on, and what it means.
The above graph clearly shows the dependence of the death rate in hospitalized Covid-19 infected patients on the measured vitamin D concentration in the blood. The data are based on the same data reduction as the above table but with finer granulation - in 20 groups. The procedure is the same as explained in the PDF above; the same data set was used. There is a very sharp drop in the death rate in the range of blood levels between 27 and 32 ng/ml vitamin D (marked area). At vitamin D levels above 32 ng/ml, the death rate determined in this study is a factor of 10 lower than at vitamin D levels below 27 ng/ml. What else you should know (WHO vs. D-A-CH limits): The Indonesians use the international guidelines of the WHO for the vitamin D level: 20 ng/ml is already considered "deficient," i.e., a deficiency, 20-30 is "insufficient," i.e., insufficient, and only more than 30 ng/ml is considered "normal." In Germany, outdated and significantly lower values apply: Above 20 ng/ml is already "normal," 10-20 ng/ml is borderline, and only below 10 ng/ml is a deficiency worthy of treatment established. In most cases, however, this is not treated because far too few tests are carried out. The test has to be paid for by the patient himself and is in the order of 30 Euros. German healthy seniors have over 80% "German" normal values, i.e., more than 20 ng/ml. 80% of sick seniors (geriatric patients), on the other hand, have insufficient, and half of them values, which even in Germany are classified as deficiency (<10 ng/ml, among others [https://www.heise.de/tp/features/Schuetzt-Vitamin-D-vor-Covid-19-4704193.html|s here)]. From the data of the RKI [https://T1p.de/2jde|(Vitamin D status in Germany], p.36, 2016), it can be calculated that 30% of all Germans between 18 and 79 must have far less than 10 ng/ml in the winter quarter (Dec/Feb):

e
C
RKI_2016
Alter
Mangel
18-29 Jahre
28.4%
30 - 44 Jahre
32 8%
45 - 64 Jahre
29.6%
65 - 79 Jahre
30 0%
Schnitt/Jahr
30,2%
Quartal
Mangel
J un/Aug
8.3%
Sep/Nov
19,3%
Pv1ar/Mai
38,4%
Dez/Feb
52,0%
Schnitt/Jahr
29,5%

 Abbildung Izeigt. dass der Vitamin-D-Status starken saisonalen Schwankungen unterliegt.Wahrend im Som­mer und Herbst 8.3 % bzw. 19.3 % der Erwachsenen einen mangelhaften Vitamin-D-Status aufweisen, sind [es im Fruhling und Winter 38.4 % bzw. 52.0 %.  The arithmetical calculation of the dec-Feb values gives an average of 6.81 ng/ml fact. However, significantly smaller values are also measured. If a Gauss distribution with values between 2 and 10 ng/ml is taken as a basis, the peak of the curve is only weak at 5.9 ng/ml, which would apply to 30% of the population between 18 and 79 in the winter quarter. Since the facts leading to this statement have been known for years, it is hardly understandable that the risks of such a serious deficiency, which are associated with severe health hazards, are not widely discussed. About Prabowo Raharusuna, we received[[https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484| another study ]on the subject with over 200 subjects, by Mark Alipio, a very young medical doctor from Davao (also, self-financed, neutral and independent). Here too, the results are very clear:

Variables	Overall N (%)
Mild	Ordinary		Severe
Critical	p-value
Overall N (%)	212(100.0)	49(23.1)	59 (27.8)		56 (26.4)
48 (22.6)
Serum 25(OH)D, ng/ml	23.8	31.2 ± 1.08	27.4 ±2.14		21.2 土 112	17.1 ±2.39	<0.001
Vitamin D status
Normal	55 (25.9)	47 (85.5)	4(7.3)		2 (3.6)
2 (3.6)	<0.001
Insufficient	80(37.7)	1(1.3)	35 (43.8)		23 (28.8)
21 (26.3)
Deficient	77 (36.3)	1 (1-4)	20 (26.0)		31 (40.3)
25 (32.5)

  The data can be summarised as follows (abstract translated). For each increase by one standard deviation of serum 25(OH)D, the probability of a mild clinical outcome instead of a severe one was approximately 7.94 times (OR = 0.126, p <0.001), while interestingly, the chances of a critical outcome instead of a mild one were 19.61 times higher (OR = 0.051, p <0.001). The following vitamin D levels were used: The mean serum vitamin D level was 23.8 ng/ml. Serum vitamin D levels in mild cases were 31.2 ng/ml, 27.4 ng/ml for normal, 21.2 ng/ml for severe, and 17.1 ng/ml for critical. From the available data, it follows that only 4.3% of the patients who had a mild course had vitamin D levels below 30 ng/ml. In contrast, 95.8% of the patients with vitamin D levels below 30 ng/ml had a severe or even fatal course. Unfortunately, no further data, such as age and BMI, were collected. In Germany, the average vitamin D level over the year is only 18.8 ng/ml. Seniors with comorbidities are almost half that level and often even below 10 ng/ml, especially in winter. According to the available studies, it follows that especially our elderly fellow citizens do not have sufficient protection against Covid-19 infections. Conversely, the data suggest that the vast majority of Covid-19 patients with vitamin D levels above 30 ng/ml would survive the infection unscathed. At this point, it should be noted that nature has provided humans with a vitamin D level in the range of 45 ng/ml. This results from the values measured in primitive peoples (Massai/Hadza). Many people nowadays do not reach this value due to our modern lifestyle, especially since we hardly ever move unprotected in the sun at the relevant times of the day. In case anyone wonders why even the Filipino patients examined do not have more than 24 ng/ml vitamin D on average when there is much more sunshine? That's exactly why it is so hot there that they usually avoid the sun. This is a bit like the situation in nursing homes, except that in this country, there is too little sunshine instead of too much, and the senior citizens stay indoors because it is cold.

A study from England also fits the picture:

The Role of Vitamin D in the Prevention of Coronavirus Disease 2019 Infection and Mortality

The researchers around Petre Cristian Ilie have tested the number of Covid-19 deaths per 1 million inhabitants against the vitamin D level in 20 European countries and come to the following conclusion:

The mean vitamin D level in the countries studied (mean 22.4 ng/ml, StDev ±4.24) correlates strictly with the number of Covid-19 infected per million population (mean 295.95, StDev ±298.73, p=0.004) and with mortality (mean 5.96, StDev 15.13,

p<0.00001)

The death rates in Spain and Italy are much higher than in Scandinavia. The researchers explain this with the statistically significant higher vitamin D level among the inhabitants of the Nordic countries: The study shows that in older people, the average blood vitamin D level in Spain is 10.4 ng/ml, in Italy, 11.2 ng/ml, while in the Scandinavian countries, it is 18 ng/ml. The northerners obviously have a better vitamin D level, although the sun is not as intense there as in the south. This could either be because they are more active outdoors or because they get more vitamin D from food, e.g., fish, or both. Fat sea fish contains a lot of vitamin D., And southerners tend to spend their midday hours in the shade or indoors. Shadow, window glass, and a longer way through the atmosphere (morning/evening, autumn/spring) reduce UVB radiation much more than UVA.

 Another study from the USA (2016) shows that high supplementation with vitamin D can still help even after the emergency has already occurred, i.e., in patients who need to be ventilated. High dose vitamin D administration in ventilated intensive care unit patients: A pilot double-blind randomized controlled trialIn the study, patients with vitamin D deficiency (<20ng/ml) were divided into three groups: A placebo group and two groups that were given different doses of vitamin D. The single administration of 250,000 IU of vitamin D was compared with the single administration of 500,000 IU of vitamin D by injection. In addition, the vitamin D levels were increased to 45 and 55 ng/ml, respectively. While the length of stay of the placebo group at the ICU was 36 days, the 250,000 IU group averaged 25 days, and the 500,000 IU group averaged 18 days. This is a smooth halving and means that vitamin D is useful in prevention and acute cases. Another very recent study is by El James Glicio, a retired general practitioner and author from New Delhi:[https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3593258|Vitamin D Level of Mild and Severe Elderly Cases of COVID-19“]. Although the study is relatively small, it provides comparable results. Most (84.6%) of COVID-19 patients with critical course had vitamin D deficiency. Among those under 75 years of age, this was even 100% of critical cases. In the following figure, the data are divided according to the international vitamin D level groupings (<20: deficiency, 20-30: insufficient, >30 sufficient/good). One can see very clearly that the severe cases are mostly due to vitamin D deficiency. In mild cases, patients with good vitamin D levels predominate. Finally, a small study in ventilated patients from Iran 2018:Effect of High-Dose Vitamin D on Duration of Mechanical Ventilation in ICU Patients [https://www.ncbi.nlm.nih.gov/pubmed/31531088|(MirMohammad Miri et al.])

Table 2. Comparison of the me. groups.	m duration of hospitalization, duration of mechanical ventilation, and mortality of the patients in two
		Group	/7-value
	Control (n = 1$)
Intervention (n = 22)
Mechanical ventilation (days)	27.72 ± 22.48
17.63 ± 14	0.06
Length of ICU stay (days)	28.72 ±23.58
19.5 ± 12*2	0.06
Mortality (%)	11 (61.1)
8 (3 6.3)	0.00

  The intervention was carried out intramuscularly with 300,000 IU of vitamin D. Instead of 28 days, only 18 days mechanical ventilation, instead of 29, only 19 in ICU, instead of 61% deaths, only 36%.__.''

'What we could do

To sum it all up: If all people, especially the seniors, had a vitamin D level significantly above 30 ng/ml rather than 40 ng/ml, there would be a high probability that we would not have to fear Covid-19. At 45 ng/ml, as found in native, traditional living peoples near the equator, we should hope to lose practically no one because of Covid-19 unless the comorbidities are so severe that it would have been a matter of days or weeks anyway. From the Indonesian study with 780 participants, it follows that the risk of death would only be 1/10 if all of them had vitamin D levels of just over 30 ng/ml. Whether there would have been any deaths at all at 45 ng/ml is difficult to answer; the highest measured value was below 34 ng/ml. There were no deaths despite hospitalization above 33 ng/ml (only women, all without comorbidities). From the Philippine study, it follows that people with poor vitamin D levels have an 8 times higher risk of having a "critical" course. So that is the same again. The Iranian "ventilator study" shows a reduction of mortality under artificial respiration by half when vitamin D is administered intramuscularly with 300,000 IU. The American study sees reduced time spent in intensive care units from 36 to 18 days at 500,000 IU. Only every tenth person is still on intensive care, half of which can be saved with high-dose Vitamin D. A lethality rate of 2-4% currently assumed would result in 0.1-0.2% or less, a figure that even severe flu would reach (2018: 25,000 deaths among perhaps 15­20 million infected persons). Apart from this, it is highly plausible that people with comorbidities would also benefit significantly from a better D-level, indeed the entire population as a whole.

Moreover, the above studies suggest that a corresponding high-dose intervention would be indicated at the time of hospitalization, not at the time of transfer to the ICU. Which could save even more lives and turn severe courses into mild ones.

[And how much does ]it cost? For a healthy level of more than 45 ng/ml at 70 kg body weight, 5,000 IU vitamin D3 + 200 mcg of vitamin K2, which costs about 7 cents per day, is sufficient. The authors explicitly state that each vitamin D supplementation must be accompanied by sufficient vitamin K2. This certainly prevents the rise of the calcium level in the blood, which is often seen as a risk for the supply of vitamin For people who are not infected with Covid-19, e.g., hospital staff and high-risk patients, corresponding studies show that the vitamin D level can be raised relatively quickly to the "healthy" range if two to three times the amount is administered for two to three weeks (10,000 - 20,000 IU depending on weight). In Covid-19 patients who are hospitalized, the level can be raised immediately to sufficient values with the 500,000 IU syringe mentioned above. From the authors' point of view, this should mean that we no longer need another partial lockdown or special protective measures. The Covid 19 pandemic would continue, but we could safely wait until herd immunity is established if vaccination is unavailable first. In addition, we would save many billions in costs and avoid social disruption. These assumptions are supported by the clinical studies listed and published basic studies: They investigated how and where vitamin D intervenes in the relevant metabolic pathways. Without going into too much detail, the so-called renin/angiotensin system (RAS) is particularly important. The misregulation of this system in vitamin D deficiency contributes decisively to the development of ARDS and the triggering of a cytokine storm. A very good summary with quotations from important publications has been compiled by Dr. Renu Mahtani, an American physician of Indian descent (see especially the second half of the lecture). She impressively proves that a sufficient supply of vitamin D is sufficient to keep Covid-19 largely in check. It should be noted that Mrs. Mahtani does not mention the parallel supply of vitamin K2, which is absolutely necessary in the authors' view, when supplementing with vitamin D.Since 20.5.2020, the Red Cross of Poona has been distributing vitamin D3 to senior citizens "in an effort to boost their immunity" according to Dr. Mahtani's protocol.[https://drive.google.com/file/d/1WzUBa3ie7-mBuUzszH0HqaP0238U5xve/view?usp=drive_web|Here is the link ]to Renu Mahtani's very convincing presentation (in English)__

Afterword

It is undisputed that Germany and many other countries have prevented many Covid-19 infections and, thus, many deaths through their measures. How many more people could have been saved if the information on vitamin D presented here had been known and implemented? Could we perhaps even have avoided the lockdown with all its consequences for our economy and social interaction? The authors have great hopes that this article will help ensure that vitamin D will, in the future, have the place it deserves in treating Covid-19 infections and that we can at least prevent the "second wave" that is already on everyone's lips about it.Heidelberg/Tubingen, Lorenz Borsche, Dr. Bernd Glauner, May 2020[Author's info:]Dr. Bernd Glauner studied biochemistry in Tubingen and, after a phase as an independent software developer, was responsible for the development and worldwide distribution of the cell counting device "CASY" for many years - first at 'Scharfe System', then at 'Innovatis' and 'Roche' and finally at 'OMNI Life Science.' In his private life, he has - in addition to his penchant for marathon running - been studying the influence of vitamins on our health for many years. Lorenz Borsche studied mathematics and physics, later sociology and political science. He is a software developer (POS/PPS), but statistics is his real vocation. “Spiegel" once ironically called him a[https://www.spiegel.de/lebenundlernen/schule/pisa-statistik-guru-haelt-die-studie-fuer-pfusch-a-203102.html| "statistics guru" ]because of his criticism of PISA. He is the founder of the largest booksellers' cooperative (such as eG) with his own nationwide website [https://www.genialokal.de/|p_] [https://www.genialokal.de/|"genialokal.de]." His most recent book has been published:[https://www.genialokal.de/Produkt/Lorenz-Borsche/Zucker-Toedliche-Versuchung_lid_34882390.html| Sugar: Deadly Temptation]. For the vitamin D thesis, see also his website: Does[https://borsche.de/page/vitamind_sars| vitamin D (& C) help with Covid-19?] as well as the latest article of both Dr. B. Glauner / L. Borsche:[https://borsche.de/page/7_cent?preferredlang=en| 7 Cent or lockdown?] [Ausgewah]lte VeroffentHchungen zur Role von Vitamin D bei der Sterblichkeit von Covid-19 Patienten.[Selected pub]lications on the role of Vitamin D regarding the mortality of Covid-19 patients.

Veroffentlichung 1 - 5 :        Klinische Studien und Erkenntnisse

Veroffentlichung 6 - 10 Wissenschafliche Beweise

Publication 1 - 5 :                 Clinical studies and findings

Publication 5 - 10                 Scientific evidence

.Raharusun P, et al. Pattern of Covid-19 Mortality and Vitamin D: An Indonesian study. 30. April 2020, SSRN. PreprintAuszug aus dem Abstract / Excerpt from the abstract:

The aim was to determine patterns of mortality and associated factors, with a special focus on Vitamin D status.

When controlling for age, sex, and comorbidity, Vitamin D status is strongly associated with COVID-19 mortality outcome of cases.

Link zur Veroffentlichung / Link to the publication:

https://papers.ssrn.com/sol3/papers.cfm7abstract id=3585561

Statistische Datenauswertung / Statistical data evaluation Borsche L.:

https://borsche.de/res/Indo 1.pdf

.Alipio M. Vitamin D supplementation could possibly improve clinical outcomes of patients infected with coronavirus-2019 (COVID-19). Apr 9, 2020, SSRN. PreprintAuszug aus dem Abstract / Excerpt from the abstract:

Vitamin D status is significantly associated with clinical outcomes. A multinomial logistic regression analysis reported that for each standard deviation increase in serum 25(OH)D, the odds of having a mild clinical outcome rather than a severe outcome were approximately 7.94 times (OR=0.126, p<0.001) while interestingly, the odds of having a mild clinical outcome rather than a critical outcome were approximately 19.61 times (OR=0.051, p<0.001).

In conclusion, this study provides substantial information to clinicians and health policy­makers. Vitamin D supplementation could possibly improve clinical outcomes of patients infected with COVID-19.

Link zur Veroffentlichung / Link to the publication:

https://papers.ssrn.com/sol3/papers.cfm7abstract id=3571484

 

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