Death Rate for COVID-19

COVID-19 is a coronavirus, which is potentially lethal, especially in the elderly

Whilst Predisposing factors are age, high blood pressure, heart disease, and diabetes, the Death Rate varies from Country to Country

Rates range from 0.4% to over 12%

Identifying the reason(s) why the death rate is so varied may enable better protection against the virus

Thus, the biggest predisposing factor for death rate is the country in which you live.

We have compared the Death Rate from COVID-19 in the three Scandinavian counties, Denmark, Norway and Sweden to see if there are nutritional correlates between DR and country

Death Rate for COVID-19 Infection by Country

Potential predisposing factors for variable death rates are

Standard of living

Standard of health care

Vitamin D levels

Dietary intake of iron

Dietary intake of Iodine/Selenium/Molybdenum/vitamin B2

Dietary intake of vitamin B12

Others yet to be identified

Death Rates from COVID-19

Death rates from COVID-19 vary greatly from country to country, with some recording death rates from infection as low as 0.4%, but others with death rates as high as 12%. Currently it is unknown why the rates vary, however, if these reasons could be identified it may go a long way to reducing the severity of the condition, which will be an essential component of dealing with the virus, particularly during the waiting period between now and the development of a vaccine. Potentially the death rate in many countries could be reduced to less than 5% of the current rates, thus saving thousands of lives. This will be more even more important if a successful vaccine is not developed. Even once the current COVID-19 epidemic is resolved these factors could potentially save lives in other respiratory illnesses.

Comparison of COVID-19 deaths in Scandinavia

In an attempt to try to address the potential factors contributing to the different death rates, we have chosen three closely related countries, Sweden (DR 8.1), Denmark (DR 4.0) and Norway (DR 1.7) and examined the various potential susceptibility factors.

Vitamin D. Vitamin D has known immune functions including stimulation of maturation of immune cells, but also in activation of several proteins in Krebs cycle. Decreased vitamin D levels in calves has been reported to increase susceptibility of calves to bovine Coranavirus (Nonnecke etal, 2014). Estimates in adults have shown a variance of in 25OH vitamin D in Sweden (100(S) - 75(W)nmol/L), Denmark (125(S)-48 (W) and Norway (300(S)-57(W), However the amounts vary dramtically from study to study, particularly in the upper limits, thus Sweden (985, 958, 100, 104), Denmark (5316, 700, 510, 125) and Norway (6932, 869, 391, 300, 253) Spiro and Buttriss 2014). Of note, Finland (DR 1.61). Fortification of milk and dairy products is common in Finland, Sweden and the USA, however, those who do not consume dairy would be expected to have lower levels. In Sweden and Norway vitamin D is also obtained from oil rich fish such as salmon and herring, but only if they are part of the normal diet, however vegan and vegetarian diets have been shown to have lower amounts of vitamin D (Elorienne etal, 2016). Preliminary data from Australia shows an increase in DR as one moves from the North of Australia (DR 0.7%) to Tasmania in the South (DR 3%). In Ireland (DR 4%) vitamin D deficiency increases with 47% of those over 85 deficient in winter.

Vitamin A. Vitamin A was originally thought of as the anti-infective vitamin, and vitamin A deficiency has been implicated in the severity of diarrhoea and measles. Supplementation with vitamin A has reduced the morbidity and severity of a range of infectious diseases including HIV, malaria, measles and measles-related pneumonia (Semba 1999). The ability to generate an immune response to inactivated bovine coronavirus vaccines is compromised in calves with low vitamin A (Lee etal, 2013).

Vitamin C. Vitamin C has been shown to support immune function and to be able to protect against coronavirus infections (Hemila 2003). Vitamin C is also essential for the formation of hydroxyproline, an essential amino acid for the production of high tensile collagen. Lack of vitamin C, could potentially lead to alveolar collapse, due to "weak" collagen.

Iodine. Iodine is the first mineral in the thyroid cascade that eventually results in the activation of vitamin B2 to form FMN and FAD, the two active analogues of vitamin B2. Iodine intake is greatly affected by diet, and by location, with Iodine deficiency being the single most preventable nutritional cause of developmental delay. The major sources of Iodine apart from seafood are iodized table salt and dairy products. Persons on diets that exclude these sources, such as the Paleolithic diet, can be at risk of Iodine deficiency (Manousou etal, 2018). Insufficient Iodine can ultimately result in raised TSH, lower T4, hypothyroidism and weight gain, one of the risk factors for COVID-19. Frequent milk and dairy product consumers have significantly higher Urinary Iodine Concentrations (99 ug/L/day) than those consuming 1-2 portions per day (83 ug/L), or those consuming 0-1 portion per day (57 ug/L)(Dahl etal, 2018). Iodine status in pregnant women in Denmark has been found to be below WHO recommendations (Kirkegaard-Klitbo etal, 2016). Similarly in Norway insufficient iodine intake has been found in 19% of men and 33% of women (Carlsen etal, 2018). Inadequate intake was found in the elderly, pregnant women and vegans (Brantsaeter eta; 2018). Historically Iodine deficiency has been common in Sweden and in Norway, but not Denmark (Manousou etal, 2017). Iodine deficiency appears to correlate with dietary sources, with Sweden mainly iodized salt, Norway, milk and dairy products, whilst in Denmark, drinking water, milk dairy products, and iodized salt.

Selenium. Selenium has an important role in the body, not only in anti-oxidant defense but also in the activation of vitamin B2, and then the activation of vitamin B6, vitamin K and also for vitamin A. High dose sodium selenite has been found to reduce viral loads, and to reduce mortality in patients with severe systemic inflammatory response syndrome, sepsis, and septic shock. Selenium is also a vital mineral for the activation of vitamin B2 . Selenium is also important for the activity of Glutathione peroxidase. Selenium status has been associated with longevity and a low incidence of age-related diseases (Robberecht etal, 2019). Individuals with lower levels of Selenoprotein P, have an increased risk of stroke (Koyama etal, 2009), cardiovascular disease and death (Schomburg etal, 2019). Swedish diets are low in Selenium, with the average intake of Selenium only 10-70 ug/day, compared with the RDA of 55-200 ug/day (Bruce 1986). Low selenium was correlated with higher cardiovascular mortality (Alehagen etal, 2016). Lower selenium in Sweden was associated with an increased risk for all-cause and cardiovascular mortality, respectively (Alehagen etal, 2016). The mean serum Selenium Sweden is 67.1 ug/L, in Denmark 98.7 ug/L (Rasmussen etal, 2009). Interestingly, Finland has been supplementing with Selenium since 1984 (Alfthan etal, 2015), and has a DR of only 1.6 (cf Sweden DR 10.9, Denmark DR 4.7 and Norway 2.3). Vegan and Vegetarian diets have been shown to have lower amounts of Selenium (Elorinne etal, 2016). Being part of the activation pathway for vitamin B2, then lower selenium would effectively lower the activation of vitamin B2, which would lower the amount of active B12 (see below).

Vitamin B2. Activation of vitamin B12, vitamin B6, vitamin A and vitamin K are all dependent upon functional vitamin B2. Hence any reduction in levels of dietary vitamin B2, Iodine, Selenium and/or Molybdenum would all be expected to result in lower functional B2 levels. Countries with higher intake of dairy would be expected to have higher vitamin B2 levels (as well as vitamin D, Iodine, and Selenium).

Vitamin B12. High dose vitamin B12 has the potential to increase melatonin levels, and to also have a beneficial effect as far as modulation of the immune response. High dose vitamin B12 has also been associated with reduction in inflammation. Serum vitamin B12 levels have been found to be lower in Sweden (DR 10.9) (300,313,332,325,310 pmol/L depending upon study; Dhonukshe-Rutten etal, 2009), than in Norway (DR 2.3)(370, 337, 360, 391pmol/L), and homocysteine (a measure of functional B12 deficiency) higher in Sweden (13.2 pmol/L), than Norway (10.3, 8.8, 11.9, 10.6 pmol/L). One of the first neurological markers to be reduced in functional vitamin B12 deficiency is the production of melatonin. Data presented above is indicative of the population as a whole, however, vitamin B12 intake is directly dependent upon diet, with intakes being recorded to be 4-10 ug/day in meat-eaters, reducing to 2-4 ug/day in vegetarians and a deficient intake of 0.2 - 0.8 ug/day in vegans. There is a considerable difference between the number of vegans in Sweden (10%, DR 10.9), Norway (4%, DR 2.3%) and Denmark (5%, DR 4.7)

Iron. Iron deficiency has been associated with an increased susceptibility to respiratory infections (Jayaweeraetal, 2019).

Melatonin. There is the potential to give melatonin to increase the resistance to COVID-19. Doses of 3, 6 and 10 mg, have been given to patients in ICU, were found to be safe. Further doses of 1 g per day have been given for a month with no effect (Zhang etal 2020). .

General. Some general information on nutrition and fighting COVID-19 has been summarized by Zhang and Liu (2020)

Co-morbidities raise the risk of death from Corona. Thus, in China the death rate in those with no co-morbidities was 0.9%, but was much higher for those with Cardiovascular disease (10.5%), diabetes (7.3%), Chronic respiratory diseases (such as COPD, 6.3%), Hypertension (6.0%) and cancer (5.6%). In many countries, including the US, many people in the population have at least one underlying health condition (US, 60%).

Conclusions

If the increased death rate observed in Sweden in comparison to Norway and Denmark can be explained by the combined deficiencies in nutrition, outlined above, then the simple supplementation with a combined multivitamin containing the RDA for Iodine, Selenium (and potentially Molybdenum), vitamin B2, vitamin C and vitamin D, could potentially lower the Death Rate to one quarter of the current rate. Further reductions could occur if high dose B12 was given either by injection or topically. No oral formulation would work, due to inactivation of oral B12 doses. Potentially saving over one million lives. If that then was applied globally, then potentially the Death Rate from COVID-19 would only be two to three times the currently accepted Death Rate from influenza. The deficiencies outline above, have though been known to have existed for many years, yet the Health Departments of these countries have failed to act to improve the basic nutrition of their compatriots. Is the current death rate from COVID-19 a reflection of this failure? Simple supplementation could have saved Trillions of dollars in the global economy and could have dramatically improved the future standard of living and quality of life of these countries now devastated by the high mortality from COVID-19. Given that the same supplements could also reduce the incidence and severity of cardiovascular disease, obesity, diabetes and depression, then this would be a massive potential benefit. Despite this, not one mention of these statistics has been cited in the coverage of the Pandemic.

References

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