How sunlight may help us fight coronavirus

People with low levels of Vitamin D are almost twice as likely to get the extreme lung infections that are now killing COVID-19 patients.

Even before the pandemic, acute respiratory tract infections have been a major killer. They were responsible for 2.8 million deaths worldwide in 2015.

In Neale’s review, which encompassed 78,000 participants, it was found that those with low levels of vitamin D — the “sunshine vitamin” — were almost twice as likely as those with high vitamin D levels to get the type of extreme lung infections that now are killing COVID-19 sufferers, and they were even more likely again to be sicker for longer.

And so how does this translate to the pandemic? “Now, more than ever, is not the time to be vitamin D deficient,” Neale says from Brisbane’s QIMR Berghofer Medical Research Institute. “It would make sense that being vitamin D deficient would increase the risk of having symptomatic COVID-19 and potentially having worse symptoms. And that’s because vitamin D seems to have important effects on the immune system.”

Neale was speaking before US President Donald Trump weighed in with his comments last week about disinfectant and ultraviolet light being used to combat the virus. And, as bizarre as it may seem, there is reason to think the President is on to something, at least as far as the sunlight goes.

It’s a message that people seem innately to understand. The carpark at my local beach has been more full in recent weeks than it usually is in the middle of summer school holidays. People are out there soaking it all up, feeling sorry for all those city folk denied access to their shimmering sands, not even allowed to sunbake in parks.

For all vitamin D’s advantages, Neale doesn’t take vitamin D pills. She is cognisant of the emerging evidence that the sun provides more benefits than just the sunshine vitamin.

Those other benefits are varied.  Dermatologist Richard Weller from the University of Edinburgh discovered more than a decade ago that the body got a shot of a molecule called nitric oxide when exposed to sunlight. He has been curious about the notion that nitric oxide and sunlight may have some effect on COVID-19.

Nitric oxide has been shown to cause blood vessels to widen, increasing oxygen flow and lowering blood pressure. The discovery of its role in the human body paved the way for Viagra.

“There are mechanistic reasons to think about benefit,” says Weller. “Ultraviolet light (which produces nitric oxide in the skin) lowers blood pressure and also markers of diabetes. Both of these are risk factors for death from COVID-19.” He points out that most viral infections wax and wane with the seasons, probably because of ultraviolet light, not heat.

The story of nitric oxide goes back to the 1990s when it was a hot molecule that won three scientists the Nobel prize. At that time, Goran Hedenstierna had a PhD student at Sweden’s Uppsala University who was among the first in the world to show that if you gave humans nitric oxide when they were suffering from severe constriction of the lungs, the lungs relaxed and oxygen levels normal­ised. During the severe acute respiratory syndrome outbreak of 2003-04, Hedenstierna had another student, Luni Chen, who wanted to go back to her home country, China, to see if nitric oxide worked to help patients dying of acute respiratory failure from that coronavirus.

“She went there in May 2003 when it was a most severe situation,” recalls Hedenstierna, Skyping from Sweden. “I organised things to be shipped — ventilators and bottles of nitric oxide gas. It took a lot of organising with the local authorities because it was a major intrusion on their crisis.”

Chen managed to get the nitric oxide treatment to six patients and she had eight in a control group receiving placebo. Five of the six who received nitric oxide were on ventilators when the study began. Only one was still on it by the end. Chest X-rays showed their lung congestion improved. One died.

Whereas in the control, six were on ventilators at the beginning and five were still being ventilated at the end. The X-rays showed only two improved, three stayed the same and three worsened. Two died.

The study was only small but Hedenstierna was surprised at the strength of the results. “We most often do see an improvement of oxygenation of 20 per cent or more in people with acute respiratory failure, but these SARS patients, they increased their PAO (the ratio of oxygen in the blood to oxygen that is breathed) almost threefold. I have never seen this big an increase. We never dis­cussed that to any extent at that time.”

To understand why nitric oxide appeared so devastatingly effective against SARS, Hedenstierna was involved in a further study in a high-security lab in Brussels where it was shown that nitric oxide killed the SARS virus in a test tube.

“It had an antiviral effect which was what we had hoped to see in view of the improved chest X-rays. So it’s helping the patient breathe and it’s killing the virus,” he says.

The way forward

Such results are now being picked up. Nitric oxide, this molecule we produce naturally with sunshine, has been used by doctors in Italy with success to help COVID-19 patients, but not in a study format. A trial of 240 COVID-19 patients is up and running in Sweden, the US and Austria.

Weller says the doses of nitric oxide the patients will receive are much greater than what you could get from sunlight. But the other half of the equation is whether people catch the disease in the first place. He is running a study to see what effects UV radiation has on the flu because there’s still not enough data on COVID-19. “I hope that our epidemiological studies will show whether it (sunshine) makes any difference at population level.”

One of Weller’s collaborators, Prue Hart from Perth’s Telethon Kids Institute, has spent a career pursuing matters of immunity and ultraviolet light and vitamin D. She isn’t so sure that UV light will have a direct effect on the novel coronavirus.

“I think the greater benefits of UV radiation during this pandemic are about our brain health,” she says. “We all know how good we feel after time in the sun, and these good feelings cannot be replaced by vitamin D from a bottle. Now that it is autumn, and the sun is not so intense and burning, I think everyone should be encouraged to get exposed to more sun, as long as they never get sunburnt. In addition, whilst outside getting a little bit more sunshine, they will be exercising.”

She says while the link between sunshine, endorphins, serotonin and mood have been known for years, in 2018 Chinese researchers proved another important piece of the mental puzzle involving a molecule called urocanic acid that resides in the outermost layer of the skin. The researchers proved that after giving shaved mice the equivalent of 30 minutes of sunshine, urocanic acid was released from the skin into the blood, then crossed the blood brain barrier and went into almost all parts of the brain. In the brain, it is involved in making glutamate — the brain’s most abundant “excitatory neurotransmitter” — which has long been known to play an important role in learning and memory.

“This is another reason time outside in the sun is important for children who are now doing online learning at home,” Hart says. Food for thought as police shoo sunbathers out of parks and arrest people lying on beaches.

And it certainly will encourage Neale to continue with her five-to-10 minute routine of midday Brisbane sun. “I personally think the best way of getting vitamin D is sun exposure because we get the other benefits that might be there, but I accept there is a role for pills for people who can’t get out,” she says, adding that she always takes care not to burn.

SOURCE 

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'It's a horror movie.' Nurse working on coronavirus frontline in New York claims the city is 'murdering' COVID-19 patients by putting them on ventilators and causing trauma to the lungs

A frontline nurse working in New York on coronavirus patients claims the city is killing sufferers by putting them on ventilators.

'It's a horror movie,' she said through a friend. 'Not because of the disease, but the way it is being handled.'

And she said relatives of the sick need to make it clear as soon as a person is taken to the hospital that they do not want them hooked up to the breathing machines.

The nurse, who has relocated to New York temporarily to help with the city's COVID-19 crisis, persuaded a friend — a nurse practitioner who is not working on coronavirus patients — to make the video for her in order to tell the world what she says is happening inside hospitals.

'I am her voice here. I'm going to tell you what she has told me,' said the nurse practitioner, who was identified only as Sara NP. 'She wants this to get out.'

'She has never seen so much neglect. No one cares. They are cold and they don't care anymore. It's the blind leading the blind.'

'People are sick, but they don't have to stay sick. They are killing them, they are not helping them,' added the friend in the video posted on YouTube.

'She used the word murder, that coming from a nurse who went to New York City expecting to help. 'Patients are left to rot and die — her words. People are being murdered and no one cares.'

Sara would not reveal which hospital the nurse is working in 'for the safety of those involved.'

More than 12,000 people have died from the virus in New York City, with another 4,300 dying in other parts of the Empire State, which is a far larger number than any other state in the country.

Republican Minnesota state Senator Scott Jensen told Fox News' Laura Ingraham that Medicare pays hospitals three times as much if patients are placed on ventilators.

'How can anyone not believe that increasing the number of COVID-19 deaths may create an avenue for states to receive a larger portion of federal dollars,' Jensen later posted on his Facebook page.

New York Governor Andrew Cuomo has said that around 80 percent of people who go on the machines die, although he's referencing patients who were already in dire conditions before being put on the machines.

 This is not the first time the use of ventilators have been questioned for its efficacy. 

In a YouTube video posted earlier this month New York emergency room doctor Cameron Kyle-Sidell said: 'I've talked to doctors all around the country and it is becoming increasingly clear that the pressure we're providing may be hurting their lungs.

'It is highly likely that the high pressures we're using are damaging the lungs of the patients we are putting the breathing tubes in.

'It's not our fault. We didn't know,' added Kyle-Sidell, saying that is the way other acute respiratory syndromes have been treated.

'We are running the ventilators the wrong way,' he said, calling for the protocols to be changed.

'COVID positive patients need oxygen, they do not need pressure. They will need ventilators, but they must be programmed differently.'

Kyle-Siddell did not return calls from DailyMail.com. He told Medscape on April 6 he stepped down from working in the intensive care unit at Maimonides Medical Center in Brooklyn because he didn't want to follow the hospital's ventilator protocol.

'I could not morally, in a patient-doctor relationship, continue the current protocols which, again, are the protocols of the top hospitals in the country. 'I could not continue those,' he said. 'You can't have one doctor just doing their own protocol.'

Maimonides also did not answer a request for comment.

Sara said COVID-19 patients are placed on ventilators rather than less invasive CPAP or BiPAP machines due to fears about the virus spreading.

She said: 'The patients don't know any better. They don't have family with them. There is no one there with them to advocate for them. So they are scared, and they give consent.

'The ventilators have high pressure, which then causes barotrauma, it causes trauma to the lungs', adding that the best way to survive is to 'buck the system.'

'Your loved one is not going to have you in there advocating for them once they go in, you're not allowed in. 'Do not give consent for intubation if you don't want to be intubated or for your loved one to be intubated… As soon as you give that consent, you might not come out of it.'

And she said if there is a specific medication — such as the hydroxychloroquine that President Donald Trump has touted, the best thing to do is lie.

'A tip from inside the system — if you want a medication to be given, you've got to report that it's an at-home medication, and that you demand that it be continued.'

Sara claimed patients who stop breathing are not resuscitated — again due to fear of the virus spreading. 'Full code, not doing compressions, family is not there. They have no one to answer to. No one is being held accountable.'

She said there are other problems in the 'crappy' hospital where her friend is working, such as lack of personal protective equipment.

'They stay in the same PPE all shift, except for the top pair of gloves… they're only changing the gloves on the outside.'

They keep the same gowns and masks on because the theory is that all patients on a COVID-19 floor will already have the virus. But she says that is faulty logic as some are there to see if the coronavirus can be ruled out.

'So even if they're rule-out COVID and they're not COVID they're going to get COVID because they're using the same PPE all shift and they're carrying that contamination to all of the patients

And she claimed some nurses who have been brought to New York are sitting in hotels never being called.

'Yet they're still understaffed and there are hundreds of people, hundreds of nurses in the hotels waiting to be called on to a shift. So there is manpower enough if the goal were to actually save people, but resources are not being utilized properly or to full capacity in a way that maximizes the patient benefit or improves the outcomes.'

The nurse practitioner also criticized some of the nurses who are risking their own health to treat COVID-19 patients.

'We have nurses being celebrated as heroes who are killing people,' she said.

'They're not heroes, and they're being brainwashed to think they're doing something great just by going to work because they're brave enough to go to work.

'But what are you doing at work? You're certainly not saving people if you're not even running codes. You're not even going into patients' rooms. You're a coward. You're hurting people, you're killing them, you're contributing to the problem.

The nurse practitioner said she knows she will receive hate messages for her comments. 'Frankly, I don't care because this could save someone's life.'

SOURCE 

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