Debate Over Vitamin D, Dogs Sniff Out COVID

What your doctor is reading on Medscape.com:

MAY 17, 2020 — Here are the coronavirus stories Medscape’s editors around the globe think you need to know about today. 

Is There a Role for Vitamin D? 

A number of new reports provide evidence both for and against an association between vitamin D levels and the severity of COVID-19 infection.

While there are no randomized controlled trials to answer the question, studies comparing outcomes from various countries suggest inverse links between vitamin D levels and the severity of COVID-19 responses and mortality. Other studies call that link into question. 

Clifford Rosen, MD, senior scientist at Maine Medical Center’s Research Institute in Scarborough and a vitamin D researcher, said having adequate vitamin D is important, especially for people at highest risk of COVID-19, but there are no robust data supporting the use of vitamin D as prevention or therapy for COVID-19. 

Still, Rose Anne Kenny, MD, professor of medical gerontology at Trinity College Dublin, Ireland, who recently coauthored an article on the inverse association between vitamin D levels and mortality from COVID-19, said there’s a “probability” that vitamin D is a contributing factor that could be addressed now. 

Kenny wants the Irish government to formally change their recommendations to that effect. “We call on the Irish government to update guidelines as a matter of urgency and encourage all adults to take [vitamin D] supplements during the COVID-19 crisis.” 

Do Dogs Have a Nose for COVID? 

Bio-detection dogs have previously been trained to detect certain cancers, malaria, and Parkinson’s disease. Now, researchers in the UK are turning to these dogs to detect COVID-19 in humans before symptoms appear. 

The charity Medical Detection Dogs is slated to work with the London School of Hygiene & Tropical Medicine and Durham University on the first phase of a trial on the concept of sniffing out the virus. 

In this first phase, National Health Service staff in London hospitals will collect odor samples from people infected with coronavirus and those who are not infected. The dogs will then be tested on whether they can accurately identify the presence of the virus in the samples.  

Online Swap Meets for PPE

Hospitals are still struggling to find personal protective equipment and other medical supplies in the midst of COVID-19. So while they wait for goods to come through more traditional supply channels, some hospitals have turned to online swap meets to fill the gaps. 

In April, the University of Vermont Health system’s Burlington hospital needed more face shields, but they had a surplus of hand sanitizer. Meanwhile, Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, was looking for hand sanitizer. Supply chain directors from each institution connected on The Exchange at Resilinc and did a swap for 500 units of the supplies they needed. The online trading platform is a new initiative from Stanford Health Care, the hospital consulting group Premier Inc, and the logistics software company Resilinc.

The swap meet approach has been effective so far because although there are many shortages, some hospitals have found themselves with a surplus of certain items because of unexpected private donations or shifts in COVID-19 hot spots. 

UK Data Point to Diabetes Risk

New data from England’s National Health Service show that about one quarter of patients who died in the hospital with COVID-19 also had diabetes. 

Of more than 22,000 people who died in hospital with COVID-19 between the end of March and the middle of May, 26% had either type 1 or type 2 diabetes, The Guardian reported. 

Other comorbidities common among patients who died in the hospital included dementia at 18%, serious breathing problems at 15%, and chronic kidney disease at 14%.

Lessons Learned for the Hospitalist

Jashanpreet Singh, MD, has been on the front line of the COVID-19 response as a hospitalist working at Adena Health System in Chillicothe, Ohio. As he looked at the lessons learned from the pandemic so far, he noted that “silos are disappearing and team-based care is taking center stage.”

He urged hospitalists to take a leadership role by having an active presence in hospital incident command centers and infection control boards, working in close coordination with emergency medical colleagues and bed placement navigators, and having frequent daily huddles to talk about testing and changes in PPE requirements. 

“Beyond the current public health crisis, these efforts will go a long way to create unshakable trust between health systems, providers, patients, and their loved ones,” Singh writes.

Volunteering for Infection 

William P. Hanage, PhD, breaks down the idea of a COVID-19 “challenge trial” that would have healthy individuals receive a vaccine and then volunteer to be exposed to the virus. 

The idea is controversial but has the potential for significant societal benefit, noted Hanage, an associate professor at the Center for Communicable Disease Dynamics at the Harvard T. H. Chan School of Public Health in Boston. 

Any such trial would have to be voluntary, involve a small number of participants, have extensive ethical oversight, and have accountability, he stressed. 

“Worth thinking carefully about once we have a decent vaccine candidate,” he writes.

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. More than 1000 throughout the world have died. 

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form. 

Mary Ellen Schneider is executive editor at MDedge, part of the Medscape Professional Network. She has more than 15 years of experience reporting on healthcare.