Laiba Siddiqui  ( 3rd Year MBBS Student, Dow International Medical College, Karachi, Pakistan. )
Faeez Muhammad  ( 3rd Year MBBS Student, Dow International Medical College, Karachi, Pakistan. )
Rabbia Gul  ( 3rd Year MBBS Student, Dow International Medical College, Karachi, Pakistan. )

DOI: https://doi.org/10.47391/JPMA.3178

Madam, the coronavirus disease 2019 (COVID-19), is a global pandemic and hazard to many lives, induced by a novel beta-coronavirus referred to as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).¹ This virus infected over 90 million people, leading to two million deaths after its outbreak in Wuhan, China.² The pathophysiology of this virus involves the invasion of the respiratory tract via respiratory droplets followed by infection of the lung parenchyma. The infection process triggers the release of proinflammatory chemokines and cytokines as an immune response, that in most cases can withstand the infection.¹ An immune response that is dysfunctional leads to further advancement of the disease in which a patient develops Acute Respiratory Distress Syndrome (ARDS).^1,3 ARDS is responsible for 10% of intensive care unit (ICU) admissions leading to the dysfunction of organ systems and death in 50% of cases.^3,4 This highlights the importance of maintaining a healthy immune system that is sufficient to combat SARSCoV- 2. A study done by Castillo et al. in Spain, led to the discovery that demonstrates how the immune response can be reinforced in patients infected by SARS-CoV-2, by the administration of oral calcifediol (25-hydroxyvitamin D3).³ Calcifediol, a metabolite of vitamin D, suppresses the "cytokine/chemokine storm" and beneficially regulates the host response to SARS-CoV-2.³ Therefore tapering down the patient's need for ICU admissions and assists in potential recovery.³ The results of this study offer countries like Pakistan, a vitamin D deficient population, a probable solution for patients with a severe case of SARSCoV-2. It has been observed that 53.5% of Pakistan's population suffers from vitamin D deficiency.⁵ Although Pakistan is a country with no shortage of sunlight, factors such as apartment living, atmospheric pollution, cultural stigmas that restrain elderly women and children to their homes and a poor diet, contribute to the deficiency of this vitamin.⁵ Taking into account that COVID-19 is an ongoing pandemic that is continuously being researched, the study conducted in Spain is fairly recent. However, the exponential rise in infections and high mortality rates raise prevention concerns for the healthcare system; thereby, increasing the responsibility of all healthcare professionals to continuously follow up with recent studies hoping to see better outcomes from the battle against COVID-19. Conducting similar studies in Pakistan have the potential to help implement a beneficial approach, in which calcifediol should be prescribed to patients in need of ICU due to SARS-CoV-2 infection.

Disclaimer: None to declare.

Conflict of Interest: None to declare.

Funding Sources: None to declare.

References

1. Bohn MK, Hall A, Sepiashvili L, Jung B, Steele S, Adeli K. Pathophysiology of COVID-19: Mechanisms Underlying Disease Severity and Progression. Physiology (Bethesda). 2020; 35:288-301.

2. WHO Coronavirus Disease (COVID-19) Dashboard. [Online] [Cited 2021 January 22]. Available from: URL: https://covid19.who.int/ .

3. Castillo EM, Entrenas Costa LM, Vaquero Barrios JM, Alcalá Díaz JF, López Miranda J, Bouillon R. Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study. J Steroid Biochem Mol Biol. 2020; 203:105751.

4. Fan E, Brodie D, Slutsky AS. Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment. JAMA. 2018; 319:698-710.

5. Jadoon SA, Ahmed A, Alam MA. Vitamin D Deficiency In Pakistan: Tip Of Iceberg. J Ayub Med Coll Abbottabad. 2018; 30:78-80.