Covid NPIs. The path not taken
I assume that the various non-pharmaceutical interventions encouraged and imposed by governments at all levels had some effect on the spread of the coronavirus. Obviously, they didn't "work" in the sense that so many people still got sick and died, but who knows if things would have been worse without them? So maybe they provided some benefit for some people. But are those the only things that work?
The healthy trinity of Physical Distancing, Handwashing and Masks quickly became a dogma of the health-government complex. And like the other theories of the pleroma, its membership is the same yesterday, today and tomorrow with no addition or subtraction. However, there were signs early on that additional things might help.
In the early stages of the virus, there was nothing else. You'd just sit at home waiting to get sick, then if you got sick you'd go to the hospital and they'd tell you to go back home and come back when your lips turned blue. And after you got into the hospital, they'd put you on a ventilator and stand around and watch you die. That's a bit of an exaggeration, but the simple fact is that for all of 2020, there was nothing that could be done. Even the original interventions at the hospital -- like ventilators -- was later found to do more harm than good. And yet, some people never got sick. People in the same household as covid-positive people would never develop symptoms and certainly never need hospitalization.
Boosting your natural immunity was a focus of a small but dedicated team of medicos on the internet. And completely ignored by everyone else. No one on the news ever mentioned boosting immunity and none of the medicos on TV like Anthony Fauci or Deborah Birx ever brought it up. Trump and his minions totally ignored it as well.
In the video that this comes from Dr Seheult makes the point that a lot of effort at the time that the video was made was being put into increasing the capacity of the hospital system. As I mentioned before, the non-pharmaceutical interventions aimed to reduce the number of people infected (the middle column) but nothing was done to reduce the percentage of the infected that would need hospitalization. And, other than vaccinations, to this day nothing has been done in that area.
So what can be done? MedCram ran a lot of videos. This one highlighted hot/cold therapy. They had more more odd-ball videos like "forest bathing". But one of the more popular ideas was Vitamin D.
Medcram ran a lot of videos on Vitamin D. See here, here, and this long overview. Other internet medicos got in on it as well for instance John Campbell (who is a "doctor" but a medical nurse, having a PhD in nursing or something) here, here and here. The two even did a combo video that covered Vitamin D among other things. The videos are based on and confirmed by various studies that have been done, like this one (which I don't entirely buy), this one, this one. Apparently Ireland went so far as to recommend Vitamin D supplementation (Dr Campbell, paper). That is the only country I know of that did.
Now I should say here that I take 4000 IU of Vitamin D every day. I started taking low amounts of vitamin D a few years ago because my doctor said my levels were low, but I increased it quite a bit after the rona hit and I saw some of the videos listed above. So I do believe that Vitamin D helps with immunity in general.
The thing about the Vitamin D studies is that they are largely observational. There have been some randomized controlled trials looking at vitamin D. But they show modest improvements. Some trials seem designed to fail, like giving a single dose of Vitamin D upon admission to the hospital. (My understanding is that Vitamin D has to be metabolized by the liver and/or kidneys before it can be used by the body which takes about 7 days, and the average length of stay in the hospital is ... 7 days, so hardly enough time to see an impact.) Since these tend to be observational studies looking at people's Vitamin D levels and comparing that to outcome, there are plenty of other factors that come in. People with higher levels might have healthier lifestyles and lower co-morbidities. For instance, they may eat better and exercise more so have lower levels of obesity and diabetes. Or the diet and exercise might itself impact coronavirus outcome. Or the higher levels of Vitamin D might correlate with season (ie, sunlight) and that correlates with how much people are spending in close contact with others indoors. And on and on.
However, there's a mountain of evidence supporting vitamin D, even if it's a mountain of weak evidence. And Vitamin D is almost free. 2000 IU of vitamin D costs around seven cents / pill. If everyone took 4000 IU a day like I do, that's 14 cents / day or $4.20 per month. And Vitamin D is extremely safe. It's almost impossible to overdose on Vitamin D and there are no ill side effects.
By contract, Dr Anthony Fauci interrupted a press conference to announce the FDA was approving Remdesivir, which costs $1000 and has since been found to be useless. Even if Vitamin D is useless, it's at least cheap.
Next on the home defense kit is Zinc. Zinc has anti-viral properties and as long been touted as a home remedy for colds. Specifically, zinc lozenges. In contrast to Vitamin D, zinc actually does have a max dosage, and it's relatively low. The max intake is 40 mg and there are pills on the market that contain 50mg, so there is some risk associated with it.
In the popular mind, zinc was mentioned most frequently as the "Z" part of the HAZ protocol: Hydroxychloroquine, Azithromycin and Zinc. Supposedly zinc needs to get INTO the cell to defeat viruses and Hydroxychloroquine in addition to its own anti-viral properties helps zinc get into the cells and so improves its effectiveness. Zinc also isn't generally touted for it's prophylactic benefit. While it takes Vitamin D a week to get into the blood stream in a useable form, and so it's generally best to keep your levels high at all time, zinc is absorbed quickly in a useable form and so is generally taken while people feel sick with the cold or another virus.
If fact, I do take zinc when I feel sick. I can't say that it helps a lot but it doesn't hurt, so why not?
Of course, the Number-1 vitamin is Vitamin C. Like with Vitamin D, it's almost impossible to overdose on Vitamin C and there are few side effects (I guess you can turn orange if you take too much). People normally take Vitamin C when they have a cold (and I still think that it's called Vitamin "C" for "Cold") so it's natural that people would take Vitamin C to ward off or recover from the coronavirus. However, it doesn't seem to work. There are a lot of other bugs out there, though, so I did take a low level of Vitamin C during the colder months of the rona.
There were other supplements that I heard about on occasion like NAC and Quercetin. However, I never really knew what those were and simply couldn't follow them. I don't even know if those are ay my pharmacy or grocery store because I always forget to look.
Finally on the list is exercise. Personally, I find this a little hard to swallow. I am a firm believer in the value of exercise. And the idea that people who had strengthened their cardio-respiratory systems through exercise would do better against a cardio-respiratory disease than those with weaker hearts and lungs is pretty obvious. But I just have some problems with it.
First of all, the effect of exercise on the immune system is ambiguous at best. It supposedly follows a "J-shaped curve" but I've never noticed that. I get as many upper respiratory tract infections when I'm running as I do when I take a break due to injury or illness (illness that I probably got while running). Of course, some of that could be allergies, but if I want to soak up that sweet, sweet Vitamin D, that's where I should be exercising. It's just more likely that if I have improved cardio-vascular health, I'll suffer less from the effects of a respiratory disease.
But the "panacea" effect of the fitness crowd turns me off. Having saved the world from cancer it will now save you from this new, unfamiliar virus. Claiming that your passion is a panacea for all the ails the world is annoying. Even when it's my passion too.
There is a common thread in these studies that "more" of something isn't necessarily better, rather than "less" of something being worse. For example, a Vitamin D deficiency is definitely bad but after you get to your normal or recommended level, the improvement levels off. In fact, that is seen for most if not all of the studies for exercise. Getting too little exercise causes disease and death, but after you are getting enough, you get limited additional benefit. In other words, it would seem that it's incorrect to say that "Taking Vitamin D will reduce your risk of going to the hospital with the rona by 20%" when it's more accurate to say "Having low vitamin D levels increases your risk of going to the hospital by 20%" (probably 25% due to the way fractions work). And then it's necessary to ask why people are deficient. Is the deficiency a sign of other health issues or frailty or even age that is also correlated to poor outcome from the rona. Maybe the Vitamin D level is just a marker for susceptibility, not a cause of susceptibility and curing the deficiency doesn't affect the underlying condition.
So saying "Take More Vitamin D" or "Take More Zinc" or "Exercise More" are all OK to the extend that most people are deficient on all of those things, but may not help beyond a certain point. But does it make any sense at all?
Well, typically the Northern States would spike their coronavirus numbers in the winter, when Vitamin D from sunlight would be low and when a lot of people can't get out and exercise, but also when people are huddled indoors in close contact with other people. Southern states typically spike in the summer, when there's plenty of sunshine for Vitamin D production, and people can get out and exercise, but during which it's typically pretty hot and so people spend a lot of time in the air conditioning. And I would note that during the lockdown era, gyms and parks were closed so people couldn't get the exercise that they might ordinarily and if they weren't already runners or cyclists may not have gotten much exercise at all. And during the lockdown era, "sitting indoors with other people" was actually forbidden (though I suspect widely ignored). Outside of the lockdown times, gyms were open and you could congregate in bars and restaurants to your heart's delight. But the sunshine was the same.
But most people are Vitamin D deficient. Period. And most people work or go to school indoors (including going to school in your house if you were remote-learning). Even in the summer most kids are indoors playing video games.
So it's kind of complicated.
Finally it has to be said that Vitamin D, Zinc and exercise are practically free. And Pfizer and Moderna and Johnson and Johnson aren't making any money selling Vitamin D and Zinc. And the scientists in the National Institutes of Health aren't making any royalties on Vitamin D patents. So no one has an incentive to promote them. Unlike the likes of Remdesivir or the vaccines. I guess insurance companies could have promoted these home remedies as a cost avoidance, but they probably got reimbursed by the government at some level. You might think that gyms have an incentive to promote the benefits of exercise during the pandemic, but even they have a perverse incentive to stay quiet. The business model of a gym requires that a bunch of people sign up for monthly memberships, then forget about them and never show up.
To play Devil's Advocate, maybe there's a risk that people will feel like they are invulnerable if they are taking Vitamin D and exercising and so would be more likely to engage in risky behavior that will cause infection. Yet the same argument can be made for masks. And masks have the same level of evidence that Vitamin D does: observational studies that back the researcher's assumptions but which could be explained by other factors.
And there's another factor related to exercise. If the government promoted exercise to ward off the rona, the natural next step would be morning shows having aerobic instructors or other workout-with-us classes. And that's just too 1984.
Overall, this was a missed opportunity. The government was handing out stimulus checks left and right during 2020. For chump change they could have distributed bottles of Vitamin D to every household. Would it have helped? Maybe a little. It wouldn't have hurt. It almost certainly wouldn't have stopped the virus, but it could have a lot of lives. But we'll never know.
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