(1 of 3) All doctors - including Dr Howard and those he criticizes - should have taken a much greater interest in generally unmet nutritional needs, especially the requirement for at least 50 ng/mL 125 nmol/L (1 part in 20,000,000 by mass) serum 25-hydroxyvitamin D in order for the immune system to mount strong innate and adaptive responses and to reduce the risk of the excessive inflammatory responses which are the cause of most deaths from COVID-19.
If they had taken a proper interest in this, every doctor would have known, long before the COVID-19 pandemic, that the great majority of people living far from the equator have 1/2 to 1/10th of the circulating 25-hydroxyvitamin D they need for full strength, well-regulated, immune responses to cancer cells, bacteria, fungi and viruses.
Inadequate circulating 25-hydroxyvitamin D has been a problem for a growing proportion of humanity since the migration out of Africa, to northern Europe and beyond, ca. 50,000 years ago.
Boston doctors clearly demonstrated the need for 50 ng/mL 25-hydroxyvitamin D clearly in 2013: https://jamanetwork.com/journals/jamasurgery/fullarticle/1782085 . With pre-operative 25-hydroxyvitamin D levels of 50 ng/mL or more, the risk of both hospital and surgical site infections was about 2.5%. With lower levels, the risk of both types of infection rose strongly and consistently. At 18 ng/mL, the risk of each type rose to about 25%. All the patients were morbidly obese and underwent the same Roux-en-Y gastric bypass surgery for weight loss. Although people suffering from obesity have greater difficulty converting vitamin D3 to 25-hydroxyvitamin D, there is no reason to believe that their immune systems need a higher level of 25-hydroxyvitamin D to function properly than people who are not suffering from obesity. The steep rise in the risk graph below 50 ng/mL 25(OH)D demonstrates, directly, the immune dysfunction which is entirely normal, and deadly, in most of the population.
Numerous articles show the strong relationship between low 25-hydroxyvitamin D levels and COVID-19 severity and death. For instance, Dror et al. 2022: Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263069 . This graph is at the start of the Brownwstone article and there was plenty of research on vitamin D and COVID-19 from mid-2020 onwards.
Proper 25-hydroxyvitamin D levels cannot be attained with government-approved vitamin D3 supplemental intake quantities, such as 0.015 mg 600 IU a day. There is very little vitamin D3 in food, fortified or not. UV-B on white skin can produce plenty of vitamin D3, but this is not available all year round - and the same ~297 nm wavelengths which convert 7-dehydrocholesterol to vitamin D3 cholecalciferol also damage DNA and so raise the risk of skin cancer.
For 70 kg 154 lb bodyweight, without obesity, most people need 0.125 mg 5000 IU vitamin D3 a day to attain at least the 50 ng/mL circulating 25-hydroxyvitamin D needed by the immune system. This is a gram every 22 years - and pharma-grade vitamin D3 costs about USD$2.50 a gram. This takes several months to raise 25(OH)D levels over 50 ng/mL. Bolus vitamin D3 (10 mg, 400,000 IU) takes about 4 days due to the need for hydroxylation in the liver.
See the Brownstone article for a table of simplified body weight ratios, for normal and overweight people - and with higher ratios for those suffering from obesity - which will generally, over several months, enable them to attain at least 50 ng/mL circulating 25-hydroxyvitamin D without the need for blood tests or medical monitoring. These are from Prof. Sunil Wimalawansa's 2022 article in Nutrients: "Rapidly Increasing Serum 25(OH)D Boosts the Immune System, against Infections - Sepsis and COVID-19" https://www.mdpi.com/2072-6643/14/14/2997 .
A single oral dose of 0.014 mg / kg calcifediol (which _is_ 25-hydroxyvitamin D) - so 1 mg for 70 kg bodyweight - takes about 4 hours to boost circulating 25-hydroxyvitamin D safely over 50 ng/mL. This is the single most important and urgently needed early treatment for COVID-19, sepsis and any clinical emergency in the great majority of the population. It is more effective and more important than ivermectin or all the other early treatments combined.
50 ng/mL 25-hydroxyvitamin D enables full-strength, rapid, innate and adaptive immune responses to cancer cells, bacteria, fungi and viruses. It also greatly reduces the chance of wildly dysregulated, indiscriminate cell destroying, inflammatory responses. These inflammatory responses are the cause of sepsis, which kills 11 million people a year worldwide: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32989-7 . There would be much less sepsis if everyone had at least 50 ng/mL circulating 25-hydroxyvitamin D, made in the liver from vitamin D3.
Such levels would somewhat reduce the chance of being infected by SARS-CoV-2 for any given viral insult - and would greatly reduce disease severity, viral shedding and so transmission.
(2 of 3) There is another pervasive form of ill-health which is not so easily corrected. Most doctors are not aware of this and vitamin D researchers take little or no interest in it. Our ancestors, going back over tens of millions of years, and until about a century ago, were ubiquitously infected by multi-cellular parasites, particularly helminths (intestinal worms).
The innate and adaptive immune responses which work well on cancer cells, bacteria, fungi and viruses (which only work properly with at least 50 ng/mL circulating 25-hydroxyvitamin D) are no use against these pathogens, which have billions of cells. The inflammatory immune response evolved to tackle helminths and the like. (Here I am using "inflammatory" to denote outright cell destruction, including potentially our own cells, rather than the healthy recruitment of immune cells to sites of injury or bacterial / viral infection.)
This healthy, anti-parasite, inflammatory immune response is mediated by cells such as eosinophils (the suicide bombers of the immune system) which indiscriminately destroy cells, including potentially our own. Long ago, helminths evolved to exude one or more compounds which down-modulate the inflammatory responses of the host (us and other mammals). Our ancestors (and those of other mammals) countered this by evolving inflammatory responses which are generally excessively aggressive without this down-modulatory influence, so that with these helminthic compounds they are about the right strength.
Now that we, in developed nations, are all dewormed, many of us suffer from a large range of chronic inflammatory, disorders - such as multiple sclerosis, rheumatoid arthritis, psoriasis, asthma, cluster headaches and migraines and neurodegenerative conditions such as Alzheimer's and Parkinson's disease.
The fundamental cause of these problems is lack of helminths, with some people having more trouble due to individual genetic variation.
Low 25-hydroxyvitamin D levels make this very much worse, because the immune system is unable to properly regulate inflammatory responses. See Chauss et al. 2021: https://www.nature.com/articles/s41590-021-01080-3 discussed at: https://vitamindstopscovid.info/00-evi/#chauss. This is "Autocrine vitamin D signaling switches off pro-inflammatory programs of Th1 cells", by a large team of researchers headed by NIH investigators Majid Kazemian and Behdad Afzali. It was published in Nature Immunology in November 2021 and the preprint was available in mid-2020. The preprint alone should have alerted doctors the world over to what they need to do in order to help COVID-19 patients.
Chauss et al. found that Th1 regulatory lymphocytes from the lungs of hospitalised COVID-19 patients were unable to transition from their pro-inflammatory startup program, to their anti-inflammatory shutdown program, despite detecting the signal to do so. The primary or sole reason for this was lack of 25-hydroxyvitamin D, which is needed to run these cells' internal intracrine signaling system, which needs to work for this to be accomplished. (The article refers to autocrine signaling, which is not quite right - it is intracrine, with the receptors inside the cell, rather than on the outside as in autocrine signaling.)
Many types of immune cell rely on 25-hydroxyvitamin D based intracrine and paracrine (to nearby cells) signaling in order for each cell to respond to its changing circumstances.
(3 of 3) No amount of fussing over vaccines or not, lockdowns, masks, antibiotics, monoclonal antibodies, surgery etc. will properly improve human health as long as the great majority of the population has half or less of the 25-hydroxyvitamin D their immune systems need to function properly.
Significantly higher levels of 25-hydroxyvitamin D, such as with the Coimbra protocol, are also effective at suppressing numerous auto-immune disorders, including MS, psoriasis, rheumatoid arthritis and both cluster headaches and migraine. Please see: https://coimbraprotokoll.de/en/home/, http://www.clusterheadaches.com and https://vitamindstopscovid.info/06-adv/. The mechanisms for this are not understood. The Coimbra protocol doctors refer to their treatment overcoming "vitamin D insensitivity", but no mechanism is proposed.
Most doctors are unaware of this, and so treat these inflammatory diseases with drugs which suppress both the cytotoxic inflammatory responses AND the already inadequate innate and adaptive responses to cancer cells, bacteria, fungi and viruses. In India, where prednisone was over-used in a desperate attempt to save vitamin D deficient patients from dying from COVID-19, the result was frequently a massive black fungal infection in the lungs which killed many who survived COVID-19.
Does he argue against perfectly effective treatments, the best known of which is ivermectin? A few faulty studies have been used to argue that this is ineffective, but this is impossible to reconcile with the great majority of RCTs listed in the "67 ivermectin COVID-19 studies after exclusions" early treatment table at https://c19ivm.org/meta.html.
Does Dr Howard argue against boosting population levels of 25-hydroxyvitamin D to 50 ng/mL or more, for general health and to protect against sepsis, influenza, COVID-19 and numerous other diseases?
Due to general disinterest in simple, unprofitable, nutritional supplements he may not have been aware of this. However, assuming he is reading this substack, he can now understand the need for 50 ng/mL circulating 259OH0D by reading the research articles cited at: https://vitamindstopscovid.info.
Vitamin D would be by far the most successful of these if all doctors recognised the need to boost 25(OH)D levels over 50 ng/mL in a few hours, rather than the 4 days or so it takes with a proper bolus dose of vitamin D3, such as 10 mg 400,000 IU. This delay is due to the need for hydroxylation in the liver. A single oral dose of 1 mg (for 70 kg body weight) calcifediol, which _is_ 25-hydroxyvitamin D, goes straight into circulation and raises the level over 50 ng/mL in a few hours.
Castillo et al.'s RCT involved, primarily, a single oral dose of 0.532 mg calcifediol for newly hospitalised COVID-19 patients. ICU admissions were reduced from 50% to 2% and deaths from 8% to zero.
This article "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" should have revolutionized the treatment of COVID-19. It didn't. This is primarily because most doctors, immunologists, virologists, vaccinologists, epidemiologists and public health officials take far too little interest in genuinely simple, safe, effective interventions. They much prefer complex, profitable interventions - including especially vaccines.
(1 of 3) All doctors - including Dr Howard and those he criticizes - should have taken a much greater interest in generally unmet nutritional needs, especially the requirement for at least 50 ng/mL 125 nmol/L (1 part in 20,000,000 by mass) serum 25-hydroxyvitamin D in order for the immune system to mount strong innate and adaptive responses and to reduce the risk of the excessive inflammatory responses which are the cause of most deaths from COVID-19.
If they had taken a proper interest in this, every doctor would have known, long before the COVID-19 pandemic, that the great majority of people living far from the equator have 1/2 to 1/10th of the circulating 25-hydroxyvitamin D they need for full strength, well-regulated, immune responses to cancer cells, bacteria, fungi and viruses.
Please read the research articles cited and discussed at:discussed at https://brownstone.org/articles/vitamin-d-everything-you-need-to-know/ and https://vitamindstopscovid.info/00-evi/.
Inadequate circulating 25-hydroxyvitamin D has been a problem for a growing proportion of humanity since the migration out of Africa, to northern Europe and beyond, ca. 50,000 years ago.
Boston doctors clearly demonstrated the need for 50 ng/mL 25-hydroxyvitamin D clearly in 2013: https://jamanetwork.com/journals/jamasurgery/fullarticle/1782085 . With pre-operative 25-hydroxyvitamin D levels of 50 ng/mL or more, the risk of both hospital and surgical site infections was about 2.5%. With lower levels, the risk of both types of infection rose strongly and consistently. At 18 ng/mL, the risk of each type rose to about 25%. All the patients were morbidly obese and underwent the same Roux-en-Y gastric bypass surgery for weight loss. Although people suffering from obesity have greater difficulty converting vitamin D3 to 25-hydroxyvitamin D, there is no reason to believe that their immune systems need a higher level of 25-hydroxyvitamin D to function properly than people who are not suffering from obesity. The steep rise in the risk graph below 50 ng/mL 25(OH)D demonstrates, directly, the immune dysfunction which is entirely normal, and deadly, in most of the population.
Numerous articles show the strong relationship between low 25-hydroxyvitamin D levels and COVID-19 severity and death. For instance, Dror et al. 2022: Pre-infection 25-hydroxyvitamin D3 levels and association with severity of COVID-19 illness https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263069 . This graph is at the start of the Brownwstone article and there was plenty of research on vitamin D and COVID-19 from mid-2020 onwards.
Proper 25-hydroxyvitamin D levels cannot be attained with government-approved vitamin D3 supplemental intake quantities, such as 0.015 mg 600 IU a day. There is very little vitamin D3 in food, fortified or not. UV-B on white skin can produce plenty of vitamin D3, but this is not available all year round - and the same ~297 nm wavelengths which convert 7-dehydrocholesterol to vitamin D3 cholecalciferol also damage DNA and so raise the risk of skin cancer.
For 70 kg 154 lb bodyweight, without obesity, most people need 0.125 mg 5000 IU vitamin D3 a day to attain at least the 50 ng/mL circulating 25-hydroxyvitamin D needed by the immune system. This is a gram every 22 years - and pharma-grade vitamin D3 costs about USD$2.50 a gram. This takes several months to raise 25(OH)D levels over 50 ng/mL. Bolus vitamin D3 (10 mg, 400,000 IU) takes about 4 days due to the need for hydroxylation in the liver.
See the Brownstone article for a table of simplified body weight ratios, for normal and overweight people - and with higher ratios for those suffering from obesity - which will generally, over several months, enable them to attain at least 50 ng/mL circulating 25-hydroxyvitamin D without the need for blood tests or medical monitoring. These are from Prof. Sunil Wimalawansa's 2022 article in Nutrients: "Rapidly Increasing Serum 25(OH)D Boosts the Immune System, against Infections - Sepsis and COVID-19" https://www.mdpi.com/2072-6643/14/14/2997 .
A single oral dose of 0.014 mg / kg calcifediol (which _is_ 25-hydroxyvitamin D) - so 1 mg for 70 kg bodyweight - takes about 4 hours to boost circulating 25-hydroxyvitamin D safely over 50 ng/mL. This is the single most important and urgently needed early treatment for COVID-19, sepsis and any clinical emergency in the great majority of the population. It is more effective and more important than ivermectin or all the other early treatments combined.
50 ng/mL 25-hydroxyvitamin D enables full-strength, rapid, innate and adaptive immune responses to cancer cells, bacteria, fungi and viruses. It also greatly reduces the chance of wildly dysregulated, indiscriminate cell destroying, inflammatory responses. These inflammatory responses are the cause of sepsis, which kills 11 million people a year worldwide: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32989-7 . There would be much less sepsis if everyone had at least 50 ng/mL circulating 25-hydroxyvitamin D, made in the liver from vitamin D3.
Such levels would somewhat reduce the chance of being infected by SARS-CoV-2 for any given viral insult - and would greatly reduce disease severity, viral shedding and so transmission.
(2 of 3) There is another pervasive form of ill-health which is not so easily corrected. Most doctors are not aware of this and vitamin D researchers take little or no interest in it. Our ancestors, going back over tens of millions of years, and until about a century ago, were ubiquitously infected by multi-cellular parasites, particularly helminths (intestinal worms).
The innate and adaptive immune responses which work well on cancer cells, bacteria, fungi and viruses (which only work properly with at least 50 ng/mL circulating 25-hydroxyvitamin D) are no use against these pathogens, which have billions of cells. The inflammatory immune response evolved to tackle helminths and the like. (Here I am using "inflammatory" to denote outright cell destruction, including potentially our own cells, rather than the healthy recruitment of immune cells to sites of injury or bacterial / viral infection.)
This healthy, anti-parasite, inflammatory immune response is mediated by cells such as eosinophils (the suicide bombers of the immune system) which indiscriminately destroy cells, including potentially our own. Long ago, helminths evolved to exude one or more compounds which down-modulate the inflammatory responses of the host (us and other mammals). Our ancestors (and those of other mammals) countered this by evolving inflammatory responses which are generally excessively aggressive without this down-modulatory influence, so that with these helminthic compounds they are about the right strength.
Now that we, in developed nations, are all dewormed, many of us suffer from a large range of chronic inflammatory, disorders - such as multiple sclerosis, rheumatoid arthritis, psoriasis, asthma, cluster headaches and migraines and neurodegenerative conditions such as Alzheimer's and Parkinson's disease.
The fundamental cause of these problems is lack of helminths, with some people having more trouble due to individual genetic variation.
Low 25-hydroxyvitamin D levels make this very much worse, because the immune system is unable to properly regulate inflammatory responses. See Chauss et al. 2021: https://www.nature.com/articles/s41590-021-01080-3 discussed at: https://vitamindstopscovid.info/00-evi/#chauss. This is "Autocrine vitamin D signaling switches off pro-inflammatory programs of Th1 cells", by a large team of researchers headed by NIH investigators Majid Kazemian and Behdad Afzali. It was published in Nature Immunology in November 2021 and the preprint was available in mid-2020. The preprint alone should have alerted doctors the world over to what they need to do in order to help COVID-19 patients.
Chauss et al. found that Th1 regulatory lymphocytes from the lungs of hospitalised COVID-19 patients were unable to transition from their pro-inflammatory startup program, to their anti-inflammatory shutdown program, despite detecting the signal to do so. The primary or sole reason for this was lack of 25-hydroxyvitamin D, which is needed to run these cells' internal intracrine signaling system, which needs to work for this to be accomplished. (The article refers to autocrine signaling, which is not quite right - it is intracrine, with the receptors inside the cell, rather than on the outside as in autocrine signaling.)
Many types of immune cell rely on 25-hydroxyvitamin D based intracrine and paracrine (to nearby cells) signaling in order for each cell to respond to its changing circumstances.
(3 of 3) No amount of fussing over vaccines or not, lockdowns, masks, antibiotics, monoclonal antibodies, surgery etc. will properly improve human health as long as the great majority of the population has half or less of the 25-hydroxyvitamin D their immune systems need to function properly.
Significantly higher levels of 25-hydroxyvitamin D, such as with the Coimbra protocol, are also effective at suppressing numerous auto-immune disorders, including MS, psoriasis, rheumatoid arthritis and both cluster headaches and migraine. Please see: https://coimbraprotokoll.de/en/home/, http://www.clusterheadaches.com and https://vitamindstopscovid.info/06-adv/. The mechanisms for this are not understood. The Coimbra protocol doctors refer to their treatment overcoming "vitamin D insensitivity", but no mechanism is proposed.
Most doctors are unaware of this, and so treat these inflammatory diseases with drugs which suppress both the cytotoxic inflammatory responses AND the already inadequate innate and adaptive responses to cancer cells, bacteria, fungi and viruses. In India, where prednisone was over-used in a desperate attempt to save vitamin D deficient patients from dying from COVID-19, the result was frequently a massive black fungal infection in the lungs which killed many who survived COVID-19.
The synopsis of Dr Howard's 606 page book at: https://www.goodreads.com/book/show/144598292-we-want-them-infected does not mention early treatment for COVID-19.
Does he argue against perfectly effective treatments, the best known of which is ivermectin? A few faulty studies have been used to argue that this is ineffective, but this is impossible to reconcile with the great majority of RCTs listed in the "67 ivermectin COVID-19 studies after exclusions" early treatment table at https://c19ivm.org/meta.html.
Does Dr Howard argue against boosting population levels of 25-hydroxyvitamin D to 50 ng/mL or more, for general health and to protect against sepsis, influenza, COVID-19 and numerous other diseases?
Due to general disinterest in simple, unprofitable, nutritional supplements he may not have been aware of this. However, assuming he is reading this substack, he can now understand the need for 50 ng/mL circulating 259OH0D by reading the research articles cited at: https://vitamindstopscovid.info.
Many other early treatments are analyzed at: https://c19early.org.
Vitamin D would be by far the most successful of these if all doctors recognised the need to boost 25(OH)D levels over 50 ng/mL in a few hours, rather than the 4 days or so it takes with a proper bolus dose of vitamin D3, such as 10 mg 400,000 IU. This delay is due to the need for hydroxylation in the liver. A single oral dose of 1 mg (for 70 kg body weight) calcifediol, which _is_ 25-hydroxyvitamin D, goes straight into circulation and raises the level over 50 ng/mL in a few hours.
This is the primary reason for the spectacular results reported in Castillo et al. fully published in August 2020: https://www.sciencedirect.com/science/article/pii/S0960076020302764 . See also the discussion by two MIT computational biologists: https://www.medrxiv.org/content/10.1101/2020.11.08.20222638v2.
Castillo et al.'s RCT involved, primarily, a single oral dose of 0.532 mg calcifediol for newly hospitalised COVID-19 patients. ICU admissions were reduced from 50% to 2% and deaths from 8% to zero.
This article "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" should have revolutionized the treatment of COVID-19. It didn't. This is primarily because most doctors, immunologists, virologists, vaccinologists, epidemiologists and public health officials take far too little interest in genuinely simple, safe, effective interventions. They much prefer complex, profitable interventions - including especially vaccines.