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Vitamin D prescribing in care and nursing homes: a prescribing ban contributing to fatalities? P.3

Vitamin D: No Action for the Deficiency Epidemic - 8.1.21

Increasing evidence suggests that Vitamin D therapy is likely to help protect against Covid-19.

Since I last wrote on the failure to provide Vitamin D to vulnerable care home residents, there is still no broad Vitamin D deficiency screening or supplement program. Covid-19 has accounted for around 21% of all care home deaths in England since April 2020.1

The Scientific Advisory Committee on Nutrition (SACN) and the National Institute for Clinical Excellence (NICE) have also released a new Rapid Evidence Review on Vitamin D for prevention and Treatment for Covid-19. They concluded that there is still insufficient evidence to review the current frugal recommendation of 10 micrograms (µg) per day (400 IU). None of the studies were included which have examined Vitamin D as a prophylactic.

Matt Hancock has at least announced that the Department of Health and Social Care would give four months’ supply of 10µg Vitamin D tablets to UK care homes in January 2021.

It’s a start, but there are a few problems: 1) 10µg isn’t a high enough dose to protect against respiratory infections, 2 2) it’s only four months, but Vitamin D is needed all year round, and 3) It’s now January and the tablets haven’t actually landed yet. They probably won’t before the Covid-19 vaccine: a vaccine is only as effective as the immune response of the host, and Vitamin D supports the immune system.3

Easing pressure on the NHS, or shifting costs around the system?

A 2015 study in the BMJ projected that, if everyone over 60 was supplemented with 20µg (800 IU) of Vitamin D per day, it would produce a net saving to NHS £420 million over five years.4

Instead of investing, even in December 2020 in the midst of the ‘second wave’, there was a bulletin advising prescribers to further to reduce spend on Vitamin D prescribing, moving any still on supplements to self-care, with no analysis of the cost of this ‘saving’.5

There is also ambiguity on the prescribing guidance, with NHS England now emphasising that their do-not-prescribe guidance for Vitamin D “does not remove the clinical discretion of the prescriber in accordance with their professional duties or legal duties of CCGs to advance equality and have regard to reducing health inequalities” (personal correspondence).

In essence, if history views this as a disaster, they will blame the GP’s for following their guidance.

The BMJ study’s cost saving projections are for prevention of falls alone, and not accounting for the many other health benefits of Vitamin D. The reduction in falls would also undoubtedly free up much needed bed space, in a crisis so extreme we are all locking down to ‘save the NHS’.

So why is this not being addressed as an urgent public health issue?

Even if NICE, SACN and PHE can’t yet acknowledge the likelihood of a direct link between Vitamin D deficiency and Covid-19, it would make sense to ‘solve’ Vitamin D, if only to ease the pressure on acute hospital beds via its benefit in falls and fractures.

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