Vitamin D Supplementation for BAME healthcare workers

The increased mortality of black and asian people with Covid 19 in the UK is stark and worrying. it is also puzzling and strange because it is not consistent with mortality rates in Asian and African countries and yet almost 80% of healthcare professionals dying here in the UK are from the BAME community. I have spent significant time trying develop a unifying explanation. This is the result of my review of the scientific literature. I must declare that as an academic, this is not directly my natural area of research expertise (which is Cardiovascular Risk).
There are a few possibilities to explain this excess mortality in BAME people. It may be that the infectious dose they may be exposed to is greater but this could not explain the discrepancy between caucasian and BAME healthcare professionals. Could it be that the genetic makeup of BAME people makes them in some way susceptible to the European strain of Covid? (?ACE2 expression-see below later) This is unlikely. For example,Indians have a much more similar genetic make-up to Caucasians in terms of ACE expression and this is very different from Blacks. Co-Morbidities have often been quoted in the media. Many of those who have died are young and do not have the co-morbidities that are often quoted and anyway I don’t think the co-morbidity issue is sufficient to fully explain such a large excess rate. My thoughts are that this may be due to Vitamin D deficiency. Most of not all of these people from BAME communities are dark(er) skinned, living in the UK and from local data from Scotland almost all are Vitamin D deficient. A recently published meta analysis ( https://www.bmj.com/content/356/bmj.i6583 ) suggested that Vitamin D supplementation protected against acute respiratory tract infection overall.
Data from the University of East Anglia published on 1st May 2020 has also shown that people with low Vitamin D were more likely to be infected by SARS-Cov2 and had a higher mortality from Covid-19. ( https://www.researchsquare.com/article/rs-21211/v1 )

On closer inspection of the biology of Vitamin D, it quickly becomes apparent that it pays a crucial role in reducing tissue damage in lung injury in lung infections. Vitamin D deficiency results in the up-regulation of renin and therefore the Renin-Angiotensin system, which is a key regulator of blood pressure, inflammation and tissue damage. Angiotensin Converting Enzymes (ACE) are key in this action. However, there are two forms of ACE, firstly ACE itself and ACE2. Briefly, ACE is deleterious and damaging but ACE2 is protective or put in another way, ACE2 counterbalances the effects of ACE. ACE2 is attached to the cell membrane of mainly lung type II alveolar cells, enterocytes of the small intestine, arterial and venous endothelial cells and arterial smooth muscle cells in most organs (sentence copied from wikipedia). In animal models, low ACE2 levels cause acute lung injury which in turn further causes low ACE2 receptor expression and therefore reduced beneficial effects of ACE2. This causes a vicious cycle of damage. Acute respiratory distress syndromes (ARDS) ensues possibly due to the unmitigated actions of ACE. Vitamin D plays a key role in regulating and normalizing ACE2 receptor expression.
SARs CoV2 binds to ACE2 receptors and internalises into cells sequestering large amounts of ACE2 resulting in ACE2 deficiency. Therefore if Vitamin D both increases the ACE2:ACE ratio and normalizes ACE receptor expression, it could counterract the effects of SARS CoV2. People who are dark skinned and living in temperate climates like the UK are very commonly Vit D deficient and therefore susceptible to SARS Cov2 induced lung damage and therefore ARDS.
Therefore the only logical conclusion that can be drawn is that all people of BAME origin should be urgently prescribed high dose Vitamin D (3000-4000iU/day adult dose) for the duration of this pandemic. It is a low risk intervention and could potentially save lives. In an ideal world, a randomised controlled trial should be conducted with Vitamin D in BAME populations but the evidence and biological plausibility is such(and the consequence of inaction being potentially fatal), this would not be a logical course of action in this pandemic.

BAME health care wotrkers in the NHS and social care settings have a significantly higher mortality than non-BAME people. Almost 80% of healthcare workers who have died from Covid-19 are from the BAME population. This simple, low risk intervention will help save the lives of BAME healthcare workers and non-BAME patients with Vitamin D deficiency in this current pandemic