Deficiency of Vitamin D is very common in Pakistan, even among healthy asymptomatic individuals [1], [2]. Recent studies have shown that the risk of contracting COVID-19 was increased to two-fold, and consequent mortality to 4-fold if the person is Vitamin D deficient [3]. Health care workers including the nursing and administration staff are at a high risk of contracting SARS-CoV2 due to increased regular exposure in a health care setting [4]. Consequently, a convergence of the COVID-19 pandemic, the deficiency of Vitamin D, and the increased exposure can render the health care workers at an additional risk to COVID-19 infection. Our objective was to determine the prevalence of vitamin D deficiency in healthy asymptomatic front-line health care workers and to analyze the change in serum level by loading oral dose of SunnyD STAT softgel capsules (200000 IU Vitamin D3). We followed single centered, cross-sectional, cohort study with subsequent randomized placebo-controlled design for supplementation and follow up. Serum level of 25-hydroxyvitamin D (25OHD) was the main outcome variable, with anthropometric data, nutritional intake, and lifestyle variables analyzed for potential association as risk factors for the outcome. Severe Vitamin D deficiency was found to be prevalent among front line health care workers in this urban hospital-based sample. Serum level of Vitamin D was found to be significantly associated with designation and presence of high blood pressure. The likelihood of increased serum Vitamin D levels was observed with increasing monthly income, higher designation, increasing age and supplementation intake. Mean increase in the serum 25(OH)D3 level after 2 doses of SunnyD STAT softgel capsule (200000 IU Vitamin D3) was 34.22 ng/ml. Public health interventions regarding Vitamin D supplementation and awareness are needed, especially amid COVID-19 pandemicDeficiency of Vitamin D is very common in Pakistan, even among healthy asymptomatic individuals [1], [2]. Recent studies have shown that the risk of contracting COVID-19 was increased to two-fold, and consequent mortality to 4-fold if the person is Vitamin D deficient [3]. Health care workers including the nursing and administration staff are at a high risk of contracting SARS-CoV2 due to increased regular exposure in a health care setting [4]. Consequently, a convergence of the COVID-19 pandemic, the deficiency of Vitamin D, and the increased exposure can render the health care workers at an additional risk to COVID-19 infection. Our objective was to determine the prevalence of vitamin D deficiency in healthy asymptomatic front-line health care workers and to analyze the change in serum level by loading oral dose of SunnyD STAT softgel capsules (200000 IU Vitamin D3). We followed single centered, cross-sectional, cohort study with subsequent randomized placebo-controlled design for supplementation and follow up. Serum level of 25-hydroxyvitamin D (25OHD) was the main outcome variable, with anthropometric data, nutritional intake, and lifestyle variables analyzed for potential association as risk factors for the outcome. Severe Vitamin D deficiency was found to be prevalent among front line health care workers in this urban hospital-based sample. Serum level of Vitamin D was found to be significantly associated with designation and presence of high blood pressure. The likelihood of increased serum Vitamin D levels was observed with increasing monthly income, higher designation, increasing age and supplementation intake. Mean increase in the serum 25(OH)D3 level after 2 doses of SunnyD STAT softgel capsule (200000 IU Vitamin D3) was 34.22 ng/ml. Public health interventions regarding Vitamin D supplementation and awareness are needed, especially amid COVID-19 pandemic.

The endemic Vitamin D deficiency in Pakistan and the current COVID-19 epidemic have converged into a double whammy scenario in Pakistan [1]. Nutritional epigenomic studies have highlighted Vitamin D as a master Vitamin influencing various genomic expressions through its active metabolite 1α,25-dihydroxyvitamin D3 [2]. The objective of this study was to evaluate the measurable impact of adjuvant Cholecalciferol therapy in the Cytokine gene expression of COVID-19 patients by quantitative Real-Time Polymerase Chain Reaction analysis. The trial was a randomized control prospective open label interventional trial done on moderate to severe COVID-19 patients with deranged inflammatory and coagulation biomarkers. SunnyD STAT (Vitamin D3 200000 IU) softgels were given at Day 1, Day 3 and Day 5 of the treatment. Optimized quantitative Real-Time Polymerase Chain Reaction analysis showed decreased genetic expressions of Interleukin 6 (IL-6), Interleukin 2RA (IL-2RA) and Tumor Necrosis Factor (TNF-a) in the interventional group against the age and co-morbidities matched controls, providing molecular and genetic level evidence for the purported mechanism of amelioration of Cytokines induced pathogenic inflammation. However, inherent limitations of the design restrict the generalizability of the results and warrants caution for extrapolation. We recommend randomized placebo-controlled trials with larger sampling and genome wide profiling to infer more definite interpretations.