Long time lurker here with a question… I’ve searched and haven’t been able to find the answer, sorry if I’ve overlooked something obvious (to everyone else)
Anyway… after reading the vitamin D threads, it got me wondering how ‘sun-shiney’ cities such as Miami and Houston, etc faired in 1918? I haven’t been able to find anything comparing rates of infection among cities that I could compare by latitude. Anyone have any thoughts or ideas? Thanks!
Doesn’t seem to have helped much-if people were outdoors enough to absorb that level of vitamin D
“That Great Pandemic also touched Florida.
In 1918, Florida’s statewide population was around five percent of what it is today-under one million people.
Despite this scant population, between mid-October and late November 1918, the state reported thousands of cases of the Spanish flu, as well as hundreds of deaths from it.
The exact numbers of Floridians affected by the flu will never be known, because regular reports to the U.S. Public Health Service were never made.”
link:http://www.pandemicflu.gov/general/greatpandemic.html#fl
Every entry on the site Grace RN – at 15:27 provided starts with the same sentence, just insert a different state’s name. JMHO but I think Mr. Leavitt was trying to make a point. I read that FL and some of the other “sunshiney” states faired much better, I think because of the Vit D and weather conditions, as well as quarantine precautions. Can’t provide a link because it was awhile back. I’ll try and find more research on this from my archives and will share it when I do.
In a history of Schenectady, NY and the 1918 flu, they give death rates by city. The worst hit cities are those that got the flu in August and Sept. while the later ones were hit much less - it appears the virus mutated. (An earlier wave in the spring also had low mortality.) So, the north/south aspect appears not to dominate in causing mortality. Minneapolis (1.8 per 1000) had a lower rate than Los Angeles (3.3) and Philadelphia (7.4) was higher than Boston (5.7). This does not mean that Vitamin D was unimportant, but it does suggest that the flu was so easily spread and so virulent that people were infected even in August when there should have been plenty of sun, especially for a farm-centered nation. The web site is at www.schenectadyhistory.org/health/morris/3.html
I think there is a strong argument to be made in favour of Vitamin D supplementation for those who do not receive enough through diet or receive the appropriate environmental exposure via the sun.
“Since MS seems to be more common in people who live farther from the equator, another theory proposes that decreased sunlight exposure[20] and possibly decreased vitamin D production may help cause MS. This theory is bolstered by recent research into the biochemistry of vitamin D, which has shown that it is an important immune system regulator
http://en.wikipedia.org/wiki/Multiple_sclerosis
There is much, much, more if you choose to Google for the information.
INFOMASS at 21:00 - Thanks for the link! What strikes me is that other than Los Angeles (and maybe St. Louis), all the cities listed are what I would consider northern cities. It makes me wonder if there is a lack of data for southern cities, or if they fared better….
GPinWI – at 21:33 wrote:
INFOMASS at 21:00 - Thanks for the link! What strikes me is that other than Los Angeles (and maybe St. Louis)
I think St. Louis had very low rates of infection because of the the amazing foresight of their mayor, applying social distancing in the community.
GPinWI at 21:33
I’d expect that in 1918–1920 southern cities (and states)were less densely populated than in the north; if so, that might have had an effect on rates of infection, though it shouldn’t have affected fatality rate of the disease.
Klatu at 21:22 - “I think there is a strong argument to be made in favour of Vitamin D supplementation for those who do not receive enough through diet or receive the appropriate environmental exposure via the sun.”
I completely agree with you. I think that many people do not realize, however, exactly how many of us do not receive enough through diet or sun exposure. In our studies in coastal South Carolina (yes, the sunny South), we see vitamin D deficiency rates of roughly 20–40% among white mothers, 40–60% among Hispanic mothers, and up to 90% among African-American mothers. Many of these people are profoundly deficient with serum 25(OH)D levels less than 12 ng/mL. Their bodies laugh at the RDI of 400 IU/day; they typically require 2000 IU/day or more to pull them up to marginally optimal levels. This is extremely important information for exclusively breastfeeding mothers, because their infants’ only source of vitamin D will be breastmilk. Vitamin D deficient moms who exclusively breastfeed will produce vitamin D deficient children, placing them at increased risk of bone diseases such as rickets and osteomalacia and possibly (still under study) a host of chronic autoimmune and inflammatory conditions.
In case anyone is interested, another couple of interesting references concerning the role of vitamin D in multiple sclerosis are: Hayes CE. Vitamin D: a natural inhibitor of multiple sclerosis. Proceedings of the Nutrition Society (2000) 59: 531–535. Munger KL et al. Vitamin D intake and incidence of multiple sclerosis. Neurology 2004;62:60–65.
As we learn more about the role of vitamin D in immunomodulatory processes, more studies are being done to examine its relationship with autoimmune diseases and chronic inflammatory conditions. It has been shown that vitamin D is also preventive of Type I diabetes (so-called “juvenile onset”) (1), associated with lowered rates of rheumatoid arthritis (2), and preventive of prostate cancer as well as being pro-differentiative and anti-metastatic (3), and is critical in the human body’s native antimicrobial response (4). Other papers that I don’t have immediately at hand indicate that adequate vitamin D intake lowers C-reactive protein (CRP), an important marker of inflammation.
What I find most interesting is the hypothesis among current researchers that adequate vitamin D intake in infancy has a priming effect on the immune system. This is supported by the studies of Type I diabetes, but a true assessment of the hypothesis will take large longitudinal studies (read: $$$). We can only hope that the NIH budget will be restored to permit studies of this sort.
(1) Hypponen E et al. Intake of vitamin D and risk of Type 1 diabetes: a birth-cohort study. The Lancet 358:1500–1503. (2) Merlino LA. Vitamin D intake is inversely associated with rheumatoid arthritis. Arthritis & Rheumatism 50(1):72–77. (3) Schwartz GG. Vitamin D and the epidemiology of prostate cancer. Seminars in Dialysis 18(4):276–289. Anything by this author is worth reading if you are interested in prostate cancer. (4) Liu PT et al. Toll-like receptor triggering of a vitamin D-mediated human antimicrobial response. ScienceExpress 23 Feb 2006.
But I guess that what matters most here is whether there is an anti-influenza effect. I’m sure that the Cannell paper on epidemic flu and vitamin D has been discussed before, and I believe that adequate vitamin D intake does afford some protection against “common” viruses by creating an environment in which our immune systems can respond healthily. I would postulate that because vitamin D is critical to an appropriate immune response, the effect in a pandemic may not be seen in attack rates, but in death rates. If the pandemic strain is new to us all, vitamin D will not provide a magical aura of protection. However, my SWAG (since this hasn’t really been studied yet) is that it may set the internal environment for a proper immune response once the body recognizes that it is under attack - hopefully, preventing cytokines from storming out of control.
Klatu, is your user name a reference to the movie Evil Dead? That is the best “worst movie” I’ve ever seen. Hilarious.
Klatu: I agree with you and Pseudorandom about the potential benefits of Vitamin D, and went so far as to (mis?)post on the news thread a few days back about a nutrition letter that summarized much of the recent research also well summarized by Psudorandom at 09:53. My only points were that the 1918 flu data did not support a sharp north/south difference in mortality and that other variables such as viral evolution and public health measures help to explain what we actually observed. Having said that, there are many good reasons to supplement Vitamin D adn few not to. It might not help a whole lot with panflu, but it likely will do some good and could help in many other ways.
(oops, ;-) I’d always been thinking, “Klaatu barada nikto”!)
crfullmoon - at 10:13 You’re right, not an oops. “Klaatu barada nikto” is from the movie series “Evil Dead.” I like the part where the guy’s zombie arm goes after him.
On second thought, I would like to quote briefly from the Cannell review paper - “Recently, vitamin D has been found to modulate macrophages’ response, preventing them from releasing too many inflammatory cytokines and chemokines [refs]. Vitamin D deficiency also impairs the ability of macrophages to mature, to produce macrophage-specific surface antigens, to produce the lysosomal enzyme acid phosphatase, and to secrete H2O2, a function integral to their antimicrobial function [refs].”
If the research is borne out in further studies, we may well have something that moderates cytokine storms.
Ironically, if the pandemic is severe when it comes, we will probably not even be able to do any studies about the possible anti-flu effects of vitamin D. If the medical system is overwhelmed, there will be minimal recordkeeping and certainly no emergency IRB sessions or extra time for docs to write protocols. We’ll be thrown back to relatively poor-quality retrospective survival studies, which will be rife with uncontrolled confounding, once we again have the research capacity to carry them out. :(
I’m old -the phrase’s originally from “The Day the Earth Stood Still” (1951)
Pseudorandom – at 11:28 wrote:
crfullmoon - at 10:13 You’re right, not an oops. “Klaatu barada nikto” is from the movie series “Evil Dead.” I like the part where the guy’s zombie arm goes after him.
The phrase “Klaatu barada nikto” originates from the 1951 Cold-War-era science fiction film The Day The Earth Stood Still. The phrase “Gort! Klaatu barada nikto!” was used to stop Gort, the robot (virus) in the film, from destroying the world.”
Well, whaddyaknow. I learn something every day.
If you want to watch a funny and really bad horror flick in celebration of Halloween, you’ll be amused by Evil Dead ripping off older sci fi. Now I’m wondering what other throwbacks were in there that I missed …
Klatu:
Just a slight clarification to the St. Louis post. Although the mayor did order the mandatory shutdowns, if it had not been for the foresight and insistence of the city health doctor, Max Starkloff, the mayor would not have done anything different than any other city. I am glad so many people are here from the medical field…it will take someone like starkloff(an authoritative, strong voice), again, to convince politicians that it is imperative to shut down cites, and not play politics. (ps I’m from st. louis, and I don’t see another starkloff on the scene yet, and waay too many politics in this area)
Thank you - I stand corrected. Credit where credit is due. (I’m from out-of-town)
‘’‘That “social distancing” of 1918 was the brainchild of the city’s health commissioner, Dr. Max C. Starkloff. Working with Mayor Henry Kiel, Starkloff closed schools, barred public gatherings and shut or limited businesses.
As a result, the city’s flu death rate for each 1,000 residents was 3.0 - the lowest big-city figure. Philadelphia’s rate was 7.3, and that was only third-worst among big cities. San Francisco’s rate ran to 7.6. In Pittsburgh, the figure hit 8.0.’‘’
http://www.flutrackers.com/forum/archive/index.php?t-7926.html