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THE BOSTON "OPEN AIR" HOSPITAL EXPERIENCE IN PANDEMIC SPANISH FLU OUTBREAKE (1918-1919)

"SUNSHINE VITAMIN" - VITAMIN D AND ITS POTENTIAL ROLE IN MANAGEMENT OF COVID-19 INFECTION
by
Vladimir Badmaev, MD PhD
The article published in 2009 in the American Journal of Public Heath describes experience of hospital in Boston, Massachusetts in a devastating pandemic “Spanish flu” outbreak of 1918–1919. The historical records from an “open-air” hospital in Boston, Massachusetts, suggest that some patients and staff were spared the worst of the outbreak benefiting from combination of fresh air, sunlight and scrupulous standards of hygiene resulting in reduction of deaths among some patients and infections among medical staff.
 
In view of the Boston “open-air” hospital experience, the potential role of vitamin D often called “sunshine vitamin” should be considered in the overall approach to management of current pandemic COVID-19 infection. Vitamin D which modulates the innate and adaptive immune responses and prevents susceptibility to infectious diseases accrues in the body via two routes - nutritional ingestion, and production in the skin by sun UV rays. During exposure to sunlight, 7-dehydrocholesterol in the skin absorbs UV B radiation and is converted into vitamin D3 or cholecalciferol. Nutritional vitamin D3 typically is found in marine food and derived as a supplement from fish liver oils. Another nutritional form of vitamin D is vitamin D2, or ergocalciferol, found in plants, e.g. mushrooms and also nutritional supplements. Vitamins D2 and D3 are inactive biologically and need to be hydroxylated twice in the body, in the kidneys and the liver, to become active as1,25-hydroxyvitamin D, called calcitriol. Calcitriol, a steroid hormone, is the active form of vitamin D.
 
Physical factors which limit the access to UV-B radiation, such as clothing, sunscreen, glass, air pollution and skin pigmentation (which screens out UV rays), significantly reduce or completely eliminate the skin synthesis of vitamin D3. Because of skin pigmentation, people with darker skin are at greater risk of vitamin D deficiency.