Nutrition for prisoners, especially vitamin D for COVID-19

2021-01-31: Please see an important update regarding mutations in the SARS-CoV-2 viruses which cause COVID-19.  https://vitamindstopscovid.info/#update-2021-01-31 The British variant is more transmissible.  The separately evolved, but otherwise identical, South African and Brazilian strain are more transmissible still.  There's no reason to believe they are less harmful, and some reasons to believe they are at least as harmful or more. Researchers in Israel and France ran experiments with yeast (not viruses) to evolve, in an accelerated manner, the likely mutations which would give rise to more transmissible variants of SARS-CoV-2, due to the variations in the spike protein's Receptor Binding Domain having a greater affinity for the ACE-2 receptor.  Their experiments evolved mutations including the same three which cause the South African /  Brazilian strain to be much more transmissible.   Their experiments also discovered other mutations which would make still more transmissible variants of SARS-CoV-2, but which have not yet evolved in the virus.   The British strain has 3.5 times the RBD affinity for ACE-2 of the strains common in mid-2020.  The South African / Brazilian strain has 12.7 times this affinity.  Their experiments found multiple combinations of mutations, including one which conferred an approximately 640 times the affinity of mid-2020 strains. It is reasonable to expect that the viruses, in the wild, in the months and years to come, will evolve to embody at least some, and perhaps all, of the mutations this team discovered - and there may be other mutations as well which increase transmissibility. Therefore, we cannot assume that the strains which affected most countries in the middle of 2020 will be the ones we have to contend with now, in early 2021, much less later in the year and in the future. These mutations tend to make immunity from prior infections or vaccines against older strains less effective, so reinfection with new strains seems possible and likely. Perhaps future strains with very high RBD affinity for ACE-2 will render any vaccine-induced immunity, and perhaps infection induced immunity, much less able to prevent infection, or to reduce the extent of an infection once it starts.   If so, then vaccines, social distancing, masks, lockdowns etc. will be even less effective than they are today.  Since population-wide, year-in year-out, antiviral drugs are impractical and undesirable, then the only option would be to do what I and others have been suggesting since March 2020: population-wide substantial supplementation with vitamin D3 and ideally other nutrients to boost strong initial immune responses to the infection and, most importantly, to reduce, as much as possible, the common tendency for the dysregulated, hyper-inflammatory, self-destructive immune responses which cause some people to have severe COVID-19 symptoms. I worked unsustainably on these websites from March to December 2020.  I will try to update them with the very most significant research, such as just mentioned - but in general I need to get back to my work with electronic musical instruments.

I wrote this page on 2020-06-22 and don't have time to keep updating it, such as be trying to mention all new research and media reports.  While the basic concerns about prisoners' general health, immune system health and COVID-19 infections remain valid, over time, it will become outdated.

Here are some newer articles of interest, most recent first:

2020-08-09:


2020-08-08:

2020-08-05:

Approximately 10 million people are confined in prisons, jails, correctional centres - hereafter prisons.  They get little sunlight, generally low-grade food and - as far as I can tell - little or nothing in the way of vitamin and mineral supplements.

COVID-19 spreads rapidly in prisons due to shared toilets and bathrooms and other facilities.  Both prisoners and prison staff are at high risk for contracting the disease.

Since prisoner's health is entirely the responsibility of the prison administrators, and since healthcare costs, and all costs associated with violence and other crimes in the prison, are borne by the governments which run the prisons, one would think that it is a no-brainer to invest a small amount of money in nutritional supplements to improve prisoners' health.

Yet it seems that in general, prisoners only get the vitamin supplements they buy for themselves, with their limited spending money.

Corrective Nutrition - How vitamins for convicts would save taxpayers' money Andrew W. Saul 2017-12-29 http://www.orthomolecular.org/resources/omns/v13n26.shtml

Andrew Saul cites research showing reduced violence and other health benefits from supplying prisoners with nutritional supplements.  He recounts some of his experience teaching in prisons.  Costs of USD$31,000 to USD$167,000 per inmate per year are quoted.

Up-to-date figures on the 2.3 million people in US prisons, jails (short-term convicted inmates and mainly suspects awaiting trial): https://www.prisonpolicy.org/reports/pie2020.html

The Vitamin D Status of Prison Inmates Benjamin Udoka Nwosu et al.  2014-03-05 https://doi.org/10.1371/journal.pone.009062

These graphs show average vitamin D levels over four seasons for prisoners from Massachusetts - who were apparently receiving at least 600IU (15ug) vitamin D in their diet every day.  This is inadequate, but it is probably more than what most other prisoners receive.



A larger version is 1453x1258.

Some of the most important COVID-19 statistics for any population are:

1. Total number of people.
   
2. Number of people infected so far.  This can only be known with extensive testing and reliable antibody tests - and this is rarely done.
3. Number of people tested positive for SARS-CoV-RNA.
   
4. Number of people tested for this.
   
5. Number of deaths attributed to COVID-19.
6. The ages and comorbidities of the people who died.
   

We are also concerned about the lasting harm done to those who survive severe COVID-19 symptoms.  This is much harder to define or measure, but I guess that for every person who dies, three to ten survive with lasting harm, such as neurological damage (micro-embolisms and on a larger scale, stroke) and damage to their eyes, heart, lungs, liver and kidneys.

The current death toll is the tip of the iceberg.  Firstly, because if new infections stopped today, many more people will die in the month to several months following their initial infection.  Secondly, because the number of people seriously harmed surely scales with the number of deaths.

I have not tried to research this assiduously.  The arguments above - in the context of the research articles I link to at ../cv19/ and ../cv19/icu/ - all that anyone should need.

The Marshal Project tracks COVID-19 deaths in US prisons:

https://www.themarshallproject.org/2020/05/01/a-state-by-state-look-at-coronavirus-in-prisons

Here are some "at least" figures from their 2020-06-12 update:

It is possible that almost all of the incarcerated people killed by COVID-19 are over 50, but my guess is that these trends are important:

1. The death rate as a percentage of population 0.023% is somewhat lower in prisons than in the general population 0.036% primarily due to there being few people in the 60+ age range in prison.  It is also possible that the infections there have been somewhat delayed compared to those on the outside.
   
   
2. The same could be said of the death rate per confirmed cases, but an additional factor in this being lower in prison 1.18% than in the wider community 5.3% is that the number of tests done per 10,000 people in prison is significantly higher than in the general population.  In other words, the number of confirmed cases in prison is closer to the real number of infections than it is in the community. 
   
   So the real question of interest - deaths per number of people infected - can't be answered reliably, but if the community had been tested as well as the prisons, the community rate would be lower than 5.3% and so closer to the deaths per number of people actually infected.
   
   
3. With more thorough testing, including of asymptomatic people, early treatment and effective isolation, prisons may have been able to slow transmission and reduce the rates of serious infection considerably compared to what would have happened if there had been no such testing or further actions.
   
   I guess that a much greater proportion of asymptomatic people were tested in prisons than in the wider community - where it was frequently difficult to get tested due to the need for travel, eligibility requirements involving active symptoms, or known exposure, and the high cost of the tests themselves, for some people at least.
   
   
4. While I can't directly infer this from the above data, I suspect that the average age of death from COVID-19 among incarcerated people is lower than that in the wider community by several decades.  Therefore, even if (for a variety of health and behavioural reasons) the incarcerated people on average have a lower life expectancy than non-incarcerated people they are still, as a group, suffering a greater loss of life years per individual killed than, on average, those generally older people in the community who died.
   
   
5. Assuming point 4 is true - COVID-19 is killing prisoners younger than in those it kills in the general community - then the same pattern is surely true of the people it seriously harms.

For simplicity I wrote as if COVID-19 kills and harms people.  See the main pages here ../cv19/ for why this is not true.  COVID-19 is the illness caused by the SARS-CoV-2 virus.  For people with strong, well-regulated, immune systems, there may be few or no symptoms and little risk of harm or death.  Generally, those harmed and killed are those whose weakened and dysregulated immune systems firstly fail to fight off the virus and then go into over-inflammatory, self-destructive, overdrive - and it is this which causes the severe symptoms, lasting harm and death.  I and a growing number of doctors and lay people believe that Inadequate vitamin D is the biggest single easily correctable cause of these immune system failures.

The Marshall Project also reported that among prison staff there are 9,180 known cases and 38 deaths.  This data is incomplete.  In this Guardian account of Last Week Tonight's John Oliver's 2020-06-21 video on COVID-19 in prisons, mentioned more than 68,000 US prisoners (of 2.2 million) known to have COVID-19 and that there are 455,000 staff.  This story also linked to a Marshall Project page which states that about 200,000 people enter and leave US jails every week.
 
The general population needs vitamin D supplementation, for numerous reasons - most urgently COVID-19.

The same is true of prison staff, who are generally at higher risk than most people in the community, because of the nature of their work.  They can afford and easily use vitamin supplements, including vitamin D supplements.

The same is true of prisoners - but they cannot easily buy their own supplements - and they are at high risk of infection, with their extremely limited behavioural choices, close living conditions with shared facilities, low vitamin D levels and limited access to high-elevation sunshine.

522 incarcerated people and at least 38 prison staff are now dead from COVID-19.  I believe that few, if any, of them would have been killed if their vitamin D levels were 40ng/ml or more.

A much greater number of these people have suffered lasting harm for the same reason.

Robust vitamin D supplementation is vastly easier, safer and cheaper than all this.

In the general population it is tricky to encourage most people to buy and take supplements.

I imagine it would be much easier in a prison.  The supplements can be purchased in bulk, at wholesale prices.  They can be distributed with little trouble to the prison population.  Improvements to general health would reduce health and other costs far more than the cost of the supplements.  All this has always been true.  COVID-19 makes it a matter of extreme urgency that such supplementation programs begin immediately.

None of these people were on death row.  But now they are dead and a greater number have brain damage, kidney damage etc.

There may be some profound problems sourcing vitamin D in the quantities needed for supplementing the whole population in the weeks and months to come.  So increased exposure to high-elevation sunlight should be maximised. 

Please see other pages at this site, linked to from the main page ../ for notes on the optimal - generally amount of sun or UVB exposure for generating vitamin D while minimising DNA damage and therefore risk of skin cancer.

I think there may also be a case for exposure to artificial UVB light - though this involves some risk of cancerous skin damage, and the need to protect the eyes.  Another page ../crisis-diy/ (not ready yet) will explore artificial UVB light exposure and alternative sources of vitamin D if the pharmaceutical stocks have been exhausted.