Hannah Sammut

A “talker” piece for my J2 class.

By Hannah Sammut

The New Player in Tackling Covid– Our Underdog Defense Fueled by the Sun

There’s been a lot of conflicting advice on how to stay healthy during one of the strangest and uncertain times in modern history. However, some advice has remained pretty universal: wash hands frequently, wear face coverings in public, and stay socially distant from others.

We know the telltale symptoms that can be experienced after exposure to Covid-19: loss of smell or taste, high fever, shortness of breath, and a persistent cough. We know that two weeks seems to be the average amount of time we should quarantine in the event that we get sick. But what’s actually going on within our own bodies during this time is more of a gray area. Without a vaccine approved for widespread use, what are our defenses against Covid, if any?

Enter Pine Street Inn, a Boston organization that provides over 650 beds at various homeless shelters. While trying to tackle the challenge of keeping his constituents safe from Covid in early spring, Jim O’Connell, the President of the Boston Health Care For The Homeless Program, noticed an anomaly- none of the 408 residents staying at the Pine Street Inn had any symptoms of Covid despite the city’s high numbers.

“The incidence of co-occurring medical, psychiatric, and substance issues are extremely high. Our fear from the modeling at the time was that when Covid would hit this population, it would be devastating. We were seeing otherwise,” O’Connell says.

Tests were in short supply then, but meanwhile, he contacted colleagues who worked as physicians for other homeless groups. Similar accounts from the physicians solidified the notion that homeless in other major cities such as New York and San Francisco were also feeling fine during the pandemic. The protocol at the time was in order to receive a test, one should pass a Covid screening, which asks if any symptoms have been felt in the last 24 hours.

“If I’m really honest,” he says, “nobody passed the screen that would have said to go get a test. But when we tested everybody anyway, there were 148 out of 408 people positive for Covid-19.”

40 percent of a population testing positive for one of the most transmissible diseases isn’t a good sign. O’Connell and his team gathered tests from other large Boston shelters, and the data was about the same. 40% to 30% of shelter residents were positive for Covid, but virtually all were asymptomatic. O’Connell and his team still continue to be stumped— why are homeless populations for the most part not experiencing any symptoms?

A few experts in the medical community have their theories, and they have to do with sunlight.

“When the pandemic hit, the advice we were given was to shelter, don’t go out, don’t socialize, and stay at home. I think that proved to be fairly detrimental,” says Yeemay Su Miller, a Human Nutrition lecturer at Northeastern University. “We absolutely need sunshine and fresh air.”

That’s because one of our main immune defenses are actually activated by sun exposure. This key player in immune response is a hormone, deceptively named vitamin D.

Although supplemented through diet in fatty fish and fortified cereals, most vitamin D is mostly made by the body when exposed sunlight. Cholesterol molecules found on skin cells are converted into preliminary versions of vitamin D3 after being exposed to UV light. After processes in the liver and kidneys, the D3 molecules are ready to be used in cells to boost immune function. While not all of its immune roles are known, vitamin D attaches to cathelicidin antimicrobial peptides (CAMPs) which in turn kill viral cells. Vitamin D synthesis also affects metabolism of zinc, which slows replication of coronaviruses.

Most importantly, vitamin D also has (unknowingly) proved throughout history to be one of the most important treatments for respiratory issues, specifically for slowing acute upper respiratory infections. Before antibiotics were widely used, tuberculosis patients were brought to sanatoriums, where the primary treatment was sun exposure. It was thought at the time that sunlight killed the tuberculosis. While not entirely correct, physicians were on the right track.  Vitamin D can reduce inflammatory responses, which in turn alleviates coughing and further spread of disease. Additionally, vitamin D has continuously been shown to improve asthma symptoms. Multiple studies highlight the relationship between vitamin D’s anti-inflammatory effects and how vitamin D supplements can decrease the need for steroid asthma medication.

Just over 100 years ago the United States was hit by another viral pandemic- the 1918 Spanish flu. Hospitals 100 years ago faced some of the same dilemmas as ours faced this spring: a shortage of beds, a shortage of staff, and the terrible calculus of being forced to play God, deciding who receives treatment, and who does not. During the worst weeks of the 1918 influenza pandemic, as hospitals were reaching capacity and the death toll was surging, the city of Boston decided to build an open-air hospital for those who were too ill to be admitted into indoor centers, named Camp Brooks. Patients were rolled out of their tents every day to lie in the sun for treatment, with “a maximum of sunshine and of fresh air day and night.”

The results were miraculous—not only had the increased ventilation meant that only two of the staff members contracted illness (an unheard of figure at the time), but the death rate was cut from 40% in hospitals to 10% in the outdoor tents.

Placing the patients outside allowed them to receive better quality air, improved their mood, but most importantly allowed them to synthesize vitamin D to fight infection. The surgeon general of the Massachusetts State Guard, William A. Brooks, put it best, writing, “The efficacy of open-air treatment has been absolutely proven, and one has only to try it to discover its value.”

The similarities between the Camp Brooks patients who rid themselves of flu-like symptoms by being outside and Pine Street residents who neglected to show Covid-19 symptoms are there. Fresh air, sunlight, and an increased opportunity to synthesize vitamin D may have quieted upper respiratory symptoms and improved immunity in the Boston homeless as a whole. 

However, other theories can’t be completely ruled out. “We’ve studied vitamin D levels in the past with our population,” says Jim O’Connell. “What we found in general was that the vitamin D levels in Boston’s homeless population are about the same as anyone else’s in Boston.”

O’Connell claims it’s likely plausible that the homeless population benefits from a high rate of acquired immunity from living in close contact with large groups of people. Constantly being exposed to new bacteria and viruses develops antibodies within the immune system. Provided that the body is supplied with necessary raw materials to produce these antibodies (such as vitamin D), other foreign viruses shouldn’t be as damaging to the host.

That’s not to say that the vitamin D theory has been completely dismissed by O’Connell. “We are anxious to see if there is any proof, but as of now we remain skeptical,” he says.

Regardless if vitamin D truly has played a role in preventing the Boston homeless population from exhibiting traditional Covid-19 symptoms, a September study has highlighted the relationship between vitamin D deficiency and susceptibility to contracting Covid-19. Covid is more prevalent among African American individuals, people living in northern cities in the late winter, older adults, nursing home residents, and health care workers—all of which are populations that are more likely to be vitamin D deficient. Those with deficient levels had a 1.77x higher risk of contracting Covid. While a small figure, researchers argue that it is still statistically significant and should be further studied. The study suggests that over-the-counter supplements should be taken to strengthen the immune system.

Yarima Su Miller agrees, especially as colder weather is approaching. “For anyone living in northern latitudes, we just can’t get enough sun in the winter months,” she says. In her opinion, taking just an extra bit of vitamin D won’t do any harm, it’ll do just the opposite. But as of now, the jury is still out on whether some extra vitamin D a day will keep Covid symptoms away.