Vitamin C (Ascorbic Acid) could be a game-changer against COVID-19

By Dr Asif Wali  

Coronaviruses (CoVs) belong to the subfamily Orthocoronavirinae in the family of Coronaviridae in the order Nidovirales, and this subfamily including α‐coronavirus, β‐coronavirus, γ‐coronavirus, and delta‐coronavirus. Coronaviruses primarily cause enzootic infections in birds and mammals and, in the last decades, have shown to be capable of infecting humans as well. Coronaviruses are large, enveloped, and positive sense RNA viruses that infect a broad range of vertebrates and cause disease of medical and veterinary significance. Human respiratory corona viruses have been known since the 1960s to circulate worldwide and to cause respiratory infection with rather mild symptoms, suggesting that they are well-adapted to the human host. However, zoonotic coronaviruses, such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome coronavirus (MERS-CoV), can cause severe respiratory tract infection with high mortality COVID-19 pneumonia seems to be a lung injury caused by the hyper activation immune effector cells. The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome.

Vitamin C is known as an essential anti-oxidant (meaning it can neutralize unstable compounds in your body called free radicals and help prevent or reverse cellular damage caused by these compounds) and enzymatic co-factor for physiological reactions, such as hormone production, collagen synthesis, and immune potentiation. Humans are unable to synthesize vitamin C; therefore, they must acquire vitamin C from dietary sources. It’s also involved in a number of biochemical processes, many of which are related to immune health. The Daily Value (DV) for vitamin C is 90 mg per day, but breastfeeding women need an extra 30 mg and people who smoke need an extra 35 mg per day. It’s pretty easy to meet your vitamin C needs through your diet as long as you eat a variety of fruits and vegetables. For example, a single medium orange provides 77% of the DV, and 1 cup (160 grams) of cooked broccoli provides 112% of the DV. In the context of Gilgit-Baltistan (GB) Apricot, Sea buckthorn and Dry Mulberry are used as an all-purpose fruit in Gilgit-Baltistan (G-B), for taste as well as a medicine are rich in vitamin C, plant antioxidants, vitamin A, and flavonoids. Furthermore, the recommended dietary allowance of vitamin C (Vitamin C) increases with age. Additionally, vitamin C is a water-soluble vitamin. It dissolves in water, meaning that excess amounts aren’t stored in your body but instead eliminated through your urine. Taking more vitamin C does not mean that your body is absorbing more. Vitamin C affects your immune health in several ways. Its natural antioxidant activity can decrease inflammation, which may help improve your immune function. the highest tissue concentrations of vitamin C are found in the brain, the adrenal gland and white blood cells, with concentrations ranging from 1 to 15 mM these concentrations are 15–200 times higher than those in the plasma owing to active transport mechanisms.

When people get sick, the first thing in their body that actually gets depleted is vitamin C.

The two-time Nobel Prize-winning chemist Linus Pauling regarded vitamin C almost as a panacea; therefore, he claimed that high doses vitamin C could combat a host of illnesses, including cancer. He further believed that vitamin C would make the flu disappear completely off the face of the earth. It is also believed that high-dose vitamin C treatment acts as a pro-oxidant for immune cells, but as an antioxidant for lung epithelial cells. Besides, vitamin c treatment may protect native immunity through the inhibition of the lactate secretion, produced by the activated immune cells. Vitamin C is best known for its role in the synthesis of collagen in connective tissues and acts as an antioxidant. Vitamin C is significant to human body and plays a role in reducing inflammatory response and preventing common cold. In addition, a few studies have shown that vitamin C deficiency is related to the increased risk and severity of influenza infections.  In addition, vitamin C can help to eliminate alveolar fluid by preventing the activation and accumulation of neutrophils, and reducing alveolar epithelial water channel damage. At the same time, vitamin C can prevent the formation of neutrophil extracellular traps, which is a biological event of vascular injury caused by neutrophil activation. Before vitamin C was identified, scurvy (vitamin C deficiency disorder) was associated with an elevated risk of pneumonia, which suggests that vitamin C might have clinically relevant effects on infections. After the isolation of vitamin C, a few German and US physicians proposed that it might be beneficial in the treatment of pneumonia

In an article published in the Chinese Journal of Infection Diseases, the Shanghai Medical Association endorsed the use of high dose vitamin C as a treatment for hospitalized people with COVID-19. Doses that are magnitudes higher than the DV are recommended to be given through IV to improve lung function, which may help keep a patient off of mechanical ventilation or life support. Additionally, a 2019 review found that both oral and IV high dose vitamin C treatment may aid people admitted to intensive care units (ICUs) for critical illnesses by reducing ICU stay length by 8% and shortening the duration of mechanical ventilation by 18.2%. A hospital has reportedly turned to vitamin C as a treatment for the coronavirus, after reports emerged from China that doses well in excess of daily Dietary Reference Values (DRV) showed promise. According to The New York Post, medical teams at the Northwell Health facilities immediately gave COVID-19 infected patients 1,500 milligrams (mg) of vitamin C intravenously (IV). The same amount was then re-administered three or four times a day. Each dose represents over 16 times the recommended allowance the European Food and Safety Authority (EFSA) permits for vitamin C, which is 90mg for adult men and 80mg for adult women.

Dr Andrew Weber, a critical-care specialist affiliated to Northwell Health told the newspaper, “The vitamin C is administered in addition to such medicines as the anti-malaria drug hydroxychloroquine, the antibiotic azithromycin, various biologics and blood thinners. “The patients who received vitamin C did significantly better than those who did not get vitamin C,” he says. “It helps a tremendous amount, but it is not highlighted because it’s not a racy drug.” The revelations come as a recent study found vitamin C could shorten the length of stay in the Intensive Care Unit (ICU). In a controlled 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003). In six trials, orally administered vitamin C in doses of 1–3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. High dose of IV vitamin C has been used in China to help improve lung function in people with COVID-19. Nevertheless, vitamin C’s effectiveness is still being tested. There is no evidence to support the use of oral vitamin C supplements for COVID-19. Vitamin C costs only few per gram, whereas one day in the ICU may cost thousands of dollars; therefore, an 8% decrease in ICU stay from the administration of 2 g/day of vitamin C warrants further research.

Vitamin C levels in coronavirus patients drop dramatically when they ensure sepsis (an inflammatory response that occurs when their bodies overreact to the infection). At least three clinical trials have started in China studying the effects of high-dose IV vitamin C for the treatment of COVID-19 with one beginning as recently as 14 February. In addition, the Shanghai Medical Association released the first and only social government guideline on March 1 for the treatment of COVID-19 where high-dose IV vitamin C (100 -200 mg/kg per day) was endorsed by experts. Furthermore, Peter McCaery, professor of biochemistry at the University of Aberdeen questioned the use of high-dose vitamin C in the treatment of COVID-19. He said that while vitamin C does have some small effect on the common cold, it’s unlikely that taking large amounts of vitamin C supplements will cure a COVID-19 infection – or have a large effect at all. Referring to the clinical trials that used high doses of vitamin C to treat COVID-19, he said that even if IV vitamin C worked to shorten or cure COVID-19, it would likely only be a stop-gap before therapies directed at the virus, such as vaccinations, took over. High-dose vitamin C may result in immunosuppression at the level of these effectors. Hence, intravenous high-dose vitamin C could be safe and beneficial choice of treatment in the early stages of COVID-19.  High dose vitamin C supplements may even cause diarrhea, as they can signal your body to pull water out of the cells and into your digestive tract. Beneficial effects of vitamin C supplementation have been reported for, elderly people with acute respiratory infections, recurrent acute respiratory distress syndrome, reducing the severity and duration of the common cold, reducing the length of hospital stay and symptoms in elderly patients with pneumonia, reducing the duration of mechanical ventilation in people in ICU, Preventing the common cold in people who are vitamin C deficient,  Preventing the incidence of pneumonia in people who are vitamin C deficient.

COVID-19 is a new disease, and we are still learning about it. But several studies in other infections or conditions suggest it may be beneficial in certain groups of people, particularly those already deficient in vitamin C who develop COVID-19. Currently, at least two trials are underway specifically investigating the use of vitamin C to treat severe COVID-19, one in New York and one in China. Moreover, although high dose vitamin C appears promising for COVID-19 treatment, these doses were exceptionally high and given via IV not taken orally. Additionally, it was only given in cases severe enough to require hospitalization. Your best gamble is to eat a diet that’s full of a variety of fruits and vegetables, which naturally provide all the vitamin C a healthy person needs along with many other nutrients and antioxidants. The most effective way to avoid the virus still remains washing hands, nose or mouth, not touching the eyes, and keeping your distance from anyone exhibiting symptoms.