DR. WALKER

Calcium Supplementations in Covid-19 Patients

Calcium is a mineral most often associated with healthy bones and teeth, although it also plays an essential role in blood clotting, helping muscles contract, and regulating normal heart rhythms and nerve functions. The body works to keep a steady amount of calcium in the blood and tissues to perform these vital daily functions. If calcium levels drop too low in the blood, parathyroid hormone (PTH) will signal the bones to release calcium into the bloodstream. When the body has enough calcium, a hormone called calcitonin lowers the calcium levels in the blood by stopping the release of calcium from bones and signaling the kidneys to get rid of it in the urine.₁

There have been a few published studies regarding the significance of calcium levels in our population of COVID patients. At the beginning of the COVID-19 pandemic, no population data on calcium levels in patients affected were available, but in April 2020, the first case of severe acute hypocalcemia in an Italian patient with SARS-CoV-2 infection was reported.2 A high incidence of hypocalcemia was observed in critically ill patients admitted to hospitals in Wuhan with Covid-19 during the beginning of the epidemic. Therefore, it was hypothesized that low serum calcium levels were associated with the severity of disease and prognosis in COVID-19.₃

Several studies revealed a correlation between hypocalcemia, higher mortality, and poor clinical outcome in hospitalized critically ill patients. Calcium plays a crucial role in the viral fusion of various enveloped viruses such as SARS-CoV, MERS-CoV, and Ebolavirus. It is known to directly interact with the fusion peptides of these viruses to promote their replication. Calcium may prove to be a useful biochemical marker of disease severity.3 Subsequently, several studies reported hypocalcemia as a highly prevalent biochemical abnormality in COVID-19 patients with a marked negative influence on disease severity, biochemical inflammation and thrombotic markers, and mortality. Due to its strict relationship with inflammatory response and disease severity, hypocalcemia has been associated with increased mortality risk. ₂

We therefore highly encourage correction through calcium supplementation to prevent further injury at the cellular level and stifle further provocation of the disease. Therefore, assessing, monitoring, and replacing calcium may be reasonable at first patient hospital evaluation and hospitalization. Finally, Vitamin D replacement may be considered in high-risk Vitamin D deficient patients since it could have, among other possible benefits, a protective role against the occurrence of hypocalcemia in patients with COVID-19.₃

The Recommended Dietary Allowance (RDA) for calcium for women 19-50 years of age is 1,000 mg daily; for women 51+, 1,200 mg. For pregnant and lactating women, the RDA is 1,000 mg. For men 19-70 years of age, the RDA is 1,000 mg; for men 71+ years, 1,200 mg. ₁

References

1. https://www.hsph.harvard.edu/nutritionsource/calcium/#:~:text=Calcium%20is%20a%20mineral%20most,heart%20rhythms%20and%20nerve%20functions.
2. https://link.springer.com/article/10.1007/s11154-021-09655-z 3. https://www.sciencedirect.com/science/article/pii/S1201971221003611