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Autism and COVID-19 Infection
The pandemic of COVID-19 infections has resulted in numerous deaths, disastrous effects on the world economy and anxiety and concerns for the future for all of us.. For autistic people and their families, the stress is very much harder to bear and many feel overwhelmed by the experience.
The website of our colleagues in the Autism Research Institute (ARI) contains a huge amount of factual and supportive information and ideas which will help a lot of individuals and families wherever you may live.
Latest Research article with information by Paul Shattock :
Autism, Vitamin D and COVID – 19 Infections
Although Autism and COVID-19 would appear, at first sight, to have very little in common, there are elements of the two conditions which do have unexpected similarities and provide further clues about the underlying problem.
At this point, it’s customary to run through the defining symptoms and the problems which may present themselves. We must assume that anyone reading this is already aware of these problems.
Our Autism Research Unit initiated our studies in the (now) University of Sunderland in England in about 1982. We were seeking metabolic abnormalities by analysing the urine of people diagnosed with autism compared to control populations. We did not collect detailed clinical histories or any other personal details apart from the contact details, birth date, and name of the diagnostician. When we had completed these initial studies, we stopped taking samples because that particular project was complete. However, by this time our work had become better known and many parents and professionals were contacting us to have samples analysed. We agreed, provided they covered the costs involved. As well as asking for names, we requested information of racial/ethnic backgrounds. This was not possible to determine from the name alone. We observed that we had rather more samples from children from ethnic minority backgrounds than we had expected. In particular, we also had more samples from Muslim families.
We did not mention this in publications as our observations were not derived from a properly designed population study; The data may have been entirely random but could result from consequence of groups of similar groups encouraging each other to contact us. We had no data with which to confirm these observations, but we also noted a greater incidence in mixed race children and had no real explanation for this – again we reported nothing.
Over the intervening years, we learned, principally through the work of Dr John Cannell (1) and his colleagues, that Vitamin D metabolism abnormalities may be more common in people diagnosed with autism. This was just one more factor which we accepted for consideration but were unable to include in our own studies.
In 2008, a series of reports came from some of the Northern States in the USA (Minnesota and Nebraska) that there was an outbreak of autism in the region and, in particular, amongst the immigrant populations who originated in Somalia in East Africa. We immediately interpreted this as a possible consequence of reduced Vitamin D levels as a result of the lower levels of sunlight in that (Northern) part of the USA. The comparatively dark skin of the Somali children and especially the fact that Somali mothers, being Muslim, would have minimal areas of exposed skin (thus accessing minimal levels of sunlight throughout pregnancy) would enhance this effect.
As a fairly frequent visitor to the Middle East, I became aware of the possibility of the lack of direct sunlight being a potential problem even there. Most adults wear traditional Arabic clothing which involves being covered to avoid the hot sun and keep cool. The women are usually covered and may or may not have facial protection. The consequence is that the direct sunlight is diminished and there could be a reduction in Vitamin D especially during pregnancy. I suggested that a change of diet to include more seafood or supplementary Vitamin tablets might be useful.
A couple of years later, I observed that many pregnant women (in Saudi Arabia) were now taking appropriate nutritional supplements – including Vitamin D to avoid conditions such as rickets.
It is interesting to note that farmers have, for as long as can be remembered, supplemented the diet of ewes before, during and after pregnancy. Human beings do this for their sheep but not necessarily for their own children.
There is evidence that supplementing the diets of autistic children with Vitamin D can be beneficial. (2) No-one is talking about curing a person with autism, but it does seem to have beneficial effects on some of the faulty metabolic processes.
Like everyone else, we learned about this viral disease during the early months of 2020 and, like many other cynics, we assumed it was just the next in a long line of diseases which would permit pharmaceutical companies to market their vaccines across the world. Gradually, we learned that it was a very unusual disease which was, as Gregg (3) stated when describing influenza, “seemingly unmindful of traditional infectious disease behavioural patterns.”
It was different from influenza type diseases in many ways – not least in its capacity to spread rapidly and to kill victims rapidly. It was described as a Coronavirus which is related to two other Corona viruses which had, in recent years, been held responsible for epidemics of SARS and MERS in humans but on a comparatively local scale.
This new disease was spreading very rapidly and there was talk of it becoming a Pandemic.
It was noted that a weird selection of unusual interventions were being employed with, allegedly, some success in the regions of China where it had first been reported (– the District of Wuhan). Then, in other countries of the Far East, Vitamin C and Vitamin D were being given by injection in heroic doses. The antibiotic Azithromycin was used (presumably to prevent secondary bacterial infections?), as well as Hydroxychloroquine (a somewhat unfashionable drug normally employed to treat or prevent malaria)..
The use of each of these for treating a viral infection (the vitamins apart) would not be an obvious choice. However, it was the Vitamin D element that caught the attention of people involved with autism.
It has been reported that many people suffering from COVID-19 also suffer from Vitamin D deficiency
Is the deficiency of Vitamin D conducive to the colonisation by the virus or is the deficiency a consequence of the infection?
Either way, it would seem that we should be concerned about the effects of low Vitamin D in people with autism at a time when such a disease is rampant.
Service Providers for Autism!
Those of us who are involved with the education, care or employment of autistic people were terrified about the situation.
Vitamin D has a very important role to play in modulating the immune system. It is required to stimulate the immune system when appropriate and, through a different system, dampen it down. We remain concerned and vigilant because any interference with the natural systems in our body by chemical or other means are not predictable or under our control. Abnormalities in the immune system are already common in people diagnosed with autism. My family and I all take 1g of Vitamin C (as a drink prepared from an effervescent tablet). It also includes 15mg of Zinc. We also take a capsule of 50 micrograms of Vitamin D3 (the most active form of the vitamin) (but intend dropping the amount (to 12.5 micrograms) shortly). We may be wasting our money (but it is only 7 pence per day per person) and at those levels and in the British climate this is unlikely to result in side effects.
It is theoretically possible to overdose with Vitamin D especially if your levels are not low in the first place. (If in doubt contact an experienced professional).
Back to COVID – 19
Most of the people who die with the virus are elderly (over 60 years) and/or have underlying health problems. Many of them have been recorded as deaths from these other causes but the disease seems to trigger other, even more serious conditions, which could result in death.
It is worth exploring these conditions and considering their relationship to Vitamin D3
Having read numerous published reports there is little consensus around the precise numerical data which seems to vary with the severity of the infection, the geographical location; the “phase” of the epidemic in that location and the differences in classification used by different authors. Hopefully, the situation will become clearer with time but I will restrict this report to general trends rather than guessing which set of data to use,
- It is reported that up to 26% of the deaths with COVID -19 occur with people diagnosed with Diabetes,
Vitamin D is believed to help improve the body’s sensitivity to insulin – the hormone responsible for regulating blood sugar levels – and thus reduce the risk of insulin resistance, which is often a precursor to type 2 diabetes (5)
- Reduction and Functional Exhaustion of T Cells in Patients with Coronavirus Disease 2019 (6)
Scientists have found that vitamin D is crucial to activating our immune defenses and that without sufficient intake of the vitamin – the killer cells of the immune system — T cells — will not be able to react to and fight off serious infections in the body.
There are many ways in which our immune system operates to keep us healthy but there must be a balance between the various systems. T Cells are the main ‘killing and destroying’ cells involved in the system. However, recent evidence suggests that they are present in insufficient numbers to control the COVID infections. Without Vitamin D, they will not overcome the virus. Was the insufficiency a precondition to catching the disease or was the reduction caused by a reduction in Vitamin D activity as a result of the infection?
- Vitamin D Supplementation Improves Cytokine Profiles
The invading organism is attacked by host’s immune system and part of the immune system general stimulation is by inflammatory cytokines. Sometimes this process can get out of hand and a “cytokine storm” results during which time the immune system attacks the host’s own cells (auto-immunity). This is probably when the real, possibly permanent, damage occurs and death can result. (7)
In the early stages of hospitalisation,, relief can be given by ventilation methods so that sufficient oxygen is absorbed. And the victim recovers. As well as inflammatory cytokines there are anti-inflammatory cytokines which act to keep the inflammatory activity optimal. Vitamin D acts to control the balance of these cytokines. Reduced levels of Vitamin D will disrupt this, otherwise balanced, inflammatory process.
The drug dexamethasone is a well-known steroidal anti-inflammatory which is being studied by a number of research teams in a coordinated way. Of course, it would not be helpful in the treatment of the early symptoms (in the ventilation stage) but could be very useful in the later stages where inflammatory consequences are more important. This damage is long lasting and difficult to control. The correct level of Vitamin D is necessary to control both of these complementary systems.
It would seem to indicate that supplementation of Vitamin D would be a more natural and less risky approach and should be used much earlier in the programme
- Effects on Blood Clotting – Increase in Blood Clots (Thrombosis) with low levels of Vitamin D
Italian physicians reported some months ago that during post-mortem examinations of those who have died of COVID – 19 infections, lung tissues were filled with black residues of clotted blood. They suggested that this was the cause of death rather than the pneumonic damage shown higher up in the lungs. British physicians, more recently, reported similar observations but felt that this indicated bacterial infection rather than the response described above.
Clinical reports correlating vitamin D deficiency with an increase in thrombotic episodes implicate the role of vitamin D and its associated molecule in the regulation of thrombosis-related pathways. Thrombosis is the formation and propagation of a blood clot, known as thrombus. (8)
There have also been a number of reports of long-lasting problems with swelling and itching; rashes and swellings of the lower limbs and especially the big toes following COVID infections. This was interpreted by the physicians as being indicative of microthrombic events in those areas. In other words, mini-thromboses around the feet and extending into the lower regions of the calves.
- Loss of sense of Smell now a diagnostic marker for COVID – 19
Possible Correlation Between Vitamin D Deficiency and Loss of Smell: 2 Case Reports (8)
Although by no means identified in all patients diagnosed with the infection. Loss or reduction of the sense of smell is now regarded as supportive of a diagnosis o COVID – 19 in the United Kingdom
Reduced levels of Vitamin D and COVID-19 causation
Is it a coincidence that the principal mechanisms underlying the disease are the same as those seen when levels of Vitamin D are lower than they should be? It could be that the virus causes the considerable reductions in Vitamin D and this results in the production of the symptoms. However, the affected subjects do not become autistic and we have yet to determine if people with autism are more susceptible to the disease virus but, at this observational phase of our studies, we see no evidence of that.
Perhaps the virus interferes with the transfer of the Vitamin (as D3) by removing the Vitamin D Binding Protein from the system for example. Such possibilities are still to be investigated and could result in another way to prevent the disease
(There is one, potentially simple explanation. I am hoping that there are enough clues here to indicate where this presentation is heading.)
Sunlight, Vitamin D and Black Asian and Minority Ethnic (BAME) individuals.
Perhaps one of the most contentious elements of the debate is: ‘Why is the relative proportion of the population with dark skins so much more likely to catch and die from the disease?’.
Sunlight stimulates the production of Vitamin D in the skin. Dark skinned people need approximately six times as much sunlight to perform this task as pale skinned people.
As far as Vitamin D is concerned, BAME persons experience significant reductions in the vitamin when living in a place where sunlight is scarce. It will be interesting to see, when all the data is collected, if the prevalence of the disease (in terms of numbers per 100,000) is higher in those parts of the United Kingdom which are further North and West and which tend to have less sunlight.
Indeed, many nutritionists suggest that even native British populations living n the Northern areas of the UK, can experience reduced levels of vitamin D throughout the Winter months when sunlight is very limited. Supplementary vitamin D is proposed. This requirement should certainly be considered by
In our local Hospital Service (South Tyneside and Sunderland NHS Foundation Heatth Trust,) BAIM staff in the front line, as well as others who are at risk and who are more likely to be affected have been invited to work elsewhere within the service. I am also informed that some hospital trusts are providing Vitamin D supplements for all of their medical staff.
The lack of sunlight has been reported as a triggering factor for COVID – 19 already but ignored. Whilst there are probably multiple causative elements which interplay in controlling the prevalence of disease, the simple evidence provided here should encourage serious consideration and evaluation. The WAO would encourage the medical establishment to investigate these plausible explanations which suggest simple and cheap steps which could help to control the disease.
The WAO is NOT claiming that dietary supplementation is a cure or a preventer of COVID-19 infections, but should be considered in helping to reduce symptoms as part of a complete programme for individuals. We encourage further studies in these areas. These mechanisms must be regarded, at this time, as hypothetical and the evidence as partially circumstantial. We are aware of a number of potentially relevant studies that are being considered or actually in progress, and will report any relevant, updating material as it becomes available.
Late News It has just been announced (18th June 2020) (11) that the two UK based official bodies “Public Health England” and “NICE” (“National Institute for Clinical Excellence”) are to examine the feasibility of using Vitamin D as a remedy for COVID-19 infections. There are a number of explanations as to why it has taken so long for the potential benefits of such an intervention have not attracted attention from the “experts” but these are beyond the scope of this presentation.
Some selected references
- Cannell J. On the Aetiology of Autism, Acta Paediatrica 2010 99 (8) 1128-1130
- Adams J.A., Audhya T et al. Effect of a vitamin/mineral Supplement on Children and Adults with Autism. M.C. pediatric Dec. 2011
- Gregg MB On the Epidemiology of Influenza in Humans.Y Academy of Science Proceedings 1980 353 45-53
- McCartney D.M., Byrne D.G. Optimisation of Vitamin B Status for Immuno-protection against COVID-19 Irish Med Journal; 113; (4); 58 – 61 2020
- Seshadri G., Tamilselvan B., Rajendran A. Role of Vitamin D in Diabetes. Journal of Endocrinology and Metabolism, 1, (2), 47-56’ 2011
- von Essen et al. Vitamin D controls T cell antigen receptor signaling and activation of human T cells. Nature Immunology, 2010; DOI: 1038/ni.1851
- Brackley P. Lower vitamin D levels associated with higher Covid-19 mortality rates (in Press)
- Syed M., Mishra A., Ashraf M Z. Emerging Role of Vitamin D and its Associated Molecules in Pathways Related to Pathogenesis of Thrombosis Biomolecules 9 (11), 649; (2019)
- Bigman G, Age-related Smell and Taste Impairments and Vitamin D Associations in the U.S. Adults National Health and Nutrition Examination Survey Nutrients 12 (4) 2020 984-1001
- Letter to the Editor, Guardian Newspaper, April 15th 2020
- Guardian Newspaper June 18th 2020
NB: The next General Assembly of the WAO
will take place online (via Citrix) on 29 November 2020:
Anyone may attend the GA, only paid up members may vote on any issue.
To keep up to date and get information or for any questions and suggestions: send an email to the WAO Secretary: Contact Us
Words of encouragement from WAO president, Dr Samira Al-Saad:
Dear Members and Friends of World Autism Organisation,
During this time of the unknown, as the whole world is facing the corona virus (covid_19), of course our dear families who have one or more member/s with Autism are among them. We urge everyone to take care of themselves as well as taking extra care and precautions for their beloved autistic family members. We know that some countries are facing harsher times than others, nevertheless this crisis will unify all of us as families and people around the world.
Any parent of a child has to give more attention to the child in times like these, especially because they can’t go out. This is the perfect time to play together, read stories, clean the house, etc.
Please take the necessary precautions as instructed by health authorities and together we will beat such virus and will move on ….
Sincerely and with best wishes
Dr. Samira Al-Saad
President, World Autism Organisation
World Autism Awareness Day 2020
Progressing from “Awareness” to “Understanding and Action”
In regard to Autism, the past year has seen a focus on the cause of Autism being neurologically based and moving from “Awareness” to “Understanding and Action” which will be of great benefit for *Autistic people across the globe.
Unfortunately, the physical progress of these developments will be severely delayed as the whole world is facing the Covid-19 pandemic and isolation. Nevertheless we must work together to keep the momentum of enhancing understanding of Autism amongst all people.
We must remember to recognise and embrace that Autistic people are different, not less, and we must presume competence, even if this is not immediately obvious. We must find and strengthen the competencies, and we must learn to listen with our whole being as to what Autistic people are trying to say. We must remain patient and give the person the time they need to respond, as, contrary to customary belief, Autistic people DO have empathy, they DO want friendships and they CAN communicate, albeit in a different way.
Time in isolation is a great opportunity for us to encourage parents of children without special needs to learn more about Autism. To consider how, rather than us spending a lot time guiding our family member how to behave during interaction with those without Autism, to encourage and teach others to understand how they can modify their behaviours and interactions with Autistic people.
During this time of self-isolation, this can also be time for the general community to consider how such loneliness and boredom can impact Autistic people. Sadly, self isolation, bringing a lot of loneliness, can often be preferable for Autistic people, rather than exposing themselves to the often unadapting and unaccommodating general public.
The Covid-19 virus offers us all time to reflect on so many issues, for example how we live and how we can positively change our approach and lives in the future.
We wish all families, especially those who have one or more members with Autism, good health and minimal impact from the Covid-19 virus. Many countries are facing critical and severe effects, but what has become apparent is that this global crisis will unify all of us as families and people around the world.
2 April: UN World Autism Awareness Day:
On World Autism Awareness Day, we recognize and celebrate the rights of persons with autism. This year’s observance takes place in the midst of a public health crisis unlike any other in our lifetimes — a crisis that places persons with autism at disproportionate risk as a result of the coronavirus and its impact on society.
Persons with autism have the right to self-determination, independence and autonomy, as well as the right to education and employment on an equal basis with others. But the breakdown of vital support systems and networks as a result of COVID-19 exacerbates the obstacles that persons with autism face in exercising these rights. We must ensure that a prolonged disruption caused by the emergency does not result in rollbacks of the rights that persons with autism and their representative organizations have worked so hard to advance.
Universal human rights, including the rights of persons with disabilities, must not be infringed upon in the time of a pandemic. Governments have a responsibility to ensure that their response includes persons with autism. Persons with autism should never face discrimination when seeking medical care. They must continue to have access to the support systems required to remain in their homes and communities through times of crisis, instead of facing the prospect of forced institutionalization.
We all have a role to play in ensuring that the needs of people who are disproportionately impacted by COVID-19 are met during this difficult period. Information about precautionary measures must be provided in accessible formats. We must also recognize that when schools employ online teaching, students with non-standard ways of learning may be at a disadvantage. The same applies to the workplace and working remotely. Even in these unpredictable times, we must commit to consulting persons with disabilities and their representative organizations, and ensuring that our non-traditional ways of working, learning, and engaging with each other, as well as our global response to the coronavirus, are inclusive of and accessible to all people, including persons with autism.
The rights of persons with autism must be taken into account in the formulation of all responses to the COVID-19 virus. On World Autism Awareness Day, let us stand together, support each other and show solidarity with persons with autism.
— António Guterres
More information: https://www.un.org/en/observances/autism-day