Here are two ads sent to me last week.  Both have now been taken down.

This one, according to reader Tony Vassallo (thanks!) comes from the Walmart Supercenter Store 908 at 8101 South John Young Parkway, Orlando FL.  I’m not the only one who thought this was in bad taste (sorry).   After a Twitter storm, Pepsi took it down.

But what about this one?

I looked up Westbrook Mall: Calgary, Alberta.  This too caused an uproar.   The franchise owner apologized, explaining that he was struggling and hoped to generate business, and the sign is now gone, apparently.

Yesterday, I wrote about current research suggesting that higher levels of blood Vitamin D [actually, 25-hydroxycholecalciferol, or 25(OH)D] help to protect against Covid-19.

To understand concerns that this evidence may not be totally convincing, it’s useful to know the basics about this “vitamin,” which I put in quotes because its active form is a hormone that helps govern calcium balance.  Here’s how it works.

• Sunlight acts on a form of cholesterol in skin (7-dehydrocholesterol) to covert it to cholecalciferol, the chemical name for vitamin D3.
• Vitamin D3 goes to the liver where an enzyme converts it to 25 (OH)D.
• 25(OH)D goes to the kidney where an enzyme converts it to 1,25-dihydroxycholecalciferol (a.k.a. 1,25-dihydroxyvitamin D), the active hormone.

If you eat foods containing vitamin D3 (fish and meat, which have it in very small amounts, or fortified milk) or vitamin D2 from plants, yeast, or supplements, these travel in the blood to the liver where they undergo the same metabolic steps.

This means that there are three sources.

• Sunlight on skin—this produces thousands of IU (International Units)
• Food—is low in this vitamin
• Supplements—vary, but high doses are not recommended by most health authorities; they may induce hyper-immune responses (not a good idea)

The commonly recommended daily dose of vitamin D is 400-600 IU.

Sunlight on skin is by far the best way to get your vitamin D hormone.

Sensible sun exposure, especially between the hours of 10:00 am and 3:00 pm produces vitamin D in the skin that may last twice as long in the blood compared with ingested vitamin D.If sun exposure produces slight pinkness, the amount of vitamin D produced in response to exposure of the full body is equivalent to ingesting 10,000-25,000 IU.

 In the UK, a study showed that 13 minutes of midday sunlight exposure during summer, just three times per week, maintains healthy levels in white adults ; other studies have shown 30 minutes of midday summer sun exposure in Oslo to be equivalent to consuming 10,000–20,000 IU of vitamin D.

How does all this relate to Covid-19?

So far, we do not have studies of vitamin D supplements in patients with Covid-19 or longer term prospective trials.  These will undoubtedly come.

While waiting for those results, enjoy the sunshine!

In the past few weeks, several studies have appeared linking low levels of the vitamin D intermediate, 25-hydroxycholecalciferol [25(OH)D] to Covid-19 severity.

• Vitamin D insufficiency is prevalent in severe COVID-19 [preprint observes that all 20 patients under age 75 had low levels of blood 25(OH)D; calls for further research]
• Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-19) [retrospective study correlating higher levels of 25 (OH)D with better COVID-19 outcomes; calls for further research]
• The role of Vitamin D in the prevention of Coronavirus Disease 2019 infection and mortality [finds low levels of 25 (OH)D among older adults in European countries; advises supplementation]
• The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients [preprint of study modeling links between 25 (OH)D, C-reactive protein [a marker of inflammation], and COVID-19; calls for further research].  This one got headlines: Vitamin D Levels May Impact COVID-19 Mortality Rates, Study Claims.
• Vitamin D and inflammation: potential implications for severity of Covid-19 [literature review found Spain and Italy to highly correlate low 25 (OH)D with high Covid-19 infection and death rates].  This one also got headlines: Coronavirus: Adults Should Take Vitamin D, Researchers Say.

Previous studies have noted that vitamin D deficiency may be a biomarker of sepsis risk, and giving supplements helps to protect people from acute respiratory infections.

Supplements?

The supplement marketer Wileys Finest says

Did you know there is a special role for vitamin D in our immune cells? Our immune cells use vitamin D to function normally. That’s why experts recommend supplementing with 2,000 IU per day (50 mcg) to support healthy immune function.^1,2  P.S. Vitamin D3 is the better choice!

It cites two additional studies:

• Martens PJ, et al. Vitamin D’s effect on immune function.  Nutrients 2020:1248
• Calder PC, et al. Optimal Nutritional Status for a Well-Functioning Immune System Is an Important Factor to Protect against Viral Infections.  Nutrients 2020:1181

But wait!

COVID-19: Internet ‘rife with misinformation’ about Vitamin D, say scientists.  Reports arguing high dose Vitamin D supplementation could treat COVID-19 are based on speculation and are a risk to public health, warns a team of scientists from across the globe…. Read more.

This article refers to Vitamin D and SARS-CoV-2 virus/COVID-19 disease, by Martin Kohlmeier and colleagues.  These scientists summarize the situation succinctly (rearranged for readability).

(1) Vitamin D is essential for good health.

(2) Many people, particularly those living in northern latitudes (such as the UK, Ireland, Northern Europe, Canada and the northern parts of the USA, northern India and China), have poor vitamin D status, especially in winter or if confined indoors.

(3) Low vitamin D status may be exacerbated during this COVID-19 crisis (eg, due to indoor living and hence reduced sun exposure), and anyone who is self-isolating with limited access to sunlight is advised to take a vitamin D supplement according to their government’s recommendations for the general population (ie, 400 IU/day for the UK7 and 600 IU/day for the USA (800 IU for >70 years)) and the European Union (EU).

(4) There is no strong scientific evidence to show that very high intakes (ie, mega supplements) of vitamin D will be beneficial in preventing or treating COVID-19.

(5) There are evidenced health risks with excessive vitamin D intakes especially for those with other health issues such as a reduced kidney function.

This seems like sensible advice.

As readers of this blog know, I am not a fan of supplements, particularly in high doses, mainly because there is so little evidence that supplements do anything to make healthy people healthier.  There is also some evidence that they could be harmful, especially those that are fat-soluble, as is vitamin D.

I am particularly skeptical of the benefits of Vitamin D:

• Its best source by far is from the action of sunlight on skin.
• It is not a vitamin; it is a hormone (widespread hormone replacement therapy does not seem like a good idea).
• It is unclear whether 25 (OH)D is the best measure of hormone status (it is just the easiest one to do).
• More research on immune effects is needed.

In the meantime, what to do?

It’s summer in the Northern Hemisphere.  Get outside!

Tomorrow: I will explain more about why the effects of Vitamin D are so hard to figure out.

This, from the Iowa Department of Public Health:

Enjoy the day, if you can.

Three exceptionally thoughtful and interesting pieces by people who have been writing about food and food systems for a long time. 

Jane Ziegelman in the New York Times: America’s Obsession With Cheap Meat

During World War I, the idea that American vitality was tied to a meat-heavy diet dictated how the troops were fed. To give them a fighting edge, tremendous quantities of beef and pork were shipped overseas, enough to provide soldiers with 20 ounces of beef a day or 12 ounces of bacon. The cost was staggering, but the Army refused to trim meat rations…It’s no coincidence that the archetypal American hero, the cowboy, is a cattle herder, or that we claim hamburgers as the quintessential American food. Or that when Mr. Trump welcomed the 2019 football college champions to the White House, he offered them Big Macs and Quarter Pounders. Much of what has defined us as Americans is expressed through our meat consumption. 

Eric Schlosser in The Atlantic:  America’s Slaughterhouses Aren’t Just Killing Animals

By issuing that order [Trump’s Executive Order], Trump helped an industry that has long been a strong supporter of the Republican Party. He reduced the likelihood that meat prices would greatly increase in the months leading up to the 2020 presidential election. And he confirmed what critics of the large meatpackers have said for years: Some of these companies care more about profits than the lives of their workers, the well-being of the communities where they operate, and the health of the American people.

Michael Pollan  in the New York Review of Books: The Sickness in Our Food Supply

Slaughterhouses have become hot zones for contagion, with thousands of workers now out sick and dozens of them dying.  This should come as no surprise: social distancing is virtually impossible in a modern meat plant, making it an ideal environment for a virus to spread. In recent years, meatpackers have successfully lobbied regulators to increase line speeds, with the result that workers must stand shoulder to shoulder cutting and deboning animals so quickly that they can’t pause long enough to cover a cough, much less go to the bathroom, without carcasses passing them by. Some chicken plant workers, given no regular bathroom breaks, now wear diapers.  A worker can ask for a break, but the plants are so loud he or she can’t be heard without speaking directly into the ear of a supervisor. Until recently slaughterhouse workers had little or no access to personal protective equipment; many of them were also encouraged to keep working even after exposure to the virus. Add to this the fact that many meat-plant workers are immigrants who live in crowded conditions with little or no access to health care, and you have a population at dangerously high risk of infection.

I’m trying to keep up with meat crisis items.  Here are two.

CULLING

This is too upsetting to even talk about.

• Letter from members of Congress asking for help with animal disposal
• Instructions on how to do this
• The New York Times on the details of pig destruction

HARVEST BOXES AGAIN

The USDA’s current version of Harvest Boxes for food assistance is called the Farmers to Families Food Box Program, as I wrote about in a previous post.

The idea is that all those food animals and other foods that are being destroyed because of food chain problems will be collected, packed in boxes, and distributed to food banks  to be further distributed to people in need.

The USDA has now issued the contracts to companies who have bid to do this work.

Oops.  Some getting millions of dollars in contracts have no experience with this sort of thing.  As Politico reveals,

Most of the most well-known companies in the business, from large national names like FreshPoint, a division of Sysco, to more regional companies like Keany Produce, based in Maryland, were left off.  Muzyk of Baldor Specialty Foods said it’s clear that some companies applied without understanding what’s really required to purchase, pack and distribute fresh food at the scale the program requires. It requires proper cold storage capacity and trucks as well as food safety practices, particularly for produce which is vulnerable to contamination.

The contracts have raised eyebrows throughout the produce industry.

The Packer, which writes about produce-industry matters, wants to know how those contracts were awarded.

But questions immediately began circulating: How does a high-dollar events promoter pull down the largest contract ($39 million) in Texas? Why are companies without Perishable Agricultural Commodities Act licenses, warehouses, coolers or trucks receiving multi-million contracts, some well beyond the annual revenue of the company?…United Fresh Produce Association president and CEO Tom Stenzel wrote to Bruce Summers, administrator of the USDA’s Agricultural Marketing Service, which is overseeing the contracts, with a list of 15 questions.

The Packer, also wonders what will go in those boxes

The U.S. Department of Agriculture gives companies participating in the Farmers to Families Food Box Program leeway on what’s going in the produce boxes. The Packer wants to see what Farmers to Families’ contract recipients are packing into their boxes.

This looks like a disaster waiting to happen.  Companies with no track-record for these kinds of logistics are supposed to collect food, pack it, and get it to food banks.

Food banks, largely run by volunteers, are supposed to get the boxes to those who need food.

I can’t imagine how this can work.  In the meantime, the culling continues.

Additions

• The USDA responded to the letter from United Fresh.
• United Fresh is pretty happy with the USDA’s response.

Let’s review what’s happened here.

• When workers at meat packing plants became ill, public health authorities ordered some plants to close.
• Meat companies—and some state governors—resisted.
• Because of consolidation in the meat industry, plant closures threatened the meat supply.
• John Tyson, a Big Meat owner, lobbied President Trump to keep plants open.

Trump ordered the plants to open via an Executive Order deeming meat essential to the national defense.

It is important that processors of beef, pork, and poultry (“meat and poultry”) in the food supply chain continue operating and fulfilling orders to ensure a continued supply of protein for Americans.  [Nutritional comment: grains and vegetables provide plenty of protein.]

A Missouri Court ruled that the Occupational Safety and Health Administration (OSHA) has the primary jurisdiction over worker safety in meat processing plants during the Covid-19 crisis—not health agencies.   The USDA applauded this ruling as “directly in line with what the Federal government has been calling for companies and communities to do in light of the President’s Executive Order.”

USDA Secretary Sonny Perdue instructed companies to open, explaining that USDA was now in charge of making sure they do.

He wrote another order saying that “Maintaining the health and safety of plant employees in addition to ensuring continued operations and a plentiful food supply during this unprecedented time is paramount.”

This, alas, defies credulity, and it is no surprise that groups representing slaughterhouse workers say not enough is being done to protect them.  OSHA is not enforcing CDC guidelines for social distancing, frequent hand washing and other such measures.

Indeed, meat processing plants are opening. including a Tyson’s slaughterhouse with more than 1000 workers who have been infected.

The National Pork Board has an interactive map showing the status of pork plants.  It also lists Resources for Pork Packers & Processors.

We will have meat—at higher prices, of course.

But at what cost to workers’ lives?

• No wonder workers are asking for safety measures.
• No wonder workers are going on strike.

Because the amount of information about what’s happening with meat is so overwhelming. I’m going to be dealing with it all this week.

Let’s start with Covid-19 illnesses and deaths of people working in slaughterhouses—workers and USDA inspectors.

How bad is the Covid-19 situation in slaughterhouses and packing plants?

The Food and Environment Reporting Network (FERN) is Mapping Covid-19 in meat and food processing plants.  As of May 15:

at least 209 meatpacking and processed food plants and 11 farms have confirmed cases of Covid-19, and at least one meatpacking plant and four processed food plants are currently closed. At least 15,744 workers  (14,271 meatpacking workers, 1,058 food processing workers, and 415 farmworkers) have tested positive for Covid-19 and at least 65 workers (59 meatpacking workers and 6 food processing workers) have died.

In Texas, for example, testing is turning up hundreds of cases of Covid-19 among workers in meat packing plants.

It’s not just workers who are getting sick and dying.  USDA inspectors are too.  Food Dive reports that 197 field employees in the Food Safety and Inspection Service ​(FSIS) tested positive for coronavirus, 120 are under quarantine, and three died (as of May 7).

And now a fourth USDA inspector has died.

Politico reported:

many inspectors were expected to find their own protective gear since USDA wasn’t able to secure face masks for all of its workers. In April, USDA said it would give a $50 reimbursement for inspectors to find their own, according to Politico.

Who is to blame?

According to Politico, Alex Azar, the Secretary of Health and Human Services,

suggested to lawmakers at the end of April that meatpacking employees were more likely to catch the coronavirus based on their social interactions and group living situations than from exposure on the job…But after the story published, spokesperson Michael Caputo said in a statement that “Secretary Azar simply made the point that many public health officials have made: in addition to the meat packing plants themselves, many workers at certain remote and rural meatpacking facilities have living conditions that involve multifamily and congregate living, which have been conducive to rapid spread of the disease.”

Blaming the victims does not explain why inspectors are getting sick.

Of course, conditions at the plants are responsible.  As quoted in the Politico story, 

“America’s meatpacking workers are putting their lives on the line every day to make sure our families have the food they need during this pandemic,” UFCW International Vice President Ademola Oyefeso said in a statement. “Secretary Azar is cowardly pointing the finger at sick workers and peddling the same thinly-veiled racism we have heard from far too many in positions of power.”

Why can’t we get authoritative information about worker illnesses and deaths?

FERN is doing its best to keep track, against all odds.

FERN’s ongoing analysis of Covid-19 cases in the food system has found that more than 14,200 meatpacking plant workers have tested positive for the virus since mid-April. That figure, derived primarily from local news reports and state officials, is likely an undercount given the lack of data available from meatpackers.

Nebraska, for example, won’t allow tracking of cases.

Governor Pete Ricketts said Wednesday that the state won’t be releasing specific numbers of cases at meatpacking plants, saying it’s a matter of privacy.

A Texas plant refused to allow the state to test workers, but then relented under pressure from the press.

State health officials say the JBS Beef plant rejected its efforts to test all employees. The company switched gears Wednesday afternoon after the Tribune reported on the lack of testing at a plant tied to a rapidly growing cluster of coronavirus cases.

Meat plants are a viral epicenter

Along with nursing homes, prisons, and other crowded places, meat packing plants are especially vulnerable, and not just in the U.S.  Slaughterhouses in Germany are also sites of lots of cases, and for the same reasons.

Tomorrow: The order to keep plants open.