Vitamin D for COVID-19 Trial

Data from laboratory studies, epidemiologic research, and randomized clinical trials conducted in the pre-COVID era strongly suggest that vitamin D is active in pathways relevant to immune function and may reduce the risk of acute respiratory infections. More recently, some observational studies have shown a significant association between low vitamin D status and worse clinical outcomes among COVID-19 patients. Whether vitamin D supplementation can reduce the risk of adverse clinical outcomes in recently diagnosed COVID-19 patients and/or reduce risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) in those likely to have been exposed to the virus (post-exposure prophylaxis) is unknown.

The Vitamin D for COVID-19 Trial (VIVID) is a pragmatic, cluster-randomized clinical trial in 2024 men and women recruited nationwide from the U.S. and Mongolia. The trial is investigating whether taking a daily dietary supplement of vitamin D3 vs. placebo for 4 weeks reduces the rate of seeking healthcare visits (including hospitalizations, emergency room visits, or ambulatory or virtual clinician visits) for symptoms or concerns related to COVID-19 or deaths in people newly diagnosed with COVID-19, and reduces the risk of SARS-CoV-2 infection in household contacts of individuals with newly diagnosed COVID-19.

The trial has enrolled 1747 individuals aged 18 or older who are newly diagnosed with COVID-19 ("index cases") and 277 household contacts aged 18 or older.

Following receipt of informed consent, participants are randomized -- i.e., assigned by chance (like a coin toss) -- to one of two groups: (1) daily vitamin D3 (9600 IU/day on days 1-2; 3200 IU/day on days 3-28) or (2) daily vitamin D placebo. Index cases and household contacts of an index case (limited to at most one contact per household), if any, are assigned to the same group (cluster randomization). Participants take three oral softgel capsules on day 1, three capsules on day 2, and one capsule each day on days 3 through 28. Participants receive a 4-week supply of study capsules via overnight courier service.

Participants fill out a short (15-20 minute) questionnaire each week during the 4-week pill-taking period, as well as a follow-up questionnaire at 8 weeks after randomization. These questionnaires ask about symptoms, general health, and use of medications and dietary supplements. Questionnaires are completed online using a secure Internet-based system known as the Research Electronic Data Capture (REDCap) system. Participants must have an e-mail address to enroll in the study. Occasionally, participants (or their delegates) may receive a telephone call from study staff to collect information or to clarify answers on the questionnaire. Participants may contact investigators or staff using a toll-free number, if they have any questions or need assistance.

Participants (or their delegates) who indicate on a study questionnaire that they have been hospitalized are sent a medical release form to be signed and returned. The release form is used to get medical records from the participant's physician or hospital to confirm the specific reason for the hospitalization. In the event of a participant's death, the participant's delegate is sent a medical release form to be signed and returned. The release form is used to get medical records from the participant's physician or hospital to confirm the specific cause of death.

Participants provide dried blood spot samples at baseline and week 4. Participants provide these samples using a sample collection kit mailed to their homes. Blood samples are collected through a finger prick onto a filter paper. Blood samples are stored and will be used to measure vitamin D (25(OH)D) levels. A subsample of participants provide follow-up dried blood spot samples at weeks 1, 2, or 3 to clarify the time course of 25(OH)D increase. In participants who are not diagnosed with COVID-19 during the study, blood samples will also be tested for COVID-19 antibodies.

Support for VIVID is provided by Harvard University and private philanthropy. Tishcon Corporation (Salisbury, Maryland, USA) is donating the study capsules. The Karolinska Institute (Stockholm, Sweden) is donating the serology assessment.

Inclusion/exclusion criteria for INDEX CASES:

Inclusion criteria

• Adults aged 18 years or older who are newly diagnosed with COVID-19 infection within 7 days of testing.
• Ability and willingness to understand and provide informed consent.

Exclusion criteria

• Known current pregnancy.
• Current hospitalization.
• Unable to complete online questionnaires or adhere to study requirements.
• Consume more than 1000 IU per day of vitamin D from all supplemental sources combined (individual vitamin D supplements, calcium plus vitamin D supplements, medications with vitamin D [e.g., Fosamax Plus D], and multivitamins) in the past 4 weeks.
• Use of prescription vitamin D treatments (Calcitriol [Rocaltrol, Calcitrol, Vectical, Calcijex] or Paricalcitol [Zemplar]).
• Consume supplements with more than 1200 mg calcium per day.
• Known diagnosis of hypercalcemia or a condition associated with vitamin D hypersensitivity.
• Prior diagnosis of cancer *AND* currently undergoing radiation, chemotherapy, or immunotherapy.
• Kidney failure or dialysis; severe liver disease or cirrhosis.
• Any parathyroid conditions.
• Use of medications for seizures or epilepsy. Examples: Carbamazepine (Carbatrol, Tegretol), Phenytoin (Dilantin, Phenytek), Valproic acid (Depakene), Oxcarbazepine (Oxtellar, Trileptal), Phenobarbital, Topiramate (Topamax).
• Use of digoxin.
• Inability to receive an overnight express mail shipment of study pills at a home address.
• Participation in other COVID-19 trials.

Inclusion/exclusion criteria for HOUSEHOLD CONTACTS:

Inclusion criteria

• Persons aged 18 years or older who live in the same household with an index individual and have been identified as the closest household contact within the same household (limited to 1 per household).
• Persons aged 18 years or older who live in household with someone who tested positive for COVID-19 within past 7 days but not participating in VIVID.
• Ability and willingness to understand and provide informed consent.

Exclusion criteria

• Known current pregnancy.
• History of SARS-CoV-2 infection.
• Receipt of a SARS-CoV-2 vaccination or monoclonal antibody.
• Unable to complete online questionnaires or adhere to study requirements.
• Consume more than 1000 IU per day of vitamin D from all supplemental sources combined (individual vitamin D supplements, calcium plus vitamin D supplements, medications with vitamin D [e.g., Fosamax Plus D], and multivitamins) in the past 4 weeks.
• Use of prescription vitamin D treatments (Calcitriol [Rocaltrol, Calcitrol, Vectical, Calcijex] or Paricalcitol [Zemplar]).
• Consume supplements with more than 1200 mg calcium per day.
• Known diagnosis of hypercalcemia or a condition associated with vitamin D hypersensitivity.
• Prior diagnosis of cancer *AND* currently undergoing radiation, chemotherapy, or immunotherapy.
• Kidney failure or dialysis; severe liver disease or cirrhosis.
• Any parathyroid condition.
• Use of medications for seizures or epilepsy. Examples: Carbamazepine (Carbatrol, Tegretol), Phenytoin (Dilantin, Phenytek), Valproic acid (Depakene), Oxcarbazepine (Oxtellar, Trileptal), Phenobarbital, Topiramate (Topamax).
• Use of digoxin.
• Inability to receive an overnight express mail shipment of study pills at a home address.
• Participation in other COVID-19 trials.