Battle against COVID-19 gets dose of vitamin C

Canadian trial pits nutrient against disease

It was once touted as a natural cure for the common cold — a coronavirus itself — but turned out to have just one well-proven and obscure benefit: Preventing scurvy.

Now a Canadian clinical trial is hoping to answer an intriguing question about vitamin C: Could infusions of the nutrient curb the death toll from out-of-control infections triggered by COVID-19 and other viruses and bacteria?

It is among myriad studies of possible treatments for the pandemic virus, but stands out as a natural, non-pharmaceutical alternative.

The trial run by physicians in Montreal and Toronto was originally set up to treat patients suffering any kind of infection that landed them in the ICU with sepsis, an out-of-balance immune response to contagions that can damage multiple organs.

But it was modified late in March to also specifically include patients with COVID-19. Since then, the study has enrolled more than 25 pandemic patients with sepsis, says Dr. Neill Adhikari of Toronto’s Sunnybrook Health Sciences Centre, one of the study’s lead investigators. He hopes to increase that number to as many as 800, possibly by linking up with a different, international coronavirus trial.

Half will get ascorbic acid infusions, half a placebo.

Most of the patients made critically ill by the new bug suffer from acute respiratory distress syndrome, where the lungs are unable to deliver sufficient oxygen to the blood stream.

But sepsis also occurs “reasonably often” in COVID-19 sufferers, said Adhikari, and can be just as deadly, killing an estimated eight million people worldwide every year.

The condition is difficult to treat, making relatively inexpensive vitamin C a potentially attractive option, especially in poorer countries, he said.

“It has potential. If it’s good, it’s potentially applicable globally,” said Adhikari. “If it’s useful, the implications for uptake are large. If it’s useless, it would be good to know quickly.”

Meanwhile, doctors in New York dealing with one of the world’s worst outbreaks of COVID-19 have already been using vitamin C as a treatment, outside of any study, he said.

But not surprisingly, with previous research offering conflicting results, it’s a controversial topic.

A February editorial in the influential Journal of the

American Medical Association suggested most of the evidence to date has been negative, and argued against any further trials, or routine use on patients.

“There appears to be no immediate justification for adoption of high-dose vitamin C, alone or in combination, as a component of treatment for sepsis,” wrote Dr. Andre Kalil of the University of Nebraska Medical Center.

Offering the infusions “just in case” or as a “measure of last resort” could divert needed funding from more promising research, delay proven treatments like antibiotics, and perpetuate “false hopes for patients, families and clinicians,” he said in the commentary.

Vitamin C has a long and contentious history as potential miracle cure, though its promise has gone largely unfulfilled. The discovery that ascorbic acid was medically important is traced to James Lind, a Royal Navy doctor who conducted one of the world’s first controlled trials in 1747, and found that vitamin C-rich citrus fruits cured sailors afflicted by scurvy. The vitamin itself was not isolated until the early 1900s.

Propelled by advocacy from Linus Pauling, a Nobel laureate in chemistry, the nutrient was examined in the 1960s and 1970s as a possible treatment for the common cold. A 2013 review of previous research concluded it did nothing to prevent or treat colds, but that longterm use might help reduce the duration of them.

More recently, alternative-health practitioners have touted vitamin C infusions as a treatment for cancer, though science has found little backing for their claims.

For sepsis, the theory is that it acts as a modulator of the body’s immune response, an idea that stemmed partly from the fact that vitamin C levels drop when people develop sepsis.

Interest was piqued by a 2017 study in Virginia that concluded infusions of ascorbic acid significantly curbed the death rate in sepsis patients.

Among the more rigorous controlled trials since then, one this year by Australian researchers found no benefit compared to placebo when used on people with septic shock, an advanced form of the condition. Another, published last year, concluded that it reduced the death rate and length of time sepsis patients spent in the ICU.

Dr. Salim Surani, a medical professor at Texas A & M University, still sees promise and urged a “relentless pursuit” of research in a journal commentary last year.

He even suggested providing vitamin C to mild COVID-19 patients, before they develop sepsis.

“You have a medicine that is very, very cheap (and) has kind of a proven track record in a substantial number of patients,” said Surani in an interview. “If something is working and … doesn’t have harmful side effects, we have pretty much nothing to lose and something to gain.”

As long as enough patients can be enrolled before the pandemic ends, Toronto’s Adhikari expects results from his trial as soon as a year from now.

IF IT’S USEFUL, THE IMPLICATIONS FOR UPTAKE ARE LARGE.