Cohort Study To assess the effects of vitamin D, magnesium, and vitamin B12 in advancing the development of serious outcomes among older patients with coronavirus disease (COVID-19). A pioneering trial in Singapore compares the clinical outcomes of older patients with COVID-19 receiving the combination of magnesium and vitamin D, along with vitamin B (also known as DMB), with those receiving no combination. Studies that looked at the combined effects of vitamin D and magnesium had improved ADHD symptoms, reduced the severity of COVID-19 decreased the risk for anemia, and increased cognitive performance.

Recent studies have suggested that increased levels of vitamin D and magnesium can help patients with COVID successfully manage COVID-19. Low levels of magnesium and vitamin D are common characteristics of most patients with COVID-19.

Interestingly, several known risk factors for COVID-19, as well as certain co-morbidities, such as acute renal failure, arterial and venous thrombosis, cardiac failure, and arrhythmias, are associated with Mg deficiency [4 5]. Several studies have demonstrated the correlation between magnesium levels and the disease outcomes in COVID-19, with magnesium deficiency most commonly found in people with COVID-19 and associated with higher mortality rates from COVID-19. Indeed, a handful of recent reports analyzed magnesium levels in patients with COVID-19 and assessed its relationship to disease outcomes (Table 1).

Our study showing that a magnesium-to-calcium ratio =0.20 is significantly associated with severe COVID-19 mortality provides new insights which may be helpful for COVID-19 management. The purpose of the present study was to assess the relationship between the serum magnesium-to-calcium ratio and the mortality of severe COVID-19. A cross-sectional study investigated the relationship of magnesium intake with COVID-19 severity and associated symptoms in inpatients.

Although no prior studies have investigated the association between magnesium dietary intake and symptoms and severity of COVID-19, we are aware of a relationship that the combination of vitamin D, vitamin B12, and magnesium associated with significant decreases in oxygen maintenance needs or the requirement for intensive care for older patients with COVID-19 (16). A recent study published in May 2020 in the preprint server medRxiv* showed that the combination of readily available, low-cost vitamin D3, vitamin B12, and the mineral magnesium, D3, may decrease the progression of COVID-19 to a severe or fatal phase. A frequent confounding factor in studies that have been cited might be that individuals with co-morbidities, such as high blood pressure, cardiovascular disease, diabetes, and obesity, who are more likely to have severe COVID-19, frequently exhibit altered Mg levels.

The COVID-19 subset described as vulnerable to severe forms of the disease, such as older cardiac patients, is particularly susceptible to magnesium deficiency given the nutritional malnutrition and the usual diuretic treatment. This clarification becomes more pertinent in the context of the ongoing systemic inflammatory processes associated with COVID, likely exacerbated by an accompanying magnesium deficiency. The current study is an observational cohort study on a consecutive group of COVID-19 patients aged 50 years or older, receiving the above-mentioned micronutrient combinations (DMB), comparing rates of disease progression in this group with that of the other group of patients who were not given the DMB.