key: cord-0952595-3xtj3urf authors: Çimke, Sevim; Gürkan, Dilek Yıldırım title: DETERMINATION OF INTEREST IN VITAMINS USE IN COVID-19 PANDEMIC USING GOOGLE TRENDS DATA: INFODEMIOLOGY STUDY date: 2021-01-10 journal: Nutrition DOI: 10.1016/j.nut.2020.111138 sha: 51806d801dc67e7a44620a2607adc3d4f1c9c78a doc_id: 952595 cord_uid: 3xtj3urf AIM: The purpose of this study is determination of interest in vitamins use in COVID-19 pandemic usıng google trends data. METHOD: Searches were made between 1 January 2016 to 30 Agust 2020. First, the word "vitamin" was searched. In addition, the search words "vitamin", " COVID-19", "immunity" and Vitamin D", "Vitamin C", "Vitamin E", "Vitamin A" were searched comparatively. Search was made Turkish (in Turkey) and English (in world). In addition "vitamin" word was translated into some countries's language and was searched. ANALYSIS: Relative search volumes (RSVs) obtained in searches are presented with graphics. RSVs, downloaded as .csv were transferred to SPSS statistics program. Descriptive data was given as numbers and percentages. Kruskal Wallis analysis was used to determine the difference of RSVs according to years and seasons. In addition, rising queries related to search words were presented in a table. FINDINGS: In the study, it was determined that the trend towards vitamins reached 100 RSVs in March 2020, when COVID-19 was declared a pandemic. Vitamin D and vitamin C was the most frequently searched vitamin type in Turkey and World. It was determined that the searches consisting of a combination of COVID-19 and vitamins were made. CONCLUSION: Vitamins attract the public interest globally. Seasonal variation and COVID-19 shape the of vitamins popularity in world and Turkey. The search made of the highest in the autumn and spring seasons, but the highest search related all search terms were determined to be in March 2020. Interest in vitamins has increased due to the COVID-19 pandemic. The COVID-19 outbreak, first reported on January 13, 2020 in Wuhan, China, has become a serious public health problem that has spread to many continents and countries in a short time [1] . The lack of immunity of people against this newly emerging virus increases the damaging effect of the disease. COVID-19 affects the immunesystem by producing a systemic inflammatory response, or cytokine release syndrome [2] . The COVID-19 virus causes symptoms of infection such as fever, cough, shortness of breath, and respiratory distress within an average of 2 to 14 day after it infects humans [3] . In more severe cases, COVID-19 can cause pneumonia, severe acute respiratory syndrome, kidney failure, and death [4] . Although COVID-19 affect severy one from newborns to old age, it has been stated that the most serious consequences are in people with chronic diseases, elderly and weak immune systems [5] . There is no known treatment and vaccine for COVID-19 yet. For this reason, individual measures are very important to prevent the disease. Mask, distance and hygiene rules are the primary measures to prevent disease [5] . However, the most important prophylactic approach against COVID-19, which causes serious damage to the immune system and causes fatal consequences in people with weakened immune systems, is the strengthening of the immune system. There are many vitamins and trace elements necessary for the normal functioning of the immune system (6, 7] It has been shown that supplementation of these vitamins has a positive effect on strengthening immunity (8] . Vitamin A and D supplementation following influenza vaccination increased humerus immunity of pediatric patients (9] . While vitamins C and E strengthen the immune system thanks to their high anti-inflammatory and antioxidant effect [10, 11] , it has been reported that vitamin D has an effect that can disrupt viral cellular infection by interacting with angiotensin converting enzyme (ACE) [11] . It is thought that vitamin D and vitamin C play an important role in determining the results of COVID-19 in many studies conducted to determine the efficacy of vitamins in the prognosis of COVID-19 [12] [13] [14] [15] [16] [17] . People who are looking for ways to potentially protect themselves from the rapidly spreading COVID-19 epidemic or to mitigate its effects after it is caught, turn to vitamins, whose beneficial effects for the immune system are emphasized in the media, and search for information about the effects of vitamins, sources of vitamins and products they can use. Today, the internet has been one of the first options to search for information. The majority of society use the internet to quickly access the information they need. They want to learn as much as they need and do not spend time with knowledge that requires expertise [18] . The use of Internet data has become an integral part of health informatics over the past decade and can be useful for analyzing and predicting human behavior [19] . The search for data derived from the internet for epidemiological purposes is called "infodemiology" [knowledge epidemiology). Infodemiology processes data from search engines, forums, and websites. [20] Google is the most widely used website in internet crests. Therefore, Google Trends [21] , which provides analysis of Google search data, has been used in many studies to analyze the search behavior of the public [22] . Google Trends can show information trends, networking on the internet and changes that can have a negative or positive impact on public health. Google search data has been used in many studies to predict the COVID-19 outbreak and its effects [22] . In this study, it is aimed to predict the tendency of the society to use vitamins through Google trends. The study data were obtained from the Google Trends website provided by Google. Google Trends provides a time-series index of the volume of queries user sentered into Google in a given geographic area. Google Trends indicate normalised results [0-100), which are compared with the maximum value for particular queries during search intervals. Data can be reached separately according to years, days and geographical areas. Furthermore, it is able to present comparisons between different terms with graphs. It is capable of comparing of 5 keywords at a time [21, 23) . Since Google trends updated data acquisition methods after 2015, searches were conducted in 2016 and beyond [21] . First, the search word "vitamin" was used. Second, the search words "vitamin", " COVID-19" and "immunity" were searched comparatively. Finally, "Vitamin D," "Vitamin C", "Vitamin E", "Vitamin A", which are reported to be effective for the strengthening of the immune system, were searched comparatively [24] Searches Turkish (for Turkey ) and English (for World ) is made as. In addition, in some countries where COVID-19 is common, the search for "vitamin" was translated into their own language. RSV values obtained in searches are presented in graphics. The graphic axis ran from August 1 to July 31. Analyzes were made by transferring RSV values downloaded as .csv to SPSS statistics program. Descriptive data are given as number percentages. In determining the difference of RSV value according to years and seasons. Kruskal Wallis analysis was used. Bonferroni correction was used to determine which group caused the difference. In addition, rising queries related to search words are presented with an expression table. Graphic 1a shows RSVs for "vitamin" in Turkey. When the graph is analyzed, the average RSV for "vitamins" for 5 years from January 2016 to September 2020 was determined as 54.6+ 11.6 (min 26-max 100) (Table1). When the distribution of searches within the year is analyzed, it is seen that it started to increase in September, and it started to decrease after May, when it reached its peak at the end of October. Considering the seasonal characteristics of exploration in Turkey "vitamins" of word RSVs are the lowest in summer (45.2 ± 9.8) and found that the difference was statistically significant (p <0.001). It was determined that the RSVs of the word "vitamin" varied by years, the highest RSVs was in 2020 (p <0.001) (Table1). The searches have reached 100 RSV only in March 2020 for the last 5 years. The rising trend of searches related to the word "vitamins" of some brand associated with the word "vitamin D" and "Vitamin C", "black elder," "sources of vitamins," "usage of vitamins" in Turkey (Table 2 ). In graphic 1.b, the words "vitamin", "immunity" and "COVID-19" were searched comparatively. When the graph is examined, it is seen that the RSV values of the three search words also peaked in March 2020. In addition, the rising trend of searches related to the word "immunity" such as "Strengthening the immune system in children", "Drugs that disrupt the immune system", "What to eat to strengthen the immune system", "The best drug to strengthen immunity", "Herd immunization", and "Coronavirus" has been determined to show (Table 2) . Graphic 2a shows RSVs for "vitamin" in World. When the graph is examined, it is seen that the RSVs of the word "vitamin" is an average of 54.6 + 11.6 (min 26-max 100) for the last 5 years from January 2016 to September 2020 (Table 1 ). It is observed that the RSV started to increase in January, peaked in mid-February, and started to decrease after May (Graphic 2a). It was determined that the most searches were made in the spring season (55.2 ± 12.3) worldwide and the difference was statistically significant (Table 1 ). It was determined that the RSV value of the word "vitamin" varied statistically by years, with the highest number of searches in 2020 (p <0.001) ( Table. 1). In the calls made, it was determined that 100 RSV reached only in March 2020 in the last 5 years (Graphic 2a). It has been determined that searches for vitamins such as " COVID-19 vitamin D", "vit D and covid", "vitamin D coronavirus", "vitamin C and" coronavirus "," vitamin C sources "around the world show an increasing trend. In graphic 2.b, the comparative search results of the search words "vitamin", "immunity" and "COVID-19" are given. When the graph is examined, it is seen that the RSVs of the three search words also increased rapidly in March 2020 (Graph 2b). In addition, it has been determined that the searches for the immune search word "Immunity COVID-19", "Immunitycoronavirus", "Corona virüs herd immunity", "Corona immunity" show an increasing trend (Table 2 ). In graphic 3 as "vitamin C", "vitamin D", "vitamin E", "vitamin" of calls made using the words of Turkey and world are given the results of RSVs. Most of the years searched for the word "vitamin C". While the searches continued similarly for 5 years, the searches for all vitamin types peaked in March 2020 and this increase is statistically different from the RSVs of the previous years (p <0.001). In Turkey and in the World, in March 2020 "Vitamin C" word related searches 100 RSVs started, "vitamin D" related searches in Turkey 88 RSVs reached ate while in worldwide 33 RSV (Table 1) . Searches dropped again after March. RSVs for vitamin types show seasonal differences. In Turkey, "vitamin C" of the words RSVs spring months is the highest, "Vitamin D", "vitamin E" and "vitamin" are the words belonging to the RSVs is determined to be the lowest in summer (p <0.001). Worldwide, it was determined that the RSVs of the word "vitamin C" was the highest in spring (p <0.005), and the lowest for "vitamin D" in summer (p <0.001) ( Table 2) . "Vitamin" word was translated into some countries's language where COVID-19 is common and was searched (Graphic 4). While the searches related to the word vitamin were similar for in March 2020. Similarly in all countries it decreased after the peak. In 2020, while the world fights against the COVID-19 pandemic, people have taken individual measures. It is reported in the literature that vitamins have an important effect on strengthening the immune system [6, 8] . The reasons such as easy access to vitamins, their availability without a prescription, their easy advertisement in the media, and inclusion in many food sources cause people to tend to vitamins first in strengthening the immune system. In this study, it was aimed to determine whether the COVID-19 pandemic has changed people's interest in the use of vitamins. In the study, when the trend towards the search word "vitamin" in Turkey was examined, it was observed that the searches revealed seasonal characteristics. It was observed that they started to increase in September, reached the highest level at the end of October, and started to decrease after May (Graphic 1). In Turkey, the air temperature starts to decrease in September and increases with the summer season after May. Furthermore, there is also an increase in viral respiratory tract infections in the autumn season, which starts as of September [25] .In Turkey, the word "vitamin" reached the highest RSV in winter, which is considered to be due to people's tendency to vitamin supplements due to the cooling of the weather and the increase in influenza infections. There are seasonal differences around the world. However, in the studies, it was generally determined that they increased in January and February, during which the weather is cold, and decreased after May (Graphic 2). The first COVID-19 case was reported in China in December 2019. After this date, it spread rapidly and cases began to be observed in many parts of the world. The world health organization declared a pandemic on March 11. Furthermore, the first COVID-19 case in Turkey was reported on March 11. In the study, it was determined that the search on vitamins in Turkey, around the world and in some countries increased rapidly in March 2020 unlike other years and that all search RSV values for vitamins in 2020 were significantly higher compared to previous years (Graphic 1, Graphic 2, Graphic 4, Table 1 ).Furthermore, in the study, searches for vitamin, immunity, and COVID-19 were evaluated comparatively. It is observed that the RSV values of the three search words increased rapidly in March 2020. Nevertheless, it was determined that the searches such as " COVID-19 vitamin D", "vit D and covid", "vitamin D coronavirus", "vitamin C and coronavirus", "Vitamin C sources", "Strengthening the immune system in children", "Drugs that disrupt immunity", "What to eat to strengthen the immune system", "The best drug to strengthen immunity", "herd immunity" and "Coronavirus" showed an increasing trend. Based on these results, it can be said that the increasing trend observed in March 2020 is an indicator of the public's search for information in order to protect against COVID-19. In Turkey, it is also observed that the word "Sambucus nigra" is in increasing trends. It is reported that Sambucus nigra with a rich content of vitamin C [26] positive effects in strengthening the immune system [27] . In accordance with this result, it is thought that people may have turned towards herbal supplements to strengthen the immune system. Some vitamins are indicated to be effective in strengthening the immune system [2, 24] . During the COVID-19 pandemic, the fact that these vitamins contribute to both protection from disease and the healing process in case of illness has mentioned in many publications [12] [13] [14] [15] [16] [17] has been frequently emphasized in the media. Accordingly, in the study, a comparative search was conducted to determine the tendency for vitamins that have positive effects on strengthening the immune system. The interest in the types of vitamin in the world and in Turkey shows seasonal characteristics. The tendency to vitamin D was determined to be the highest in winter season in Turkey. This result can be attributed to people's need for supplementary products for vitamin D due to the lack of sunlight in winter in Turkey. It was determined that the tendency to all types of vitamins decreased in summer. It is observed that the tendency to vitamin C increase in the spring season both in Turkey and in the world, the reason of which is considered to be the effect of reaching 100 RSV in March 2020, which is one of the spring seasons, on the average. The tendency to all types of vitamins has increased in 2020 and differed significantly from previous years. In particular, the tendency to vitamin C has reached 100 RSV. Vitamin C or ascorbic acid is a water-soluble food that cannot be synthesized by humans. Vitamin C acts as an antioxidant that can scavenge reactive oxygen species (ROS), and thus it protects biomolecules such as proteins, lipids and nucleotides from oxidative damage and dysfunction. Vitamin C accumulates in leukocytes at concentrations 50-100 times higher than in plasma. It is well known that vitamin C provides a preventive benefit in infectious disease. It is known that Vitamin C supplementation supports respiratory defense mechanisms, prevents viral infections, and has antihistamine properties that can improve flu-like symptoms as well as reducing the duration and severity of infections. This essential protective effect against respiratory tract infection has made vitamin C an attractive target for COVID-19 [28] . Vitamin D is the vitamin that reaches the second highest RSV value. Vitamin D, a fat-soluble vitamin, has a vital role in modulating both innate and adaptive immune responses [29] . The epidemiological data have associated vitamin D deficiency with increased susceptibility to acute respiratory viral infections [30] . In a systematic review, it is indicated that vitamin D has a significant regulatory role in innate immune responses to respiratory viral infections such as Influenza A and B, parainfluenza 1 and 2, and respiratory syncytial virus [31] . It has been suggested that vitamin D deficiency increases the frequency and severity of COVID-19 infection. It is indicated that adequate vitamin D levels may help protect respiratory epithelium from pathogenic spread and reduce the risk of infection. There are studies demonstrating that COVID-19 patients have lower vitamin D levels with average plasma concentrations about half that of controls. Therefore, vitamin D supplementation is recommended to improve immunity against COVID-19 and reduce human deaths [32] [33] [34] [35] [36] . Undoubtedly, vitamins have many positive effects in strengthening the immune system. However, accurate determination of the need, accurate product selection, the appropriate amount and correct use of vitamins will ensure maximum benefit from them and also prevent the occurrence of potential side efects. Therefore, it is very important that people are informed correctly and reach the right sources of information. At this point, the effect of dieticians, doctors, nurses and the media, which has a great effect on people, in guiding people is very important. In addition, databases such as pubmed.gov, scholar.google.com can be used to examine the peer-reviewed journal literature on vitamins. The authors declared no potential conflicts of interest with respect to there search, authorship, and/or publication of this article. Our study had some limitations. Google Search Trends provides data related solely to the population that has internet Access and uses the Google search engine for searches. The kinds of searches that users perform can be a good Proxy for the publics interests, concerns or intentions, but these searches do not necessarily represent users' opinions. What to eat to strengthen the immune system The best medicine to strengthen immunity Herd immunization Coronavirus "İmmunity" World Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)? Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19? Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study World Health Organization COVID-19 and NCDs Hornig Contribution of selected vitamins and trace elements to immune function Vitamin C and immune function Tsoupras A. COVID-19: The Inflammation Link and the Role of Nutrition in Potential Mitigation &Heine, R. Baseline serum vitamin A and D levels determine benefit of oral vitamin A&D supplements to humoral immune responses following pediatric influenza vaccination Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)? Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Dietand Nutrition: Considerations during the COVID-19 Crisis Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths A new clinical trial to test high-dose vitamin C in patients with COVID-19 Low population mortality from COVID-19 in countries south of latitude 35 degrees North supports vitamin D as a factor determining severity Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-19) Vitamin C as a Possible Therapy for COVID-19 Vitamin D can be effective on the prevention of COVID-19 complications: A narrative review on molecularaspects Information Seeking Behaviours on the Internet Google Trends in infodemiology and infoveillance: methodology framework Google Trendler The use of google trends in health care research: a systematic review YES or NO: Predictingthe 2015 GReferendum results using Google Trends Integrative considerations during the COVID-19 pandemic Bioactive properties of Sambucus nigra L. as a functional ingredient for food and pharmaceutical industry Nutrition for Immune Health An evaluation of the protective role of vitamin C in reactive oxygen species-induced hepatotoxicity due to hexavalent chromium in vitro and in vivo Vitamin D and the immune system Vitamin D status and acute respiratory infection: crosssectional results from the United States National Health and Nutrition Examination Survey Vitamin D modulation of innate immune responses to respiratory viral infections 25-hydroxy vitamin d concentrations are lower in patients with positive PCR for SARS-CoV2 Vitamin D and survival in COVID-19 patients: A quasi-experimental study Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study Vitamin D Supplementation Associated to Better Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Quasi-Experimental Study Evidence Regarding Vitamin D and Risk of xThe authors declare that they have no known competing financialinterestsor personal relationships that could have appeared to influence the work reported in this paper.