Dr. Tudor Scridon nurtures more than 40 bonsai in his backyard, spending his off-hours snipping and misting in a contemplative ritual that prolongs the trees’ lives while reining in growth.

In his cardiology practice, he exhibits the same steadfastness, trying to manage his patients’ environment to protect them from COVID-19. Turns out his patients, like his bonsai, could benefit from the right amount of sunlight – enough to raise levels of vitamin D.

Scridon points to multiple studies showing a link between severe COVID-19 disease and vitamin D deficiency. One study of more than 200 COVID-19 patients in Spain that was published in October showed 80 percent had a vitamin D deficiency.

Another study showed that patients with an adequate level of vitamin D had a 51 percent lower risk of dying of COVID-19, as well as a reduced risk of complications. Still another showed more inflammatory markers in COVID-19 patients lacking adequate vitamin D.

Many scientists now believe the vitamin may blunt the effects of the coronavirus and ward off severe disease in vulnerable populations.

Because sunlight is hard to dose properly without injury – as his bonsai would attest – Scridon has already put many of his patients on a vitamin D3 supplement.

“It’s not expensive, it’s easy to use, and it’s not very risky either,” he said, noting that the vitamin’s apparent protective effect against respiratory infection was first seen in patients with tuberculosis.

“I usually go with the premise that everybody’s deficient [in vitamin D] and that is largely true. It’s something that may have other benefits, improvements in the way people feel. And I’m not sure how practical it is for people to stay hours in the sun.”

Scridon faces a daunting reality as the coronavirus pandemic escalates for a third time – his patients are at higher risk for severe COVID-19 disease should they become infected because people with heart problems are more vulnerable to the virus.

Almost a quarter of patients hospitalized with COVID-19 show some kind of cardiac problem, and cardiac complications are said to contribute to 40 percent of COVID-19 deaths.

At the same, time the virus seems to be generating new cardiac patients by damaging hearts that were healthy until the virus struck.

A growing number of studies show some COVID-19 survivors have heart damage even though they had no prior heart issues and weren’t hospitalized during their illness.

That residual heart damage – as well as complications like myocarditis, an inflammation of the heart muscle – could eventually lead to a higher incidence of heart failure, Scridon said.

Through the last COVID-19 spike that ended in July, Scridon treated a half-dozen patients hospitalized with the coronavirus at Cleveland Clinic. At that point, Scridon was in his 12th year with a group of seven hospital-employed cardiologists who took turns rounding in the COVID-19 wing, mostly through remote visits.

When he treated those hospitalized COVID-19 patients, they had a range of heart issues, Scridon said, including some whose hearts had been healthy before contracting the virus.

“I did see signs of damage to the heart muscle like you see in a heart attack, what we call elevation of the cardiac enzymes, and weakness of the heart muscle,” he said.

He also saw heart rate problems, “either the heart was too slow and making pauses every few seconds; or too fast – atrial fibrillation – all in people who did not have these problems before.”

One heart patient who regularly saw Scridon in his office lost her battle with COVID-19. The nurse and single mother of eight young children ended up dying of the disease due to the failure of her lungs, though she too showed cardiac enzyme elevation, Scridon said.

Scridon said microscopic clotting in the small vessels of the heart is another hallmark of COVID-19 cardiac involvement and could explain the rise in the enzymes troponin and creatine kinase – typical warning flags of a heart attack.

“[COVID-19] seems to cause all kinds of trouble in the heart and kidneys,” he said.

At the same time, as the virus spikes again, Scridon fears for his patients’ well-being on another front – those in need of care may avoid appointments or delay emergency room visits, even with symptoms of heart attack, thinking healthcare settings may expose them to the virus.

Scridon, who estimates he has about 3,000 patients, joined cardiologist Dr. Arley Peter in private practice this month, after working for many years in a cardiology practice now owned by Cleveland Clinic Indian River.

He also volunteers his time and expertise every Tuesday at We Care, based at the Gifford Health Center, where specialists like Scridon treat low-income patients at no cost.