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This high prevalence suggests that the SARS-CoV-2 virus either rapidly depletes bodily stores of cobalamin during the acute infection phase or severely disrupts the gut microbiome's ability to absorb it post-infection

Screening may be warranted in patients with one or more risk factors, such as gastric or small intestine resections, inflammatory bowel disease, use of metformin for more than four months, use of proton pump inhibitors or histamine H 2 blockers for more than 12 months, vegans or strict vegetarians, and adults older than 75 years

[3] This is a known effect and not cause for concern

Overall certainty of evidence was characterized as high, moderate, low, or very low based on these considerations