COVID-19

Diabetes and Covid-19

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Catching up on diabetes and found several interesting studies.

CONCLUSIONS: Diabetes status, both type 1 and type 2, independently increases the adverse impacts of COVID-19. Potentially modifiable factors (e.g., HbA1c) had significant but modest impact compared with comparatively static factors (e.g., race and insurance) in type 1 diabetes, indicating an urgent and continued need to mitigate severe acute respiratory syndrome coronavirus 2 infection risk in this community.

COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic’s Impact in Type 1 and Type 2 Diabetes — http://Diabetes Care 2021 Feb; 44(2): 526-532. https://doi.org/10.2337/dc20-2260

CONCLUSIONS: Social vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19.

Incremental Risk of Developing Severe COVID-19 Among Mexican Patients With Diabetes Attributed to Social and Health Care Access Disadvantages — http://Diabetes Care 2021 Feb; 44(2): 373-380. https://doi.org/10.2337/dc20-2192

This study shows that diabetes is associated with a greater risk of fatal COVID-19, influenza/pneumonia, and CHD in both sexes. However, unlike for CHD, there are no sex differences in the association between diabetes and death from COVID-19 or influenza/pneumonia. Our finding that diabetes is associated with higher risk of COVID-19 mortality is consistent with other studies (1–4). A study of 61 million individuals in England showed that over a third of all in-hospital COVID-19–related deaths occurred in those with diabetes, and those with diabetes had higher odds of in-hospital COVID-19–related death than those without diabetes (1). In contrast to our study, however, that study suggested that women with diabetes were at higher risk of COVID-19–related mortality than men (1). Our results suggest that worse glycemic control might further increase risk of COVID-19 mortality among those with diabetes. Some studies have also reported that individuals with undiagnosed diabetes are particularly at increased risk of severe COVID-19 infections (3,4). Although relatively few participants had undiagnosed diabetes in the current study, we showed that undiagnosed diabetes was associated with a 3.5-fold excess risk of COVID-19 mortality in men. Although there were no sex differences in the association between HbA1c levels and COVID-19 mortality, the finding that associations are broadly similar across sexes and diseases with the exception of women with CHD is interesting, and it is important when considering mechanistic explanations of the female disadvantage in CHD. Overall, these findings indicate that strategies to prevent diabetes, to promptly identify individuals with diabetes, and to improve glycemic control among those with diabetes could lead to better COVID-19 outcomes for both sexes.

Diabetes and COVID-19–Related Mortality in Women and Men in the UK Biobank: Comparisons With Influenza/Pneumonia and Coronary Heart Disease — http://Diabetes Care 2021 Feb; 44(2): e22-e24. https://doi.org/10.2337/dc20-2378

Take home lesson: don’t develop diabetes.

Does Vitamin D Deficiency Raise COVID-19 Risk? – JAMA

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Despite Fauci’s recommendation and claims by many supplement sellers, conclusions about vitamin D blood levels’ connection to a host of diseases, including infections, cannot be determined because of mixed or sparse evidence, according to a recent report written for the US Preventive Services Task Force, which is updating its recommendation on vitamin D deficiency screening. The draft updated recommendation, like its 2014 predecessor, concludes that the evidence is insufficient to assess the benefits and harms of screening in asymptomatic adults for any reason.

Sorting Out Whether Vitamin D Deficiency Raises COVID-19 Risk — https://jamanetwork.com/journals/jama/fullarticle/2775003

The comments to this JAMA article are as educational as the article itself.

But as the debate rages on, I’ll continue to take 1000iu D3 daily. It can’t hurt.

Quote for Today – 01.30.21

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“In the event that you have the choice to get vaccinated, I’d encourage you to take the vaccine that you’re given,” John Brooks, the chief medical officer of the Centers for Disease Control and Prevention’s Covid-19 response, said at a briefing Friday.

Additional Covid-19 vaccines bring choices — and complications — to the rollout — https://www.statnews.com/2021/01/29/additional-covid19-vaccines-bring-choices-and-complications-to-rollout/

Let’s get one thing clear: I am not a medical doctor nor is anything you read on this blog to be considered medical advice. Now that we have mutual understanding…

This is NO time to be picky. You can be picky about the brand of coffee you drink (or how it should be brewed). Or you can be picky about which vegan eatery serves up the best tofu in your town. Go ahead. Be picky on pretty much anything in your life.

But when it comes down to a vaccine for a virus that to the best of our knowledge we have no known natural immunity I suggest you take whatever vaccine is available.

Leave the debates about efficacy to experts who know what they’re talking about.

Rant over.

We Are Experiencing Technical Difficulties – Please Stand By

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One question we see frequently – if you have a confirmation email, with a link taking you to a sign-up page, when all the appointments are full, should you expect an email telling you when they become available? The short answer, no.

Oklahoma Vaccine Portal problems persist as Oklahomans scramble to get a shot appointment — https://kfor.com/news/local/oklahoma-vaccine-portal-problems-persist-as-oklahomans-scramble-to-get-a-shot-appointment/

Officials with the Oklahoma State Department of Health said about 290,000 eligible Oklahomans are signed up on the scheduler portal. Plenty of people in the phase two distribution plan told 2 Works for You they are having issues scheduling a vaccination.

Senior citizens struggle with state COVID vaccine portal — https://www.kjrh.com/news/local-news/senior-citizens-struggle-with-oklahoma-state-covid-vaccine-portal

Tulsa Health Department posted on Facebook saying, that due to technical difficulties, there is no way for eligible individuals in Tulsa County to sign up.

‘Technical difficulties’ halts OSDH’s vaccine scheduling portal in Tulsa — https://ktul.com/news/local/technical-difficulties-halts-osdhs-vaccine-scheduling-portal-in-tulsa

Friday 1/29

Today began like any other workday. Wake up, coffee, shower, get dressed, more coffee, make the bed, power up the computer. But this morning I did not turn my workstation on. I took the morning off to get my SARS-Cov-2 vaccination shot. Total estimated round trip drive time will be about 3 hours. We’re headed to a mall in Enid, OK (that’s nearly Kansas IMO). This is my vaccine story.

Like the rest of the world we’ve been pretty much cooped up for nearly a year. Getting out of the house for “essential” activities isn’t the same as getting out and doing things. The arrival of vaccines for this horrible virus was good news. This certainly doesn’t herald the end of The Great Pandemic but it’s a hell of a good start. Somehow I knew with governments at multiple points in the vaccination process you just know there will be problems. Keep this in mind and carry on.

The state of Oklahoma is presently in Phase 2 of a four phase rollout. When The Boss and I became eligible for a jab we started hearing nightmare stories about actually securing an appointment. I knew the hiccups at the beginning were due to vaccine supply. The supply side is still a problem but not nearly as big of a problem as the steps you must take to register and find some vaccine. OSDH (Oklahoma State Department of Health) is the agency that set up the state’s vaccine portal. A lifetime ago I managed technology for two different companies and I know what can go wrong with systems implementation. Here we had a website set up by a government agency rolled out to the public with zero instructions on how the process would work. What could go wrong?

Yup, “technical difficulties”.

After hearing horror stories of a crashed website and other “technical difficulties” I waited a few weeks before signing up on the site. When I signed up I immediately received an email telling me I was eligible to be vaccinated. The email contained a link to the appointment scheduler. And that’s when the fun began. No appointments. Nada. Zilch. The instructions on how to use the site were nowhere to be found. After some time clicking around I managed to figure out how the site worked. First come, first served. If you can’t get an appointment come back later and try again.

So I went back to work and left my personal computer up with the vaccine portal website up. Every now and then I turned around from my Day Job Workstation and checked to see if any appointment openings popped up. After several hours of intermittent checking a massive number of slots opened up at a single site, the Oakwood Mall in Enid Oklahoma. So I used the home office intercom and yelled rather loudly:

“Get on the site. It’s number 47. Take the 10:30 am slot and I’ll grab the 10:45. GO!!!”

We both got slots for shots on January 29th. I suspect our experience was a lot better and a lot more successful than for others around the country. In my next post I’ll describe a few of the reasons why Oklahoma is doing a decent job with their vaccine rollout. Decent not good. Keep this in mind too because we haven’t opened up the process to the general population yet.

PS. My worst side effect so far has been an illogical urge to buy a 12 string acoustic guitar. Strange but true.

Indian scientists divided over restricted use approval for Covaxin — Science Chronicle

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While some scientists have raised concerns about granting restricted use approval to Covaxin even in the absence of efficacy data, four-dozen scientists have in a statement slammed them saying “reprehensible utterances are causing huge credibility crisis for the Indian scientific community”. Apparently, questioning the approval process by the Indian regulator is seen as being anti-Indian […]

Indian scientists divided over restricted use approval for Covaxin — Science Chronicle

India’s drug regulator approved two COVID-19 vaccines on 3 January, a decision Prime Minister Narendra Modi hailed on Twitter as “a decisive turning point to strengthen a spirited fight!” against the pandemic and a testament to the Indian scientific community’s self reliance. But some scientists and patient advocates are sharply critical of the move—in particular, the decision to greenlight Covaxin, a vaccine developed in India by Bharat Biotech, without awaiting the results of a phase III trial to determine efficacy and safety…

Efficacy data from a challenge study in rhesus macaques and immune responses in a human phase II trial suggested the vaccine was likely to be very effective.

The approval of a vaccine without phase III data is “unconscionable,” says Vineeta Bal, an immunologist at India’s National Institute of Immunology.

Scientists criticize ‘rushed’ approval of Indian COVID-19 vaccine without efficacy data — https://www.sciencemag.org/news/2021/01/scientists-criticize-rushed-approval-indian-covid-19-vaccine-without-efficacy-data

It worked in monkeys so let’s just skip the Phase III trial.

See my earlier post I would not take Covaxin without efficacy data: Gagandeep Kang — Science Chronicle

Utter Chaos? No Just Your Normal Vaccine Rollout in a Pandemic

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With the vaccine rollout left mostly up to states and counties, they have had to rapidly devise their own methods for distributing shots to their residents. Every state has its own priority system and way of scheduling appointments, which sometimes change week to week. The complicated logistics paired with inconsistent communication to the public has resulted in mass confusion. The result: People are spending hours seeking information and searching for coveted appointment slots.

‘Just utter chaos’: A Twitter thread offers a window into the frustrating search for Covid-19 shots — https://www.statnews.com/2021/01/28/just-utter-chaos-twitter-thread-offers-window-into-frustrating-search-for-covid19-shots/?utm_campaign=rss

Here in Oklahoma we’re in Phase 2 of the rollout and the process to get a Covid vaccination appointment in this state can best be described as incredibly difficult. We don’t have a huge number of residents here in flyover country and to be honest, that’s a good thing. I can’t imagine how difficult this process is in the more heavily populated areas of the country.

BTW I’m getting jabbed tomorrow.

Covid-19 Vaccine for Cats (not The Onion)

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A feline vaccine for COVID-19 could be available by the end of the year. “We are also concerned with vaccinating people, but we believe that any reservoir of the virus is one to be concerned about,” says James Hayward, CEO of Applied DNA Sciences, which will soon begin clinical trials of the new feline vaccine in New York. The company is working in partnership with Italy-based Takis Biotech, and has manufactured the first doses of a DNA-based vaccine for the trial. “It has never been demonstrated that cats can transfer the virus to humans. But even having been vaccinated, I think I would not want sleeping at my feet a reservoir of SARS-CoV.”

Will your cat need a COVID-19 vaccine?

Does anyone other than myself suspect a profit motive here?

Immune system mounts a lasting defense after recovery from COVID-19

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A closer look at the memory B cells revealed something surprising: these cells had gone through numerous rounds of mutation even after the infection resolved, and as a result the antibodies they produced were much more effective than the originals. Subsequent lab experiments showed this new set of antibodies were better able to latch on tightly to the virus and could recognize even mutated versions of it.

Rockefeller University. “Immune system mounts a lasting defense after recovery from COVID-19, researchers find.” ScienceDaily. http://www.sciencedaily.com/releases/2021/01/210121131909.htm (accessed January 26, 2021).

Journal Reference – Evolution of antibody immunity to SARS-CoV-2. Nature, 2021; DOI: 10.1038/s41586-021-03207-w

Vinay Prasad MD MPH is a Very Smart Person

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For most people, once you get 14 days out of your second dose of vaccine, I believe you can ease up on masking or another restriction, such as visiting a loved one for lunch or having more than one person visit a nursing home at the same time, or a small gathering of vaccinated people for dinner without masks.

Op-Ed: Throw Away Your Mask After COVID Vaccination? — Op-Ed: Throw Away Your Mask After COVID Vaccination?

Dr. Prasad’s Op-Ed article is worth reading. Or if you’re a watch, listen and learn type check out the video.

BUT if you have an hour to spare the following podcast is downright entertaining.

More Than One Third of COVID-19 Infections Are Asymptomatic

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In the current systematic review, the highest-quality evidence comes from large studies in England and Spain. The nationally representative evidence included serologic surveys from more than 365,000 people in England and more than 61,000 in Spain. When analyzed separately, about the same proportion of asymptomatic cases emerged: 32.4% in England and 33% in Spain. 

“It was really remarkable to find that nationwide antibody testing studies in England and Spain — including hundreds of thousands of people — produced nearly identical results: about one third of the SARS-CoV-2 infections were completely asymptomatic,” said Oran, a researcher at Scripps Research Translational Institute in La Jolla, California.

Cite this: More Than One Third of COVID-19 Infections Are Asymptomatic: Review – Medscape – Jan 25, 2021. — https://www.medscape.com/viewarticle/944662?src=rss#vp_1