The Latest in COVID-19 News: Week Ending 02.27.21 – NEJM Journal Watch

Click on the link for the NEJM Journal Watch weekly update.  One hell of a great week for SARS-CoV-2 articles.

Meanwhile at the NIH/NIC…

People who have had evidence of a prior infection with SARS-CoV-2, the virus that causes COVID-19, appear to be well protected against being reinfected with the virus, at least for a few months, according to a newly published study from the National Cancer Institute (NCI).

NIH study finds that people with SARS-CoV-2 antibodies may have a low risk of future infection –

Diabetes and Covid-19

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.

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.

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 (14). 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.

Take home lesson: don’t develop diabetes.

Science Daily Covid-19 Links – 11.06.20

Massachusetts Institute of Technology. “COVID-19 ‘super-spreading’ events play out-sized role in overall disease transmission: Mathematical analysis suggests that preventing large gatherings could significantly reduce COVID-19 infection rates.” ScienceDaily, 2 November 2020.

Journal Reference: Felix Wong, James J. Collins. Evidence that coronavirus superspreading is fat-tailed. Proceedings of the National Academy of Sciences, 2020; 202018490 DOI: 10.1073/pnas.2018490117

University of Alberta Faculty of Medicine & Dentistry. “Review finds almost 20 percent of COVID-19 patients only show gastrointestinal symptoms: Radiologists encouraged to remain watchful for signs of the virus.” ScienceDaily. ScienceDaily, 3 November 2020.

Journal Reference: Kevin Lui, Mitchell P. Wilson, Gavin Low. Abdominal imaging findings in patients with SARS-CoV-2 infection: a scoping review. Abdominal Radiology, 2020; DOI: 10.1007/s00261-020-02739-5

Brigham and Women’s Hospital. “Study uncovers subset of COVID-19 patients who recover quickly and sustain antibodies: Researchers identify patients who cleared the disease faster and had a persistent antibody response, with important implications for immunity.” ScienceDaily. ScienceDaily, 3 November 2020.

Journal Reference: Yuezhou Chen, Adam Zuiani, Stephanie Fischinger, Jyotsna Mullur, Caroline Atyeo, Meghan Travers, Felipe J.N. Lelis, Krista M. Pullen, Hannah Martin, Pei Tong, Avneesh Gautam, Shaghayegh Habibi, Jillian Bensko, Deborah Gakpo, Jared Feldman, Blake M. Hauser, Timothy M. Caradonna, Yongfei Cai, John S. Burke, Junrui Lin, James A. Lederer, Evan Christopher Lam, Christy L. Lavine, Michael S. Seaman, Bing Chen, Aaron G. Schmidt, Alejandro Benjamin Balazs, Douglas A. Lauffenburger, Galit Alter, Duane R. Wesemann. Quick COVID-19 Healers Sustain Anti-SARS-CoV-2 Antibody Production. Cell, 2020; DOI: 10.1016/j.cell.2020.10.051

Texas A&M University. “Four major predictors of COVID-19 emerge in new study: Researchers identified socioeconomic predictors that could inform future pandemic response.” ScienceDaily. ScienceDaily, 4 November 2020. <>.

Journal Reference: Richard S. Whittle, Ana Diaz-Artiles. An ecological study of socioeconomic predictors in detection of COVID-19 cases across neighborhoods in New York City. BMC Medicine, 2020; 18 (1) DOI: 10.1186/s12916-020-01731-6

Brigham and Women’s Hospital. “Rapid changes in biomarker of inflammation may be a key predictor of COVID-19 outcomes: Results provide insight into underlying mechanisms of inflammation that may help anticipate clinical trajectories of COVID-19 patients.” ScienceDaily. ScienceDaily, 5 November 2020.

Journal Reference: Alisa A. Mueller, Tomoyoshi Tamura, Conor P. Crowley, Jeremy R. DeGrado, Hibah Haider, Julia L. Jezmir, Gregory Keras, Erin H. Penn, Anthony F. Massaro, Edy Y. Kim. Inflammatory Biomarker Trends Predict Respiratory Decline in COVID-19 Patients. Cell Reports Medicine, 2020; 100144 DOI: 10.1016/j.xcrm.2020.100144

Executive Summary

  • Super spreading events are real so avoid large crowds when possible and wear a mask.
  • I had the worst stomach bug in my entire life back in February. I ate only to keep my strength up but no foods were appealing. The thought of alcohol made me cringe. It lasted a week and I lost five pounds. Covid?
  • Did I develop and sustain antibodies?
  • The socioeconomic predictors of Covid-19 are pretty much what they have been for many years. The virus has merely put a spotlight on existing economic and other inequalities in the world.
  • C-Reactive Protein (CRP).

COVID-19 and Diabetes, Sub-types of DM2, B Vitamins in Diabetes Incidence and more

This article provides an overview of the clinical evidence on the poorer clinical outcomes of COVID-19 infection in patients with diabetes versus patients without diabetes, including in specific patient populations, such as children, pregnant women, and racial and ethnic minorities.

COVID-19 and Diabetes: A Collision and Collusion of Two Diseases — Diabetes 2020 Oct; dbi200032.

In the article above the researchers reviewed nearly 90 studies.

Novel diabetes subtype characteristics. Overview of distribution and characteristics of subtypes generated by clustering based on clinical parameters in the Swedish ANDIS cohort.

Type 2 diabetes (T2D) is defined by a single metabolite, glucose, but is increasingly recognized as a highly heterogeneous disease, including individuals with varying clinical characteristics, disease progression, drug response, and risk of complications. Identification of subtypes with differing risk profiles and disease etiologies at diagnosis could open up avenues for personalized medicine and allow clinical resources to be focused to the patients who would be most likely to develop diabetic complications, thereby both improving patient health and reducing costs for the health sector. More homogeneous populations also offer increased power in experimental, genetic, and clinical studies. Clinical parameters are easily available and reflect relevant disease pathways, including the effects of both genetic and environmental exposures. We used six clinical parameters (GAD autoantibodies, age at diabetes onset, HbA1c, BMI, and measures of insulin resistance and insulin secretion) to cluster adult-onset diabetes patients into five subtypes. These subtypes have been robustly reproduced in several populations and associated with different risks of complications, comorbidities, genetics, and response to treatment. Importantly, the group with severe insulin-deficient diabetes (SIDD) had increased risk of retinopathy and neuropathy, whereas the severe insulin-resistant diabetes (SIRD) group had the highest risk for diabetic kidney disease (DKD) and fatty liver, emphasizing the importance of insulin resistance for DKD and hepatosteatosis in T2D. In conclusion, we believe that subclassification using these highly relevant parameters could provide a framework for personalized medicine in diabetes.

Subtypes of Type 2 Diabetes Determined From Clinical Parameters — Diabetes 2020 Oct; 69(10): 2086-2093.

Not just potential for personalized medicine in the treatment of diabetes but perhaps a framework for better risk stratification and selection in life insurance.

Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study

RESULTS During 30 years (mean 20.5 ± 8.9) of follow-up, 655 incident cases of diabetes occurred. Intake of folate, but not vitamin B6 or vitamin B12, was inversely associated with diabetes incidence after adjustment for potential confounders. Compared with the lowest quintile of total folate intake, the multivariable-adjusted hazard ratios (95% CI) in quintiles 2–5 were 0.85 (0.67–1.08), 0.78 (0.60–1.02), 0.82 (0.62–1.09), and 0.70 (0.51–0.97; Ptrend = 0.02). Higher folate intake was also associated with lower plasma homocysteine (Ptrend < 0.01) and insulin (Ptrend < 0.01). Among supplement users, folate intake was inversely associated with serum C-reactive protein levels (Ptrend < 0.01).

CONCLUSIONS Intake of folate in young adulthood was inversely associated with diabetes incidence in midlife among Americans. The observed association may be partially explained by mechanisms related to homocysteine level, insulin sensitivity, and systemic inflammation.

Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study — Diabetes Care 2020 Oct; 43(10): 2426-2434.

Folate is a B vitamin that occurs naturally in foods such as green leafy vegetables, citrus fruit, and beans. So eat your greens and beans. Taking a supplement can’t hurt either. My multivitamin has plenty of folate.

Covid-19 – Kids Have Better Immune Response, D614G Mutation and I Don’t Want to Live in an Assisted Living Facility

Saturday mornings are my time to catch up on news. Here are a few articles that caught my eye today.

Researchers studied 65 children and 60 adults with COVID-19 at a hospital system in New York City and found the children stayed in the hospital shorter periods of time, needed ventilators less often, and had a lower death rate, according to the study published in Science Translational Medicine. Those findings fell in line with what other scientists had noticed: Children don’t get as sick with coronavirus as adults do. The CDC, for instance, says around eight children per 100,000 were hospitalized with COVID-19, compared to 164.5 adults per 100,000. But scientists are not sure why this happens.

Citation: Children Have Better COVID Immune Response Than Adults – Medscape – Sep 25, 2020 —

The virus is mutating and appears to be more infectious.

The study, published as a preprint on the medRxiv server (, found that nearly all (99.9%) of the strains in the second wave had a mutation, known as D614G, which has been shown to increase the number of “spikes” on the crown-shaped virus, increasing its ability to infect cells.

Citation: Houston Study: More Contagious Coronavirus Strain Now Dominates – Medscape – Sep 24, 2020 —

And the first study I’ve stumbled upon on Covid-19 mortality in assisted living facilities.

In North Carolina and Connecticut, for example, the proportions of COVID-19 cases that were fatal across the state were 3.3% and 9.3%, respectively. In assisted living facilities in those states, the fatality rate climbed to 13% and 31.6%. Unlike nursing homes, assisted living communities are not subject to federal regulation and are not required to collect and report data on COVID-19, coauthor Helena Temkin-Greener of the University of Rochester School of Medicine & Dentistry said in a news release

Citation: High COVID-19 Mortality Seen in Assisted-Living Facilities – Medscape – Sep 24, 2020 —

We are learning there may be an underlying genetic and immunological basis in cases of severe Covid-19.

The researchers found that more than 10% of people who develop severe COVID-19 have misguided antibodies―autoantibodies―that attack the immune system rather than the virus that causes the disease. Another 3.5% or more of people who develop severe COVID-19 carry a specific kind of genetic mutation that impacts immunity. Consequently, both groups lack effective immune responses that depend on type I interferon, a set of 17 proteins crucial for protecting cells and the body from viruses. Whether these proteins have been neutralized by autoantibodies or―because of a faulty gene―were produced in insufficient amounts or induced an inadequate antiviral response, their absence appears to be a commonality among a subgroup of people who suffer from life-threatening COVID-19 pneumonia.

Scientists discover genetic and immunologic underpinnings of some cases of severe COVID-19 —

Finally from my long read of the day is a quote from our Covid-19 rock star in the U.S. I’ve got the full article open in my browser to read later. Enjoy!

You know, you just do it: you tell things the way they are. Sometimes that’s not in agreement with what people would like to hear. But I learnt a long time ago that people will ultimately have sustained respect for you if you give them the information based on science and are not afraid to tell people things they do not want to hear. Whether they act on the things you tell them is beyond my power. The only thing that I can do is analyze the situation, look at the scientific data, and make whatever recommendation they ask me to make. But you can be assured that it will be always based on scientific evidence and data.

Citation: BMJ 2020;370:m3703 — The BMJ interview: Anthony Fauci on covid-19 —

The Latest in COVID-19 News: Week Ending 08.22.20 – NEJM Journal Watch

Click on the link for the NEJM Journal Watch weekly update.  NO paywalls on any of the links in this article.  (paywalls bother me)

Meanwhile in Harrah, Oklahoma…

The corned beef became an unexpected, additional source of sadness: The flavors I love have become associated with the bitterness of closing down. I can only taste the sourness of worry. I can only smell the rottenness of having to furlough six people who depended on the pub for a paycheck. Years of enjoyment have boiled down to a few long months of anxiety, endless discussions about to close or stay open—and if we can reopen safely, how we will survive.

We own an Irish Pub in Harrah, Oklahoma. When Covid-19 hit, we had to eat our own corned beef and potatoes for weeks.

The Latest in COVID-19 News: Week Ending 07.25.20 – NEJM Journal Watch

Click on the link for the NEJM Journal Watch weekly update.  NO paywalls on any of the links in this article.  (paywalls bother me)

The Latest in COVID-19 News: Week Ending July 25

Meanwhile in Imperial County California…

For many decades, a relative few white farmers who tilled vast acreages of winter vegetables, cotton and alfalfa held that power. Ultimately, however, demography shifted power to Latinos, the sons and daughters of field workers from Mexico who are today 80% of Imperial County’s population.

Changing demography didn’t change Imperial County’s basic nature. It exists primarily to grow food and fiber with little economic diversity and always ranks high on California’s lists of unemployment and poverty.

Imperial has another distinction these days — the epicenter of California’s COVID-19 pandemic. Its infection rate is six times as high as California’s as a whole and victims are overwhelming its two hospitals.

Imperial County, the COVID-19 epicenter