Diabetes and COVID-19
Diabetes and COVID-19
As the weather gets colder, we are seeing case rate and deaths go up across the country. What are you telling your patients to do between now and through New Year's Eve?
Avoid any parties or gatherings unless they are held outdoors, people are socially distancing and wearing masks. In general, there should be no more than 10 people and everyone should be from the same “bubble”. We are seeing that seemingly safe social gatherings with-in a friend and family circle are leading to COVID infections. Especially when the virus is circulating at higher rates it is easier for a trusted contact to become infected and transmit the virus before they experience any symptoms. The most infectious time is a one day before an infected person starts feeling symptoms and holiday gatherings are safer if they are limited to an immediate family bubble or smaller groups.
Try your best to avoid gathering indoors - especially in small spaces. And if you do need to be indoors make sure that the windows are open to provide free circulation and the risk can be reduced with the use of a medical grade (H13) HEPA filter to help filter out any potentially dangerous aerosolized virus particles.
What is the risk of coronavirus for people with diabetes on the Westside?
The risk is lower on the Westside than people who live in the other parts of town, but I've been seeing patients, both older and younger, getting COVID after staying mostly healthy since March. This is happening largely through exposures in small family groups at events such as holidays, funerals and weddings. Everyone should wear masks (and good surgical grade masks). Try to keep your socializing on Zoom and do not go outside your bubble. This is the single best way to stay healthy. Follow the CDC and local health department guidelines.
The best way to improve your odds of doing well if you develop COIVD-19 infection is to have good control of your diabetes. Keep your A1C at target and stay otherwise healthy (no smoking) and your odds of doing well increase.
How is the situation similar and different for the people with diabetes that you see in East Los Angeles?
Never have health care disparities seemed worse than now. 73% of the cases of COVID are in East Los Angeles and patients there are 2 to 3 times more at risk for being hospitalized with COVID. This is also true of South Los Angeles that has a higher mix of an African American population, although the rates of dying are greater in the Black population than in Latinos. The higher rates of deaths in the African American population most like have to do with other preexisting conditions that increase their risk, but other factors are likely to plan a role.
We are seeing the bad news of increasing cases COVID, but lower rates of deaths. What sort of progress have we seen in treatment?
We are now better at treating hospitalized patients because we have learned that people may develop hypercoagulation that increases blood clots. Now we treat this condition earlier. We have Remdesiver and the steroid Dexamethasone both of which can help. Monoclonal antibodies may also be helpful, especially if given early. All the major hospitals in LA County can provide these treatments.
It is good news that we are better at treating hospitalized patients, but if you are hospitalized with COVID the recovery is really long - so it is a very bad idea to get sick. People with type 2 diabetes remain at a high risk of developing severe COVID, but the risk is lower when diabetes control is in the recommended target range. The risk increases with age, being male, being overweight and if you have diabetes complications. The good news is that well controlled type 1 diabetes is not considered a severe risk factor by the CDC.
What should people do about vaccinations?
Everybody should have the flu shot and check with your primary care provider to see if you have also had the necessary pneumonia shot, Tdap shot (tetanus, diphtheria, and pertussis), and shingles (Shingrix) shot for people older than age 50. Be up to date on all of your vaccinations.
Should I get a COVID vaccination? How will I know if the vaccination is safe and how should I decide what version to get?
We have been hearing lots of good news about vaccines which is exceedingly encouraging!!! There are a number of vaccines under development, and at least two seem to be effective, but we really need to understand how safe these vaccines are in the general population. Early data can show us that they work against the virus, but more data will come out on safety. So, we will be learning more and more about vaccines for COVID and will have a number of them by spring. As an individual, you may not want to rush out to get the first vaccine available, you may want to look at the safety profiles in the choices we have.
It is expected that some of these vaccines may have some of the common side-effects of sore arms, fatigue, fever and joint and muscle aches that last for a day or two. Some of the vaccines also may require two injections, so as we learn more you will need to evaluate the options, but they should not be considered a "Get out of Jail Free" card because we need to have a significant number of the population vaccinated to reduce the spread and that will take a while. Clearly a vaccine will be a good step forward for all of us, but it may not replace wearing masks, staying safe and practicing social distancing and interacting with people outdoors. But ultimately vaccines will be key in returning us back to our “normal” lives.