Quote Originally Posted by mathguy View Post
What's the deal with diabetes/diabetics - RISK LEVEL

There are studies on the effects of diabetes, yes. Not exactly in the way you asked lol.

Diabetes carries extra risk but the reasons need to be examined b/c it may not actually be the diabetes or COVID-19. I'll explain. It tends to be worse in type 1 diabetes vs type 2 diabetes. However, the general theme is once again, age. For example, regardless of the type of diabetes, there is a 700-1000x increase in serious complication or even fatality (in the worst cases) for someone aged 80 vs someone aged 40.

So, again, age is a HUGE factor. It is the MAIN factor bar none. The general idea there is that late in life there are many compromised systems, concomitant infections, complications of respiratory functioning, COPD, etc...

And, yet again, remember that we know ~35%-40% of all deaths occur in various nursing homes/outbreaks where the average age is 80-85 with ~3 comorbid conditions. This is important b/c we need to realize that's a large number. That means a HUGE number of deaths occur mainly in people who are already on "deaths door" (unfortunately). Not to be insensitive.

There are also other reasons we hypothesize that diabetes has higher risks. In type 2 diabetes this is typically an adult onset condition caused by poor diet (high sugars) and increased BMI association.

Here are a couple reasons why diabetes may result in more severe illness or, in the worst cases, even death:

1. There are already major concerns over the restrictive ventilatory effect of adipose tissue, particularly abdominal fat (adipose tissue). It cause respiratory distress (i.e. we would see severe cases and/or death more commonly in high BMI or obese diabetic patients).

2. ACE2 is highly expressed in epicardial adipose tissue. SARS-COV-2 has a strong affinity for ACE2 receptors (this is also why kidney disease, lung diseases, heart trouble, etc... are high risk factors). ACE2 is a receptor that the SARS-COV-2 virus uses to enter the cell membrane and infect the target cell. So any areas or places where ACE2 is found heavily are target areas for increased severity of infection (this is also obviously mediated by genetics and your own innate and adaptive immune functions - that's a case by case issue).

Another reason diabetes is believed to be a problem, again it's not really the diabetes itself, it's an underlying issue which tends to be common in diabetes. This next one has to do with "inflammation". Diabetics are already at increased risk of inflammation and inflammatory conditions. That makes the possibility of a "cytokine storm" more likely as diabetes is characterized by chronic low-grade inflammation.

What makes this particularly bad is that SARS-COV-2 doesn't *only* infect alveolar epithelial cells of the lungs and upper respiratory system. It also infects some/certain circulating immune system cells which effectively induces apoptosis of the lymphocytes (death to white blood cells - immune fighting cells). As the T cells of the adaptive immune response inhibit innate immune response (phagocytic cells, neutrophils, natural killer cells...), the resulting lymphocytopenia (low white blood cell count) could suppress the innate immune system further and buildup the secretion of cytokines. The overproduction of cytokines is bad and can result in the "cytokine storm" I've talked about before. Cytokines are a pro-inflammatory cellular structure and obviously are not good for any susceptible to chronic low-grade inflammation in the body (i.e. diabetics).

If you are borderline diabetic you could get a form of new-onset diabetes as COVID-19 has a tropism for B-cells (beta cells) which are made in the pancreas. Diabetics have reduced or non-functioning pancreatic cells for producing insulin. The B-cell impairment with the possibility of inflammatory cytokine conditions and counter regulatory hormonal response could precipitate acute metabolic complication (such as diabetic ketoacidosis or hyperglycaemic syndrome).

In such cases you don't actually get severely ill or die of COVID-19 itself, rather, it's a result of what COVID-19 *can* do. However, let's remember this is all still very rare and doesn't happen a lot, but we do notice increases when certain concomitant conditions are present. What we don't yet know is if it's SARS-COV-2 --> COVID-19 that is actually causing it or if it's simply the fact that people with these particular conditions are more susceptible due to things COVID-19 ends up doing in the body which many other people can fight off.

VACCINE

Let me also mention vaccines again (since you mentioned it in your question). Vaccines are not always a magic medicine bullet. They are not at all. Vaccines come in different flavors. You have live attenuated viruses (weakened), dead viruses, recombinant/conjugate vaccines that contain subunits or parts of the virus. Finally there is one other called, toxoid vaccines.

When you get a vaccine you are being injected with a virus. That's what a vaccine is. It's a virus, sometimes live, but weakened, low load, or it's only part of the virus, or it's dead, etc... and it basically "tricks" your immune system into producing protein antibodies so you will easily fight on the real virus if you come into contact with it. The issue is that a vaccine can make you sick. It can. Sometimes it can even be severe. Particularly if it's live viral vaccination. This is also why certain age groups get different kinds of vaccines (for protection). Children and older people too get boosters b/c they need a "boost" to keep the immunity as they got such a weak load, dead, subunit viral vaccination.

A live viral vaccination creates the strongest response with the longest immunity from the immune system but it also has the highest risk of getting sick. The other issue to consider with vaccines is that they only have a certain efficacy level. As an example something like the measles vaccine will have >98% success (meaning only 2 in 100 wouldn't be inoculated by the vaccine when they got it - those 2 the viral vaccine didn't work in "tricking" their body to create enough immunity or the response wasn't strong enough). The season flu vaccine that many people get has an efficacy of about 60-70% (yes, folks, that means 30-40 people in 100 who get inoculated with the flu vaccine will not actually be immune - sorry to break it to you that way). It's likely that the SARS-COV-2 vaccine, particularly initially, will have at best 50-60% efficacy if we are lucky.

I just really want people to understand that vaccines are not some kind of magic pill. They ARE the virus; only they are in a lesser form, broken up, weakened, or even killed, to try to make your body turn on the "antibody generator" (so to speak). It doesn't always work though (b/c it's not the exact same fully loaded live virus but it is the virus). And you are STILL at risk of having side-effects (though in fairness they are quite low - but you also have to mitigate that with the fact that something like the flu vaccine is only 65% effective on average).

My Suggestion And Final Thoughts

You mentioned you are over 65 and you have diabetes.

Do I think you are at a "major risk"? Likely not.

The OVERALL risk to everyone is just ~.25% (about twice the rate of season flu). This is the TOTAL risk for EVERYONE, so it includes everyone up to even >110yrs of age (there have been plenty of centenarians who recover - plenty). Yes, go down to age 45-50, or, say, 40, and the risks becomes astronomically low. Dr. John Ioannidis, Middleton, Wittkowski and many others (there were >100 co-authors working on the Stanford study) basically put the risk for age <45 (no major health problems) at virtually 0%. It's statistically about .002485%. Even for under 70 yrs of age the median across now 50+ serology studies puts it at .04% (i.e. the common flu is 2-4 times as deadly if you are under 70).

NOW, that being said, do I think you should risk yourself right now? No, I do not. I would not advise it with the diabetic issue or if you have any major comorbid or concomitant conditions. Not until we know more.
Thanks. I feel like I should send you a check after that lengthy analysis.