Glad you are optimistic, @BunsenBurner. It’s just that there seems to be no cause for optimism that anything can be managed efficiently under the current regime. So far, no good.
@compmom best wishes to your D. I hope she stays healthy, but if not, as a mild case. My favorite co-worker’s wife is a type 1 and he has plenty of horror stories of the hospital staff not having a clue about managing insulin.
Hype for a vaccine that isn’t even close.
It’s not the case that 33% of young adults get severe covid. Not 33%, not anything close to 33%.
Please remember my inhouse cautionary tale. 24 years old, non smoker, skinny, very active - she was not hospitalized but still has consequences to her lungs.
Regarding blood sugar management - my daughter felt very nauseated for a couple of days. She managed to sip on tea but didn’t really want anything to eat. The diabetic daughter probably knows from stomach bugs how to handle nausea but may need to be reminded in the moment. My kid doesn’t do her best thinking when feverish and miserable.
@Sybylla - I do not see hype. It is smart to make sure the supply chain is not going to cave in when the demand arrives. Vials and syringes have long shelf life; they can sit and wait to be put in use. The JIT Toyota-style manufacturing did not mesh well with a pandemic as we have seen MANY times already.
The Oxford/AstraZeneca vaccine is close. If it turns out to work, the first doses will be available this fall.
However, according to the vaccine experts I was listening to on Andy Slavitt’s In the Bubble podcast, vaccines probably won’t be a magic bullet. They’ll be good incremental improvements. A vaccine will be approved if it cuts your risk of being infected by 50%. It’ll be approved if it does almost nothing to your risk of being infected, but cuts your risk of serious disease by 50%.
If we had universal access to such a vaccine, and we abandoned all social distancing and masking, a lot of people would still get sick and a lot of people would still end up in the ICU or dead.
@snowball city yes nausea is tough, it causes lows.
Hospitals like to take the insulin pump off, which means they start using syringes with increments of whole units when the pump is .025 increments! If she is conscious and able to manage herself, the CGM stays on and the pump often does. But if she were really sick or not conscious I am afraid all devices would be removed because staff aren’t trained.
After surgery, despite all our planning, the ICU nurse did not connect the pump. I was managing blood sugars and didn’t know. As her blood sugars rose, I asked the nurse and she told me she had not connected the pump because she “only needs insulin when she eats.” Good lord.
The management has to be dynamic, and almost moment to moment. One of the top hospitals in the world tested every two hours, which meant 40, then 300, seriously. A nurse in the ICU in this top hospital told me they had never had a type 1 in a 30 year career. But they confuse it with type 2.
An algorithm written by the MD won’t work consistently but nurses cannot make decisions so that means a bad algorithm continues for hours.
They give insulin and meals are delayed.
I could go on and on.
Sorry folks for the tangent but it’s been 25 years of this stuff.
A nurse in the ICU in this top hospital told me they had never had a type 1 in a 30 year career. <<<<<<<<
This must some kind of BFE ICU. Also in any normal ICU there would be no way a parent would be managing blood sugars, the liability for that is bananas. However, IME ICU pts are not eating. That might mean there is some nuance here.
As a former ICU nurse, I find it absolutely impossible to believe she had never encountered a type 1 diabetic in a 30 year career. I just cannot believe this. I have to wonder if she had worked another field, then transitioned to ICU. We had type 1s in at least one of our ICUS on the daily.
I’m sure that there are parents and patients that actually know more about type 1 diabetes than many professionals, but it is unacceptable that any hospital ICU would not have a good handle on how to manage a type 1 diabetic, particularly one in a crisis mandating intensive care.
@calmom Thank you for giving us the information about Von Willebrand Factor being higher in COVID-19 patients who did worse. It led me to find further information about how COVID is basically a blood-clotting illness.
I watched the YouTube “Coronavirus Pandemic Update 95: Widespread Clotting on Autopsy; New COVID-19 Prognostic Data”.
One of the articles presented in this video stated that patients taking anticoagulants still developed clots in their organs. A comment by “David L” explained that there is a connection between a protein in the blood called alpha defensin and Von Willebrand Factor. He said that Israeli researchers discovered that an increased level of alpha defensin increases the formation of fatal clots in coronavirus patients. Alpha-defensins are released by neutrophils, and they inhibit an enzyme that prevents Von Willebrand Factor from causing the formation of too many blood clots.
The Israeli researchers said that “existing anticoagulant drugs do not impact alpha-defensin.” They want to try the drug colchicine in human trials to reduce alpha defensin in COVID-19 patients.
From:
"COVID-19 Update:
COVID-19 Patients Develop Fatal Blood Clots Due to High Alpha Defensin Protein Levels, Find Researchers "
May be, but any vaccine launching this fall will be launching with no long term safety data…typically vaccines launch with multi-year safety data. That’s concerning whether we are in a pandemic or not…note I am pro vaccine and long term pharma industry worker.
Here is part of the FDA guidance:
The full guidance can be downloaded here: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/development-and-licensure-vaccines-prevent-covid-19
I agree that if a vaccine just makes the 50% hurdle, that SD and masks may still be required, potentially for quite a long time. Hopefully, a couple of vaccines will do much better than 50% efficacy. But we will still have the lack of long-term safety data.
This is the same situation if we see a treatment approved that can be used early in the disease course…we can’t just let the virus spread unabated even with a treatment on the market because that treatment won’t work for everyone, and said product supply would likely be constrained. So SD and masks still required in that scenario as well.
What’s the estimated effectiveness of the the flu shot in comparison? I know it’s less than 100% but can’t recall the actual percentage. Anyone?
Varies year to year, often depending on if the guessed strains months in advance of the flu season are well matched to the actual flu strains that are predominant during the flu season.
https://www.cdc.gov/flu/vaccines-work/effectiveness-studies.htm
Thanks - so looking through that info, the percent effectiveness is often less than 50%, yes? So if a new vaccine for Covid 19 has an estimated effectiveness of around 50%, that would be pretty good, yes? (Hoping here…).
That would be good compared to many years’ flu vaccines, but not compared to some other vaccines like measles, mumps, rubella, chicken pox, polio, diphtheria, tetanus, and (historical) smallpox.
If a new vaccine was 50% effective, it would be absolutely fantastic and would save many lives. Many, many, many lives.
That level of effectiveness might or might not slow down the disease spread, depending on what the vaccine does. Suppose it prevented 50% of the infections . That would be amazing. With some social distancing, masks, and wide uptake of the new vaccine, the infection numbers would plummet, because many people would be exposed but not get infected. (This is when the exponential nature of contagion gets good. Stopping the first superspreader from spreading as much means that the superspreader he would have infected might have the vaccine, not get sick, and not infect anyone else. Stopping the first infection means stopping everyone in the infection chain from getting sick.)
On the other hand, if the vaccine didn’t stop people from getting sick, but did stop them from getting severely ill, that would still be amazing. People who otherwise would have died would instead get rather sick and then recover.
Folks, it was an exact quote from a nurse, that she had never had a type 1 diabetic in the neuro ICU in her 30 year career.
And I managed type 1 diabetes in the ICU for a child with a serious brain injury. Do you think I am making this up? The ICU doctors and nurses were completely unable to manage it. It was dangerous. They knew it. They were glad to hand it over once she was out of her coma. While in a coma she was unable to consent. Once out of the coma she was still cognitively challenged but able to give consent. We now have a note on file that says I can manage her.
The endocrinology department explained that the neuro ICU rarely encountered type 1 and so it was not considered worth it to take the time to train nurses on insulin pumps. They told me they had a committee formed to educate staff and they were lucky to even get across the ketoacidosis dangers of highs. The idea of teaching the intricacies of management was light years away, they said. Hospitals like to run patients high because they are afraid of lows. The committee was trying to get across the point that highs are also dangerous, particularly when infection is involved.
In fact, along with a head injury that almost killed her, my daughter developed pneumonia while on a ventilator, and high blood sugars were going to kill her. Bacteria love sugar in the blood. I had to argue with MD’s and fellows who assured me that high blood sugars were fine.
This was one of the top hospitals in the world.
When she went to rehab (a top rehab associated with the hospital, which is famous from certain news events) noone even tried to manage her diabetes. I was required to.
Throughout the 5 week ordeal of hospital plus rehab, I was with her 24/7. I got up at 1 am and 3 am to check her.
Maybe this is offending nurses. But it’s true. And every type 1 knows it. Every magazine for type 1’s write about it.
That hospital stay was only one of about 10 really bad experiences.
This is a tangent. But after 25 years of this, please don’t tell me you don’t believe me.
Back to the regular programming.
ps eating is irrelevant; with current diabetes management the basal rate works with or without eating
Health experts raise concerns about emergency use authorizations for Covid-19 vaccines
From CNN’s Wes Bruer
Health experts testifying before the House Oversight Subcommittee on Economic and Consumer Policy expressed concerns that a Covid-19 vaccine would have to be distributed under a US Food and Drug Administration’s emergency use authorization.
Emergency use authorization from the FDA is not the same as approval, but when there is no available or accessible alternative, it’s a signal from regulators that the likely benefits of a product seem to outweigh the risks.
The experts testified at a Tuesday hearing and cautioned against rushing a vaccine before Phase 3 clinical trials are complete. They urged decision makers to balance the need for urgency with transparency.
Here’s what the experts said:
Dr. Bruce Gellin, president of global immunization at the Sabin Vaccine Institute, said he “strongly recommends that any vaccine being considered for any type of approval by the FDA be reviewed in an open, public meeting of the FDA Vaccine and Related Biological Product Advisory Committee.” Gellin added that “if a vaccine used under an EUA turns out to be ineffective or raise safety concerns and users are unclear if the vaccine was unapproved, a crisis could occur undermining confidence in all vaccines.”
Dr. Jesse Goodman, director of the Center on Medical Product Access, Safety and Stewardship a Georgetown University, said that while issuing an EUA to distribute a vaccine in an area with a severe Covid-19 outbreak could be appropriate, “experience has shown the public may interpret an EUA as the same as an approval.”
Dr. Jason Schwartz, assistant professor of health policy at Yale University, echoed those concerns, saying he would also be worries that an EUA “would not be understood to be different from full approval” of a vaccine.
Dr. Ruth Karron, director of the Center for Immunization Research at Johns Hopkins Bloomberg said “decisions may need to be made about issuing EUAs for one or more vaccines with data that are promising but incomplete,” which would raise questions about the risk and benefits to those in high-risk groups.
Baby infected with Covid-19 in womb, study finds
From CNN’s Marisa Peryer
A French team has reported transmission of Covid-19 across the placenta after a mother become infected during the last trimester of pregnancy.
Both the mother and her newborn tested positive for coronavirus, according to the report, published Tuesday in the journal Nature Communications.
The woman was admitted to a French hospital in March with symptoms including fever and a severe cough. Genetic evidence of coronavirus were detected in her blood and in nasopharyngeal and vaginal swabs. Doctors decided to deliver the baby by cesarian section.
Tests also detected SARS-CoV-2 in the newborn. And days after birth, the child also developed neurological complications, including irregular muscle contractions. The infant’s cerebral spine fluid tested negative for coronavirus or any other germ. At 11 days after birth, an MRI of the child’s brain showed abnormalities in some white matter regions.
Analysis of the placenta detected coronavirus at much higher levels than in either the mother’s or child’s blood or in the intact amniotic fluid surrounding the fetus before birth. That suggested to the researchers that the virus crossed the placenta and infected the baby in the womb.
The mother was discharged in good condition six days after delivery, and the child was discharged after 18 days. Roughly two months later, the child showed improved neurological condition with an otherwise normal clinical exam, the researchers reported.
Other researchers have described potential Covid-19 transmission during the period immediately before or after birth. The authors of the Nature Communications study said these cases had unaddressed issues, such as an unclear route for transmission of the virus.
“It is important to clarify whether and how SARS-CoV-2 reaches the fetus, so as to prevent neonatal infection, optimize pregnancy management and eventually better understand SARS-CoV-2 biology,” they wrote.