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More Omicron: Diabetics Appear Even More Vulnerable as Diabetic Ketoacidosis Strikes

Summary:
Our IM Doc sputtered early on in the Omicron wave about not only continued lack of guidance about treatment but also clues as to how Omicron symptoms and progress might differ from earlier variants, particularly given the lack of sequencing in many hospitals (including his) and now even test shortages. As we’ll discuss, there is yet more confirmation that Omicron is much less likely to produce debilitating and often deadly viral pneumonia than early variants. However, the ongoing claim that it is mild may be overdone. We are not alone in wondering if the apparent higher frequency of less debilitating cases is a statistical anomaly due to incomplete data. We aren’t alone; Yaneer Bar-Yam has expressed similar concerns. Take two populations of 1000 people. Assume 200 of one group got

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Our IM Doc sputtered early on in the Omicron wave about not only continued lack of guidance about treatment but also clues as to how Omicron symptoms and progress might differ from earlier variants, particularly given the lack of sequencing in many hospitals (including his) and now even test shortages. As we’ll discuss, there is yet more confirmation that Omicron is much less likely to produce debilitating and often deadly viral pneumonia than early variants. However, the ongoing claim that it is mild may be overdone.

We are not alone in wondering if the apparent higher frequency of less debilitating cases is a statistical anomaly due to incomplete data. We aren’t alone; Yaneer Bar-Yam has expressed similar concerns.

Take two populations of 1000 people.

Assume 200 of one group got symptomatic Delta and 350 of the second group got symptomatic Omicron. That’s hardly nuts in terms of relative penetration of the two variants, given the massive Omicron spike.

Assume 10 of the Delta group wind up being hospitalized and two die. Assume 13 of the Omicron group become hospitalized and two die.

On a population-wide level, Omicron is as deadly and leads to a higher rate of hospitalizations.

But that is not what clinicians will observe. They will look at the level of severe cases among the patients they see or know about. That will of course only be symptomatic cases.

Using the illustrative numbers above, Omicron looks less bad. Delta has a 5% hospitalization rate among symptomatic cases versus 3.7% for Omicron, and a death rate/symptomatic cases of 1% for Delta versus 0.6% for Omicron.

Another factor that may be giving doctors some relief is the shift away from viral pneumonia means that hospitalized patients are likely to have their cases resolve faster. In earlier Covid waves, the severely ill often spent 2 to 3 weeks in a hospital, which is far longer than for most ailments. That meant Covid cases would quickly consume hospital capacity.

However, an offset with Delta is that bad Covid cases, if caught early enough, could be treated with monoclonal antibodies. That’s largely out with Omicron. Most monoclonal antibodies are ineffective against Omicron and the few that work are in very short supply.

And consider:

And we’ve repeatedly pointed out from the very get go in South Africa that Omicron is putting an unprecedented level of babies to nine year olds in the hospital. The current vaccines do not produce an adequate antibody response in children under five to justify their use. So when the press demonizes the unvaxxed, that includes toddlers as well as young school age children not yet vaccinated either due to lack of availability or parental concern about limited safety testing on the young.

To have a solid handle on Omicron severity, we need large scale, population-wide surveys, and a ton of sequencing to identify Omicron versus Delta cases. That means we may have to wait for the UK to do the work, since they conduct periodic tests of 100,000 and lots of sequencing.

In the meantime, US testing is a shambles. Readers were describing the difficulty of getting a test in comments. From IM Doc yesterday:

The testing supplies and kits are simply non-available – except in the health department and the hospital.

So so many people are calling in – and we are just assuming they have COVID. There are not enough tests to even begin to appropriately deal with this problem.

The ones I am screening and are of a concern – we also check for RSV or the FLU – but by the time most people hear there is no COVID testing – they are not interested in anything – and it will likely be expensive. Never dreamed that 2 years into this – THE TESTING REGIME WOULD BE WORSE THAN IT WAS IN APRIL 2020. JUST SIMPLY UNBELIEVABLE.

The rage is palpable and getting worse by the minute.

IM Doc is also seeing Covid, presumably Omicron-induced diabetic ketoacidosis, as well as some other disturbing symptoms:

2 very distinctive things happening in this current COVID wave –

1). I have now had 2 DKA [diabetic ketoacidosis]’s in young healthy people who are COVID positive. This is just in the past week – I maybe see them 3-5 times a year – 2 in the last week is very different. I have also admitted 4 TYPE II DM – not in DKA – but they are in hyperosmolar coma with very elevated blood sugars – the lowest in the group was 683. All 6 of these patients are COVID positive – 4 with very mild cases – And I cannot tell you how unusual it is to see even 1 of these in 6 months. Almost exclusively type 2 DM who have fallen off the truck and gone on a Ding Dong binge or some such.

Not sure what to make of this – but the timing is concerning.

2). All 3 of these guys are COVID positive – 2 under 30 – 1 much older – all 3 came in the past few days – with massively swollen testicles. All I can say is I certainly do not see this problem very often at all – to have 3 in the span of just a few days is really different. ALL 3 Sonos were orchitis. I cannot tell you how unusual this is.

It must be noted that everyone of these patients is vaccinated.

Maybe nothing – but maybe that Omicron is playing games with the endocrine organs.

Dr. Craig Spencer, Director of Global Health in Emergency Medicine at Columbia Medical School, also reported seeing apparent Covid-induced diabetic ketoacidosis:

The reason we keep emphasizing the risk of Covid is that the precautionary principle argues for conservatism when uncertainty meets serious outcomes. And it is simply maddening to see the “We must keep the economy open” forces seizing on preliminary data, particularly of the cheery sort, and treating it as dispositive. The sound course is to continue to be cautious until we have better information or better remedies.

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