High blood sugar puts COVID patients at high risk of needing a ventilator or admission to an intensive care unit.

COVID patients with high blood sugar, whether they have diabetes or not, suffer worse outcomes and increased risk of death.

Hyperglycemia or high blood glucose is a condition that happens when not enough insulin is produced or used by the body.

However, stress, certain medications, illness, lack of exercise, and excessive eating can lead to this condition.

A study examined the effect of hyperglycemia in coronavirus patients and found that these patients experienced worse health problems, no matter if they were diabetics or not.

Patients hospitalised for COVID who had high blood sugar were more likely to be put on a ventilator or admitted to the intensive care unit (ICU), develop an acute kidney injury (AKI), and die in hospital.

Dr Samara Skwiersky, the study’s lead author, said:

“COVID-19 patients presenting to the hospital with hyperglycemia require closer observation, as they are likely to require more aggressive therapies.”

The research team looked into undesirable COVID outcomes in 708 adults by measuring their blood glucose levels.

Hospitalisation of a patient with diabetes is recommended when the blood glucose values are between 140 and 180 mg/dL.

The study found that diabetes patients with a blood glucose value of over 140 mg/dL were 2.4 times more likely to need a breathing machine and be admitted to ICU.

The undesirable COVID outcomes got worse in diabetic patients with blood glucose levels of over 180 mg/dL as they were twice as likely to die in hospital.

However, patients who were not diabetics, but had a blood glucose level of over 140 mg/dL, were twice as likely to die of COVID.

Also, the odds of intubation and developing AKI were increased by 2.3 times and the risk of ending up in ICU was 3.5 times higher for these patients.

The odds of intubation and ICU admission was almost tripled and death risk was quadruple for those without diabetes but with a blood glucose level of over 180 mg/dL.

Dr Skwiersky said:

“The results from our study, reiterate the importance of regularly monitoring blood glucose in patients hospitalized with COVID-19, even without a prior diagnosis of diabetes.”

She added:

“More frequent glucose monitoring and treatment with insulin therapy to a target glucose value less than 140 mg/dL could improve outcomes in these patients.”

The study was presented at ENDO 2021, the Endocrine Society’s annual meeting.

Are people with one particular blood type more at risk of COVID infection?

Previous studies have been found that people with O-type blood are at lower risk from coronavirus, while others with blood type A or AB are more susceptible to infection.

However, new research finds no link between blood type and catching the disease or getting seriously ill.

The study included 107,796 people tested for COVID, of which more than 11,000 tested positive.

They compared the blood type of COVID patients with those who tested negative, were hospitalized or non-hospitalized, and those who were in intensive care unit (ICU) with non-ICU patients.

The review found no relationship between ABO blood groups and contracting coronavirus disease.

Also there was no link between blood type and a reduced or increased risk of COVID-19 severity.

The authors wrote:

“The smaller sample sizes and retrospective, observational nature of many prior studies, in addition to their striking heterogeneity of ABO associations with disease susceptibility and severity, could be due to chance variations, publication bias, differences in genetic background, geography and environment, and viral strains.”

They added:

Given the large and prospective nature of our study and its strongly null results, we believe that important associations of SARS-CoV-2 and COVID-19 with ABO groups are unlikely and will not be useful factors associated with disease susceptibility or severity on either an individual or population level for similar environments and ancestries.”

However, a recent Danish study, which is larger, compared data from nearly half a million people tested for COVID with more than two million non-tested individuals (the control group).

The results suggest that those with blood type O are less vulnerable to the virus and so they have the lowest risk of developing serious illness.

This is because blood group O has no antigens but contains anti-A and anti-B antibodies that are able to neutralize the virus when entering human cells.

Another study analysed the blood group antigens on respiratory and red blood cells and found that SARS-CoV-2 is highly attracted to the blood type A antigen expressed in the respiratory tract.

The study was published in JAMA Network Open (Anderson et al., 2021).

A common virus that blocks the replication of the SARS-CoV-2 virus and reduces COVID-19 disease severity.

The virus that causes the common cold has the ability to give people some protection against coronavirus infection.

Rhinovirus is a mild viral infection responsible for the common cold in humans.

According to a new study, the virus can stimulate an innate immune response against SARS-CoV-2, stopping the virus from replicating in the respiratory tract.

An innate or natural immunity is the first line of defence against any infection invading our body.

Respiratory viruses such as rhinovirus often infect cells in the respiratory tract whereas other type of viruses can only infect some of the cell types in the human body.

The interaction between different viruses may change the epidemiology of respiratory infections so as the prevalence of rhinoviruses increases, the number of new COVID cases will go down.

Rhinoviruses are responsible for more than 50 percent of respiratory tract infections, therefore the rhinoviruses’ interactions with other respiratory viruses influences the severity and type of infections in people.

This virus-to-virus interaction may also influence patterns of infection and how they circulate and infect different people.

As well as the respiratory tract, virus-to-virus interactions can happen in multi-virus environments such as the gastrointestinal tract.

For this study, samples of human respiratory cells were infected with SARS-CoV-2 in the lab.

The team created a similar environment to the human body where infections occur.

Then they examined the replication SARS-CoV-2 in these cells in the absence or presence of rhinovirus.

Professor Pablo Murcia, the study’s co-author, said:

“Our research shows that human rhinovirus triggers an innate immune response in human respiratory epithelial cells which blocks the replication of the COVID-19 virus, SARS-CoV-2.

This means that the immune response caused by mild, common cold virus infections, could provide some level of transient protection against SARS-CoV-2, potentially blocking transmission of SARS-CoV-2 and reducing the severity of COVID-19.

The next stage will be to study what is happening at the molecular level during these virus-virus interactions, to understand more about their impact on disease transmission.

We can then use this knowledge to our advantage, hopefully developing strategies and control measures for COVID-19 infections.

In the meantime, vaccination is our best method of protection against COVID-19.”

The study was published in The Journal of Infectious Diseases (Dee et al., 2021).

An early clue of who is more likely to get seriously ill from COVID-19.

Blood tests of COVID patients when they arrive in emergency rooms can give doctors important clues if the patient will recover quickly or will be taken to intensive care.

Certain biomarkers related to the activation of white blood cells, if found in a patient’s blood sample, can predict worse outcomes from COVID, a study reveals.

Dr Hyung Chun, study co-author, said:

“Patients with high levels of these markers were much more like to require care in the intensive care unit, require ventilation, or die due to their COVID-19.”

Patients with COVID have elevated levels of some proteins in the blood such as D-dimer and cytokines.

These markers are part of the inflammatory response.

Until now, no biomarkers have been identified to predict which patients will get very sick from the coronavirus.

The study identified five proteins known as HGF, lipocalin-2, G-CSF, resistin, and IL-8 in the patients’ blood samples.

These proteins are linked to neutrophils that are the most abundant type of white blood cell that defends the body against infection and inflammation.

The team found that patients with coronavirus who later became severely ill, have high levels of these proteins in their blood.

Previously the link between these proteins and obesity has been established but not for viral illnesses including coronavirus disease.

Dr Alfred Lee, study co-author, said:

“This is one of the first demonstrations that a set of biomarkers in the blood of COVID patients can predict eventual ICU admission, even before such patients become critically ill.”

The authors emphasised that detecting these indicators at the early stage of infection will help patients and enhance treatment.

Dr Chun said:

“If a diagnostic test [for these biomarkers] could be ordered early, it could give us a better sense of who is more likely to become critically ill and will benefit from a higher level of care and consideration for therapies that affect the immune system early on in their hospitalization.

Many of these drugs do carry potential side effects, and these tests may help identify those patients who would benefit the most.”

The link between obesity and COVID has already been established as obese people are at higher risk for getting seriously ill, being hospitalised, and dying from the infection.

Dr Lee said:

“Neutrophils are inflammatory cells so it makes sense that they would be elevated in the context of both obesity — which involves chronic, low-grade inflammation — and COVID-19, which causes hyperinflammation in the most severe cases, leading to tissue damage and organ failure.

There are also signs that neutrophils might participate in thrombosis or blood clotting.”

The study was published in the journal Blood Advances (Meizlish et al., 2021).

COVID-19 reinfection is possible and some are at higher risk.

If you are under the age of 65 and have had COVID-19 then most likely you are protected from catching it twice, at least for six months after the infection.

But those aged 65 years and older are at higher risk of getting the disease again.

According to a new study, the protection against repeat infection among adults 65 years and older is 47 percent while for younger people it is 80 percent.

The study also found that immunity and protection will last at least six months after infection.

Dr Daniela Michlmayr, the study’s co-author, said:

“In our study, we did not identify anything to indicate that protection against reinfection declines within six months of having COVID-19.

The closely related coronaviruses SARS and MERS have both been shown to confer immune protection against reinfection lasting up to three years, but ongoing analysis of COVID-19 is needed to understand its long-term effects on patients’ chances of becoming infected again.”

The study analysed COVID test data on 4 million people in Denmark from March to December 2020.

It shows that most people who recovered from COVID infection were protected against reinfection, only 0.65 percent returned positive tests, meaning about 1 in 200 people tested positive for COVID twice.

Seniors are more susceptible to coronavirus reinfection as generally aging is a key factor in the severity of the disease.

Dr Steen Ethelberg, study co-author, said:

“Our study confirms what a number of others appeared to suggest: reinfection with COVID-19 is rare in younger, healthy people, but the elderly are at greater risk of catching it again.

Since older people are also more likely to experience severe disease symptoms, and sadly die, our findings make clear how important it is to implement policies to protect the elderly during the pandemic.

Given what is at stake, the results emphasise how important it is that people adhere to measures implemented to keep themselves and others safe, even if they have already had COVID-19.

Our insights could also inform policies focused on wider vaccination strategies and the easing of lockdown restrictions.”

Due to the limitation of clinical information it is not clear yet if the severity of COVID symptoms influences patients’ protection from catching it again.

The study was published in The Lancet (Hansen et al., 2021).

The psychology studies that reveal what the pandemic did to us and how we learned to cope with it.

The pandemic has turned our mental worlds upside down — not to mention the physical.

First it made us hoarders, then gave us new social rules to follow.

Soon we were working from home, feeling the pressure on our relationships, accompanied by mental health problems and strange dreams.

And still it goes on.

Slowly we learned to cope, by staying in touch with our emotions, doing meaningful activities, accessing nature whenever possible, turning to our partners for comfort (should we be lucky enough to have one) and getting help online when it was all too much.

Here is PsyBlog’s guide to the major psychology studies of the pandemic.

A. How COVID changed us

1. Hoarders

First it turned people into hoarders: some stashed cash under the mattress, others hand sanitiser and masks.

But it was the hoarding of toilet roll that really caught the headlines.

But why toilet roll?

Some psychologist think it was partly down to herding — in other words, people saw others hoarding it and then copied each other (Baddeley, 2020).

In the end we are social creatures and we partly learn by copying, especially when under stress.

2. Learn new social rules

To fight the pandemic, we had to learn a load of new social rules: when to go out, stay at home, wear a mask, how to greet each other and when and where to walk, run and travel.

Who followed the rules and what influenced them, psychologists asked.

Research found that people are more likely to follow COVID restrictions when their friends and family do.

Social influence was a more powerful motivator than whether or not people agreed with the rules.

The findings underline the tremendous power of social influence on people’s behaviour.

3. Why people flout the rules

In the absence of other people to copy, though, we have to rely on our own memories which, it turns out are not great.

People with better memories followed all the rules, but those with worse memories tended to forget, one study found (Xie, 2020).

Similarly, worrying about money, jobs and where the next meal is coming from also limit people’s ability to follow all the rules (Probst et al., 2020).

There’s even evidence that people started taking more risks during the pandemic and are more prone to punishing others as a result of reduced cognitive capacity (Bogliacino et al., 2021).

Professor Francisco Lupiáñez, study co-author, said:

“People’s decision-making abilities were impaired, and their reactions were not those we might have expected.

Instead of being more careful because they were in a pandemic, they were taking risks, because they couldn’t take it any more.”

4. Anxious and depressed

Quite naturally the pandemic made a lot of us depressed and anxious.

One study found that one-in-three adults are anxious and depressed as a result of quarantines, lockdowns and social distancing.

But some groups are suffering more.

Women, young people and the poor are experiencing the worst psychological distress from COVID, research from 68 studies found.

Another study suggested that 80 percent of people in their 20s in the U.S. are experiencing significant depressive symptoms (Horigian et al., 2020).

Along with increased depression and anxiety, people are experiencing higher rates of post-traumatic stress disorder and insomnia.

Interestingly, the old have fared better emotionally compared to younger people.

That is despite the fact that older people are more at risk from the virus (Klaiber et al., 2020).

Mr Patrick Klaiber, the study’s first author, explained:

“Younger and middle-aged adults are faced with family- and work-related challenges, such as working from home, homeschooling children and unemployment.

They are also more likely to experience different types of ongoing non-pandemic stressors than older adults, such as interpersonal conflicts.”

The personality type faring the worst during the pandemic is, unsurprisingly, people high in neuroticism.

And the personality type ‘enjoying’ the pandemic?

Sadists.

5. Working from home

Perhaps one of the biggest changes to people’s lives is the accelerating trend towards working from home.

The challenges people face working from home are well-known and include a loss of social connectedness, lack of separation between work-life and home-life and increased risk of substance abuse (Kniffin et al., 2020).

There are advantages as well, of course, but periods of dramatic change like this are bound to be stressful for people.

Whether people will go back to the office and how these changes will play out over the coming years, we just do not know.

6. Relationship strain

The pandemic put tremendous strain on people’s relationships.

With schools shut, parents suddenly had to take on more childcare responsibilities.

Women did more than their fair share, research from the U.S. has found (Shockley et al., 2020).

That was bad for relationships, explained Dr Kristen Shockley, the study’s first author:

“When the wife does it all, not surprisingly, the outcomes are bad for the couple.

It’s not just bad for the wife, it’s also bad for the husband, including in terms of job performance although his work role presumably hasn’t changed.

When one person’s doing it all, there’s a lot of tension in the relationship, and it’s probably spilling over into the husband’s ability to focus at work.”

7. Upsetting dreams

The pandemic has not just changed people’s days, it has warped their nights as well, infecting our dreams.

The most common bad dreams are worrying about failures in social distancing, forgetting to wear a mask, getting the disease itself and even the end of the world.

Bad dreams may be one way for the brain to process and so reduce the fear related to the virus.

Once again, though, it is women that are having the worst of the pandemic, suffering more bad dreams than men (Schredl & Bulkeley, 2020).

B. How we coped with COVID

The keys to keeping psychologically healthy are similar whether or not there is a pandemic.

Eating right, exercising and the rest will help at any time, but there are some factors that are particularly relevant during the pandemic.

Here are a few of them:

8. Stay in touch with emotions

Staying in touch with your emotions is a good way to deal with COVID-19 stress.

It is natural to experience emotions like sadness, fear, loneliness and anxiety during the pandemic.

However, people who are psychologically flexible tend to do better.

Flexibility means acknowledging emotions, accepting them and taking whatever action is possible.

Continuing to do whatever is important to you — even if it is in modified form — is key to reducing stress.

9. Meaningful activities

Meaningful activities are central to boosting happiness while social distancing and lockdown rules are in effect.

In contrast, keeping busy just for the sake of it does not boost happiness.

Indeed, mindless busywork tends to leave people feeling unsatisfied and unsettled.

It is better to continue with activities that were enjoyable before the pandemic, as far as possible.

When people took up novelty lockdown activities, like baking and painting, just to keep busy, this was linked to more extreme emotions.

Incidentally, people who feel life has less purpose tend to sleep worse, research finds.

This could be one of the reasons that people report sleeping worse during the current pandemic.

During lockdown people are denied many of the usual routines that give meaning to life, such as work, meeting with friends and pursuing recreational activities.

Without these, life becomes devoid of purpose.

10. Nature

Access to nature is vital for surviving the pandemic.

People who are able to get out into nature are less likely to suffer depression and anxiety during lockdown.

Even a natural view from inside can help to ameliorate the effects of COVID-19 related policies.

Pandemic or not, green and blue spaces have a remarkable healing effect on people’s mental health.

11. Partners for comfort

People’s partners provide the best buffer against social disconnection due to the pandemic.

Romantic partners help keep each other’s well-being from taking a knock from social isolation.

In contrast, chatting with friends on Facetime and any number of children and pets have little effect on making people feel socially connected.

In other words, it doesn’t matter how big your household is, it’s all down to the quality of the connection.

The research affirms the importance of romantic partners for mental well-being.

12. Get help online

Like everything else nowadays, psychology went online.

People are going online to get help and psychologists are going online to give it.

The number of clinical psychologists helping people online has gone up 12-fold, one recent study found (Pierce et al., 2020).

Mr Brad Pierce, the study’s first author, said:

“I was shocked to see how quickly telepsychology was adopted.

The shift from 7% of clinical work to more than 85% represents a lot of heavy lifting in a very short time.

There was a concerted effort among the community to identify and remove long-standing barriers.

Psychologists sought out additional training, equipment was purchased, and policies were adjusted at every level to facilitate telehealth and telepsychology.”

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Some people may not need a second dose of an approved COVID-19 vaccine.

One dose of an authorized COVID-19 vaccine is enough for those who have already recovered from the infection, a new study reveals.

A person with previous exposure to COVID has a much better response to a single shot compared to uninfected individuals.

This due to the immune memory and higher levels of antibody production.

The fact that the second dose for COVID survivors is not needed could be a sensible option to stretch the vaccine supply.

Furthermore, individuals with prior COVID infection could be rescued from side-effects of a second dose which are likely to be stronger than the first shot.

Professor Viviana Simon, study co-author, said:

“We showed that the antibody response to the first vaccine dose in people with pre-existing immunity is equal to or even exceeds the response in uninfected people after the second dose.

For that reason, we believe that a single dose of vaccine is sufficient for people who have already been infected by SARS-CoV-2 to reach immunity.”

After the approval of the Pfizer-BioNTech and Moderna COVID vaccines by the U.S. Food and Drug Administration (FDA) in December 2020, millions of Americans have received one of the vaccines.

These vaccines have been reported to be highly effective against COVID infections after the second shot, with at least three weeks in between doses.

The two vaccines are well-tolerated for most people, showing no serious side effects, however, in some cases extra medical care is needed.

For this study, a group of adults with previous COVID infection were compared with another group who had no pre-existing immunity.

Within days after the first dose of vaccine, those with a history of COVID infection developed antibodies 10 to 20 times more than uninfected people.

In some cases the level of immunity was even higher than those uninfected people who received two doses of vaccine.

Professor Florian Krammer, the study’s first author, said:

“These findings suggest that a single dose of vaccine elicits a very rapid immune response in individuals who have tested positive for COVID-19.

In fact, that first dose immunologically resembles the booster (second) dose in people who have not been infected.”

The research team have also compared the adverse reactions after vaccination.

Both groups displayed symptoms such as swelling, pain, and skin redness after the first injection.

However, subjects with pre-existing immunity were more likely to experience headaches, fever, chills, fatigue, joint pain, and muscle aches than the other group.

The adverse effects to the first dose in subjects with pre-existing immunity were as severe as uninfected people experienced from the second shot.

The strong reaction is probably because the immune cells are already familiar with the virus’s spike protein and therefore the immune cell response is much stronger to the vaccine.

According to Professor Simon, a serological assay can be used to detect existing antibodies in a person that has already been infected so the booster dose can be avoided.

She said:

“If the screening process determines the presence of antibodies due to previous infection, then a second shot of the coronavirus vaccine may not be necessary for the individual.

And if that approach were to translate into public health policy, it could not only expand limited vaccine supplies, but control the more frequent and pronounced reactions to those vaccines experienced by COVID-19 survivors.”

The study was published in the New England Journal of Medicine (Krammer et al., 2021).

The vaccine also greatly reduces the chance of passing on the virus to others.

Real-world data from 1.2 million people in Israel confirms that the Pfizer vaccine is 94 percent effective against COVID after the second dose.

It gives further hope that mass immunization will end the pandemic.

The vaccine also gives strong protection against the infection since it greatly reduces the chance of passing on the virus to others.

Dr Benjamin Neuman, a virologist from Texas A&M University, commented on this study:

“The fact that the vaccines worked so well in the real world… really does suggest that if the nations of the world can find the will, we now have the means to end COVID-19 forever.”

The research covers a period from December 2020 to February 2021 when a new SARS-CoV-2 variant was first seen in England and then was detected in different countries, including Israel.

To ensure the Pfizer vaccine’s reliability and its effectiveness on the new variant, every single vaccinated person was matched to an unvaccinated person who was in the control group.

The participants in the control group shared some similarities such as sex, geographic area, age, and medical conditions with those who had been vaccinated.

The results from 14 to 20 days after the first dose suggest at least a 57 percent effectiveness for symptomatic infection and 62 percent for severe COVID.

However, for the second dose seven days after injection the efficacy was increased to 94 percent for symptomatic COVID and 92 percent for severe disease.

Moreover, the outcomes from 7 days after the second dose suggest an 87 percent effectiveness against hospitalization.

Regarding different variants of the virus, the vaccine proved to be highly effective as those who received their second injection were 92 percent less likely to become infected with any strains of coronavirus than unvaccinated people.

Despite these promising outcomes, experts believe more evidence is needed due to participants not being tested systemically.

Dr Natalie Dean, a biostatistician at the University of Florida, explained:

“Unless you are testing everyone all the time, this will miss some infections.

Nailing down this number more precisely will require specialized study designs with frequent testing.”

However, she is sure that the vaccine provides strong protective benefit.

Another study suggests that a single shot of the Pfizer-BioNTech COVID-19 vaccine gives people 90 percent protection three weeks after injection.

The study was published in the New England Journal of Medicine (Dagan et al., 2021).

Delayed hypersensitivity after the first dose of the Moderna COVID-19 vaccine is often seen in drug reactions.

Some people are having delayed skin reactions after the first dose of the Moderna COVID-19 vaccine and scientists have called for more awareness.

While day-by-day larger population are receiving a vaccination for COVID-19, more studies are coming out featuring new or extended side-effects of the injection.

(Here are the common side-effects of the Moderna vaccine.)

Communicating them to the public helps stop them being afraid of getting the vaccine.

A report on phase 3 clinical data from the Moderna vaccine trial shows that 244 of the 30,420 participants experienced delayed skin reaction after the first dose.

The research team pointed out that clinicians need to prepare their patients for possible side-effects of the first dose including large, red, sometimes raised, itchy or painful skin reactions.

Dr Kimberly Blumenthal, the study’s first author, said:

“Whether you’ve experienced a rash at the injection site right away or this delayed skin reaction, neither condition should prevent you from getting the second dose of the vaccine.

Our immediate goal is to make physicians and other care providers aware of this possible delayed reaction, so they are not alarmed, but instead well-informed and equipped to advise their patients accordingly.”

The paper provides a series of photos on patients with the delayed skin hypersensitivity to the Moderna vaccine.

The severity and size of the reactions varied widely and symptoms include localized rashes on the arm, papules (raised bumps on the skin) on the palm and fingers, edematous plaques (abnormal swelling with fluid), and targetoid lesions.

The adverse reactions began from four days after the first dose to 11 days following vaccination.

The majority were treated with antihistamines and ice but some patients received corticosteroid treatment either orally, topically or both.

However, one case was wrongly treated with antibiotics, Dr Erica Shenoy, study co-author, explained:

“Delayed cutaneous hypersensitivity could be confused—by clinicians and patients alike—with a skin infection.

These types of reactions, however, are not infectious and thus should not be treated with antibiotics.”

These patients recovered from the adverse effects on average 6 days after symptoms occurred.

About half of the patients had recurring reactions two days after receiving the second dose.

However, none of these experienced any worse reaction regarding the second dose than the first injection.

The skin-biopsy test in this study showed a delayed type hypersensitivity immune response which is often seen in reactions to drugs.

Dr Esther Freeman, study co-author,

“For most people who are experiencing this, we believe it’s tied to the body’s immune system going to work.

Overall, this data is reassuring and should not discourage people from getting the vaccine.”

The study was published in the New England Journal of Medicine (Blumenthal et al., 2021).