Those with diabetes are at a much higher risk of developing a severe COVID-19 infection, leading to hospitalization and/or death. Diabetes causes your body to have increased inflammation, weakened immune responses, and decreased circulation [1,2]. Diabetes can also cause damaged or weakened blood vessels, which increase the likelihood of unwanted blood clots to form [3]. Overall, diabetics are 2X more likely to develop severe COVID-19 and 3X more likely to die. [4]

SARS-CoV-2, the virus that causes what we know as COVID-19, is a respiratory virus. While many viruses primarily infect the upper respiratory system (nose, mouth), SARS-CoV-2, can also infect the lower respiratory system (lungs), leading to pneumonia and/or acute respiratory distress syndrome (ARDS), which are deadly in and of themselves. For diabetics, COVID-19 can cause high blood sugars and diabetic ketoacidosis (DKA) [5]. Additionally, COVID-19 can also damage various tissues in organs outside of the lungs from increased inflammation. 30% of COVID-19 deaths are due to heart, liver, or kidney failure [6].

New studies have shown alarming evidence that COVID-19 infection may be leading to the development of diabetes among children and adolescents. In a study of over 80,000 individuals, those who became sick with COVID-19 were 166% more likely to develop diabetes than those who had not been infected. No other respiratory viruses have been associated with diabetes [7].

There are plenty of ways to reduce your risk for COVID-19 infection including vigilant masking, hand washing, and social distancing.  While all of these reduce the likelihood you become infected, vaccination is your best option when it comes to the extra protection your body needs to fight off the virus if you do become infected.  Be proactive; vaccination is a vital step in protecting yourself when you have a high-risk health condition. 

Making a plan for a COVID-19 positive test is also important.  You should make sure you have enough groceries and household items, an abundance of simple carbs at home (e.g. soda, honey, jam, etc.) and enough medication and insulin for 14 days.  You should also have enough glucagon and ketone strips in case of lows or highs [8].  You may need to check your urine ketone levels to detect if you may be in DKA.  Watch for signs of high blood sugar or DKA, which can include increased urination, excessive thirst, nausea or vomiting.

Please talk to your physician for more information to stay prepared and to protect yourself from severe COVID-19.

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Citations:
1. Caio Oliveira de Sá-Ferreira, et. al. Diabetic ketoacidosis and COVID-19: what have we learned so far? American Journal of Physiology-Endocrinology and Metabolism 2022 322:1, E44-E53. Dec 22, 2021.
2. Mayo Clinic. How does COVID-19 affect people with diabetes. Jan 04, 2022.
3. National Heart, Lung, and Blood Institute. COVID-19 and the Blood. November 03, 2021.
4. Mantovani, Alessandro, et al. Diabetes as a risk factor for greater COVID-19 severity and in-hospital death: a meta-analysis of observational studies. Nutrition, Metabolism and Cardiovascular Diseases 30.8 (2020): 1236-1248.
5. Lim, S., Bae, J.H., Kwon, HS. et al. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol 17, 11–30 (2021).
6. Tay, M.Z., Poh, C.M., Rénia, L. et al. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol 20, 363–374 (2020).
7. Barrett CE, Koyama AK, Alvarez P, et al. Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged 8. American Diabetes Association. Planning for Coronavirus. Accessed Feb 3, 2022.
9. American Diabetes Association. If You Get Sick, Know What to Do. Accessed Feb 3, 2022. 

Those with heart disease or various other cardiovascular problems are at a much higher risk of developing a severe COVID-19 infection, leading to hospitalization and/or death. When your lungs are damaged and cannot supply your body with enough oxygen, your heart has to work even harder [1]. If your heart is weak or experiencing other problems, this puts you at even greater risk of death. Those with high blood pressure also may have damaged or weak blood vessels, which increase the likelihood of unwanted blood clots to form [2]. Those with hypertension are 2.5X more likely to develop severe COVID-19 and those with cardiovascular disease are 3.1X more likely. It has also been shown that younger individuals that have these conditions are at greater risk than older individuals with the same condition [3]. Overall, about 10% of patients with pre-existing cardiovascular disease (CVD) will die if they contract COVID-19 [4].

SARS-CoV-2, the virus that causes what we know as COVID-19, is a respiratory virus. While many viruses primarily infect the upper respiratory system (nose, mouth), SARS-CoV-2, can also infect the lower respiratory system (lungs), leading to pneumonia and/or acute respiratory distress syndrome (ARDS), which are deadly in and of themselves. However, severe COVID-19 infection can can also cause inflammation in other organs leading to multi-organ failure. 30% of COVID-19 deaths are due to heart, liver, or kidney failure [5]. Much of this multi-organ damage can be linked to blood clots, which can lead to heart attacks or strokes. Inflammation can cause blood clots to form and starve organs of oxygen. When people are ill, they may be lying in bed for extended periods of time. This immobility makes the likelihood for clots even worse [6]. In the ICU, upwards of 20% of COVID-19 patients develop blood clots [7].

There are plenty of ways to reduce your risk for COVID-19 infection including vigilant masking, hand washing, and social distancing. It is also important to keep up with your heart health through healthy eating, exercising, good sleep, and monitoring your blood pressure [8]. Talk with you doctor about your current medications and make sure to stick with it. While all of these options help, vaccination is your best option when it comes to the extra protection your body needs it needs to fight off the virus if you do become infected. Be proactive; vaccination is a vital step in protecting yourself when you have a high-risk health condition.

There have been reported cases of myocarditis/pericarditis (heart inflammation) in male adolescents and young adults 16 years and older after the second dose of Pfizer or Moderna. Not only are these cases extremely rare, but they are also generally mild and resolve quickly with medicine and rest [9]. Blood clots that have been linked to women between the ages of 30-49 who have taken the Johnson & Johnson vaccine, are even more rare [7]. Keep in mind, COVID-19 infection has also lead to myocarditis, blood clotting, other cardiovascular issues at a much greater rate than vaccination [10,11]. As of January 31, 2022, more than 539 million doses of the COVID-19 vaccine have been given in the United States. There have been 57 confirmed cases related to severe blood clotting and 1,277 confirmed cases related to myocarditis [12].

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Citations:

1. Maragakis, Lisa. Who Is at High Risk for Severe Coronavirus Disease? John's Hopkins: Medicine. Updated December 8, 2021.
2. National Heart, Lung, and Blood Institute. COVID-19 and the Blood. November 03, 2021.
3. Bae S, Kim SR, Kim MN, Shim WJ, Park SM. Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis. Heart. 2021 Mar;107(5):373-380. 
4. Lee Lewis, Dara K. How does cardiovascular disease increase the risk of severe illness and death from COVID-19? Harvard Health Publishing. April 2, 2020.
5. Tay, M.Z., Poh, C.M., Rénia, L. et al. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol 20, 363–374 (2020). 
6. Kurtzman, Laurie. Why COVID-19 could be causing blood clots—and what you can do to lower your risk. Ohio State University: Wexner Medical Center. April 23, 2021.
7. Katella, Kathy.  The Link Between J&J’s COVID Vaccine and Blood Clots: What You Need to Know. Yale Medicine. Updated Dec 17, 2021.
8. Glassberg, Helen. How to Keep Your Heart Healthy During the COVID-19 Pandemic. Penn Medicine. June 3, 2020. 
9. UC Davis Health. Heart inflammation, COVID-19 and the rare side effects of the vaccine. September 2, 2021. 
10. Center for Disease Control. Myocarditis and Pericarditis After mRNA COVID-19 Vaccination. Updated September 8, 2021. 
11. Boehmer TK, Kompaniyets L, Lavery AM, et al. Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021. MMWR Morb Mortal Wkly Rep 2021;70:1228–1232. 
12. Center for Disease Control. Selected Adverse Events Reported after COVID-19 Vaccination. Updated Jan 31, 2022

Obese individuals are at a much higher risk of developing a severe COVID-19 infection, leading to hospitalization and/or death. Obese individuals are 3X more likely to be hospitalized, making up 30.2% of COVID-19 patients in the hospital in 2020 [3]. Obesity is linked to a weakened immune system, chronic inflammation, higher chances for blood clots, as well as other deadly comorbidities like diabetes and heart disease [1,2]. Obesity also affects the ability for ventilation to be successful while in the hospital, reducing chances of survival even further. Individuals with a BMI between 30-34.9 have a 36% increased chance for ventilation and individuals above a BMI of 45 have a 61% increased chance of death [4].

SARS-CoV-2, the virus that causes what we know as COVID-19, is a respiratory virus. While many viruses primarily infect the upper respiratory system (nose, mouth), SARS-CoV-2, can also infect the lower respiratory system (lungs), leading to pneumonia and/or acute respiratory distress syndrome (ARDS), which are deadly in and of themselves. Obese individuals may have reduced lung capacity making it even harder to oxygenate the body. Additionally, inflammation caused by COVID-19 and blood clots are attributed to multi-system organ damage. When hospitalized, obesity can make it harder for physicians to treat severe COVID-19. Ventilation or being laid prone are both tools physicians use to save patients, and become harder when a patient is obese [3,6].

There are plenty of ways to reduce your risk for COVID-19 infection including vigilant masking, hand washing, and social distancing. While all of these options help to prevent infection, vaccination is your best option when it comes to the extra protection your body needs it needs to fight off the virus if you do become infected. The Obesity Society has recognized the efficacy of vaccines for obese individuals as data shows that COVID-19 vaccines are 90%+ effective at preventing hospitalization and death [7]. Be proactive; vaccination is a vital step in protecting yourself when you have a high-risk health condition.

In addition, weight loss is something that individuals can work on to improve their overall health. Eating a healthy diet, engaging in regular physical activity, and getting enough sleep are all important steps to consider when developing healthy habits and improving your overall health.

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Citations:

1. Shetye, Bharti. Covid-19 and Obesity: What Does it Mean For You? Obesity Action Coalition. Winter 2021.
2. Demeulemeester F, de Punder K, van Heijningen M, van Doesburg F. Obesity as a Risk Factor for Severe COVID-19 and Complications: A Review. Cells. 2021;10(4):933. Published 2021 Apr 17.
3. Center for Disease Control. Obesity, Race/Ethnicity, and COVID-19. Reviewed November 8, 2021.
4. Kuehn BM. More Severe Obesity Leads to More Severe COVID-19 in Study. JAMA. 2021;325(16):1603.
5. Tay, M.Z., Poh, C.M., Rénia, L. et al. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol 20, 363–374 (2020).
6. MacMillan, Carrie. Obesity Emerges as Risk Factor for Severe COVID-19 Illness. Yale Medicine. August 10, 2020.
7. Butsch WS, Hajduk A, Cardel MI, Donahoo WT, Kyle TK, Stanford FC, Zeltser LM, Kotz CM, Jastreboff AM. COVID-19 vaccines are effective in people with obesity: A position statement from The Obesity Society. Obesity (Silver Spring). 2021 Oct;29(10):1575-1579.