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COVID-19 – Latest News on the Delta Variant, Booster Shots, and Mask Mandates

Last updated: 8/2/21
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By: Arvind Sommi Matthew Garza

COVID-19 cases are back on the rise. The best way to keep you, your loved ones, and those around you safe and healthy is to get vaccinated. Get our updates on the importance of vaccinations, especially for people with diabetes, COVID variants, vaccine boosters, and how to talk to others about vaccines.

With COVID-19 cases rising quickly in many areas of the country, healthcare professionals are urging everyone, and especially those with diabetes, that be the best way to protect yourself and others is by getting vaccinated and encouraging others to do so as well.

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What do we know about how COVID impacts people with diabetes? Does COVID affect blood sugar levels?

What we have learned so far from researchers during the COVID-19 pandemic is that glucose control matters before and during COVID infection – poor glucose control can lead to worse outcomes (read these studies to learn more: “Association of Blood Glucose Control and Outcomes in Patients with COVID-19 and Pre-existing Type 2 Diabetes” and “Association Between Achieving Inpatient Glycemic Control and Clinical Outcomes in Hospitalized Patients With COVID-19: A Multicenter, Retrospective Hospital-Based Analysis”). Negative outcomes associated with COVID infection include prolonged length of stay in the intensive care unit (ICU), greater risk for mechanical ventilation, and increased mortality rates.

“The risk [of experiencing worse outcomes if infected with] COVID is greatest for those with diabetes who already have other problems – excess weight or obesity, high blood pressure, or kidney, heart, liver disease,” said Dr. John Buse, director of the Diabetes Center at University of North Caroline School of Medicine. “People with their blood sugar in range, no diabetes complications, lower age, and lower weight seem to be less likely to have severe COVID, but they are still at higher risk of hospitalization or death than people without diabetes.”

Research also suggests that COVID might be causing new cases of hyperglycemia that could lead to diabetes in rare cases. In a research study published earlier this year looking at 551 people who were hospitalized in Italy, the investigators found that 46% of those without diabetes who were newly hospitalized for COVID experienced new instances of hyperglycemia (indicated by the fact that their A1C was normal even though they were experiencing high blood sugar levels). Of those cases, 35% still had elevated glucose levels that persisted six months after infection, and 2% reached a level high enough to be diagnosed with diabetes.  

Scientists think that this may be because COVID can directly infect the beta cells in the pancreas, leading to the beta cells damage.

Research presented at the 81st ADA Scientific Sessions in June also suggested that high glucose levels may increase the expression of COVID receptors in the body, leading to worse outcomes and severity from infection.

“I also think the connection between diabetes and a higher risk of complications from COVID is an opportunity for a call to action to address underlying system failure and health disparities that existed prior to the pandemic,” said Dr. Nicolas Cuttriss, Founding Director of ECHO Diabetes Action Network and a pediatric endocrinologist.

“The connection between racial disparities and risk of complications from COVID is an opportunity for people with diabetes to speak up and demand better care,” he said. “Unfortunately, the majority of people living with diabetes in the United States are not able to achieve the recommended diabetes outcomes (A1C targets, blood pressure control, lipid control). If you have diabetes and A1C is not in the ‘target range’ – which is true for the majority of people living with diabetes – it is not your fault, and you are not failing.” There are other factors (social determinants of health) that can contribute to not reaching your targets including not having access to quality care or healthy lifestyle options – the responsibility is not only on you.

He urged those who become infected with COVID to seek immediate treatment from their healthcare provider or if you are experiencing emergency warning symptoms of COVID to go to an urgent care or emergency care center. “Do not let guilt or fear prevent you from reaching out to get immediate guidance,” he said. “And for your diabetes, do not forget about basic ‘sick day management’ principles, the same holds true for COVID.”

What is the Delta variant and why is getting vaccinated more important now than ever?

A COVID infection is concerning and dangerous for anyone, but those with diabetes face unique challenges that warrant extra precautions – especially considering the new Delta variant.

The Delta variant is one of the latest in a series of variants and has quickly become the predominant virus in US COVID cases. Part of what can makes a variant so dangerous is that it may spread more easily than the original virus. Data shows that the Delta variant is so far the most aggressive and transmissible version yet – with the CDC saying that this virus is as infectious (or transmissible) as chickenpox. The Delta variant now accounts for the majority of new COVID hospitalizations in the US, and unvaccinated people are at the highest risk of getting infected.

The best protection against the Delta variant is to be fully vaccinated – in the case of the Pfizer or Moderna vaccine, this would include both shots and the recommended two week waiting period after the second shot. So far, there has been data (not peer-reviewed) that the Pfizer vaccine is 96% effective against hospitalization for the Delta variant while the AstraZeneca vaccine (which is uncommon in the US but has been widely used in Europe) is 93% effective.

“I ask every patient and family if they have been vaccinated – whether they have diabetes or not. I tell them all to get vaccinated,” said Dr. Cuttriss. “To parents of children who are not yet eligible for COVID vaccination, I tell them to be ready to get their child vaccinated once it becomes available for their age group. Keep up to date with the evolving guidelines and speak with your health care provider if you have questions or need additional guidance.”

Dr. Buse agreed. “The most important thing to know now in the face of Delta variant and the emerging surge is that vaccination is the key to your best possible outcome,” he said. “Wearing a mask will protect those around you but does less to protect you. The most important thing is to get the vaccine to protect your health and future wellness.”

If you or someone you know is interested in getting vaccinated, click here to help you locate the closest vaccination site.

How can you talk to people who may be hesitant about getting vaccinated?

You may know people who have fears or reservations about the COVID vaccine. When speaking with people who might be hesitant about getting the vaccine themselves or for their loved ones, there are a few things you should keep in mind for a productive conversation.

First, try to target the middle ground and focus on those who are considering the vaccine and are not staunchly opposed. When having these conversations, be sure to ask open ended questions that allows you to have a detailed discussion such as:

  • What do you think about the COVID-19 vaccines?

  • Why do you feel this way about the vaccine?

  • What kinds of concerns do you have about the vaccines?

  • Are there specific things that you are worried about for yourself or your loved ones?

  • Do you have any questions about the vaccines or what the process was like to get the vaccine?

By listening to what they have to say, you can better understand their doubts without making them feel ashamed or embarrassed. You should also try to reference trusted health officials (or point them in the direction of their own trusted healthcare providers) and avoid pushing your own opinions and beliefs. At the end of July, over 164 million people in the US had been vaccinated and the risk of an adverse or deadly event occurring as a result of the vaccine is extremely rare. The research shows that the benefits of receiving the vaccine far outweigh the risks.

“I have a very personal approach,” said Dr. Anne Peters, an endocrinologist and professor at the University of Southern California, Keck School of Medicine. “I tell them that I had COVID at the start of the pandemic and was sick for a year with long-haul symptoms which they definitely do not want to get. I also tell them that my father got COVID one week before he was supposed to get the vaccine because an infected person came into the house he was living in. I tell them that there was nothing worse than holding my father’s hand as he struggled for breath and passed away from pneumonia [as a result of his COVID infection]. I tell them that if they love their family, they will get vaccinated.”

“It is absolutely critical that everyone with diabetes be vaccinated. The benefits are large, and the risks are small,” said Dr. Buse. “The potential harms from COVID-19 in patients with diabetes are substantial in the short run including hospitalization, stroke, kidney failure, heart damage, or even death. In the long run, many people, even with mild cases of COVID, may be left with lingering problems or full disability. Please get vaccinated!”

Will I need a booster shot for COVID-19?

President Biden and the nation’s top infectious disease expert Dr. Fauci have both publicly stated that the government is considering the need for an additional dose of the vaccine, known as a booster shot, in particular for those who are immunocompromised. While you are protected against COVID if you are vaccinated, research from Israel has shown that the Pfizer vaccine may be less effective after 6 months. However, this same research also found that the Pfizer vaccine was still 91% effective for preventing serious illness from COVID and 88% effective at preventing hospitalization.

“I do not believe there is an urgent need to get a booster now and it is not currently recommended by the CDC. However, I imagine boosters may be recommended in the weeks and months to come,” said Dr. Buse. There are also some important questions that need to be answered for booster shots, including: when should they be given, what dose should be used, and whether getting the same vaccine from the same company is necessary.

Pfizer has said that it has plans to ask the FDA for the authorization of booster shots, but the CDC still maintains, for now, that booster shots are not required for otherwise healthy people. The CDC also does not recommend Americans mix COVID vaccines from different companies. Information on this topic is still developing and we will provide updates as needed.

Do you have to wear a mask again?

The CDC has recently updated its position that vaccinated individuals can return to doing the activities they participated in prior to the pandemic; however, in order to reduce the risk of being infected with the Delta variant and possibly spreading it to others, they suggest in areas of substantial or high transmission of COVID-19 that everyone should wear a mask indoors in public spaces. Several prominent healthcare organizations, such as the American Academy of Pediatrics, have also called for universal masking of both vaccinated and unvaccinated people to stop the overall spread of COVID.

While many of the new COVID cases have been in unvaccinated young people who are less likely to be hospitalized, this group could transmit the virus to high-risk populations who are unvaccinated for various reasons.

“For now, I encourage people to use common sense,” said Dr. Peters. “If you are indoors, wear a mask or socialize with vaccinated people. Kids below age 12 are the biggest risk because they can’t be vaccinated yet, but being together outside is always good and most people I know find ways to interact safely. COVID is definitely not gone, and we all need to keep vigilant while remembering that it is equally important [for your mental and social well-being] to socialize and live one’s life.”

It’s important to follow your local government guidelines as they may require masks to be worn indoors. Although getting everyone vaccinated is the ultimate goal, wearing masks could potentially slow the spread of COVID to people who are at higher risk or immunocompromised. It can also help prevent breakthrough cases in vaccinated people with diabetes who may be at greater risk for severe complications.

More resources

While we await further information and research on COVID vaccines, booster shots, and variants, make sure you do your part protect yourself and those around you.

You can learn more about COVID-19 and its impact on people with diabetes by visiting our COVID-19 Resource Hub. In addition, our article from earlier this year, “What You Should Know About COVID-19 Vaccines and Diabetes,” has more information about vaccines.

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