CROWN POINT, IND. —
When their 11-year-old son started losing weight and drinking lots of water, Tabitha and Bryan Balcitis chalked it up to a growth spurt and advice from his health class. But unusual crankiness and lethargy raised their concern, and tests showed his blood sugar levels were off the charts.
Just six months after a mild case of COVID-19, the Crown Point, Indiana, boy was diagnosed with Type 1 diabetes. His parents were floored — it didn’t run in the family, but autoimmune illness did and doctors said that could be a factor.
Could his diabetes also be linked with the coronavirus, wondered Nolan’s mom, a respiratory therapist. Turns out scientists in the U.S. and elsewhere are asking the same question and investigating whether any connection is more than a coincidence.
It’s clear that in those who already have diabetes, COVID-19 can worsen the condition and lead to severe complications. But there are other possible links.
Emerging evidence shows that the coronavirus — like some other viruses — can attack insulin-producing cells in the pancreas — a process that might trigger at least temporary diabetes in susceptible people. Rising cases might also reflect circumstances involving pandemic restrictions, including delayed medical care for early signs of diabetes or unhealthy eating habits and inactivity in people already at risk for Type 2 diabetes.
A Centers for Disease Control and Prevention report looked at two large U.S. insurance databases that included new diabetes cases from March 2020 through June 2021. Diabetes was substantially more common in kids who’d had COVID-19. The report didn’t distinguish between Type 1, which typically starts in childhood, and Type 2, the kind tied to obesity.
Rates of both types of diabetes have risen in U.S. kids in recent years, but reports from Europe and some U.S. hospitals suggest the pace may have accelerated during the pandemic.
“I think we’re all a little worried,” said Dr. Inas Thomas, a specialist at the University of Michigan’s Mott Children’s Hospital.
Her hospital has seen a 30% increase in Type 1, compared with pre-pandemic years, Thomas said. It is not known how many had COVID-19 at some point, but the timing raises concerns that there could be a connection, she said.
Type 1 diabetes occurs when the pancreas produces little or no insulin, a hormone that regulates blood sugar. It is thought to involve an autoimmune reaction, with the body attacking insulin-making cells in the pancreas. Patients must use manufactured insulin to manage the chronic condition.
Experts have long theorized that some previous infection may trigger that autoimmune response.
With COVID-19, “We don’t know if it’s a direct effect or some other factor that’s not fully understood yet, but we are hoping that this trend may help us figure out the trigger for what causes Type 1 diabetes,” Thomas said.
At Rady Children’s Hospital in San Diego, Type 1 diabetes cases jumped almost 60% during the first year of the pandemic, compared with the previous 12 months, researchers reported recently in JAMA Pediatrics. Just 2% of those children had active COVID-19 and the report lacked information on any prior infections. But the sharp increase was striking and “clearly there’s a lot more work to be done to try to answer why is this happening,” said co-author Dr. Jane Kim.
Type 2 diabetes, which mostly affects adults, impairs how the body uses insulin, leading to poorly regulated blood sugar. Causes are uncertain but genetics, excess weight, inactivity and unhealthy eating habits play a role. It can sometimes be treated or reversed with lifestyle changes.
Globally, more than 540 million people have diabetes, including about 37 million in the United States. Most have Type 2 diabetes, and many more have higher than normal blood sugar levels, or prediabetes. Doctors worry that COVID-19 or sluggish pandemic lifestyles might be among things that push them over the edge.
A diabetes center at Chicago’s La Rabida Children’s Hospital has seen a pandemic surge in prediabetes. Center co-director Rosemary Briars suspects long, sedentary hours of online learning played a role.
Dr. Rasa Kazlauskaite, a diabetes specialist at Chicago’s Rush University Medical Center, said steroid drugs that are sometimes used to reduce inflammation in hospitalized patients with infections including COVID-19 can cause blood sugar increases leading to diabetes. Sometimes it resolves after steroids are stopped, but not always, she said.
The physical stress of severe COVID-19 and other illnesses can also cause high blood sugar and temporary diabetes, she said.
To learn more, scientists in Denmark are enrolling adults recently diagnosed with Type 1 diabetes, including some who had COVID-19. Over time, the researchers will check whether the condition progresses faster in those who had COVID-19, which could help clarify the infection’s role, if any, in developing diabetes, said researcher Dr. Morten Bjerregaard-Andersen, a diabetes specialist at the Hospital of South West Jutland.
“The theory is if you had COVID-19, then your own insulin production will be more compromised than if you weren’t infected,” Bjerregaard-Andersen said.
Researchers at King’s College London and Monash University in Melbourne, Australia, have launched an international COVID-19-diabetes registry. Among things they hope to learn: Does diabetes in COVID-19 patients persists after they recover; do they face higher risks of getting diabetes again; could diabetes in COVID-19 patients be an entirely new type of diabetes.
Nolan Balcitis, now 12, says he knew nothing about diabetes before his diagnosis last year. He was nervous at first about all that’s involved in managing the disease — counting carbohydrates, checking blood sugar, insulin shots. But a wearable insulin pump lets him skip daily injections, and a sensor on his arm makes monitoring a breeze.
A typical kid who likes baseball and playing with his yellow Labrador retriever, Callie, Nolan shrugs off his condition.
“I’m just kind of used to it now,” the boy said with the nonchalance of an almost-teenager.
What is monkeypox, and is it in BC? | CTV News – CTV News Vancouver
Hours after the country’s top doctor suggested there could be a “couple” of cases of monkeypox in British Columbia, provincial officials said it’s been determined those people do not have the disease.
The B.C. Centre for Disease Control said Friday afternoon that there were two reported cases that could have been the disease, but that public health officials interviewed those people.
It was determined that they were not considered contacts of known cases and had not been exposed.
“No suspect cases or contacts of monkeypox are under investigation in B.C. at this time,” the BCCDC said in a statement.
“B.C. continues to work closely with the Public Health Agency of Canada and public health will follow up with anyone thought to be exposed to monkeypox.”
The news came hours after Canada’s top doctor, Dr. Theresa Tam, said in a news conference that officials are investigating what could be the disease in a couple of people who live in the province.
“Right now I would say just under a couple of dozen people under investigation by local authorities mainly in Quebec but a couple of contacts being followed up in British Columbia as well, but only two cases confirmed (in the country),” she said.
“There are samples under processing at the National Microbiology Lab as we speak so we might expect to hear more confirmations in the upcoming hours and days. “
She said local authorities are doing contact tracing, so right now, they don’t know the extent of the spread in Canada.
“So far we do know that not many of these individuals are connected to travel to Africa, where the disease is normally seen. So this is unusual,” she said.
WHAT IS MONKEYPOX?
Monkeypox was discovered in the late 1950s, and is a disease caused by a similar virus as the one that causes smallpox.
Symptoms are similar as well, including fever, chills, exhaustion, and head, muscle and back ache. Unlike smallpox, it can also cause lymph node swelling, and it’s considered to be more mild.
Later, those who’ve been infected get a rash and raised bumps filled with fluid. Those bumps turn to scabs over time and fall off.
Anyone who has developed signs or symptoms, including these blisters, should get advice from their doctor.
The name comes from its discovery – it was first found in colonies of monkeys that were being used for research.
A number of countries including the U.S. and U.K. are experiencing an outbreak of the disease, which is more commonly found in central and western Africa.
“It’s unusual for the world to see this many cases reported in different countries outside of Africa,” Tam said Friday.
Health officials say the virus is transmitted through close contact with an infected person, and while it’s generally transmitted through large respiratory droplets, Tam said Friday it may even be transmitted through contaminated clothing.
With files from CTV News Vancouver’s Alyse Kotyk and CTV News’ Solarina Ho
Canada’s first two monkeypox cases confirmed in Quebec, others under investigation
MONTREAL — The Public Health Agency of Canada says two cases of monkeypox in Quebec are the first confirmed cases in the country.
The agency said in a release late Thursday that it is working with the United States Centers for Disease Control and Prevention, and public health officials in Quebec to investigate potential exposure and contacts of a case of monkeypox recently identified in the U.S.
It says a U.S. citizen recently travelled to Canada by private transportation and may have been infected before or during his visit to Montreal.
“Tonight, the Province of Quebec was notified that two samples received by the National Microbiology Laboratory have tested positive for monkeypox,” the release said. “These are the first two cases confirmed in Canada.”
The agency said the investigation into monkeypox is evolving and ongoing in Canada and around the world.
“More information is needed to assess if there are increased health risks to people in Canada.”
Earlier Thursday, the Quebec Health Department confirmed the province’s first two cases of monkeypox and said 20 other suspected cases are under investigation.
In a news release, the department said people should be alert to symptoms of the rare disease but stressed that it is spread through prolonged close contact with someone who is infected.
“Its contagiousness is thus considered limited compared with other viruses (flu, COVID-19, etc.),” the release said.
Montreal public health authorities urged calm as they confirmed they are investigating 17 suspected cases of monkeypox, saying the disease isn’t likely to spread through the community.
Montreal’s public health director said that based on recent outbreaks in Europe and a case reported in the United States, there is a “strong possibility” that the infections in the city involve the virus linked to monkeypox.
“We do not have to panic. At the time that we are speaking, it is not something that is going to go to community transmission that is going to be sustained,” Dr. Mylène Drouin told a news conference.
Drouin said the first suspected cases in Montreal were reported on May 12 from clinics specializing in sexually transmitted diseases, although symptoms had begun appearing around April 29. She said the cases are seen mostly in men between the ages of 30 and 55 years old who have had sexual relations with other men.
Most cases identified in the city are not severe, and symptoms involve a period of fever and sweating followed by the appearance of a painful rash in the genital area, Drouin said. All of the suspected cases are isolating and they have been instructed to cover their lesions until they heal. Those considered significant contacts — people in the same household or sexual partners — have been asked to monitor for symptoms for 21 days.
“There is no specific treatment currently available,” Drouin said. “It is painful, but mainly the forms we have right now are not severe forms of the illness.”
Drouin said the disease is transmitted by prolonged close contact and by droplets, adding that there is no risk from activities such as taking public transit, eating at a restaurant or shopping.
“This is not something we can acquire by going to the grocery store,” she said.
Although the infections were likely acquired through sexual activity, monkeypox is not considered a sexually transmitted disease.
“We do not want to stigmatize any segment of the population,” said Dr. Geneviève Bergeron, the medical officer for health emergencies and infectious diseases at Montreal public health. “We want people to be aware of the concern but also to keep it in perspective that what we’re worried about is prolonged close contact, and that can happen in any sort of different type of setting.”
She said there are likely other cases in the city that haven’t been identified, and she called on people who are showing symptoms to contact a doctor.
Monkeypox is typically limited to Africa, and rare cases in the United States and elsewhere are usually linked to travel there. A small number of confirmed or suspected cases have been reported this month in the United Kingdom, Portugal and Spain.
On Wednesday, health officials in Massachusetts reported a monkeypox case in a man who had recently travelled to Canada. The man was in Montreal at the end of April to meet friends and returned home in early May.
Montreal health officials initially thought they were dealing with cases of chancroid, a sexually transmitted bacterial infection, until they received word of the U.S. case and changed the focus of their investigation.
“The case that we have in Boston was linked to a few of the suspected cases (in Montreal) but not all of them,” Bergeron said, noting some had travelled to Mexico and Belgium, while other cases weren’t linked to travel at all.
Bergeron said there is evidence that those who received the smallpox vaccine as children may have better protection against monkeypox. It was routinely offered to those born before 1972 in Canada. Drouin said any decision about reviving vaccination would come from the federal and provincial governments.
Monkeypox typically begins with a flu-like illness and swelling of the lymph nodes, followed by a rash on the face and body. In Africa, people have been infected through bites from rodents or small animals, and it does not usually spread easily among people.
Monkeypox comes from the same family of viruses as smallpox. Most people recover from monkeypox within weeks, but the disease can be fatal for up to one in 10 people, according to the World Health Organization.
This report by The Canadian Press was first published May 19, 2022.
— With files from The Associated Press.
Sidhartha Banerjee, The Canadian Press
Quebec coroner says many people share blame for high death toll in COVID first wave
MONTREAL — Quebec authorities share blame with the owners of a private Montreal-area long-term care home where 47 residents died during the early days of the COVID-19 pandemic, the province’s coroner said Thursday.
The owners of the home, the Quebec government and a Montreal health authority “passed the ball around” while vulnerable people died alone, coroner Géhane Kamel told reporters.
“There were a lot of emails that were sent, but during that time, people died,” Kamel said. “There were people who were dehydrated; there were people who were in their excrement and no one came …. Everyone failed.”
Thursday’s news conference was the first time Kamel spoke publicly since she released her report on Monday regarding her investigation into 53 deaths at several long-term care homes during the pandemic’s first wave.
She said that on March 29, 2020, officials at the local health authority were sending lawyer’s letters to the owners of the Herron care home, writing to the Health Department and deciding whether to call the police.
“While all this was happening, people were dying,” she said.
In August 2021, Quebec’s Crown prosecutor’s office says the Herron’s owners wouldn’t face criminal charges. The office said that after an “exhaustive” investigation, the evidence did not meet the high bar for criminal charges, adding the decision not to lay charges did not minimize the “tragic events” that took place at the home, nor did it rule out that civil or ethical violations could have been committed.
Kamel said one death in particular at the Herron still haunts her — that of Leon Barrette, who died March 29, 2020, two days after he had been transferred to the facility. His body was cold when it was found, according to her report. He had died alone, apparently forgotten in his room.
“Did we leave the people to die without care?” she said.
While Kamel said her mandate wasn’t to blame specific people, her report was highly critical of Lynne McVey, the CEO of the health authority. Kamel refused to comment on an announcement that McVey would step down at the end of her mandate in July.
The coroner thanked Seniors Minister Marguerite Blais for her honesty at the inquest. Kamel said Blais’s testimony made it clear how little was done to protect older people living in long-term care.
Kamel’s report said that residents of Quebec long-term care homes were kept in a blind spot while the provincial government focused on protecting hospitals as it prepared for the first wave of the novel coronavirus in the spring of 2020. Almost 4,000 long-term care residents died between March and June of that year.
Her report included 23 recommendations intended to prevent future deaths. “Ultimately, what I hope we remember is that this report is supposed to be used so that this never happens again,” she said.
Patrick Martin-Ménard, a lawyer who represented some of the families of people whose deaths were investigated by Kamel, said her report is a good first step but that a full public inquiry is needed.
“We know that there were a number of shortcomings by a number of people in decision-making positions, from the top to the bottom of the health-care system, that led to significant casualties during the pandemic,” he said in an interview Thursday. “It’s not so much about pointing the finger, it’s about learning the lessons of what went wrong.”
Martin-Ménard said long-term care facilities are still seen as a place where elderly people are sent to die and that “sustainable” change is needed.
“There was an issue with the culture, the approach with which we take care of our most vulnerable elderly people, and this approach, unfortunately, has not changed; we’re seeing the same mentality prevail today,” he said.
This report by The Canadian Press was first published May 19, 2022.
Jacob Serebrin, The Canadian Press
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