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Lower neighbourhood socioeconomic status and greater household crowding increase the risk of becoming infected with SARS-CoV-2, the virus that causes COVID-19, warn researchers.

"Our study shows that neighbourhood socioeconomic status and household crowding are strongly associated with risk of infection," said study lead author Alexander Melamed from Columbia University in the US.

"This may explain why Black and Hispanic people living in these neighbourhoods are disproportionately at risk for contracting the virus," Melamed added.

For the findings, published in the journal JAMA, the researchers examined the relationships between COVID-19 infection and neighbourhood characteristics in 396 women who gave birth during the peak of the Covid-19 outbreak in New York City. Since March 22, all women admitted to the hospitals for delivery have been tested for the virus, which gave the researchers the opportunity to detect all infections -- including infections with no symptoms -- in a defined population

The strongest predictor of COVID-19 infection among these women was residence in a neighbourhood where households with many people are common.The findings showed that women who lived in a neighbourhood with high household membership were three times more likely to be infected with the virus. Neighbourhood poverty also appeared to be a factor, the researchers said.Women were twice as likely to get COVID-19 if they lived in neighbourhoods with a high poverty rate, although that relationship was not statistically significant due to the small sample size.

The study revealed that there was no association between infection and population density.

"New York City has the highest population density of any city in the US, but our study found that the risks are related more to density in people's domestic environments rather than density in the city or within neighbourhoods," says co-author Cynthia Gyamfi-Bannerman."

The knowledge that SARS-CoV-2 infection rates are higher in disadvantaged neighbourhoods and among people who live in crowded households could help public health officials target preventive measures," the authors wrote.

Recently, another study published in the Journal of the American Planning Association, showed that dense areas were associated with lower COVID-19 death rates.

New Delhi, Mar 16: A recent survey across 140 districts of the country shows that about 54 per cent of Indians are finding travelling to be unsafe as the deadly coronavirus (COVID-19) pandemic sweeps globally.

The big worry that people have is community transmission, something that researchers from around the world have approximated at 10 per cent of total infections and more common in places like Wuhan in China, South Korea, Iran and Italy.

The months of March to June have historically been high travel season for most Indians, largely due to the summer vacations in schools. "But it seems that Indians do not want to take a chance with this rather scary virus and are either cancelling or postponing their travel plans," concluded the survey by LocalCircles.

The survey gathered more than 22,000 responses from participants in tier one, two and three cities. It said 48 per cent Indians plan to cancel their international business travel for the next four months.

Besides, nearly 38 per cent of respondents said they had to pay cancellation fee to the website, travel agent, airline or railways.

"These are testing times for the entire travel and tourism industry -- airlines, hotels, travel agents as well as small tour and taxi operators. The best solution at this point is to adjust cost structures, stay flexible and work with a collective approach to minimise the period of impact to both citizens and business," said LocalCircles.

Between 30-40 per cent of deaths from studies in intensive care units from different countries are people with diabetes, said Paul Zimmet, Professor of Diabetes, Monash University, Australia.

Zimmet, who is President International Diabetes Federation, added that the actual mechanism as to why COVID-19 may cause diabetes is as yet unknown, however, several possibilities exist. "COVID-19 is a very destructive and cunning virus and causes terrible damage to tissues including the lungs and pancreas," said Zimmet. Below are excerpts from an exclusive chat with IANS.

Why do you say Diabetes is dynamite if a person has been infected with COVID-19?

There have been many deaths in many countries, e.g. Italy, China, the UK and US among people with diabetes after infection with COVID-19 (SARS-Cov-2).

The mortality tends to be mainly in older Type 2 diabetics. Between 30-40 per cent of deaths from studies in intensive care units from different countries are people with diabetes. This outcome and other complications from the virus, particularly pneumonia, are more likely in people with diabetes which is poorly controlled with high blood sugars (poor metabolic control).

Diabetes is often associated with other chronic conditions, including obesity, hypertension and heart disease compounding the risk. These latter conditions all convey higher risk to COVID-19 infections.

ACE-2, which binds to SARS-Cov-2 and allows the virus to enter human cells is also located in organs and tissues involved in glucose metabolism. Is there solid evidence that virus after entering tissues may cause multiple and complex impairment of glucose metabolism?

The actual mechanism as to why COVID-19 may cause diabetes is as yet unknown.

However, several possibilities exist. Firstly, COVID-19 is a very destructive and cunning virus and causes terrible damage to tissues, including the lungs and pancreas.

A new study just published showed that in miniature lab-grown pancreas, and other cells such as liver, made using human stem cells, COVID-19 caused destruction of the pancreas beta cells that produce insulin.

It is possible that the virus causes disruption of the cells by disrupting cellular metabolism. This is possibly the way it brings about new-onset diabetes. ACE-2 exists in high concentration in the lung as this also explains the terrible lung side effects of COVID-19 infections.

Can COVID-19 lead to a new mechanism of diabetes? Probably a new form of diabetes or a new form of disease?

The COVID-19 virus has only been with us for about 5 months and there is a huge amount that we still must learn about its cunning and devastating ways. The purpose of the Global COVIDIAB Diabetes Registry, a joint initiative of Monash University in Australia, and King’s College London is to gain a much better understanding of how common is the appearance of COVID-19 related diabetes, what form does it take be it type 1 or type 2 or a new form, and how common are the complications that we already know e.g. diabetic keto-acidosis, hyperosmolar coma and high insulin requirements are causing high rates of ill health and mortality worldwide. The knowledge gained will aid our understanding for developing strategies to prevent and treat this terrible virus that has caused destruction globally.

Diabetes is one of the most prevalent chronic diseases in India. According to a recent study, sugar levels of diabetic persons increased by 20 per cent during nationwide lockdown in India to contain COVID-19 outbreak. Even after lockdown was lifted, many people are confined within their home. Do you think lack of physical activity will create more problems for diabetics?

My own major research has been on studying populations with high rates of diabetes, including ethnic Indian communities including India, Mauritius, and Fiji so I am very well aware of this. It is now well established that along with diabetes, that associated poor metabolic control of their diabetes places these people at the highest risk for COVID infection and its devastating complications and the associated morbidity and mortality. And these communities have high prevalence of heart disease as well.

Lockdown not only has deleterious effects on metabolic control of the diabetes through reduced opportunities for exercise to be protective serious consequences of SARS-CoV-2 infection, lockdown usually results in disruption of the regular medical care and the regular monitoring of metabolic control. This may also be partly due to the stress and poor compliance, or inability to afford their medications such as insulin. It may also be compounded by inability to access the care during the pandemic. Nevertheless, we now know that poor metabolic control heightens their risk as described above.

You have said diabetes is itself a pandemic just like Covid-19, and the two pandemics could be clashing. How could governments address this problem?

These are “The Times of COVID-19”. Most nations of the world were totally unprepared for a pandemic of this magnitude. They underestimated its potential impact and the destructive nature of the viral infection. This should prompt all countries to upgrade their guidelines to take into account the lessons learnt on infection control including training of staff specialising in infectious diseases and improved public education and taking their communities into their confidence about the terrible nature of COVID-19. The risks of COVID-19 infection need a much higher priority in the general community, particularly for people with chronic conditions such as diabetes, obesity, and cardiac conditions.

Governments are faced with chronic diseases (NCDs) like diabetes and communicable diseases (CDs) like viral and enteric diseases and TB. In general WHO gives the highest priority to communicable diseases and much less attention and funding to chronic diseases like diabetes (I was an adviser to WHO for many years (about 30) on diabetes and obesity and it was very frustrating to deal with this situation).

This attitude to diabetes, for example, has a flow down effect so that diabetes funding in countries by governments, rich and poor, suffered and was insufficient.

So now we have a COVID-19 pandemic and who are those at highest risk, yes people with diabetes and other NCDs, it is very important that now the two, Diabetes and COVID-19 are clashing face-to-face. This is a major issue that WHO and national governments have to face with equal priority’

Stressed people suffering from diabetes run a greater risk of poor blood glucose levels, what do you suggest to these people?

As mentioned in the answer above, stress is an important factor in upsetting the blood sugar (metabolic) control of diabetes. Additive to this is poor compliance with medications and diet. These and potential associated comorbidities due to other chronic conditions are part of the dynamic dynamite mixture.