Coronavirus Preparation Strategies for People with Diabetes

By Dana M. Lewis

With coronavirus in the news, our editor in chief, Kelly Close, suggested some resources on protecting yourself and your loved ones with diabetes; plus, Kelly spotted an incisive message from Dana Lewis on social media and asked Dana to share the measures she’s taking to prevent the spread of germs

It’s been in all the headlines – the novel coronavirus, also known as COVID-19, is moving through local communities around the world. At diaTribe, we want to make sure that our readers are informed of various approaches to staying safe with diabetes in the face of the epidemic.

The CDC released a complete guide to COVID-19 resources, for people with or without diabetes. Their web page includes:

• General information and updates
• Prevention
• Symptoms
• What to do if you are sick
• Preventing germs in home, work, and school settings
• Resources for healthcare facilities

The JDRF published an article on type 1 diabetes and coronavirus. The article includes a general section on what people with type 1 diabetes should know about viral illnesses. As background, while we recommend that everyone with diabetes pay close attention to coronavirus risks, since type 1 diabetes is an autoimmune disease, people with type 1 diabetes who have compromised immune systems are particularly encouraged to pay attention to reducing risk. 

Dr. Dan DeSalvo, a pediatric endocrinologist, gave advice to people with diabetes:

Outbreaks of novel viruses should always be a public health concern, but not a reason to panic. As people living with diabetes, we should always be extra prepared, especially in situations like this. It is important to have a reliable source of information such as the CDC. There currently is no vaccine to prevent COVID-19, so everyday preventive actions are key: 

• Wash your hands multiple times daily (especially before eating) with soap and water or alcohol-based hand sanitizer for at least 20 seconds

• Avoid close contact with people who are sick

• If YOU are sick, stay at home and monitor your blood glucose levels closely. Follow your sick day management plan and reach out to your diabetes care team.

As of now, most people in the US have low immediate risk of exposure to the virus, but it is important to be prepared.  There is still much to learn about the unfolding cases and the potential public health threat of COVID-19 over time. People with close contacts of persons with COVID-19 are at greater risk.

The American Diabetes Association shared valuable COVID-19 tips on how to make a sick day plan, and what to do if you get sick. 

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Finally, Dana Lewis, a greater Seattle-area resident who lives with type 1 diabetes, has written about her own strategies to protect herself from the virus. Below, Dana explains her personal experiences, perspectives, and measures she has chosen to take. Go on over to Facebook where our Community Manager, Cherise Shockley, would love to hear about what you are doing.

What you should know about COVID-19, self-isolation, and social distancing – plus how you can directly save a life

Even if it has not been detected near you (yet), COVID-19 is spreading as you read this. This can be scary, especially if you’re living with diabetes or another chronic illness, but there IS something you can do to protect yourself and your loved ones, and there are ways to limit the spread across your local community. In fact, you can do many things. Read on to learn what those are, why you should take action now, and what the known risks levels are for individuals living with diabetes.

Why you should care about COVID

First, why should you individually care about COVID? You may be in an age group where the risk of severe illness and death from this virus is fairly small. After all, 80% or more of COVID cases are expected to be mild illness, similar to a bad cold or the flu. However, because you’re reading this in diaTribe, you or someone you know is likely living with a type of diabetes or another chronic illness. And our parents, grandparents, and other friends and loved ones may be in age groups with higher risk of a severe case of COVID if they’re infected.

What we know about COVID and diabetes

Diabetes is generally known to cause an increased risk of infection. This could be due to fluctuating blood glucose levels, challenged immune systems, or a combination of the two. In the early COVID cases from China, 7.3% of people with diabetes died. That’s a high percentage. Is there something that could have been done to prevent the deaths? That’s what we want to ensure for everyone learning about COVID now.

Additional data has been released, analyzing the impact of various health conditions in a study of 1,590 patients with COVID-19 from China. After adjusting for age and smoking status, diabetes was one of the things that was associated with a greater risk of infection compared to someone without diabetes. This study is interesting because it is looking at the risk for hospitalization, need for ventilation, and death combined, whereas the other data has solely reflected the rate of death of the disease or age group (but not both combined). The study shows that on average, having one health condition increases the risk by 1.79 times, and two health conditions increases the risk by 2.59 times – all compared to individuals without pre-existing conditions. However, diabetes itself is calculated to increase risk by 1.59 times. This means that compared to someone in your age group who doesn’t have diabetes, you are 1.59 times as likely to develop a case of coronavirus that requires hospitalization or ventilation.

How might you use this data? You can look up your age group risk and multiply that risk by 1.59 (if diabetes is your only chronic illness) to assess what your risk might be compared to others in your age group. Note again – this is the increased risk of being hospitalized or dying if you do get infected with COVID-19; it does not represent share of deaths by pre-existing condition.

So what can you personally do about COVID?

First and foremost, wash your hands frequently (with soap and water). This is the most important thing you can do to protect yourself, your immediate household, and your community.

• Wash your hands when you enter the house (coming from the outside world).

• Don’t touch your face (mouth, nose, eyes) if you haven’t just washed or sanitized your hands.

Also, if you have symptoms of a cold, flu, or other illness, don’t go out into the world if at all possible. If you can work from home, please do. If needed, send someone to run errands for you or go to the grocery store or pick up supplies.

I am not a doctor and none of this can be considered medical advice, however, this is what I recommend. If you do feel ill enough that you need to see a healthcare professional, but don’t urgently need immediate care (e.g., calling 911 or being driven to the ER), try calling your provider, a telehealth service, or your local coronavirus hotline to help figure out where you should go for care.

Remember, 80% of COVID cases have ended up being mild, but 15-20% do need more care (such as hospitalization). Even with mild illness, you should also try to limit transmission within your household.

Here’s an example of what I’ve done, and why, given my personal situation.

For background, I’ve had type 1 diabetes for more than 17 years and consider myself to be in good health overall. I have used a DIY closed loop (OpenAPS) system to help me manage my blood sugar levels for more than five years. However, I tend to catch colds and the flu more often than most people I know – so I am generally more concerned than most people about limiting contagious illnesses. I’ve been watching the news about COVID since mid-January, and increasing my preparation for COVID prevention and protection over this time, including staying away from my friends and family with cold or illness symptoms.

I live with my husband, Scott, who happened to have a work trip down to the Santa Clara area on February 22. While he was in Santa Clara, the first US case of suspected community-transmission-acquired COVID was announced. We decided that when Scott returned home, for additional protection, we would self-isolate from each other within our household for at least a week.

What does self-isolation look like?

I haven’t touched Scott since before his trip – e.g., no hugging, kissing, hand holding, or any kind of skin contact. I moved his stuff into our guest bedroom and guest bathroom so that we could stay separate as much as possible. This means making sure to also stay six feet away from each other – which is droplet range. We frequently wipe down our apartment’s kitchen and wash our hands after using shared spaces.

He doesn’t have any symptoms, but it’s possible for people who acquire COVID to develop symptoms in the 2-14 days after exposure. We’ll see how things are at the seven day mark and then we’ll decide whether to continue to self-isolate.

Unfortunately, his Santa Clara trip is not the only possible source of COVID exposure for our household. Beginning February 28, community-acquired (non-travel) cases were first detected in the greater Seattle area and Washington state area. Researchers originally estimated that the virus has therefore been present in the community for at least two or three weeks; more recent genomic evidence now indicates circulation since mid-January. Therefore, in addition to self-isolation from each other, we are also continuing and increasing our social distancing efforts from the community.

What does social distancing look like?

Because we do not have kids in our household, our social distancing efforts mainly revolve around working from home, no longer eating out at restaurants, not going to the grocery store, and not seeing close family members with whom we would normally frequently interact. Social distancing might be different for everyone, depending on whether you have kids in school, etc.

When we do leave the house, but it’s mainly to go for a walk, run, or bike ride on a nearby trail. We stay more than six feet away from people even on the trail. Once I return to the house, I immediately wash my hands.

In the future, once we confirm Scott does not have symptoms and is likely not contagious, because of my higher risk he will be the person to make limited (when needed) runs to the grocery store. He may choose to wear a mask (and gloves) in the store, and when returning home immediately wash his hands, to attempt to limit transmission from any potential exposure.

Make a game plan now and get buy-in from your friends and family

Full self-isolation between household members or social distancing may not be feasible for everyone, but if you are part of a group with a higher risk of infection, here are some things to talk about with close contacts and loved ones:

• Begin proactively discussing your symptoms and alerting others if you have symptoms and are not able to socially distance yourself from them. (As a side note, we are working on an open source app to make location tracking and symptom traction more feasible, bringing #WeAreNotWaiting to COVID-19 prevention, but in the meantime we can all do this manually.)

• If you share a household, someone with less risk could be the delegate for errands.

• Have a plan for how someone sick would self-isolate at home (as much as possible), and come up with transmission-reducing measures like paper towels instead of cloth towels after hand washing.

• If you live alone, think about grocery delivery (or curbside pick-up) options to limit your interactions and exposure at the grocery store.

• If you live alone and develop mild symptoms, have a contact who can check on you every day and can deliver groceries or supplies to your doorstep.

• For everyone, especially those with diabetes, it’s a good time to re-check our supplies and sick-day plans. If you can – and this is not always possible – try to get a 90-day supply of insulin, pump supplies, syringes or insulin pens, etc. If you need supplies within 90 days, see if there is a mail-order option you can try.

When discussing your game plan with your household, friends and close family, don’t forget to ask about flu vaccine status. Getting a flu shot means that if you get the flu, you’re more likely to have a mild case. That can be significant, because it reduces your chances of needing to be hospitalized if the healthcare system is overwhelmed with serious COVID cases. And getting the flu and COVID at the same time can be particularly dangerous.

Remember, even if you feel like you are not at increased risk, someone you know is. Any self-protection measures you do will help protect your loved ones and your community. Hand washing and self-isolation when ill, plus increased social distancing efforts, will help cut down on community transmission of COVID and other illnesses.

Dana Lewis has lived with type 1 diabetes for more than 17 years. She’s one of the creators and founders of the open source artificial pancreas (OpenAPS) movement, has been using OpenAPS for more than five years, and wrote the book "Automated Insulin Delivery: How artificial pancreas “closed loop” systems can aid you in living with diabetes," to help more people understand automated insulin delivery systems. She’s also helping bring the #WeAreNotWaiting approach to help fight against COVID transmission in our communities by working on the open source CoEpi.org project.