This article was updated to include information about home testing kits on April 27, 2020.

The global threat of coronavirus is looming larger every day, with news of additional cases and deaths, travel advisories, and potential economic fallout. The media keeps reporting that people with “underlying health conditions” are at particularly high risk — and diabetes is at the top of the list.

So should we PWDs (people with diabetes) be especially concerned? And what can we do to prepare?

Here’s what we know, based on information from health authorities including Centers for Disease Control and Prevention (CDC) agency resources, the World Health Organization (WHO), and credentialed medical professionals within and beyond the diabetes space.

The CDC reports that “coronaviruses” are a large family of viruses common in animal species, and only rarely do they infect and spread among humans. That’s happened here with this officially named COVID-19 virus that started late last year with an outbreak in Wuhan, China, linked to a market selling seafood and live animals. From there, it’s gone global, and has been responsible for millions of infections and hundreds of thousands of deaths worldwide.

Importantly, the incubation period is 2 to 14 days, per the CDC. This means people can be exposed and spread the virus for days or weeks before even developing any symptoms.

About a dozen states — including California, Illinois, Michigan, and Nebraska — have gotten CDC approval for a coronavirus test that health officials can administer and process in as few as 4 days.

On April 21, the Food and Drug Administration (FDA) approved the use of the first COVID-19 home testing kit. Using the cotton swab provided, people will be able to collect a nasal sample and mail it to a designated laboratory for testing.

The emergency use authorization specifies that the test kit is authorized for use by people who healthcare professionals have identified as having suspected COVID-19.

It will most likely take up to a year to get a working vaccine for COVID-19, according to the CDC. But an antiviral medication could be available to public health and hospital workers within the next few months.

“In general people with diabetes face greater risks of complications when dealing with viral infections like flu, and that is likely to be true with COVID-19,” the American Diabetes Association (ADA) said in a statement in late February.

The ADA encourages people with diabetes to follow the guidance of the CDC and to review their diabetes sick day protocols in case they do get infected.

The fact is that people with diabetes are at higher risk when it comes to things like influenza (flu), pneumonia, and now COVID-19 because when glucose levels are fluctuating or elevated consistently, we have a lower immune response (less protection against disease), so we risk getting sicker quicker. There may also be an underlying risk of exacerbated illness simply due to having diabetes even if glucose levels are in range.

While there is no proven direct connection between diabetes and death from COVID-19, the Journal of the American Medical Association (JAMA) reports on a higher case-fatality rate among those with preexising conditions:

  • 10.5 percent for cardiovascular disease
  • 7.3 percent for diabetes
  • 6.3 percent for chronic respiratory disease
  • 6.0 percent for hypertension
  • 5.6 percent for cancer

The CDC recommends that all people wear cloth face masks in public places where it’s difficult to maintain a 6-foot distance from others. This will help slow the spread of the virus from people without symptoms or people who do not know they have contracted the virus. Cloth face masks should be worn while continuing to practice physical distancing. Instructions for making masks at home can be found here.
Note: It’s critical to reserve surgical masks and N95 respirators for healthcare workers.

The CDC’s recommendations for protecting against COVID-19 include social distancing of at least six feet, washing hands often with soap and water for at least 20 seconds, and making sure you’re up to date with vaccinations like the flu and pneumonia shot. It’s also critical to keep your hands away from your eyes, nose, and mouth — because that allows germs that cause respiratory infections to enter the body.

As of early April, the CDC reversed its earlier guidance on use of face masks and now recommends “wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especiallyin areas of significant community-based transmission.”

This is now deemed critical to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others.

This piece from Medical News Today explains why diligent hand washing really could slow down an epidemic. “If 60 percent rather than 20 percent of air travelers maintained clean hands, it could slow down the spread of infections by almost 70 percent,” according to researchers at Massachusetts Institute of Technology in Cambridge.

The CDC and other authorities are emphasizing that if you think you might be sick, stay home from work or school.

That recommendation is not without criticism, however. A recent article in The Atlantic explores how difficult it can be for working America to stay home in the event of any illness. For that reason, many businesses are now issuing their own updated Work from Home (WFH) policies, canceling unnecessary business trips or events, and working with employees individually to navigate this COVID-19 situation as best as possible.

Most medical professionals who treat diabetes seem to be emphasizing basic hygiene and illness precautions, as well as doubling down on efforts to achieve good glucose control.

Endocrinologist Dr. Jennifer Dyer in Ohio tells us she’s been receiving patient calls concerned about COVID-19, and the information she is passing along is, “Bottom line: make sure you get a flu shot. If you or your loved ones get sick with a flu-like or cold-like illness, first make sure it’s not the flu, which is treatable. If there is any progression to pneumonia, get support and treatment fast as this is what typically makes these viruses dangerous.”

Well-known Philadelphia-area diabetes education and care specialist Gary Scheiner reminds us that PWDs can also be more prone to dehydration, especially when blood sugars rise, so it’s important to stay hydrated. This may mean stocking up on bottled water, or even sugar-containing liquids like Gatorade that can also provide electrolytes and energy in the event of emergency situations where food may become scarce.

In a recent interview on the Diabetes Connections podcast, Scheiner explains that if a person with diabetes is infected with coronavirus, “it’ll impact them just like it affects a person without diabetes, but in a PWD it’s gonna cause the glucose levels to rise as well… you’re going to see some intense inflammation of the respiratory tract. One of the unique things about it compared to some other viruses like the flu is it can cause some severe shortness of breath, which we don’t always see with other communicable common illnesses. So that’s something to watch for.”

He also shares some specific reminders for people with diabetes:

  • “I tell patients to be a bit OCD about hand washing — be very compulsive about that.”
  • “Get a flu shot, because you can prevent any form of the flu, and that’s always beneficial.”
  • “Be very careful around people who have signs of respiratory illnesses who are coughing, sneezing, etc. Keep your distance or just try to be very cautious about physical contact with them.”
  • “In general, face masks are not a very effective preventive option. It’s more… (about) the hand washing and getting your flu shot.”
  • “A humid environment is also beneficial. If your house is dry, especially in the wintertime, use a humidifier. The first place where germs can penetrate into the body is the nasal passages and if they dry out due to dry air, you’re kind of opening the door and marshaling germs into your system.”

Regarding glucose control, Scheiner says, “We see the risk of these types of problems almost go up exponentially when the A1C starts getting up into the 9 or 10 range. And with an A1C in the 6 or 7s, the risk is slightly increased. I wouldn’t say it’s dramatically higher than in someone without diabetes, but there is some increased risk.”

“The other issue is managing the glucose if you do get sick, which becomes more challenging, but even more important, because when glucose levels are elevated, you’re sort of aiding and abetting the infection that virus or bacteria has a lot of fuel to grow off of. So you’re feeding the enemy in a way if your blood sugar is poorly controlled. When you’re sick, running a lot of high blood sugars is going to extend your recovery time and cause your symptoms to become that much worse,” he explains.

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Image: DiabetesDietBlog.com

No doubt, emergency and disaster planning is a critical component to all of this.

“In general, I think this virus is bringing up the question of disaster preparedness, and is reminding many in the diabetes community about how poorly we are prepared for disaster scenarios,” says endocrinologist Dr. Jason Baker in New York, who also lives with type 1 diabetes himself. “We are indeed reminded right now of how vulnerable we are living with diabetes, how reliant we are on the uninterrupted manufacture and distribution of our life-sustaining insulin and glucose monitoring supplies; we are indeed naked without them.”

Baker encourages PWDs to have extra insulin on hand, preferably a month’s worth at least, along with extra glucose monitoring and diabetes supplies. He recognizes the built-in barriers of access and affordability, too often dictated by insurance companies. That’s why it’s important to research any local grassroots relief efforts in your area, and to talk with your doctor now about working through and around these barriers if and when needed.

In Colorado, diabetes education and care specialist Jane Dickinson says she’s had conversations with people trying to stockpile insulin and supplies. “I think there’s a feeling that people on pumps need to not only have pump supplies on hand, but also MDI (multiple daily injection) supplies as a backup.” She finds this wise.

Thankfully, dozens of medtech and pharma companies are proactively tackling awareness and disease preparation as it relates to COVID-19 — notably J&J, Medtronic, and Roche.

Industry trade group AdvaMed notes that by the end of February, nearly three dozen member companies had donated a collective total of $26.8 million worth of medical products to the China Red Cross (since COVID-19 originated in that country) as well as other health institutions and clinics globally. The group has also formed a “Coronavirus Task Force” focusing on personnel, transportation, supply, etc., that is meeting regularly to coordinate the industry response.

It seems too soon to tell whether this will be a real concern.

Spokeswoman Stephanie Caccomo with the FDA’s Center for Devices and Radiological Health (CDRH) that regulates and oversees diabetes devices told DiabetesMine on March 2 that they had not received any reports of diabetes products being directly impacted by the COVID-19 crisis to date.

But the FDA is warning overall that potential medical product supply chain impacts could materialize. “FDA is keenly aware that the outbreak will likely affect the medical product supply chain, including potential disruptions to suppliers [and] shortages of critical medical products in the U.S.,” FDA Commissioner Dr. Stephen Hahn said in late February.

The agency recently issued an update on the medical device and product supply chain, noting that they are “closely monitoring the situation.”

Meanwhile, news reports say the FDA has suspended inspections of Chinese facilities, and that could lead to shortages at some point.

Of the “big three” U.S. insulin manufacturers, only Eli Lilly has issued a formal statement so far, assuring customers that the company “does not anticipate shortages for any of our products, including all forms of insulin.”

Insulet, makers of the tubeless Omnipod insulin pump, has also published an alert assuring customers they “do not anticipate any product supply issues at this time.”

Others in the diabetes industry are likely to follow suit, but the overall impacts on the medical supply chain remain TBD.

Interestingly, we’ve seen PWDs online taking various stances on this, from heightened concern to brushing it aside as nothing more than typical flu season preparedness.

In one Twitter thread, fellow T1D-peep Kelly Rawlings shared her diabetes-centric #COVID19 strategy and welcomed others to share theirs:

  1. Refill insulin & key supplies prescriptions ASAP.
  2. Update my primary care doctor contact info.
  3. Review basal/bolus rates; convert to multiple daily injection plan, JIC I can’t operate pump.
  4. Wash hands. And you?

Dana Lewis and her husband Scott Leibrand, the entrepreneurs behind the first homemade artificial pancreas technology, have also been sharing what they are doing to stay safe.

In this remarkable Twitter thread, Dana announced: “I’ve been personally watching the information about #COVID19 for over a month and a half, and expecting it to come to my doorstep. It’s now here, as predicted, so I wanted to share some of what I’m personally able to choose to do & why, with regards to individual protection.” She then explains which diabetes tools she’s using, and how she’s keeping herself safe inside and outside of their home.

The couple lives in the Seattle, Washington area, and Scott had traveled to Silicon Valley in mid-February — an area now reporting cases of coronavirus. As a result, aside from taking general health precautions, Scott put himself into “self-isolation” at home for a time.

Dana and Scott are also behind the push by the #WeAreNotWaiting community of diabetes do-it-yourself (DIY) technology enthusiasts to do more than just washing hands, covering coughs, and not touching faces.

They are working to generate a DIY tool for self-reporting of health factors related to virus monitoring.

Collaborating with health professionals, infectious disease experts, and others, they’re creating what is known as CoEpi (Community Epidemiology into Action), a mobile tracking app. It will allow anyone to easily and privately track who they’ve been in contact with, and anonymously share reports and updates on their own symptoms and likely contagiousness — whether that be a cold, flu, COVID-19, or any other contagious disease.

They are now searching for more coders, designers, and people with specific skills to help develop this tool ASAP. This LinkedIn post has more details, along with this CoEpi project page.

Creating new self-generated tools can certainly make people feel empowered.

“Yeah, this pandemic is scary, but it’s exciting that there’s something we personally can all do to help protect ourselves, our loved ones, our social networks, and our communities,” Scott Leibrand tells DiabetesMine.

This story has been updated to include the latest guidance about COVID-19 infections and will continue to be updated as more knowledge becomes available.