We are amidst a global epidemic due to a virus called Corona virus (SARS-CoV-2), commonly known as COVID-19. This virus causes respiratory tract infection leading to pneumonia. It was first recognized from Wuhan, China in December, 2019 and later it spread rapidly to involve every continent worldwide. Till date, >20,00,000 people have been affected worldwide and more than 11, 500 cases have been confirmed in India. In India, >400 people have lost their lives due to this deadly virus. Even doctors and healthcare workers are still learning about this virus and its effects. Purpose of this blog is to make you all aware of this virus, its route of spread, disease, prevention and management with special regard to diabetes mellitus.

About COVID-19- How does it spread?

This virus spreads from human to human or animals to human via contaminated droplets that come out of the mouth of infected person while talking, coughing or sneezing. This virus can survive in the environment on different surfaces for variable time period ranging from few hours to days. Most important route of spread is via hands, that is, we touch some surface which has virus on it (like buttons, door handles, table tops, boxes etc) and then if we touch our face, nose or eyes without washing our hands. Good news is that virus can be killed by simply washing our hands with soap and water for 40 seconds or using alcohol based sanitizer for 20 seconds.

About COVID-19- What does it do to your body?

COVID-19 causes mild respiratory disease in most of the affected individuals. Mild disease means either no symptoms or minimal flu like symptoms like fever, cough, sneezing and almost 98% patients recover. About 80% patients do not even require hospitalization. Some people may get severe pneumonia and about 2% people may die

Symptoms usually start in 2-14 days after you get infection with virus (in most people- 3-7days). Symptoms include cough, fever, breathing difficulty, tiredness, muscle pain and diarrhea.

COVID-19 in a diabetic- What are the implications?

 It has been seen that people with pre-existing illness like Diabetes mellitus, heart disease, high blood pressure or people with previous lung disease are more susceptible to having serious complications from COVID-19. People with uncontrolled diabetes have a higher rate of getting serious infection because these patients have low immunity to respond to a new infection. Remember, the risk of catching infection is not high in a diabetic. But, if they catch it, they are more likely to get a serious illness.

 COVID-19 and diabetes- What should you do?

 In general, recommendations are same as for everyone else. Most important advice is PREVENTION AND SOCIAL DISTANCING along with good glycemic control. These are the rules that should be followed-

1. Wash your hands frequently with soap and water for 40 seconds or alcohol based sanitizer for 20 seconds specially before eating anything or after coming from public place.
2. Avoid touching your face, nose or eyes without washing your hands.
3. Stay home as much as possible. In India, we are already under the lockdown.
4. If you do need to go out to buy essentials, stay at least 1 metre away from other people.
5. Don’t shake hands/ hugs, share food, tools, glass or towels.
6. Keep a distance of at least 6 feet from people who do not live with you.
7. Wear cloth masks when in public areas where its difficult to maintain distance.
8. Avoid close contact with those who are ill/ sneezing/ coughing.

What do you do if you get symptoms?

 Mild disease

1. If you get sick with fever, cough and it is mild, then do not rush to the hospital as you may spread the virus to other people.
2. Isolate yourself from other members of the family.
3. There is no specific treatment. Only symptomatic treatment is required.

Severe disease

1. If you have severe symptoms like breathing difficulty, put on a face mask and contact your local health authorities. In India, central government’s 24×7 helpline number is 011-23978046 and for Punjab state helpline number is 104/ +91-8872090029/+91-172-2920074.
2. If doctor feels that you have COVID-19 infection, your sample will be sent from oral/ nasal cavity.
3. You may or may not be hospitalized based on severity of symptoms.
4. If you are hospitalized, take your insulin and other diabetes supplies/medicines with you as hospital may not have all types of insulin/medicines available.

Management at home

 If you are not hospitalized or you have mild disease, follow these rules-

1. Isolate yourself in a room for 2 weeks.
2. Identify all the people you have had contact with since the onset of symptoms and isolate them also for at least 2 weeks.
3. Stay home in a well ventilated room
4. Other members should stay in other rooms
5. Maintain proper hand hygiene.
6. Wash hands again and again and use disposable paper towels to dry. If not available, use dry cloth and replace it whenever it is wet.
7. Wear mask as much as possible.
8. If unable to wear mask, cover your nose/ mouth with paper/tissue/crook of elbow while sneezing/ coughing.
9. Throw tissue in a bin.
10. Caregivers should also wear tight fitting mask when in same room.
11. Avoid unprotected contact with farm animals.
12. Make sure that you have adequate stock of medicines and supplies for monitoring at home.
13. Keep monitoring for-
    1. Worsening of symptoms
    2. Check sugar frequently
    3. Check body temperature frequently
    4. Drink plenty of fluids/ keep hydrated
    5. If on insulin- monitor urine ketones if RBS is >250mg/dl.

In the end, I’l emphasize that

• Prevention is better than cure.
• Don’t worry about being stuck at home because being home is better than being in an ICU.
• Even if you have to go out, wearing a mask is essential. Remember wearing a mask is better than a ventilator.

Stay home, stay safe.

ALL THE BEST!!