COVID-19 has been on top of mind for nearly everyone across the globe. With many reading daily reports on the spread of the virus and the potential impact on those with compromised immune systems, we decided to reach out to our Patient Partners to respond to their questions and concerns regarding your own risks as someone living with diabetes and with other chronic diseases.

During four video teleconferences between April 8^th – April 15^th, 2020 our Patient Partners had an opportunity to connect with leading experts in Canada in diabetes research discussing both type 1 and type 2 diabetes in both French and English. From these discussions we have compiled the following frequently asked questions (FAQs) to make available to all members of our research Network.  The information provided reflects what we know now about the novel coronavirus, we expect that with new information emerging there will be additional questions and we will endeavour to add and update the information provided as it becomes available.

Also, for your reference we have put together a COVID-19 resource page with information from our partners discussing diabetes and COVID-19.

Why are we required to stay at home?

Although we are still learning about the novel coronavirus we do know the virus is primarily spread by person to person contact. Transmission is through droplet spread from infected individuals coming into contact with the mucous membranes of the nose, mouth, throat and eyes of others. These droplets can be produced when someone coughs, sneezes, speaks, and breathes. If you pass through an area where droplets have been created (less that 6 feet from the person spreading the droplets), you could get infected. Crowded rooms with poor circulation increase the chance of getting infected.

Non-essential workers have been asked to stay at home, because you cannot catch the virus unless you are exposed to someone who is infected with the virus. These droplets can settle on objects, so if you do need to leave your home carry sanitizer with you and use it after touching objects, wash your hands with soap for 20 seconds immediately upon returning and take care NOT to touch your face. When you are out, stay at least 6 feet away from people. Some people do take the extra measure of washing the food products they purchase and disinfecting the surface of packages they receive. Although, the probability of getting infected by touching foods is low, one may wish to do so if you would like to be extra cautious.

Is it more dangerous for me as someone living with diabetes to leave my home?

A major risk factor for poor outcomes with COVID-19 is age (over age 70 and to some extent over age 60). Other risk factors, not for catching the virus but for doing poorly if you get infected, may include diabetes, but quite clearly centre on heart disease, kidney disease, high blood pressure and a suppressed immune system, for example from immunosuppressant medication.

Although health authorities have emphasized the risk of poor outcomes among people with diabetes who develop COVID-19,  having diabetes does not necessarily mean you are more susceptible to infection from the coronavirus or poor outcomes. There are theories that individuals living with diabetes are at a greater risk of any viral infection, not just the coronavirus, with increased or highly variable blood sugar levels, but this is not confirmed. Secondly, emerging data about the coronavirus has shown that diabetes alone does not seem to increase the risk of poor outcomes among those with COVID-19, but diabetes in combination with the other conditions (such as advanced heart disease or kidney disease) can impact health outcomes. Current data tells us that those with diabetes without these other complications have the same degree of poor outcomes as those without diabetes.

Is there any data suggesting that those living with T1D vs T2D have a different response to the virus?

We are still learning about this virus, but there is currently no definitive evidence that those living with type 1 vs type 2 diabetes respond differently if infected with COVID-19.  Generally, people with type 1 diabetes are younger so may fair better whereas those living with type 2 diabetes, who are generally older and may have other conditions impacting their ability to fight the infection.  People with pre-existing conditions, like heart disease, lung disease and kidney disease have a harder time recovering from the illness. The association of diabetes and bad outcomes with COVID-19 may be more about having diabetes plus other conditions and not about just having diabetes, but we are still learning about this illness.

Why is there the need to quarantine for 14 days if you have been travelling or exposed to someone who has been diagnosed as having COVID-19?

The coronavirus can jump easily from person to person. We have learned that a quarter of people (and perhaps more) who carry the virus show no symptoms – often younger people. For the virus to no longer be infectious in individuals who are ‘silent carriers’ can take up to 14 days and in rare cases even longer. Although these individuals display no symptoms, they can infect others who may develop symptomatic infection.

Individuals who have been infected by the virus usually show symptoms in 3 to 5 days, but in some it can take up to 14 days to display symptoms.  During the time between infection and symptoms emerging, individuals can spread the virus to others.  By staying away from others we are fulfilling our civic duty not to overload the healthcare system and infect hospital and essential workers.  Since you can never be sure about how others are practicing social distancing and/or isolation, it is highly recommended not to interact with anyone face-to-face as they may have likely been interacting with others when shopping, or leaving the house.

As an essential worker living with diabetes and caring for others with vulnerable conditions, am I putting my family at risk?

If your work place has installed the proper safe guards and you have access to personal protective equipment, sanitizer and areas to regularly wash your hands you should be protected. If your diabetes is in good control, you are healthy and below the age of 70, public health guidelines say it is safe to work. Older individuals (>70 years old) with diabetes and other illnesses should be more cautious and remain isolated with their immediate family members for now. These individuals are at higher risk of poor outcomes from the virus and it is best to stay at home.

Should I wear a mask when I leave the house?

It is recommended by public health officials to wear a face covering when you leave your home and when social distancing is a challenge. Face coverings, with the exception of certified N95 masks, will not stop you from breathing in the virus if it is airborne, what it will do will keep droplets that you may create from becoming airborne, therefore protecting others from you.  This means that if you are a carrier of the virus, and you are unaware of the infection, a face covering will protect others from you. For face coverings to be truly effective they must be worn properly, washed after each use (if reusable) and face touching should be avoided.  A risk to using face coverings is it may give the wearer a false sense of security and regular social distancing measures may not be taken. Meticulous hand hygiene is still the best defense against contracting COVID-19.

If I prick my finger to take my blood sugar, will the microabrasions on my fingers increase my chances of contracting the virus?

The novel coronavirus is a respiratory virus that latches onto mucous membranes as its route of entry into the body and not, micro skin abrasions. Don’t lick your finger after a finger prick.

Why are we not testing everyone for a COVID-19 infection if so many don’t exhibit symptoms?

At this time, our healthcare system does not have the capacity to test everyone for the novel coronavirus.  It is hard to prepare for a pandemic when there is no immediate threat as governments and societies have to decide where to allocate resources.   Before December 2019, there was no immediate threat worldwide of this or any other virus becoming such an issue, therefore stockpiling health resources was not considered necessary.  In retrospect this was a mistake that has cost lives and will hopefully not be repeated. Countries are more prepared for military catastrophes than they are for health catastrophes, as there is more ability to predict these threats. Post-pandemic this will hopefully change.

If so many people carry the virus, but have no symptoms what about testing for immunity or antibodies for the virus?

When you get tested for COVID-19, it is a nasal/throat swab to test for the presence of RNA released from the virus.  Researchers are now developing tests for antibodies that develop once a person has been infected with the virus. Since so much is unknown about the virus we are not sure how much antibody you need to be considered immune, whether immunity is long-term, or whether recovery from virus makes you immune against a second infection. More clinical research is required to answer these important questions. It is believed that antibody testing will be one solution to get the economy back up and running, but this is not ready yet to be deployed at a population level.

When can we expect a vaccine against the novel coronavirus?

Vaccines are very hard to produce and need time to be tested for safety and efficacy, before being given to diverse populations.  While we wait for the vaccine development, we are hoping for some sort of herd immunity, which means that as more and more people become immune naturally (through previous exposure or infection), the virus will not have the same impact, reducing the number of people who exhibit symptoms, and preventing our health care system from becoming overrun.

Is there a possible insulin shortage in Canada?

The Canadian supply of insulin is good, but some distribution challenges have occurred. Production is going well and supply is not a worry, especially with the decline of cross-border purchasing of insulin from the USA. It is not necessary to stockpile insulin, as hoarding could impact others from getting their supply of this life-saving medication. Other medications (not insulin) used in the treatment of diabetes have seen recent shortages, but this is not due to COVID-19, but other health and regulatory concerns.

Should I get my routine labs done during the pandemic?

During the pandemic, many Endocrinologists are conducting telephone and video appointments rather than in person appointments. To prepare for these appointments many physicians are asking for the health data, like CGM reports, foot self-exams, etc., in advance.  In many cases, lab work is not urgent, but it is best to follow the advice of your physician before deciding not do routine blood work.