Editor’s Note: This content has been verified by Calvin Sun, MD. He is a frontline worker in the ER at a prevalent hospital in New York. He’s currently practicing Attending Physician and Clinical Assistant Professor in Emergency Medicine, a public speaker, phoblogopher, activist, choreographer, and entrepreneur based in NYC. Follow him @monsoondiaries on Instagram. See his LinkedIn profile here. I am beyond honored and thankful for his support. Our frontline workers, healthcare heroes, whom we owe our deepest gratitude in these most dire times. Do not let their hardships and deaths be forgotten. This topic is continuously evolving and will be updated accordingly.
Update: Wednesday, April 1, 2020 – Mayor Garcetti and CA Governor Newsom finally announces everyone to wear a mask but save N95’s for healthcare workers. Use only what you have at home – DO NOT go out to buy supplies. If so, order from Amazon.com or any other online sewing supply store (Google it).
Update: Thursday, March 26, 2020 – The U.S. now has more confirmed cases than anywhere else in the world and we still haven’t hit our peak yet according to NIAID Director Dr. Anthony Fauci. Read this article from Vox news for more details and what to do next. Hint: Continue to practice strict physical distancing. Otherwise, this will drag on longer than it should.
Update: Tuesday, March 17, 2020 – Latest medical research shows SARS-COV-1 and 2 stable on surfaces for hours up to days. Learn more on NIH.gov. Yes, we knew that but millions didn’t. Just read it. Hint: It’s airborne – since the first transmission from animal to human. It attaches to air / respiratory droplets. Hence, how easily and quickly it spreads (aka Rnaught).
Update: Friday, March 13, 2020 – President Donald Trump declared a National Emergency to free up Federal funding to battle this pandemic. Currently, his travel ban only restricts foreigners coming into America, but not Americans traveling out of the U.S. Track latest case numbers as more testing is made available here or scroll down to bottom list of resources and view Johns Hopkins University interactive map.
As of Wednesday, March 11, 2020, the World Health Organization (WHO) declared the novel coronavirus a “pandemic.” This simply means that the disease it causes known as Covid-19 has spread globally affecting more than 118 countries and territories including the U.S. since it’s outbreak in Wuhan, Hubei Province, China from December 2019. They have since recovered and have returned to their daily lives as of the first week of March, per my in-laws in Shanghai. China recovered quickly because their government took extreme, but necessary, measures to contain the virus by prohibiting any social gatherings and imprisoned anyone and their families who broke self-quarantine or isolation. We know this because my husbands family has ties to military in China. His family worries for our lives now as the virus spreads quickly across America with over 30 cases in Los Angeles county alone as of March 12, 2020. *Note: Check CDC.gov or Johns Hopkins map for daily rates of cases.
Check Facts to Ease Panic
This article is meant to serve as a point of reference for factual resources. As Health Officials advised weeks prior to the writing of this post, don’t panic, and for crying out loud – we are NOT going to run out of toilet paper or our water supply. This is not the zombie apocalypse. However, I really want to stress to those who think Covid-19 isn’t any big deal: CHECK YOUR FACTS in the resources listed below. If you don’t like to read much, follow @who @nihgov @niaid and @cdcgov on Instagram or Twitter. Covid-19 is deadlier than the seasonal flu (Rnaught of 2-2.5% vs 1.3%* as of this writing) especially to those who are high-risk with “underlying health conditions, diabetes” and compromised immune systems including my Type 1 diabetic five year old daughter (oldest of two). New research regarding how the coronavirus affects those with Type 1 diabetes is still underway. As of March 12th, I decided to keep Coral home from school until CDC updates the public with a decline in cases in LA regardless of LAUSDs lack of prompt action.
Learn more about how Covid-19 compares to the seasonal flu here. Note: There is a multitude of information but researchers are still gathering data on a more accurate mortality rate of the novel coronavirus as the days go by. The article I’ve linked from Live Science was thorough and pulled sources from Health Officials I’ve mentioned earlier. Research the term R-naught or reproduction rate or fatality rate of Covid-19 to find true case fatality rate of this novel virus. Believed to be anywhere between 2-3. 1 person can spread it to 2-3 people through either coughing, sneezing or exhaling. LEARN MORE ON NIH.GOV or NEJM.ORG. *See video explanation of Rnaught on Vox.com.
Instructions for downloading map: Click on your state and or county from your desktop computer. Then, click and generate an infographic with statistics and save as a png to share and inform others on social media, email, or text.
Be considerate of your community and stay in self-quarantine as advised by your physicians and the Department of Health. Don’t be a foolish a-hole and put other people’s lives at risk. Practice strict physical distancing now to prevent further spread and deaths within your community. Otherwise, this is going to take a lot longer than it should to slow down the spread, return to our usual T1dlives, and recover the economy. As of April 28, 2020, we have at least 10 confirmed cases of Covid-19 in our very own neighborhood and we see people walking past our house with no masks – including families, every day! If you live in Southern California, I highly suggest you check your neighborhood’s cases here and help spread awareness – not the virus.
Follow Health Officials Guidelines
Although WHO, CDC, and almost every county or state seriously lagged on preventitive measures, we should still follow their basic protective measures even well after each state lifts it’s Stay-at-Home Orders. It’s important to note that we can still change the course of this pandemic by taking steps listed out by WHO (follow Coronavirus on your Apple news feed):
- Stay home if sick and experiencing flu-like symptoms – call your physician asap. Do not head directly to the hospital or ER until you receive further instructions from your healthcare provider.
- Avoid touching face
- Cough or sneeze into your elbow or tissue
- Wash your hands and tell your kids to do the same – especially if still at school. Be vigilant with good hygiene and sanitizing surfaces with frequent contact.
- Follow health officials and physician’s orders to self-quarantine if you’re experiencing Covid symptoms regardless if you’ve traveled out of the country in the past 30 days primarily Iran, China, South Korea. Check CDC.gov for more level 3 zones and travel restrictions. Important: Symptoms of children with Covid-19 vary widely, but fever and shortness of breath remains consistent across all demographics. Learn more about how Covid-19 affected children in parts of China here.
- Be considerate of those with compromised immune systems and the elderly – they are at highest risk of Covid-19. However, as of March, there are developing cases within 7 month olds and other youth. Learn more from medical videos about why and how the immune system is affected during a Covid-19 attack.
- Further educate yourselves – per CDC, people may be asymptomatic for days or weeks and still contagious. A new study published on The-Scientist.com reveals that asymptomatic people including those who’ve tested positive for antibodies or have recovered from Covid-19, may become reinfected and still spread it to others more vulnerable. Those antibodies (IgG) may be destroyed by the virus (in lesser words unless you care to learn more about the immune system) within weeks to months depending on the severity of Covid-19 infection in each individual’s immune system. So stay the f*ck home and don’t spread the disease or at least wear masks or face coverings whenever you leave the house. Nobody is immune to this novel meaning new, coronavirus!
- Break the Stigma – Just because we’re [part] Asian doesn’t mean we have the coronavirus and stop calling it the “Chinese Virus” or “Kung Flu.” Learn the basics here.
- #Flattenthecurve – the only way we’re going to be able to control the rate of speed this disease is spreading is to do all the above AND practice #socialdistancing, per Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases (NIAID).
- WEAR A MASK any time leaving the house for essentials or exercise. Make one if you can’t buy one. Otherwise, shop my newly designed masks and read the full manufacturer’s description. Mahalo for supporting my small business on Zazzle.com/T1dlife. There are many medical research journals like that published on the National Institutes of Health in recent weeks proving the effectiveness of simply wearing a face cloth covering to help slow down the spread (aka Rnaught) of the novel coronavirus. Most people don’t care to read or can barely understand medical journals, so please learn more from this article on NPR.
- Postpone social gatherings until there’s a safe vaccine for children – use apps like Zoom, Facetime, Skype, WhatsApp or WeChat.
- Stay 6ft to 8ft away from other people even if you’re asymptomatic – you could still be carrying the virus and be contagious.
- If you must go out for vital essentials (not limited to Prosecco), then go during off-peak hours before 9am or after 8pm. Check your local grocer for hours of operation and Google it for peak times prior to leaving your home. Ladies, take pepper spray with you or send a male friend or your spouse in the evenings.
- Order in dinner or non-perishable groceries with apps like DoorDash, Grub Hub, Amazon Fresh, or Pavilions (AKA Vons). Use your own discretion as to how safe you think the food is from the restaurant to the driver then to you receiving it. If you haven’t stocked up your freezer and pantry of a minimum two weeks worth of food by now, then you’re way behind the rest of us proactive peeps. So far, according to the CDC, there is still no data that proves the coronavirus can be transmissible through foods. Fingers crossed.
- Watch Dr. Jeffrey VanWingen’s video on how to properly sanitize your groceries before putting them in the freezer or fridge.
- Update 4/2/20: DoorDash delivery workers and many more “contract” workers are now on strike. Thankfully, we are still able to order delivery from Costco.com to avoid exposing ourselves in the market or at grocery stores.
- Update 3/26/20: We haven’t been able to place an order on Amazon Fresh or the Pavilions app for the past two weeks. Costco.com delivery has worked out better but we must place our order a week in advance and keep checking our order status daily for updates. Watch this YouTube video of a doctor’s advice how to sanitize your groceries or takeout food (only order hot foods).
- If available, order all medication and insulin through an online pharmacy like OptumRx Even though they’re absolutely clueless about Dexcom, it’s more convenient than physically picking it up at a major pharmacy where the lines will be hectic with a bunch of sick frantic people. Check with your insurance provider to see what’s available in your area. When we had Kaiser living in the Valley in 2016, we were able to request the pharmacy mail us our insulin and they’d place it with gel ice packs in a well-insulated box with padding and/or styrofoam.
- Have endo rewrite your prescriptions to the max allowed covered by insurer. Even if you get denied by insurer, then have your endo send a pre-auth for a higher quantity of medication so you don’t run out of life-saving insulin or medication during these hectic times. Be persistent and resilient.
DiaTribe – What you need to know about diabetes and the Coronavirus, 5 minute read. Bottom line: the more chronic conditions one has, the higher the risk of severe Covid-19 symptoms. Also, read Coronavirus Preparation Strategies and see their Diabetes Shopping List.
I posted some immune boosters we usually stock up on and have used before this outbreak on Instagram. Also, shop our Low Carb Goodies and typical T1d Supplies on Amazon (not sponsored). You may also refer to our Quick Referrals and Good Glucose Snacks pages for more of our favs.
Top Resources for Coronavirus Facts and Updates
Centers for Disease Control and Prevention (CDC) – This is the main resource for facts and updates on the novel coronavirus. Read carefully asap! Stop the spread of misinformation especially on social media. CDC.gov should be everyone’s first go-to for current factual information about the novel coronavirus. Repost their infographics from Instagram and share to spread awareness – not the virus.
World Health Organization (WHO) – cross-reference data and resources on this site and above-mentioned CDC.gov. The top four I’ve listed will often reference each other because they all work together to combat the spread of viruses and diseases. Download and share WHO’s free infographics like some of the ones below on how to protect yourself.
National Institute of Health (NIH) – A valuable resource of must-read information and news of a clinical trial for vaccine. If there are any medical journals within the U.S. regarding new research findings of how the coronavirus affects T1ds, this will be one of those main sources. See their informative posts on Instagram and share please.
National Institute of Allergy and Infectious Diseases (NIAID) – See factual and realistic approach by Dr. Anthony S. Fauci, MD, Director of NIAID here.
Johns Hopkins Coronavirus Resource Center – Take 15-20 minutes to explore and navigate your way through this site, but don’t let all the news feeds distract you. View their interactive map for live updates of cases around the globe. Be aware of the spread within your community. Learn some Covid-19 Basics with insights from JHU experts.
Vox.com – This has been the most straight-forward well articulated news coverage with educational videos, infographics, and podcasts for the novel coronavirus. I highly suggest exploring their site and sharing it on all your online platforms and social media. Start with this article for those who still refuse to accept how seriously life-threatening Covid-19 can be for the more vulnerable. Follow @voxdotcom on Instagram too and share their posts and IGTV to your feed or Stories.
California Department of Health – Update: As of July 13, 2020, there are 8,358 new cases, 329,162 new positive cases, and total of 7,040 deaths in CA . Go to Johns Hopkins Maps for daily updates as mentioned earlier, but lately they’ve been one day behind. See infographic below, save and share to social media to encourage everyone to do their part to slow the spread.
As of March 12, 2020, 7 a.m. Pacific Time, there are a total of 198 positive cases and four deaths in California: 24 cases are from repatriation flights.
The other 174 confirmed cases include 60 that are travel related, 43 due to person-to-person transmission, 44 are community acquired (map of community transmission by county in California- PDF) and 27 are from unknown sources. Of all the confirmed positive cases:
- Age 0 – 17: 4 cases
- Age 18 – 64: 113 cases
- Age 65+: 79 cases
- Unknown: 2 cases
Approximately 11,100 people are self-monitoring, across 49 local health jurisdictions, after returning to the U.S. from travel. Google your state’s department of health for updates on daily cases and measures your state officials are taking to minimize the spread of Covid19.
CNN Audio: Coronavirus Fact vs Fiction – Listent to this series of podcasts. Share with friends and family or those misinformed Facebook groups who are too lazy to do their own research.
Type 1 diabetes and Covid-19
Dr. Bernstein’s take on diabetes and Covid-19 – watch YouTube video or see blog from A Sweet Life. Bottom line: Avoid the novel coronavirus and social distance or self-isolate as long as possible. If itching to hang out with others who say they’re “negative,” than you’re putting each other at risk of exposure and that is detailed in the safety guidelines on CDC.gov mentioned earlier.
Beyond Type 1 – a brief 5 minute read of the coronavirus and how to prepare for it as a diabetic. Emphasis on difficulty of managing and controlling BGs once contracting the virus still needs to be addressed on all medical journals, research, and by diabetes organizations. Possibility of DKA remains a threat similar with the seasonal flu. Bottom line: Have tight control over glucose levels before actually getting sick and you’ll have better immune response to a virus.
Update 4/29/20 – Beyond Type 1 and JDRF have formed an alliance and have listed some very important resources and videos for the T1d community. Click here for more info and read everything thoroughly as you would on my blog.
American Diabetes Association – Read their articles covering Covid-19 before JDRF’s. Bottom line: Everyone with any type of medical condition should take proper precautions and stock up on medication and supplies. Practice social distancing and stay at least 6ft away from other people even if they are asymptomatic.
Parents, scroll down to the part where ADA mentions children with diabetes protected under Section 504. Emphasize to your school faculty and nurse(s) that your child is considered “high-risk” per the CDC and health officials recommend social distancing. Ask your child’s teacher for homeschool materials or a packet to be sent with you or mailed to you. As of today, 3/12/20, over 39,000 concerned parents have signed a petition requesting the closure of all LAUSD schools. I signed it.
Update: Friday 3/13/20, 9AM, PDT – LAUSD Superintendent Austin Beutner finally announced closure of all schools for two weeks starting Monday, 3/16/20 after a tremendous amount of pressure from concerned parents across all demographics. See that announcement here.
JDRF – As of 3/13/20, I received an email from CEO, Aaron Kowalski like many of you have, stating the “risk of contracting Covid-19 does not increase with T1d.” However, I stress the point, again, that there is still not enough conclusive medical research that proves whether or not this is true. I will post an update once I finally do find valid research from reliable medical sources (so closer to 6-12 months from now). See their guide here.
NOTE: My request on social media for anyone who knows of someone with T1d who has recovered from Covid-19 was met with a few different articles of the same one guy who went skiing in Italy and returned to the UK with coronavirus symptoms and later tested positive. See his recent interview with JDRF here where he finally speaks of how Covid-19 affected his BGs and more. Please, speak out to your public health officials and diabetes organizations if you are T1d or a parent of a T1d child who has recovered from Covid-19. You will be doing a great service to the diabetic community. Thank you in advance.
American Association of Clinical Endocrinologists (AACE) – Type 2 diabetics or anyone averaging higher glucose levels are more susceptible to additional and severe complications once contracting Covid-19. Learn more here. Contact your endo or CDE for managing your diabetes.
National Center Biotechnology Information or NCBI, a division of NIH. “Is it fair to hope that patients with Type 1 Diabetes (autoimmune) may be spared by the infection of Covid-19?” Published 2020 April 29. Read this medical journal carefully and you’ll find that it points to the Th1 autoimmunity prevalent in those with autoimmune diseases such as T1d and Hashimoto’s. The researchers or authors provide a very optimistic outlook that T1d’s especially “younger” individuals, with Th1 pathogenesis or manner of how a disease develops, may be able to be spared (aka asymptomatic) or have very mild Covid symptoms (see below screenshot). However, I would like to continue to emphasize that there is still not enough T1d patients across all demographics and ages, who have actually survived Covid, to conduct a thorough study. This study also refers to the first T1d adult most of us heard of who went skiing in Italy and contracted Covid-19 (listed above under JDRF section).
Therefore, journals like these give us anecdotal evidence, or too little information based on singular experience, word of mouth, or casual observations rather than hard scientific analysis. I am personally dismissing said journal for now and will continue to check for more recent publications as the weeks develop. [Note: The main reason I decided to list this medical journal was because some of my followers on Instagram messaged me for some clarification regarding an Instagram post by Juicebox Podcast. So, I decided it was best to interpret what couldn’t be said on the Juicebox Podcast blog on my platform instead, to keep readers informed in a comprehensive manner, to benefit all. Otherwise, I wouldn’t have listed the Journal at all since it requires further analysis by epidemiologists].
DreaMed – Virtual diabetes management service (referred by BeyondType1). Click to register an account and schedule your online session with an endocrinologist. Do not hesitate to seek help from a medical professional when it comes to your health. If you or someone you know has used DreaMed, please leave a comment below of their experience. Note: I am not sponsored by them.
Download a Medical Alert Stop Sign I designed. FREE for personal use only. It took me about three unpaid hours to design this on Adobe Illustrator. Please follow and credit @type1diabetic_life if reposting on Instagram or @typeonediabeticife on Facebook and mention my blog, Typeonediabetic-life.com in your caption. Mahalo!
Further Reading & Education
If you’ve been staying home and self-isolating like we have, then you should have no excuses to make time to view and read the following resources I’ve gathered for you. Please discuss it with your family and friends.
Kurzgesagt – Coronavirus Explained and What You Should Do. It’s animated, watch it with your kids. My 5yr old daughter knows way more about this topic than most adults we’ve spoken to.
MedCram – Medical lectures explained clearly by Dr. Seheult. If you can’t understand him, then read all the other resources I’ve listed for you in this blog post thoroughly. Otherwise, there’s no hope for you.
Ninja Nerd Science – A comprehensive lecture on Covid-19 from start to early March, 2020.
Live Science – “Can People Spread Coronavirus After Being Infected?” Good 3 minute read and actually gives a positive outlook.
New York Times – Possible source of outbreak came from the rare pangolin at a wet market in Wuhan, China. Now, President Xi Jinping of China banned trade of exotic animals. As of late March, we now know it came from a bat to a pangolin to a human due to strains of SARS present with the novel coronavirus which infectious disease experts are labeling as SARS-COV-2.
National Health Commission of People’s Republic of China – all in Chinese, but you can use the translator feature in your Google Chrome browser and it’ll translate some of it.
The Scientist – Covid-19 is very different in children versus adults. Learn more and explore this incredible resource of information with your mom “friends” who insist on having playdates.
Questions About T1d and Coronavirus Remain
Even after all the research I’ve dug up from Beyone Type 1, JDRF, and the ADA, I am still wondering how exactly does Covid-19 affect those with Type 1 diabetes. We all know BGs are extremely difficult to manage with a regular cold or seasonal flu. I would like some answers from endocrinologists and epidemiologists as more research develops regarding the following:
- Once a person with T1d contracts Covid-19, how severe does it affect blood glucose? Does it make the person more resistant or sensitive to insulin? Depending on the type of virus, Coral typically becomes insulin resistant the first few days and then super sensitive as her cold subsides. It requires constant monitoring with her Dexcom CGM more often than usual and basal adjustments even with Loop. Note: We make all changes to her insulin needs without endo’s help and have done so since first several months post-diagnosis. See Justin Wilhite’s interview with JDRF mentioned earlier.
- How does Covid-19 affect younger populations under the age of 12 who also have T1d? Or those using immunosuppressants likely due to kidney or any other organ transplant?
- How does Covid-19 affect those with other autoimmune diseases such as celiac, hashimotos, rheumatoid arthritis or lupus? This a huge population of over a million strong individuals who would like some answers once more research is available.
Due to this being a novel or new coronavirus transmitted from an animal to humans, medical researchers are still gathering more information as the weeks go by. Therefore, it’s important to have realistic expectations of when this pandemic will finally be over – not until there’s a safe and effective vaccine for both adults and children; and to continue strong physical distancing and wearing masks. We can continue to check for any clinical trials requesting group studies for T1d-Covid19 patients. In the meantime, use good judgement, pray your CGM continues to work accurately, and monitor closely especially when ill as advised by your endo.
BOTTOM LINE: Regardless of age or how healthy a person may be, it all depends on how their individual immune system will respond to the Virus. As of early April, there have been reported cases of children across multiple states including New York, California, and Louisiana with rare Kawasaki’s Disease – another type of autoimmune disease triggered by Covid19 causing severe multi-inflammatory responses throughout a child’s body. It simply is not worth risking our child’s life to go back to school or be around anyone else during this pandemic due to her chronic autoimmune condition.
Spread Awareness Not the Virus
Please help spread awareness and educate those that are willing to listen. Use credible sources like what I’ve listed above and share to social media with your friends and family. Please encourage them to do their part in society by strict physical distancing to #protectothers. Stay strong and know that whatever emotions we are feeling are okay. Smart people will survive this pandemic no matter how long it takes. I will try my best to keep this page updated as the weeks go by. Malama pono (live well in Hawaiian).
Page Updated: 7/14/20
Note: The way we evaluate a medical journal publication site is through A) Googling main three researchers who wrote the paper to see how much they got paid by what university – the least paid typically the more credibility since money wasn’t a top motive, B) how many individuals were involved in their group study and for how long, C) if their research contradicts our own medical knowledge and the majority of other medical journals from said resources above like NIH, NAIAD, Health Departments, etc., then it’s dismissive, misleading, inconclusive and/or false.
Disclaimer: Nothing I say or do on this Blog or my social media accounts @type1diabetic_life on Instagram and @typeonediabeticlife on Facebook is meant to be taken as medical advice. Do not literally follow us. Always seek counsel from your healthcare provider like your endocrinologist or certified diabetes educator. Make educated decisions for your and/or your child’s safety. Call 911 for an emergency. I am not an epidemiologist, but I wish more people would listen to them and Health Officials regarding this pandemic. Also, I do not make a profit from this blog, social media accounts, or my Zazzle.com/t1dife shop. I actually have to pay a subscription for this blog on WordPress. An average of 15% of royalties I make from my Zazzle shop designs all goes back to maintenance and supporting my family. I am in no way compensated for sharing products and educating others on my platforms. Mahalo for reading and please subscribe to my blog or follow us on Instagram.