The novel coronavirus has been declared a national emergency and a serious global pandemic – you didn't read it here first. Given the virus' high infective potential and rapid transmission throughout our communities, many more cases are expected to be identified.
In an effort to limit the spread of the virus throughout communities, policies were implemented throughout the country to restrict travel, limit congregating in large social gatherings and halt regular operations such as school and office work.
In rapidly developing pandemics, early preparation and response is the single most important factor in ensuring the best outcome for patients in the face of a health care system that may be stressed to its limit.
While not all the answers to our questions are clear, I would like to share some practical information based on very early data that is emerging from countries with a significant number of cases, and from our previous knowledge of how to manage endocrine diseases in patients with viral infections.
Here are three things you should know if you have an endocrine problem in the time of COVID-19.
1. If you have diabetes: You are at higher risk for developing more serious complications if you have been infected by the virus. The adverse effects of the virus do not seem to discriminate between those who have Type 1 and Type 2 diabetes. Additionally, if you have uncontrolled diabetes or associated co-morbid conditions, like heart disease, the situation is even more critical.
Infections thrive in sugar-rich environments, and high blood sugars are known to impair healing. This leaves patients who have diabetes in an immune-impaired state that can lead to more serious consequences compared to a healthy population. As we're learning from our Chinese medical counterparts, individuals who were infected with COVID-19 and had diabetes had higher rates of serious complications and death as compared to the general population in China. According to The Chinese Center for Disease Control and Prevention, a case fatality rate of 7.3% was reported in patients with diabetes who were infected with the virus, compared to a case fatality rate of 0.9% in individuals without pre-existing conditions. This is a very relevant fact for more than 34 million Americans who currently suffer from diabetes.
Moreover, as seen with illness in general, being infected with COVID-19 may precipitate the onset of diabetic ketoacidosis, a critical consequence that may occur as a result of profound hyperglycemia and the build-up of acid metabolites in the blood. DKA is most commonly seen in people who have Type 1 diabetes, but has occurred in people with Type 2 diabetes as well.
Although it's unclear whether patients with diabetes are at an increased risk of being infected with the virus, it's still very important to maintain social distancing and take precautions to reduce your risk of being infected. For example, ensure that you have enough medication to last you through the next month. And be sure to have extra healthy diabetic-friendly foods stocked in your home. It's important to remember to keep an extra supply of simple sugars (such as candy and orange juice) in case of low blood sugars.
If you're infected with COVID-19, reach out to your diabetic care team immediately. Generally speaking, expect higher blood sugars than usual, and work with your health care professional to plan how to keep your levels in a safe range.
2. If you have adrenal insufficiency: Do not stop your steroids, unless advised to do so by your medical provider. The most important thing to remember during this time is to never stop your steroids abruptly. This is not only for those with adrenal insufficiency, but for any individuals who may be taking long-term steroids for underlying chronic conditions.
Although some may assume that steroidal medications may compromise the immune system, having the right amount of steroid in your body is essential for normal bodily function and can be life-saving when dealing with an infection. Being compliant with these medications, as scheduled, is extremely important. As a precautionary measure, discuss management strategies with your health care provider in the event of a COVID-19 infection. Additionally, keeping an extra supply of steroids, having your emergency stress dose steroids on hand and wearing your adrenal insufficiency medical alert bracelet are of great importance during this time.
3. If you have a thyroid dysfunction: To date, there have been no studies to investigate the consequences of acquiring the virus in patients with known thyroid dysfunction. Furthermore, recently published data did not look at thyroid diseases as co-morbid conditions in those diagnosed with COVID-19. Although further research on this topic can be pursued, in the meantime, patients with thyroid diseases such as hypothyroidism and hyperthyroidism should not stop taking their medications without first consulting with their healthcare provider. Having an extra supply of thyroid medications is also advised.
In this uncertain time of the COVID-19 pandemic, exercising precautionary measures to keep you and your community safe is crucial. If you have a routine doctor appointment, work with your health care team to avoid unnecessary exposures and opt for virtual care visits when feasible. Exercise social distancing, proper hand hygiene and stay at home if you're ill. The onus is now on us, as a community, to prevent further spread of COVID-19, and together, with the right preparation and action, we can help ensure the best outcomes for all.
Author: By Shirisha Avadhanula, M.D., Contributor
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