What is COVID-19?

Coronavirus disease 2019, or "COVID-19"is the infectious disease caused by the most recently discovered coronavirus called SARS-CoV-2. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. But it has spread quickly since then to more than 190 countries, including India.

How does COVID-19 spread?

People can contract COVID-19 from others who have the virus through

• Close personal contact, such as touching or shaking hands then touching your mouth, nose or eyes before washing your hands.
• Touching something with the virus on it (such as objects and surfaces), then touching your mouth, nose or eyes before washing your hands.
• People can also contract COVID-19 if they breathe in droplets from a person with COVID-19 who coughs out, sneezes out or exhales droplets.

Can the virus that causes COVID-19 be transmitted through the air?

Studies to date suggest that the virus that causes COVID-19 is mainly transmitted through contact with respiratory droplets rather than through the air.

What are the symptoms of COVID-19?

Symptoms usually start a few days after a person is infected with the virus. The most common symptoms of COVID-19 are fever, tiredness, and dry cough. Some patients may have muscle aches, nasal congestion, runny nose, sore throat or diarrhoea. Most people have mild symptoms. Some people become infected but don’t develop any symptoms. Most people (about 80 per cent) recover from the disease without needing special treatment. Around one out of every six people becomes seriously ill. COVID-19 can lead to serious problems like pneumonia, difficulty breathing, or even death. Coronaviruses can cause more severe symptoms and complications in people with diabetes, as well as in older people, and those with other long-term conditions such as cancer, cardiac disease chronic kidney disease or chronic lung disease.

How does COVID-19 affect those living with diabetes?

People with diabetes are equally (not more) likely as the general population to get COVID-19. However, COVID-19 can cause more severe symptoms and complications in some people living with diabetes, because your body’s ability to fight off an infection is compromised. People who have diabetes-related health problems are likely to have worse outcomes than people with diabetes who are otherwise healthy. Viral infections increase the likelihood hyperglycemia or hypoglycaemia. When sick with a viral infection, people with diabetes (commonly type 1 diabetes) face an increased risk of diabetic ketoacidosis (DKA)-a dangerous condition that demands immediate medical attention, and can be fatal if left untreated - particularly in type 1diabetes.

How can I prevent infection?

Since COVID-19 is so new, there is not yet a vaccine, nor are there medications to treat it.

Take these steps to reduce exposure to the virus and protect your health:

• Wash your hands frequently with soap and water for at least 20 seconds, especially after having been in a public place.If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.
• To the extent possible, avoid touching high-touch surfaces in public places–elevator buttons, door handles, handrails, handshaking with people and other body contacts.
• Sneeze and cough into your sleeve; when using tissues, immediately dispose of them into the garbage as soon as possible and wash your hands afterwards.
• Do not spit in public
• Avoid touching any part of your face including eyes, nose or mouth
• Regularly clean commonly used surfaces and devices you touch or handle.
• Try to avoid contact with people who are showing symptoms of respiratory illness, such as coughing. Stay at least 6 feet (2 metres) away from a person who is sick.
• Avoid crowds, especially in poorly ventilated spaces.
• Avoid all non-essential travel including plane trips.Check national travel advice at the website of Ministry of Health & Family Welfare, Government of India at mohfw.gov.in before planning or taking trips.
• If COVID-19 is spreading in your community, take measures to put distance between yourself and other people to reduce your risk of being exposed to the virus. Stay home as much as possible.Work from home, where possible.
• If you have a fever, cough and difficulty breathing, seek medical care early and share previous travel or contact history with your health-care provider.
• If you are sick, avoid contact with others and stay more than 1.5 metres away from people.Stay home from office/work or school, and disinfect frequently touched objects and surfaces.

I have diabetes and I think I may be infected. What do I do?

You might have been exposed if any of the following happened within the last 14 days:

• You had close contact with a person who has the virus – This generally means being within about 6 feet of the person.
• You lived in, or travelled to, an area where lots of people have the virus.
• You went to an event or location where there were known cases of COVID-19 – For example, if multiple people got sick after a specific gathering or in your workplace.

If you have diabetes and you have symptoms such as a cough, high temperature and feeling short of breath, you need to continue taking your medication and contact your physician or local public health authority. While visiting doctor wear a mask / cloth to cover your mouth and nose to protect others. Stay at least 1.5 metres away from other people. Cover your coughs or sneezes with your elbow.

When do I need to get tested for COVID-19?

You are not required to get tested for COVID- 19 if you do not have any symptoms (cough, fever or difficulty in breathing)

Your doctor will tell you if you should be tested. They will arrange for the test.You will only be tested if your doctor decides you meet the criteria (the criteria may be modified from time to time):

• You have returned from overseas in the past 14 days and you develop respiratory illness with or without fever
• You have been in close contact with a confirmed COVID-19 case in the past 14 days and you develop respiratory illness with or without fever
• You are a healthcare worker managing respiratory distress / Severe acute respiratory illness and you have a respiratory illness with or without fever

Alternatively, if you meet any of the above criteria, you can call the State Helpline Number or Ministry of Health & Family Welfare, Government of India’s 24×7 helpline 011-23978046. The helpline service will note down your contact details and contact you with the testing protocols of COVID-19. If you qualify as a case for testing as per the protocol, you will be tested at a Government approved lab.

If you are a confirmed case, you need to be isolated and treated.

How do I manage my diabetes during sick days?

It is important that you practice sick day management.Here are some common:

• Stay hydrated.Drink lots of fluids. If you’re having trouble keeping water down, have small sips every 15 minutes or so throughout the day to avoid dehydration.Practice eating smaller portions but more often.If youre vomiting, or not able to keep fluids down, get medical help as soon as possible.
• Follow the advice of your diabetes care team regarding medication usage.
• If you routinely check your blood glucose at home youll probably need to do it more often.
• If you dont test your blood glucose levels at home, be aware of the symptoms of hyperglycemia, which include passing more urine than normal (especially at night), being very thirsty, headaches, tiredness and lethargy. You should contact your doctor if you have above symptoms.
• If you have type 1 diabetes, check your blood glucose at least every four hours, including during the night. It may be necessary to take extra insulin to bring down higher blood glucose levels.Check your ketones if your blood sugar level is high(greater than 240mg/dl) more than 2 times in a row.Contact your doctor immediately, if you have medium or large ketones, vomiting, or symptoms of DKA.
• Be aware of symptoms of hypoglycaemia. If you are experiencing a low blood glucose(below 70 mg), eat 15 grams of simple carbs like glucose, honey, jam, hard candy, juice or regular soda, and re-check your blood sugar in 15 minutes to make sure your levels are rising. Repeat the cycle if low blood glucose is persisting.
• If your blood glucose is persistently high or low contact your doctor.
• Wash your hands and clean your injection/infusion and finger-stick sites with soap and water or rubbing alcohol.

What medicines can I take for the infection?

Many over-the-counter (OTC) medications affect blood glucose levels. Many cough syrups contain sugar, which exacer- bates blood glucose levels.Other drugs like decongestants also raise blood glucose.Be aware of the effects of pain and fever reducers, too. Aspirin in large doses can lower blood glucose levels. Some CGM sensors (Dexcom G5, Medtronic Enlite, and Guardian) are impacted by Paracetamol. Check with finger sticks to ensure accuracy.Talk to your health care team about medications you should use for colds, flu, and infections.

Should I stop taking certain blood pressure medications because I’ve heard that these drugs may affect my risk of COVID-19 infection?

Blood pressure control is an essential part of managing diabetes. Certain blood pressure lowering medications[known as angiotensin converting enzyme inhibitors (ACE-i) or Angiotensin Receptor Blockers (ARBs)] are often recommend- ed for people living with diabetes to protect them from kidney and heart-related complications, even in the absence of high blood pressure. At the present time, there is no confirmed scientific link between these blood pressure medications and the risk of COVID-19 infection or its complications. Please do NOT stop or change any of your medications without discussing with your health-care team.

How can I prepare in the event I become infected and have diabetes?

Everyone should have a plan in case they or a loved one becomes ill. For people living with diabetes, thisis very import- ant.Your plan may include:

• Gather the contact information for your doctors, clinic, pharmacy and your insurance.
• Write down the names and doses of your medications.
• Have enough medication for one-two weeks in case you cannot get to the pharmacy to refill your prescriptions.
• Ensure you have enough device supplies (i.e. pump supplies, pen supplies, monitorsupplies, etc.)
• Ensure all your medications have refills available, so you do not have to leave the house if youbecome ill.
• Have extra supplies like rubbing alcohol, hand sanitizers and soap to wash your hands.
• Keep simple sugars (e.g. glucose tablets, hard candies) on-hand in case you need to treat low blood glucosewhich may occur more frequently with illness.
• Have ketone strips available (if you have type 1 diabetes).
• Review how you manage sick days.

Should I go to work / not see friends / not see friends who’ve travelled from affected areas?

People with diabetes follow the latest social distancing measures. For a list of social distancing measures visit the website of Ministry of Health and Family Welfare, Government of India at mohfw.gov.in

What if I have travel planned or a holiday booked to one of the affected areas. Am I more at risk if I do travel?

Avoid all non-essential travel.Any country or area may restrict travel without notice.Check national travel advice at the website of Ministry of Health and Family Welfare, Government of India at mohfw.gov.inbefore planning or taking trips.

I have returned from international travel. What precautions do I need to follow:

Even you are asymptomatic, you should stay in home quarantine for 14 days. For information on precautions to be followed during home quarantine, visit the website of Ministry of Health & Family Welfare, Government of India at mohfw.gov.in.You will need to be tested for COVID-19 if you become symptomatic (fever, cough, difficulty in breath- ing etc.). If test result is positive, then you need to be isolated and treated.

I have been in contact with a laboratory confirmed person with COVID- 19. What precautions do I need to follow?

Even you are asymptomatic, you should stay in home quarantine for 14 days. For information on precautions to be followed during home quarantine, visit the website of Ministry of Health & Family Welfare, Government of India at mohfw.gov.in. You will need to be tested for COVID-19 if you become symptomatic (fever, cough, difficulty in breath- ing etc.). If test result is positive, then you need to be isolated and treated.

When to wear a mask?

Everyone need NOT wear a mask.

Only wear a mask if

• You have symptoms (cough, fever or difficulty in breathing)
• While visiting a healthcare facility.
• You are caring for COVID- 19 suspect / confirmed patient
• You are a health-worker attending to patients with respiratory symptoms

Where can I get more information on COVID- 19?

There is a large amount of unverified information circulating on social media. It is important that you seek information on coronavirus from trusted sources.

Visit the website of Ministry of Health & Family Welfare, Government of India at mohfw.gov.in.The page on Novel Corona Virus is regularly updated with the latest information.If you have questions about coronavirus please call the 24×7 central HelplineNo: +911123978046 or Toll Free No: 1075. Additionally helpline numbers of each state and union territory are available in the website. The helpline Email ID is ncov2019@gov.in

The complete document is available on www.rssdi.in

This document has been prepared by experts from Research Society for

Study of Diabetes in India (RSSDI)