Type 2 diabetes and hypertension (high blood pressure) are the most common underlying health conditions in patients with SARS. [2] There is also evidence that people with type 2 diabetes and the metabolic syndrome (a combination of diabetes, high blood pressure (hypertension) and obesity) may have a higher risk of being seriously ill if they develop COVID-19. There are also specific features of coronavirus infections which could increase this risk.

One type of coronavirus infection, Severe Acute Respiratory Syndrome (SARS) was found to cause more serious disease in those patients who had hyperglycaemia (increased blood glucose levels) and type 2 diabetes. This could be because these patients tend to have metabolic inflammation, which is inflammation that affects the metabolic tissues, such as the liver and the pancreas. This makes these patients more susceptible to enhanced release of cytokines (molecules that circulate in the blood and signal for the body’s immune cells to fight the infection). During an infection the immune system increases the release of cytokines. A cytokine storm (an excessive release of cytokines) occurring in COVID-19 patients can damage tissues and organs and can even cause multi organ failure [3].

Inflammation of the metabolic tissues also affects the immune system, which means it finds it harder to fight infection and slows recovery. A study in animals has shown that type 2 diabetes results in breakdown of control of the immune system and enhances disease severity following infection with a type of coronavirus called Middle East Respiratory Syndrome (MERS) [4]. Although these findings have not been replicated in humans  this data  may support the theory that developing a coronavirus infection with type 2 diabetes causes more serious symptoms.

What are the specific mechanisms in the endocrine system linked to coronavirus infection?

The endocrine system refers to a number of different glands which secrete hormones into the blood and around the body. The Covid-19 virus uses a protein on its surface, which binds to a type of receptor called angiotensin-converting enzyme 2 (ACE2) to enter cells in the body of the infected person. [5] ACE2s purpose in the lungs is to break down a hormone called angiotensin II into another hormone angiotensin 1-7. When ACE2 is blocked and angiotensin II builds up this can cause problems such as an increase in blood pressure and hypoakalemia (low potassium levels in the blood) and increases risk of respiratory distress syndrome (the lungs not being able to provide the body with enough oxygen).

Angiotensin 1-7 leads to anti-inflammatory and anti-fibrotic (reduces scar tissue build up) responses, both of which are required for the recovery of COVID-19 [6].

What is the metabolic link to coronavirus infection?

There is an association between serious complications from the coronavirus and hypertension (high blood pressure), and also to type 2 diabetes. In the pancreas, evidence shows that the SARS coronavirus binds to the ACE2 receptor, which reduces insulin release (7). One study found that patients with the SARS infection with no history of type 2 diabetes became temporarily hyperglycaemic during hospitalisation for the infection. As the human endocrine pancreas expresses ACE2 the coronavirus could enter the cells, leading to acute hyperglycaemia (high blood sugar levels) and temporary type 2 diabetes.

Type 2 diabetes also induces expression of the angiotensin hormone converting molecules (such as ACE2) in other tissues such as the lung, liver and heart, this may help explain why type 2 diabetes could cause higher risk of developing multi-organ failure in coronavirus infections such as SARS [8].

How could this effect treatment for patients with COVID-19?

The data suggests that metabolic control of type 2 diabetes and associated metabolic parameters in patients with COVID-19 may be important. This could help reduce the risk of complications in patients with type 2 diabetes and a severe infectious disease [1].

The article concludes that good metabolic health is more important than ever for us living through the COVID-19 pandemic

References

1. Bornstein,S.R., Dalan, R., Hopkins,D., Mingrone, G. & Boehm,B.O.(2020) Endocrine and metabolic link to coronavirus infection. Nature Reviews Endocrinology. [Online] Available at: https://doi.org/10.1038/s41574-020-0353-9 [Accessed 07 May,2020]
2. Yang, J. K. et al.(2006) Plasma glucose levels and diabetes are independent predictors for mortality and morbidity in patients with SARS. Diabet. Med. 23, 623–628 [Online] Available at: https://doi.org/10.1111/j.1464-5491.2006.01861.x Accessed 07 May,2020]
3. Mehta, D. et al. (2020). Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. [Online] Available at: https://doi.org/10.1016/S0140-6736(20)30628-0 [Accessed 07 May,2020]
4. Kulcsar, K. A., Coleman, C. M., Beck, S. E. & Frieman, M. B. (2019). Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight. 4, 131774. [Online] Available at: 10.1172/jci.insight.131774 [Accessed 07 May,2020]
5. Hoffmann, M. et al. (2020). SARS-CoV-2 Cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. [Online] Available at: https://doi.org/10.1016/j.cell.2020.02.052 [Accessed 07 May,2020]
6. Simões e Silva, A. C., Silveira, K. D., Ferreira, A. J. & Teixeira, M. M. (2013). ACE2, angiotensin-(1–7) and Mas receptor axis in inflammation and fibrosis. Br. J. Pharmacol. 169, 477–492 [Online] Available at: https://doi.org/10.1111/bph.12159 [Accessed 07 May,2020]
7. Roca-Ho, H., Riera, M., Palau, V., Pascual, J. & Soler, M. J. (2017). Characterization of ACE and ACE2 expression within different organs of the NOD mouse. Int. J. Mol. Sci. 18, E563 [Online] Available at: https://doi.org/10.3390/ijms18030563 [Accessed 07 May,2020]

Since the beginning of the pandemic, virtual consultations have become the norm, while face-to-face appointments are now seen as a ‘privilege’.

As a short-term measure during the first lockdown, most General Practitioners were speaking to their patients over the phone, videocall or email.

Nearly 18 months after the beginning of the pandemic, face-to-face appointments have still not fully returned in the UK, data from the Commons Library identifies.

Healthcare professionals across the UK have now revealed what type of appointments require an in-person consultation and which ones should remain virtually.

They have claimed that three quarters of GP appointments could be conducted by nurses or pharmacists instead of doctors, such as medication checks and blood pressure readings.

In addition, they have said that individuals who frequently suffer with urinary tract infections (UTI) should be spoken to virtually.

Former chair of the Royal College of GPs (RCGP), Dr Clare Gerada said: “If a young woman who has had a UTI before accurately describes symptoms of a UTI again, a GP doesn’t need to see her but can prescribe antibiotics.

“It is when you have these symptoms for the first time, or UTI symptoms don’t clear up with treatment, that patients should push for a face-to-face consultation, as this may suggest GPs need to take a sample to check which antibiotic to give.”

Experts have stated that people should see a GP face-to-face if they suffer with continuous headaches, constant back ache or serious skin conditions.

They have also advised that children below the age of one with a high temperature should physically see a doctor.

Additionally, suspected breast or testicular lumps should be examined in person, healthcare professionals say.

Consultant Breast Surgeon at the Princess Grace Hospitals in London, Professor Kefah Mokbel said: “Most doctors and patients believe virtual consultations cannot be an adequate replacement for face-to-face consultations especially when a clinical examination is required in patients with breast symptoms.

“Even breast cancer can present with symptoms less obvious than a lump — dimpling of the skin, for example.”

He added: “With other cancers it may be even more subtle, hence the need for a face-to-face consultation.

“However, virtual appointments are adequate for follow-up to ‘discuss results of tests, side-effects of treatment, management of chronic cancer symptoms and genetic counselling.”

Previous studies have found that virtual diagnoses can be problematic, especially for complicated cases.

New RCGP research has revealed that more than half of GPs think remote appointments are more suitable for current patients instead of newly joined patients.

The government is keen to modernise remote consultations but has instructed GPs to still offer in person appointments.

Professor Martin Marshall, Chair of the Royal College of GPs said: “Face-face-appointments will always be an essential element of general practice, but remote consulting should also be an option as things get back to normal because there are advantages to both.”

13/05 – Outdoor Activities allowed in England from 13th May 2020, subject to social distancing rules

From today (13 May 2020) people in England can spend more time outdoors and enjoy a wider range of activities for any length of time, subject to social distancing rules.

• From today, people are allowed to spend more time outdoors.
• They will be able to go to parks and beaches to sunbathe, have a picnic and go fishing.
• Outdoor sports courts can reopen, including tennis and basketball courts as well as golf courses.
• People will also be able to see one person from another household, as long as they follow social distance guidance
• This follows scientific advice that the risk of infection outside is significantly lower than inside
• All of the new regulations are subject to social distancing rules
• The advice is strictly limited to spending time with your household or with one other person and is subject to social distancing rules.

It remains the case that you cannot gather with more than one member of another household for example to play sports. You also cannot:

• Go on holiday.
• Visit and stay overnight at a holiday home or second home.
• Visit the homes of friends and family, unless it’s to help a vulnerable person, for medical reasons, or to take a child to another household with whom parental responsibilities are shared

12/05 – Chancellor extends furlough scheme until October 2020

In complete contradiction to the rumours that the government furlough scheme could be reduced to 60%, today Rishi Sunak said the furlough scheme would be extended by a further four months with workers continuing to receive 80% of their current salary.

• Coronavirus Job Retention Scheme will continue until end of October.
• Furloughed workers across UK will continue to receive 80% of their current salary, up to £2,500.
• New flexibility will be introduced from August to get employees back to work and boost economy.

11/05 – Government of England sets out its conditional plan to return to normal

This guidance applies in England – people in Scotland, Wales and Northern Ireland should follow the specific rules in those parts of the UK

The government has set out its plan to return life to as near normal as we can, for as many people as we can, as quickly and fairly as possible in order to safeguard livelihoods, but in a way that is safe and continues to protect our NHS. The government has set out a conditional roadmap for lifting further restrictions and opening more businesses and venues. The roadmap is dependent on successfully controlling the spread of the virus. If the evidence shows sufficient progress is not being made in controlling the virus, then the lifting of restrictions may have to be delayed. If, after lifting restrictions, the government sees a concerning rise in the infection rate, then it may re-impose some restrictions. Here is a breakdown of the eight key parts of the governments guidance:

Protecting Different Groups of People

This guidance is for the general public who are fit and well. There is separate, specific guidance on isolation for households with a possible coronavirus infection. Those aged 70 and over, those with specific chronic pre-existing conditions and pregnant women are clinically vulnerable. This means that they are at a higher risk of severe illness from coronavirus’. As restrictions are relaxed, this group who are clinically vulnerable should continue to take particular care to minimise contact with others outside of their household. There is a separate group of people who are defined, on medical grounds due to specific serious health conditions, as clinically extremely vulnerable to coronavirus. This group is advised to continue shielding measures to keep themselves safe by staying at home and avoiding all contact with others, except for essential medical treatment or support.

Staying at Home

It is still very important that people stay at home unless necessary to go out for specific reasons set out in law. These include:

• For work, where you cannot work from home
• Going to shops that are permitted to be open – to get things like food and medicine, and to collect goods ordered online or on the phone
• To exercise or, from Wednesday 13 May, spend time outdoors for recreation
• Any medical need, to donate blood, avoid injury or illness, escape risk of harm, or to provide care or to help a vulnerable person
• Where parents or someone with parental responsibility do not live in the same household, children under 18 can be moved between their parents’ homes to continue existing arrangements for access and contact.
• School for children of critical workers – the government has also identified a number of critical workers whose children can still go to school or their childcare provider. This critical worker definition does not affect whether or not you can travel to work – if you are not a critical worker, you may still travel to work if you cannot work from home. However, if you, or a member of your household are unwell with symptoms of coronavirus, you should isolate and should not travel to or attend the workplace.
• Critical workers and parents or guardians of vulnerable children may leave their home to take children to and from school or their childcare provider.
• You can also attend the funeral of a close family member or member of your household (or, of a friend, if no one from their close family or household is attending).
• Religious ministers or leaders can leave their homes to go to their place of worship, but these should remain closed to the public
• You may also leave or be outside of your home in order to access other critical public services, such as social services, support provided to victims, services provided by the Department for Work and Pensions, to fulfil a legal obligation, or to move home in line with the government’s guidance.

A fuller list of the reasons you can leave home is set out in the regulations. When you do need to go out, you should follow the guidelines on staying safe outside your home.

Businesses and Venues

For the time being, certain businesses and venues are required by law to stay closed to the public. These include:

• Restaurants and cafes, other than for takeaway
• Pubs, cinemas, theatres and nightclubs
• Clothing and electronics stores; hair, beauty and nail salons; and outdoor and indoor markets (not selling food)
• Libraries, community centres, and youth centres
• Indoor and outdoor leisure facilities such as bowling alleys, gyms, arcades and soft play facilities
• Some communal places within parks, such as playgrounds and outdoor gyms
• Places of worship (except for funerals)
• Hotels, hostels, bed and breakfasts, campsites, caravan parks, and boarding houses for commercial/leisure use, excluding use by those who live in them permanently, those who are unable to return home and critical workers where they need to for work

Food retailers and food markets, hardware stores, garden centres (from Wednesday 13 May) and certain other retailers can remain open.

VISITING PUBLIC PLACES

• From Wednesday 13th May, the “one exercise per day” rule is lifted and you can exercise as often as you want. You are also able to sit and rest outside. Exercise or recreation can be alone, with members of your household, or with one other person from outside your household, while keeping two metres apart at all times.
• From Wednesday 13 May, you can drive to outdoor public open spaces irrespective of distance, but should follow social distancing guidance whilst you are there. When travelling to these outdoor spaces, it is important that people respect the rules in Scotland, Wales and Northern Ireland and do not travel to different parts of the UK where their intended activities there would be prohibited by legislation passed by the relevant devolved administration.

Public gatherings

The government has prohibited by law all public gatherings of more than two people, except for reasons set out in the regulations. These include:

• Where the gathering is of a group of people who live together in the same household – this means that a parent can, for example, take their children to the shops, although you are advised to do so only if there is no option to leave them at home
• Where the gathering is essential for work purposes – but workers should try to minimise all meetings and other gatherings in the workplace

Going To Work

You should travel to work, including to provide voluntary or charitable services, where you cannot work from home and your workplace is open.

ENFORCING THE LAW

From Wednesday 13th May, the government is introducing higher fines for those who do not comply. Once these new limits are in place, if the police believe that you have broken the law – or if you refuse to follow their instructions enforcing the law – a police officer may issue you with a fixed penalty for £100 (reduced to £50 if paid within 14 days). If you have already received a fixed penalty notice, the amount will increase to £200 and double on each further repeat offence, up to a maxmium of £3,200.

In comparison, the fixed penalty notice until Wednesday 13th May is £60 (reduced to £30 if paid within 14 days). If you have already received a fixed penalty notice, the amount will increase to £120 and double on each further repeat offence, up to a maxmium of £960.

Clinically Vulnerable People

If you have any of the following health conditions, you are clinically vulnerable, meaning you are at higher risk of severe illness from coronavirus. You are advised to stay at home as much as possible and, if you do go out, take particular care to minimise contact with others outside your household. Clinically vunerable people are those who are:

• Aged 70 or older (regardless of medical conditions)
• Under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab as an adult each year on medical grounds)
• Chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
• Chronic heart disease, such as heart failure
• Chronic kidney disease
• Chronic liver disease, such as hepatitis
• Chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy
• Diabetes
• A weakened immune system as the result of certain conditions, treatments like chemotherapy, or medicines such as steroid tablets
• Being seriously overweight (a body mass index (BMI) of 40 or above)
• Pregnant women

As above, there is a further category of people with serious underlying health conditions who are clinically extremely vulnerable, meaning they are at very high risk of severe illness from coronavirus. You, your family and carers should be aware of the guidance on shielding which provides information on how to protect yourself still further should you wish to.

10/05 – Key points from today’s briefing

Mr Johnson thanked the public for their efforts in social distancing but said it would be “madness” to allow a second spike in the coronavirus pandemic by removing the lockdown completely. Instead, he announced the government’s new plan – but stressed the plan is “conditional” and would be led by science. The message has now changed from “stay at home” to “stay alert” in order to help control the spread of the virus, protect the NHS and save lives. Here are the eight key points from today’s briefing:

• A new Covid alert system – The system will be run by a new Joint Biosecurity Centre. The UK is currently at level four of the five-tier system, just below the “most critical” threat – the kind that would have seen the NHS swamped by coronavirus cases. The further down the ladder the country goes, the more lockdown measures could be eased.
• Construction and manufacturing workers to go back to work – People in the construction and manufacturing industry are being “actively encouraged” to go back to work. This also extends to anyone who is not able to work from home.
• Avoid public transport and instead use cars, walk or cycle – Mr Johnson urged people to avoid public transport when travelling to work. Mr Johnson also stated, “But just as with workplaces, public transport operators will also be following COVID-secure standards.”
• Unlimited outdoor exercise – This lifts the “one daily exercise per day” rule and will begin on Wednesday, May 13th.
• Fines for lockdown flouters will be increased – The increase in fines has not been announced yet.
• Phased reopening of schools – Mr Jonhson said the aim is to open the schools for reception, year one and year six pupils. However this plan is conditional depending on the rate of new infections and the progress the country has made in regards to the coronavirus pandemic.
• Reopening of hospitality industry and public places – The Prime Minister said: “Step three – at the earliest by July – and subject to all these conditions and further scientific advice; if and only if the numbers support it, we will hope to re-open at least some of the hospitality industry and other public places, provided they are safe and enforce social distancing.”
• Imposed quarantine on people flying into the country – Lastly, Mr Johnson announced plans to impose quarantine on people flying into the country.

06/05 – Business rates revaluation postponed

The postponement comes on top of the government’s support package for business and workers during the economic emergency including:

• Businesses are set to receive a discount of almost £10 billion on their rates bills this financial year in response to coronavirus, after the business rates retail discount was increased to 100% from 50% for 2020 to 2021
• Over £12 billion for local authorities to deliver grants of up to £25,000 to eligible businesses. As of 3 May, over £8.6 billion has been paid out to over 697,000 business properties
• Protections for UK high street shops and other companies under strain will be protected from aggressive rent collection and asked to pay what they can during the coronavirus pandemic
• The Coronavirus Job Retention Scheme where small and large employers will be eligible to apply for a government grant of 80% of workers’ salaries up to £2,500 a month, backdated to March 1 and available for at least 3 months. The first grants have been paid.
• A deferral of the next quarter of VAT payments for firms, until the end of June – representing a £30 billion injection into the economy
• A total of £330 billion worth of government backed and guaranteed loans to support businesses

30/04 – VAT exemption for PPE

From tomorrow (1 May 2020), PPE purchased by care homes, businesses, charities and individuals to protect against Covid-19 will be free from VAT for a three-month period.

• A zero-rate of VAT will apply to sales of personal protective equipment (PPE) for Covid-19 from 1 May 2020 until 31 July 2020
• Move will save care homes and businesses more than £100 million
• Comes after import duty also removed from PPE

28/03 – Further expansion of access to coronavirus testing helps protect the most vulnerable

• Anyone in England with coronavirus symptoms who either has to leave home to go to work or is aged 65 and over will now be able to get tested.
• Symptomatic workers who are unable to work from home also eligible for testing
• Testing of all asymptomatic NHS and social care staff and care home residents also being rolled out
• New expansion of testing made possible due to rapidly increasing testing capacity.
• For more information regarding coronavirus testing or to book a test using the government’s online portal, click here

23/03 – Key points from today’s briefing

There is a clear message to stay at home and you are only to go out for:

• Shopping for essentials.
• One form of exercise a day.
• Medical need/caring for a vulnerable person.
• Travelling to/from work – where this is absolutely necessary and you cannot work from home.

Further points include:

• Do not meet up with friends or family members you do not live with.
• Closure of all shops selling non-essential goods.
• Closure of libraries, outdoor gyms, places of worship.
• No gatherings of more than 2 people in public, apart from those you live with.
• The police will have power to enforce rules – this includes fines and dispersing gatherings.
• Measures will be reviewed in three weeks.

22/03 – UK Government announces guidance and advice to avoid non-essential travel in the UK

Who this guidance is for:

• This guidance is for people planning to visit second homes or holiday premises during the coronavirus (COVID-19) pandemic.
• Essential travel does not include visits to second homes, camp sites, caravan parks or similar, whether for isolation purposes or holidays. People should remain in their primary residence. Not taking these steps puts additional pressure on communities and services that are already at risk.

The main message:

• Following on from the government’s guidance on social distancing in relation to COVID-19, people should avoid traveling unless it is essential.
• The UK Government has also announced people must follow virus advice or ‘tougher measures’ are likely.

21/03: UK Government announces further measures on social distancing

• Measures to close entertainment, hospitality and indoor leisure premises across the country to take place from the end of trading hours today (Friday 20 March) to limit spread of coronavirus
• New measures will further limit people’s sustained social contact as we tackle the spread of coronavirus, guided by scientific evidence
• Public urged to stay at home and limit all but essential travel – people who can work from home should do so

20/03: The UK Government has introduced guidance for households with possible coronavirus (COVID-19) infection.

Who this guidance is for:

• people with symptoms that may be caused by coronavirus, and do not require hospital treatment, who must remain at home until they are well
• those living in households with someone who shows symptoms that may be caused by coronavirus

The main messages:

• if you live alone and you have symptoms of coronavirus illness (COVID-19), however mild, stay at home for 7 days from when your symptoms started
• if you live with others and you are the first in the household to have symptoms of coronavirus, then you must stay at home for 7 days, but all other household members who remain well must stay at home and not leave the house for 14 days. The 14-day period starts from the day when the first person in the house became ill
• for anyone else in the household who starts displaying symptoms, they need to stay at home for 7 days from when the symptoms appeared, regardless of what day they are on in the original 14 day isolation period
• it is likely that people living within a household will infect each other or be infected already. Staying at home for 14 days will greatly reduce the overall amount of infection the household could pass on to others in the community
• if you can, move any vulnerable individuals (such as the elderly and those with underlying health conditions) out of your home, to stay with friends or family for the duration of the home isolation period
• if you cannot move vulnerable people out of your home, stay away from them as much as possible
• if you have coronavirus symptoms: do not go to a GP surgery, pharmacy or hospital. You do not need to contact 111 to tell them you are staying at home. Testing for coronavirus is not needed if you are staying at home
• plan ahead and ask others for help to ensure that you can successfully stay at home and consider what can be done for vulnerable people in the household
• ask your employer, friends and family to help you to get the things you need to stay at home
• wash your hands regularly for 20 seconds, each time using soap and water, or use hand sanitiser
• if you feel you cannot cope with your symptoms at home, or your condition gets worse, or your symptoms do not get better after 7 days, then use the NHS 111 online coronavirus service. If you do not have internet access, call NHS 111. For a medical emergency dial 999

Further details on exams and grades announced:

• This year’s summer exam series, including A levels, GCSEs and other qualifications, and all primary assessments, have been cancelled.
• The exam regulator, Ofqual, and exam boards will work with teachers to provide grades to students whose exams have been cancelled this summer.
• There will also be an option to sit an exam early in the next academic year for students who wish to.
• Ofqual and exam boards will be discussing with teachers’ representatives before finalising an approach, to ensure that it is as fair as possible. More information will be provided as soon as possible.
• The Government will not publish any school or college level educational performance data based on tests, assessments or exams for 2020.
• You can find out more here

Online isolation notes launched – providing proof of coronavirus absence from work:

• People unable to work for more than seven days because of coronavirus (COVID-19) can obtain an isolation note through a new online service.
• An isolation note can be obtained without contacting a doctor, this will reduce the pressure on GP surgeries and prevent people needing to leave their homes.
• For the first seven days off work, employees can self-certify so they don’t need any evidence for their employer. After that, employers may ask for evidence of sickness absence. Where this is related to having symptoms of coronavirus or living with someone who has symptoms, the isolation note can be used to provide evidence of the advice to self-isolate.
• The notes can be accessed through the NHS website and NHS 111 online. After answering a few questions, an isolation note will be emailed to the user. If they don’t have an email address, they can have the note sent to a trusted family member or friend, or directly to their employer. The service can also be used to generate an isolation note on behalf of someone else.
• For further information please click here

WHO Health Alert brings COVID-19 facts to billions via WhatsApp:

• WHO is launching a messaging service with partners WhatsApp and Facebook to keep people safe from coronavirus.
• This easy-to-use messaging service has the potential to reach 2 billion people and enables WHO to get information directly into the hands of the people that need it.
• The service can be accessed through a link that opens a conversation on WhatsApp. Users can simply type “hi” to activate the conversation, prompting a menu of options that can help answer their questions about COVID-19.

Further announcements include:

• Driving tests and MOTs for heavy vehicles suspended for up to 3 months to help tackle spread of coronavirus
• Isolation guidance for residential educational settings
• New arrangements for MHRA Good Practice (GxP) inspections due to coronavirus (COVID-19)
• Crucial medicines protected for coronavirus (COVID-19) patients
• Coronavirus (COVID-19): scientific evidence supporting the UK government response
• MHRA services during the Coronavirus (COVID-19) response
• Ibuprofen use and Coronavirus (COVID-19)

19/03 – The UK Government has announced the following:

• £2.9 billion funding to strengthen care for the vulnerable
• Plans set out to support pupils eligible for free school meals
• Military stands up COVID Support Force
• Government agrees measures with energy industry to support vulnerable people through COVID-19

18/03 – School Closures

The Prime Minister has said schools will close from Friday, March 2020 until further notice as a response to the coronavirus pandemic, except for looking after the children of keyworkers and vulnerable children. Read more here.

16/03 – Further social distancing guidance

The Government is advising those who are at increased risk of severe illness from coronavirus (COVID-19) to be particularly stringent in following social distancing measures.[2]

This includes people:

• aged 70 or older (regardless of medical conditions)
• adults under 70 with an underlying health condition including diabetes, chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis, chronic heart disease, chronic kidney disease, being seriously overweight, or pregnant.
• If you are instructed to get a flu jab as an adult each year on medical grounds, then you are part of this advice.

What is social distancing?

Social distancing measures are steps you can take to reduce the social interaction between people. This will help reduce the transmission of coronavirus (COVID-19).

• Avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough;
• Avoid non-essential use of public transport, varying your travel times to avoid rush hour, when possible; Work from home, where possible. Your employer should support you to do this.
• Avoid large gatherings, and gatherings in smaller public spaces such as pubs, cinemas, restaurants, theatres, bars, clubs
• Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media.
• Use telephone or online services to contact your GP or other essential services.

Tell us about yourself

My name is Laura Thornton, I’m 28 years old and have had type 1 diabetes for 8 years. I’ve always used injections and am currently on long acting Abasaglar and Novorapid for carbohydrate counting which works well for me after many changes and tweaks along the way.

How do you manage your type 1 diabetes?

I use a FreeStyle Libre sensor. When I became an ambulance technician, I started to fund these myself as it’s much more practical working as an ambulance technician with a sensor rather than having to finger prick constantly which wouldn’t be practical in my job. I now have these on prescription which I’m very thankful for. On average my reader tells me I scan my sensor an average of 19 times per day – I am very well controlled with a current hba1c of 61.

Life with type 1 diabetes

I was diagnosed after a traumatic event in my family and have no other family members with diabetes. I wasn’t always well controlled; I was in university when I was diagnosed and was very naive to the condition for about a year before I started really learning about my disease and learning how best to control it for me. It’s now just a part of my life which has made me a stronger person in the long run. Yes, I have had more hurdles to jump over than others, especially in getting my current job as an ambulance technician, but it has all been so worth it. It’s not something that should hold us back but push us harder to achieve our goals.

Contracting COVID-19

Yesterday marked my last day of quarantine, myself and my partner Benjamin who works as a frontline police officer have both been isolating for 2 weeks after both testing positive for COVID-19 after showing symptoms. My symptoms have been substantially worse than Ben’s and very textbook COVID-19 – starting with a dry cough and a fever.

I then experienced sore eye sockets and shooting pains in my ears, it felt like razor blades in my lungs every time I coughed, aches all over especially in my shins and neck, unbelievable headaches and lethargy beyond anything I have experienced before. I have also lost all sense of taste and smell which is unfortunate! For 2 days I experienced breathlessness but only when I exerted myself (walked to the bathroom) or lay down on my back. I then developed a chest infection which I was given antibiotics for as the virus had at this point turned bacterial, the worry then being pneumonia starting however this didn’t happen and the chest infection resolved after a week. My partner and I are both still experiencing headaches and lethargy but it comes in waves.

Right now, I’m feeling positive and looking forward to returning to my job on the frontline but thankfully have 2 weeks off from now to make sure I’m 100% recovered. I don’t know whether it was because I have type 1 diabetes that I experienced worse symptoms than my partner did, but the main thing is that we have both beaten coronavirus and are now looking forward to putting this behind us. Needless to say that being a type 1 diabetic and testing positive for COVID-19 was a scary and emotional pill to swallow but we just took it day by day. I keep myself very fit and healthy which I do believe helped me recover so well.

How did COVID-19 affect your blood glucose levels?

During this time, my blood sugars were running a little higher than normal which was to be expected with being so ill along with the additional stress. I was checking my blood sugars a lot more frequently and when I was asleep Ben would also scan me which was a huge help. I found myself taking more insulin to maintain an acceptable level but it’s never an exact science especially when we’re ill so we can’t be too hard on ourselves and stress too much over it – that just makes our sugars go higher.

When the worst few days were over, I found limiting the news channel to an hour a day and focussing on positive things which helped lower my stress levels such as painting and reading and gardening now I’m up and about. Our mental health is so important and even more so through this unprecedented time, I can’t begin to tell you how inspired and motivated I have been from the diabetic community and especially seeing all of the type 1 key workers and frontliners out there showing strength and unity.

What would you say to someone with type 1 diabetes and COVID-19?

Being a type 1 diabetic and having COVID-19 is a scary prospect and we will all react differently to this virus, diabetic or not. We are immunocompromised as diabetics so are higher risk, but we are all so different so to categorise us as one group just isn’t accurate at all. However, if we look after ourselves by controlling our sugars the best we can, staying motivated to fight this virus, staying as active and healthy as possible and allowing ourselves to not be perfect all the time then we can and will get through this.

What I would say is if you do have this virus then please stay as active as you can, as uncomfortable as it is. Breathe deeply and move and you will be doing yourself a huge favour – I did breathing exercises which hurt a lot and made me cough but really kept my lungs moving fully and prevented any congestion. Eat well and stay well hydrated and paracetamol every four hours will help the fever and the pain. Stay connected, I’ve been so lucky to have had Ben with me but my mum has been dropping our shopping of at the front door like a star and we have been in contact with family, friends and colleagues which have lifted our spirits.

How has type 1 diabetes affected your career?

Working in the ambulance service as a diabetic used to be unheard of until not so long ago, there are still very little of us out there but it’s amazing to see us defying the odds. I use my sensor all the time and always have my sensor and injections on me on shift, I check my BM before driving which takes but a second on the way to the motor. My colleagues are all fully supportive of me and as long as I maintain good control, I’ll hopefully have a long career ahead of me.

It has never held me back or hindered my abilities and hope it wouldn’t for anyone else. If my story helps 1 person in any way get through this terrible time or even motivates 1 person to fight for what they want in life, then it’s served its purpose.

Stay safe, stay protected, stay positive

• Researcher thinks DDP4 inhibitors could help battle COVID-19
• Recovering from coronavirus with type 1 diabetes
• A detailed account of recovering from coronavirus
• UK’s oldest COVID-19 survivor pays tribute to hospital staff
• Young teacher with type 1 diabetes and lung condition conquers COVID-19

This page will be updated as events unfold and advice is provided by WHO/NHS/UK Government

It’s been impossible to avoid news of the coronavirus outbreak in recent weeks. Understandably, people may worry or feel uncertain about what the spread of the virus means for them or their loved ones. Times are uncertain, but please try not to worry. It’s not as bad as the media can sometimes make it out to be. Here’s more on a person with type 1 diabetes who recovered from coronavirus.

Coronaviruses are a large family of viruses which have been around for a long time and can cause illness. In humans, coronaviruses are known to cause respiratory infections from a common cold to more severe diseases.

The coronavirus disease COVID-19 that is currently in the news is caused by a newly discovered type of coronavirus. Prior to the outbreak in Wuhan, China in December 2019, this new virus and the disease were unknown.

Read more in the forum:

• COVID-19: comorbidity with diabetes
• Is everyone managing to eat usual foods?
• Coronavirus: how at risk am I?
• Self isolation for 12 weeks

Symptoms

The most common symptoms of COVID-19 include:

• Fever
• Tiredness
• Dry Cough

Some patients may have aches and pains, nasal congestion, runny nose, sore throat or diarrhoea. These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don’t feel unwell.

What is the risk?

Current reports indicate that illness as a result of the virus is generally mild, especially for children and young adults. In the majority of cases, those who contract the virus recover from the disease without needing special treatment. This is believed to be approximately 80% of affected individuals.[1]

Older people, those with a compromised immune system and individuals with underlying medical problems like diabetes, high blood pressure, heart problems or being very overweight, are at an increased risk of developing a serious illness.

It is estimated that approximately 1 out of every 6 people who gets COVID-19 becomes seriously ill and develops difficulty breathing. People with a fever, cough and difficulty breathing should seek medical attention.[2]

Should I be worried?

It is quite normal to feel worried about how the COVID-19 outbreak affects us or the people around us.

However, it is important to remember that at present the risk of infection is low in those who have not travelled to affected areas and have not had contact with someone with the virus.

Read the story of a person with type 1 diabetes who fully recovered from COVID-19.

Coronavirus and diabetes

The prevention mechanisms outlined below are useful to reduce the risk of becoming infected and control the spread.

Diabetes can make you more susceptible to illness. It is one of the underlying conditions reported to be associated with the onset of more severe symptoms in individuals affected by the coronavirus.

However, there are steps to take to keep your blood glucose levels well controlled to help reduce your risk of becoming ill. Eating well, testing blood sugars regularly, reducing stress and getting plenty of sleep can help with blood sugar control.

Dan Howarth, head of care at Diabetes UK, said: “Coronavirus or Covid-19 can cause complications in people with diabetes.

“If you have diabetes and you have symptoms such as cough, high temperature and feeling short of breath, you need to monitor your blood sugar closely and call the NHS 111 phone service.”

Simple steps to lower your risk of contracting the virus

There are actions you can take to reduce your risk of contracting the virus and help limit the spread among communities.

1. Wash your hands regularly

It might sound simple, but regular hand washing is important as it can help kill any viruses that may be on your hands.

You should thoroughly wash your hands with soap and water for at least 20 seconds (handy tip – sing happy birthday to yourself twice whilst washing). Take notice of areas you might miss including the back of your hands, between your fingers and around the nails. Or use an alcohol-based hand rub. The NHS recommends ensuring you wash your hands when you get home or arrive at work.

2. Maintain a distance

Avoid close contact with people who are unwell. Keeping at least a 1-meter (3 feet) distance between yourself and anyone who is coughing/ sneezing is recommended by The World Health Organisation.

3. Practice good hygiene

Be sure to cover your mouth and nose when you cough or sneeze. You should not use your hands to do this. Covering your mouth and nose with a tissue or your bent elbow is more appropriate. It is important to dispose of used tissues immediately and thoroughly wash your hands afterwards.

4. Keep your hands away from your face

Our hands touch many surfaces and can transfer a virus from surfaces into your body. A simple step to minimise this risk is to avoid touching your eyes, nose or mouth if your hands are not clean.

5. Stay informed and follow official advice

The spread of the coronavirus is an ongoing situation. It is important to stay informed with the latest information and to protect yourself and others from COVID-19 following advice from your healthcare provider, your national and local public health authority.

Sources of information:

• https://www.who.int/news-room/q-a-detail/q-a-coronaviruses
• https://www.nhs.uk/conditions/coronavirus-covid-19/
• https://www.nhs.uk/conditions/coronavirus-covid-19/common-questions/
• https://www.gov.uk/government/publications/coronavirus-action-plan/coronavirus-action-plan-a-guide-to-what-you-can-expect-across-the-uk

If you have fever, cough and difficulty breathing, seek medical care early.

Follow the directions of your local health authority.

National and local authorities will have the most up to date information on the situation in your area. Calling in advance will allow your health care provider to quickly direct you to the right health facility. This will also protect you and help prevent the spread of viruses and other infections.

The spread of coronavirus is an ongoing situation. Information contained within this programme is in accordance with World Health Organisation and NHS guidelines at the time of publishing.

Jess is part of the team at the Intensive Treatment Unit at the Royal Papworth hospital. She is a newly qualified nurse and works with patients every day. She feels very lucky to be part of such an amazing team – all the nurses at Papworth are really supportive and have never given her issue if she needs to go out and test her blood sugar levels.

“Honestly, I feel really mentally proud. I know it is such a scary time for everyone, but I’m staying positive. I’m so proud of what the NHS is achieving, and I feel really lucky to be a part of that. I’ve wanted to be a nurse for ages, and now I’m newly qualified, working in ITU during a global pandemic! So yeah it is definitely overwhelming at times, but I’ve had such good support at the Royal Papworth, from all the staff there. They are all amazing mentors, so it has really helped my transition, as a newly qualified, and with diabetes, as well as with everything that has been going on.”

Jess was diagnosed with type 1 diabetes when she was 25. In the four years since, she has learned to manage her blood sugar levels with finger prick testing and insulin injections.

A typical day for Jess involved testing her blood sugars at least 8 times. Before she eats, before she drives, and when she can while at work. One of the impacts of the novel coronavirus that people with diabetes working in hospitals are reporting is how the personal protective equipment (PPE) can make testing difficult.

Of course, PPE is incredibly important and is saving lives and limiting the spread of the disease. But getting in and out of it can make testing that bit more complicated. Jess has to leave the work area, remove the PPE and test or eat, so testing can become time consuming during her shift.

Despite this, she has manged to keep her blood sugars fairly stable during this time of upheaval. When she began working in January, she reported that her sugars were a bit more up and down, but as she settled into a routine, her sugars settled too. She said: “They can sometimes be a bit erratic, as anyone with diabetes will know! But I just try and make sure I’m prepared so I’ve always got glucose with me, I’m always able to go and test.”

“It’s a challenge! I won’t say that it isn’t. Especially working in such an acute area. Living with type 1 diabetes is a constant balancing act. You’re always thinking about your blood sugar levels, your activity levels, what your carb intake is. So many things can have an impact on your blood sugar levels – I just feel like I’m constantly doing maths.

“At work I think I try and remember that I need to look after myself, which can go against your instinct as a nurse a bit. You always feel like you need to put your patient first. But it has really taught me that planning ahead is so important, and you can only control what you can control – as long as you use that and look back and make changes… I’m very lucky that the Royal Papworth are so supportive to me.”

Three key things

When asked what she would like to say to others in a similar situation, Jess made it very clear: “Three key things. The first one is exercise. For me it’s invaluable. I joined a CrossFit gym in Stevenage about 18 months ago and it has been so good for my stress management and my diabetes management. It’s been really difficult not being able to go to the gym, but they’ve been posting home workouts, so I’ve been doing them and going for runs.

“Secondly, utilise the people around you. I’m lucky that I’ve got a really good close-knit group of friends who are always up for a laugh or a gin and tonic over a video call. They are absolutely incredible, and I couldn’t do without them.

“Lastly, is my partner. With him being a paramedic, obviously he understands the stresses that I have when I go to work. We’re lucky that we can come home, and we can debrief with each other. I know not everyone will have that, but it is so important to find people who understand because we do live in quite different worlds sometimes and to find people who can relate to you is something that should definitely be utilised if it can be.”

“I just think that ultimately diabetes is such a challenge, but it shouldn’t stop you from living your life. I wish that I’d been told that when I was first diagnosed. I just thought ‘that was it’ and I couldn’t live a normal life anymore… as much as you think you can’t get through it sometimes, you really can. Diabetes lives with me; I don’t live with it. It has taught me confidence and self-belief. Because if you can do this, you can do anything.”

Jess is doing a fantastic job, and we are really lucky that she was able to spend some time with us telling her story. The work that she and the rest of the NHS are selflessly doing at this time is humbling and we are truly grateful to any and all keyworkers.

Joanne has type 1 diabetes. This means that should she contract the coronavirus, she may be more likely to develop severe illness compared to others. And still she works the front lines.

Diagnosed 41 years ago, Joanne is no stranger to diabetes. She has had decades of experience managing her blood glucose levels. Over the last year and a half, she’s managed to enhance her management with a FreeStyle Libre sensor. The easy-to-use device has been a huge help to her and others working in hospitals at this time too.

Currently, she tests her blood glucose four or five times a day. Ideally, she would be able to test more, but she can’t carry her FreeStyle Libre reader with her on the ward. She has to find time between lending aid to her patients to fetch it. With the current global crisis, she has noticed that anxiety has elevated her blood glucose levels.

Despite these difficulties and the danger her work poses to her, she has opted to carry on working after her placement ends on Monday. She is dedicated to her patients and to her own safety, making full use of the personal protective equipment that the hospital provides, and following all the government guidelines to keep herself and her family safe.

We are all hugely grateful for the fantastic work that Joanne and all the NHS workers are doing and want to celebrate their continued achievements and efforts! Thank you

Read more:

• Coronavirus: should I be worried
• Update for those vulnerable to Coronavirus
• Rhonda Green: Working on the frontline with type 1 diabetes
• Laura Thornton: a diabetes hero on the Coronavirus frontline
• Grandad with diabetes recovers from COVID-19

When times become tough and stressful, blood sugar levels can begin acting strange. 2020 has definitely been a tough year so far, so we asked Sarah if this was reflected in her blood sugar levels. She said: “Definitely the first few weeks my blood sugar was a lot higher when everyone was really, really anxious about it all.

“Things seem to be a bit better; anxiety isn’t so high now. I’m quite protected. Just getting on with it now really. Much better than it was but stress definitely bumped them up a little bit.”

Several people we have spoken to have said that the FreeStyle Libre has been tremendously helpful for keeping an eye on blood sugar trends during the pandemic. Sarah only recently got a FreeStyle Libre, but it has been a big help. She said: “I’m a little bit scan happy at the moment. It’s a novelty! I used to test about 8 times a day. I think I scanned yesterday about 20 times. It’s only because it’s new – a new little gadget.

“It has shown me what my blood sugars are doing when I didn’t actually realise that they were dipping or going high. Especially during the night. So, I’ve actually changed my basal to suit it now… definitely a game changer!”

Balancing a busy day on the ward with looking after your own health can be tricky, but Sarah makes it work. “I take my breaks. We have a break in the morning and in the afternoon. I make sure I eat. I’m quite hypo aware, so obviously if I’m a lot busier than normal, I’ll reduce my basal on a temporary basal rate for an hour or so. The lovely public have donated lots and lots of food, so there’s a big supply of treats. If I feel I’m starting to dip a little bit, I go off and have something to eat, then carry on. It’s no different to normal really.”

A nurse’s job can be tough at any time. Sarah is about to qualify, during the largest global pandemic we have ever seen. Not only this, but she is a mother of two. How is she managing?

“The ward I’m on is really good. We’ve got enough PPE. I get changed at work. My lovely friends’ mum and sister made me one of these uniform bags. I shove it all in the wash. I clean out my shoes. I’m quite conscious about how I clean and anti-bac everything. I won’t actually touch the children until I’ve showered. And when I get home they are usually already in bed as I work long days.”

As someone with hands-on experience of the hospital frontlines, we wanted to know what advice Sarah has to give people. She said simply to “Keep going. I definitely recommend using your exercise time. I try to go up the hill every morning with my dog, even before work. To try and get some headspace, really.

“Definitely exercise. Normally I run quite a lot, but I cannot see my friend that I run with at the moment. I’m usually on my own. I’ll be very slow when we get back to normal! That’s definitely my best stress buster. Also just talking to people – that’s really important. – I got a really good group of friends and student nurse friends. We will talk to each other if we’re feeling a bit low. It’s ok to feel a bit rubbish, this is unknown territory!”

“Keep hydrated. Keep eating. Try not to stress too much, even though I know some wards and some jobs are harder than others. It’s not forever! Things will go back to how it was.”

“Thank you to all the public for all your lovely support and donations. All my friends and family have been amazing. Just keep going. And stay at home!”

Read more:

• Coronavirus: should I be worried
• Update for those vulnerable to Coronavirus
• Dr Dipesh Patel on diabetes and vulnerability to COVID-19
• Bruce Woolfit: NHS worker with type 2 diabetes working during COVID-19 pandemic
• Joanne Wignall: Working on the hospital frontline with type 1 diabetes
• Rhonda Green: Working on the frontline with type 1 diabetes
• Laura Thornton: A diabetes hero on the Coronavirus frontline

Dean has type 1 diabetes with an added complication

Eleven years ago, at the age of 41, Dean was diagnosed with type 1 diabetes. Often, type 1 diabetes is diagnosed much younger than this, but Dean is a somewhat different case. He has tested positive for type 1 diabetes, although he also has insulin resistance – one of the major mechanisms behind type 2 diabetes.

This means that Dean has to manage his blood glucose levels with insulin injections, even while his body is resistant to it. As a result, the number of units he must inject tend to be higher than they would otherwise.

Dean’s work

Working just a few minutes from his house, Dean works the midnight shift. He has dinner at 6 o’clock and heads out to work. He helps the elderly residents of the care home before they go to sleep, and he is there for them until they wake up.

Although many people would find the long nights alone tough, it really suits Dean. It means he has the days free to do everything that needs doing, both in terms of managing his diabetes, and walking his three dogs!

Struck by the onset of cold and flu-like symptoms, Dean self-isolated for a week in order to protect the elderly and vulnerable people that he works with. Fortunately, it turned out to be a simple cold and not coronavirus, but the precautions were necessary, and he is glad that he took action to protect those to whom it could have done a lot more harm.

The consequences of bad habits

Dean readily admits that he hasn’t lived a perfect life. Before his diagnosis, he had some bad lifestyle habits that have now led to him developing neuropathy in his lower legs. Sadly, this means that his much-loved habit of beach fishing is harder than ever, and he can sometimes struggle to visit his favourite beaches down in Kent and Sussex.

With this first-hand experience of complications, and the impact it is beginning to have on the things he enjoys in life, the importance of looking after himself is clear. With several young relatives who have been diagnosed with type 1 diabetes, he stands as an example to them of how important it is to look after their blood sugar levels.

How he manages now

Dean now uses insulin injections alongside type 2 diabetes medication. Some changes to his medication prescriptions in the last year have helped with the pain he experienced in his legs as a result of neuropathy.

With the added complications of his regime which can be difficult to overcome, his blood sugars tend to sit on the slightly higher side, usually between 10 and 20mmol/L. To try and keep on top of them, he tests his blood up to 8 times per day with a blood glucose meter and test strip.

Rather than just focusing on injecting insulin, Dean also tried to keep blood sugars low by being careful about what he eats, and he shies away from carbs. He doesn’t drink fizzy drinks, and he limits meals to twice a day.

Importantly, Dean is positive about what he should be doing to improve his health. He has mended his ways since his diagnosis and feels much better about his lifestyle.

What words of advice does Dean have for others with type 1 and those working in care?

Everyone needs to manage their diabetes as well as they can, Dean said. “The main thing is to try and keep your spirits up. I can understand the worries that people have… It’s a struggle to keep as healthy as you can.” Keep yourself occupied and make sure you don’t end up eating out of boredom

Rhonda works in Craigavon Area Hospital in Northern Ireland. Before the coronavirus crisis, she was working as a respiratory physiologist, but given the option, she leapt at the chance to be redeployed into intensive care.

Diagnosed at the age of 9 with type 1 diabetes, the thought of coronavirus coming to the UK caused Rhonda a lot of anxiety and some sleepless nights. However, sticking to the government guidelines and making sure she had the correct personal protective equipment (PPE) while at work has helped to reduce her fears and let her get on with her incredibly important frontline work in the hospital.

Checking her blood glucose levels is crucial while at work. She checks them very regularly – every hour at least. Her FreeStyle Libre sensor has been a huge help too, with the arrow system letting her know whether her blood sugars are on the rise or are falling, before she dives in to a hands-on job. It is a big concern of hers that if she suffered a hypo while in full PPE and on a job, it could pressure resources that could be being spent on people with COVID-19. This is why she takes her blood sugar levels so seriously.

Rhonda’s efforts, and the efforts of all our fantastic hospital staff, do not come without personal sacrifice. Commenting on life at home, Rhonda said that she and her paramedic husband have had to take precautions to protect their own children. She said, “the children know that mummy and daddy can’t hug them and can’t kiss them etc, and we do try to keep that wee bit further from each other.”

We are hugely grateful to all keyworkers during this time and want to thank them and celebrate all their efforts. We finished off by asking Rhonda what tips she has for someone with type 1 diabetes during this time.

She said:

• Keep your sugars as controlled as possible
• Follow the social distancing rules
• Wash your hands
• Get your daily exercise if possible
• Take care of yourself

Read more coronavirus stories:

• Laura Thornton: a diabetes hero on the Coronavirus frontline
• Grandad with diabetes recovers from COVID-19
• UK’s oldest COVID-19 survivor pays a special tribute
• Man with T2D recalls ‘scary’ COVID-19 experience but fully recovers

Social distancing

The Prime Minister has acknowledged that it is not always possible to stay 2m apart so he is asking people to keep a distance of “one metre plus” between one another.

The 2m rule still applies for people in In Scotland, Wales and Northern Ireland.

People are being asked to continue to observe precautions to reduce the risk of transmission.

Business safety

Places of business are being asked change office layouts to avoid face-to-face seating and reduce the number of people in enclosed areas.

Ventilation must be improved and protective screens and face coverings should be introduced.

Social spaces that are not needed should be closed and hand sanitiser must be provided.

Hospitality

Restaurants, pubs and cafes in England are now allowed to open but table service is only allowed and customers must give their contact details before entering an establishment.

People can now stay in hotels, B&Bs, cottages, campsites and caravan parks overnight.

In Northern Ireland holiday accommodation can reopen for business from 26 June, and pubs and restaurants can open on 3 July. It is thought hospitality and holidays decisions in Wales and Scotland will be announced in July.

Meeting people

Two households of any size will be able to meet indoors or outside. It will be possible to stay overnight and it does not have to be the same set of households, although social distancing must still be adhered to, unless they are part of the same support bubble.

It is not recommended that people from different households meet up inside though.

Several households can meet in groups of up to six outside, but two households can meet regardless of size.

What else can open?

Outdoor gyms and children’s playgrounds.

Hairdressing salons must take safety measures using screens.

Libraries, community centres, bingo halls, cinemas, museums and galleries.

Funfairs, theme parks, amusement arcades, outdoor skating rinks, social clubs and model villages.

Prayers and services can take place in places of worship and weddings can go ahead for up to 30 guests and social distancing measures must still apply.

What is to remain shut?

Nightclubs, bowling alleys, spas, swimming pools, indoor gyms and soft play centres.

Live performances at theatres and concert halls are still not allowed.

Talk to others in the forum about lockdown:

• Are we returning to normal too quickly?
• COVID-19: the numbers
• What do you do during isolation?
• Anyone been shopping yet?

What is Vitamin D?

Often known as ‘the sunshine vitamin’, vitamin D is actually a vitamin and a hormone, which can be made in the body.¹ Vitamin D regulates the amount of other important minerals in our body such as calcium and phosphate, both needed for healthy bones, teeth and muscles.

Vitamin D & Diet

There are two major forms of vitamin D which are vitamin D3 (cholecalciferol) and vitamin D2 (ergocalciferol). The main sources of vitamin D are sunlight exposure (where it is synthesised in the skin) and foods or dietary supplements. Between the months of April and September, skin synthesis is the main source of vitamin D for most people.² Vitamin D is found in modest amounts in some foods;

– Oily fish such a salmon, sardines and pilchards contain reasonable amounts.
– Red meat
– Egg yolks, meat and offal contain modest amounts but this can vary throughout the seasons

Vitamin D and Coronavirus

We know that individuals with diabetes are at higher risk of infections, especially pneumonia and influenza and that people living with obesity (who have a body mass index (BMI) of greater than 40kg/m2) as well as those 70 years old and above should be shielding and staying home as much as possible.²

A recent study concluded that attention to nutrition and protein intake is important for individuals with diabetes in times of COVID-19 and also that deficiencies of vitamins need to be corrected.³

Public health England guidelines state that the following groups are at risk of vitamin D deficiency and should take a 10 microgram supplement of vitamin D all year around:³

• People in institutions such as care homes
• People who always cover their skin when outside
• People whose skin has little or no exposure to the sun

Higher dose Vitamin D?

A recent Irish study led by Professor Rose Anne Kenny published in the Irish Medical Journal called for immediate higher vitamin D supplementation for those in hospital, in nursing homes or those who are older.⁴

Prof Kenny said: “Though we do not know specifically of the role of vitamin D in Covid-19 infections, given its wider implications for improving immune responses and clear evidence for bone and muscle health, those cocooning and other at-risk cohorts should ensure they have an adequate intake of vitamin D.”

Another group of researchers from the US have recommended a very high does of vitamin D for the first few weeks of infection (10,000IU/day), however, the team acknowledge the limitations of the study and say that further research is required before suggesting these very high supplementation levels for the general public.⁵

One more recent study had suggested that those with vitamin D deficiency may be more prone to infection (specifically respiratory infections) from the Coronavirus and that vitamin D could work as a therapeutic option for treatment of the virus. It is important to note this is a very early recommendation and based on bovine studies, therefore cannot be translated to humans yet.⁶

It should be noted that an expert panel in the UK 2016 Vitamin D report evaluated the evidence and did not find strong enough evidence to support recommending vitamin D supplements to reduce the risk of respiratory tract infections.

Should I supplement?

If you are shielding and not getting sunlight, the government recommendation is that you should take an over the counter vitamin D supplement of 10 micrograms every day. If you have had very low vitamin D in the past, you may need a higher dose – speak to your pharmacist or doctor for advice on this.

As for the higher doses of vitamin D specifically to prevent or treat Coronavirus, the evidence so far is very limited and higher dose recommendations cannot be made yet. If you are unsure or want to take a higher dose then you should discuss this with your doctor or pharmacist.

Read more on overcoming COVID-19:

• Researcher thinks DDP4 inhibitors could help battle COVID-19
• Recovering from coronavirus with type 1 diabetes
• A detailed account of recovering from coronavirus
• UK’s oldest COVID-19 survivor pays tribute to hospital staff
• Young teacher with type 1 diabetes and lung condition conquers COVID-19

Working for the NHS

Bruce works as an emergency care support worker for the NHS, at one of the three main hospitals in Lincolnshire. He was also diagnosed with type 2 diabetes in 2000 and begun managing it with insulin in 2006. One of the biggest obstacles he faces at work is his night shifts.

Managing blood sugar levels while working night shifts can be exceptionally hard, especially when there are no set times for breaks. Many night workers see their blood sugars creeping upward. Bruce told us that he generally tests his blood sugar levels 3-4 times per day and more so at work as he is driving and has no set meal breaks.

Food and the family

Bruce lives with his wife, and for this couple, food is a team effort. Bruce’s wife is highly supportive and helpful when it comes to what he has to eat; she prepares his packed lunches to take to work, which often include tuna and oily fish. At home, she is conscious of the food on the table at mealtimes. During the coronavirus pandemic, shops like Sainsburys and M&S food halls have been fantastic to people like Bruce, allowing NHS staff in at certain times when there are not so many people about. This has made it much easier to keep up good social distancing, something Bruce said helped him to feel at ease, while still having access to good, nutritious foods.

Keeping moving

Of course, getting enough exercise has always been important, but nowadays we have to take extra care to make sure we get enough per week. We asked Bruce what exercise looks like for him following the coronavirus outbreak.  He said that on his days off from work, he maintains regular daily exercise with his golden retriever, out and about at the parks, but of course, always keeping social distancing in mind.

Staying safe

Personal protective equipment (PPE) is key to keeping our healthcare workers safe, and Bruce is not any different. He has been very vigilant with his PPE, simply stating that “we can’t take any chances.” It is important to remember that people with diabetes are generally more prone to catching illnesses.

His team leader and colleagues have been a huge help, keeping Bruce as safe as possible. He doesn’t go on house calls to see patients confirmed with COVID-19 if it is possible for one of his colleagues to go in his stead. They also work in a secure ward, meaning that the patients that come into the ward for an appointment have already been vetted by the 111 nurse, then triaged by the NHS practitioner, so they have a good idea what is wrong with the patient before they step inside the building. The knowledge of their patients’ conditions and control over the flow of patients through their ward mean that they can limit Bruce’s exposure, let him continue his hard work, and reduce his risk of contracting the virus.

What does Bruce want to say to you?

When asked for tips to pass on to other people with diabetes, Bruce made it clear: talk to other people in similar situations. They are probably experiencing similar worries or thoughts, and it can help to reduce the stress of these unprecedented times. He added that PPE is incredibly important, and for other workers not to forego it. And, above all, be wary and follow the Government’s advice.

Bruce wanted us to share his story, to show how he is managing at work with his type 2 diabetes. It can be done, and he is thinking of all the other key workers with diabetes every step of the way.

Read more:

• Coronavirus: should I be worried
• Update for those vulnerable to Coronavirus
• Dr Dipesh Patel on diabetes and vulnerability to COVID-19
• Rhonda Green: Working on the frontline with type 1 diabetes
• Laura Thornton: A diabetes hero on the Coronavirus frontline
• Joanne Wignall: Working on the hospital frontline with type 1 diabetes