On March 11th, 2020, the World Health Organization declared the COVID-19 disease a pandemic. A pandemic is the worldwide spread of a new disease. It occurs when a new virus emerges and spreads across the globe, but most people do not have immunity to it.

World Health Organization. What is a pandemic? Available from: https://www.who.int/csr/disease/swineflu/frequently_asked_questions/pandemic/en/

Coronavirus disease 2019 (COVID-19) is caused by a new coronavirus. Coronaviruses are a large family of viruses that are common in people and many different species of animals. Rarely, animal coronaviruses can infect people and then spread between people such as with this new virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 is the virus strain that causes COVID-19.

Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19): https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html 

As COVID-19 is a new disease, there are limited data on how this disease affects children. Currently, there is no evidence that children with diabetes are at a higher risk of contracting the SARS-CoV-2 virus that causes COVID-19.

However, new data are emerging all the time, so it is important to be vigilant and control diabetes well during this time.

JDRF, 2020. https://www.jdrf.ca

Children with well-managed diabetes are predicted to have similar symptoms to children with no diabetes and are advised to follow general guidelines for “sick day” management. However, the infection may make it more difficult to control blood glucose levels and this may increase the risk of ketosis and DKA.

There are data from adults with diabetes and underlying medical conditions, like heart or lung disease, that they may be at risk for a more severe illness. There is no information at this point to support the same conclusion in children with diabetess.

Consult the diabetes healthcare team and follow the sick day management strategies.

For more information, Click Here.

JDRF, 2020. https://www.jdrf.ca

American Diabetes Association. Diabetes and Coronavirus (COVID-19): https://www.diabetes.org/coronavirus-covid-19

ISPAD – International Society for Pediatric and Adolescent Diabetes. Chapter 13: Sick day management in children and adolescents with diabetes: https://www.ispad.org/page/sickday

Social distancing refers to minimizing close-contact with others. However, a better concept to follow is that of “physical distancing”. Maintaining social interactions virtually is encouraged through the use of social media and video apps to support and take care of one another until the pandemic is under control. Practicing safe physical distancing and adhering to local public health authority guidelines is something we can all do to effectively prevent the spread of the COVID-19 virus. Keep a distance of at least 2 arms-length (about 2 metres, 6 feet) from others.

Public Health Agency of Canada. Being Prepared, Coronavirus disease (COVID-19). Government of Canada: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/being-prepared.html

The SARS-CoV-2 virus that causes COVID-19 is spread from person to person through small droplets from the nose or mouth when in close contact with others. These droplets can also coat surfaces and the virus can then spread when the surface is touched and hands come in contact with the eyes, nose, or mouth. Airborne transmission of this virus has not been reported so far. Additionally, there have been no reports of fecal-oral transmission of the virus to date. 

World Health Organization. Coronavirus disease (COVID-19) Pandemic: https://www.who.int/emergencies/diseases/novel-coronavirus-2019

The COVID-19 virus may survive on surfaces for a few hours to several days. Specifically, the COVID-19 virus is detectable for up to 4 hours on copper, 24 hours on cardboard, and up to 2-3 days on plastic and stainless steel. Taking precautionary measures by wiping down all incoming packages and frequently-used surfaces with disinfectants reduces the chances of infection by removing the virus.

Van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, Tamin A, Harcourt JL, Thornburg NJ, Gerber SI, Lloyd-Smith JO. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. New England Journal of Medicine.

Ontario Agency for Health Protection and Promotion (Public Health Ontario). Review of “Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1”. Toronto, ON: Queen’s Printer for Ontario; 2020.

There has been some debate about this question. Some counties have suggested using a mask to reduce the spread of the virus.

No significant benefits have been observed when healthy people in the general population wear masks to prevent infection.

However, masks may be helpful in reducing the spread of the infection in those with symptoms and perhaps even in pre-symptomatic people.

The effectiveness of non-medical (e.g. cotton fabric-based) masks can vary and is lower than that of surgical and N95 masks. Some masks may increase the risk of infection through self-contamination. Wearing a non-medical mask in public is recommended in Canada when it is not possible to consistently maintain physical distancing (i.e. 2 metres or 6 feet from others). In addition, air passengers are required to wear a non-medical mask or face covering when flying into or within Canada. Please refer to recommendations in your jurisdiction.

Surgical and N95 masks are currently not recommended for general public use, and regular hand washing, coughing and sneezing into the elbow, and distancing measures are critical to prevent the virus from spreading. 

Ontario Agency for Health Protection and Promotion (Public Health Ontario). 2019-nCoV – What We Know So Far About…Wearing Masks in Public. Toronto; 2020.

WHO. Advice on the use of masks in the context of COVID-19, 2020.
https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-
home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-
outbreak

Pan-Canadian Public Health Network. Use of non-medical cloth masks or face coverings in
community settings. http://www.phn-rsp.ca/sac-covid-ccs/wearing-masks-community-eng.php

CDC. Use of Cloth Face Coverings to Help Slow the Spread of COVID-19, 2020.
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

There is no evidence to suggest that any animal, including pets, livestock can spread the COVID-19 virus to people or that they might be a source of infection. However, recent reports have indicated that animals, including cats, can become infected with COVID-19. It is advisable to practice healthy habits with pets and other animals. Wash your hands after handling animals, their food, waste or supplies. Disinfect and clean your pet’s belongings. Do not wipe or bathe your pet with products that are not approved for animal use, as these products are harmful to your pet’s health. Treat pets as you would other human family members; do not let pets interact with people or animals outside the household. If a person inside the household becomes sick, isolate that person from everyone else, including pets.

If you believe that your pet has COVID-19 symptoms (e.g. fever, coughing, difficulty breathing, lethargy, sneezing, runny nose, eye discharge, vomiting, diarrhea), seek advice from your veterinarian to discuss next steps and continue to monitor your pet’s symptoms

If your pet is tested and confirmed to have a COVID-19 infection, follow the recommendations of a veterinarian in your jurisdiction. You may follow similar recommendations for caring for an infected person at home. Some tips include:

• Keep your pet at home, except for medically necessary appointments 
• Separate your pet from other people and pets in the home. 
• Do not put a mask or face covering on your pet
• Avoid contact with the pet as much as possible (e.g. petting and being licked). Wash your hands with soap and water immediately after coming into contact with your pet. Ensure that you do not touch your eyes, nose, and mouth with unwashed hands. 

Centers for Disease Control and Prevention. Coronavirus Disease 2019: https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Public Health Agency of Canada. Coronavirus disease (COVID-19). https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

Information regarding COVID-19 is changing rapidly. The Government of Canada and the Province of Ontario website regularly update their website to display the most recent information regarding COVID-19. These links are provided below:

Government of Ontario: https://covid-19.ontario.ca/

Public Health Ontario: http://www.publichealthontario.ca/en/diseases-and-conditions/infectious-diseases/respiratory-diseases/novelcoronavirus/public-resources

Find information from your Ontario public health unit here: http://www.health.gov.on.ca/en/common/system/services/phu/locations.aspx#18

Government of Canada: http://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

Currently, there are no cases that suggest that the COVID-19 virus can be transmitted through food. Please follow the guidelines and recommendations in your jurisdiction. Here are some tips on how to safely handle food during the COVID-19 pandemic:

• Wash your hands or use a hand sanitizer before and after you handle food and food packages
• Wash fruits and vegetables with water; using soap and chemicals is not recommended. Produce is porous and chemicals that are not intended for consumption can be absorbed.  
• Cook food to recommended temperatures. See this chart for more information: Recommended safe internal temperatures (https://www.canada.ca/en/health-canada/services/general-food-safety-tips/safe-internal-cooking-temperatures.html) 
• Prevent cross-contamination between raw and cooked foods.
• Clean and disinfect surfaces before and after using them to process food.

Centers for Disease Control and Prevention. Coronavirus Disease 2019: https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Public Health Agency of Canada. Coronavirus disease (COVID-19). https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html

We do not know for sure if kids with diabetes are at more risk of DKA when compared to them getting other infections.

In one study of kids admitted to pediatric intensve care units in the USA, four kids had DKA. There were no further details that were shared about these cases to help us understand why these kids got DKA.

The important issue here is that kids with diabetes should follow their sick day management protocols and call their team or attend the emergency department if they are not able to control their diabetes while sick.

Shekerdemian, L. S. et al. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatrics, doi:10.1001/jamapediatrics.2020.1948 (2020).