Day 4: Differentiating the Terminology

Last night was a tough blood sugar night. As a Type 1 diabetic I needed to change both my insulin site and also my Dexcom CGM site. My insulin site connects to an insulin pump that gives me the insulin that most people get normally from a fully functioning pancreas. I have had a pump since age eight, although I have been diabetic since age six. I only got my Dexcom G6 (which gives me real time blood sugar readings, but from my blood tissue) a few months ago, but it has completely changed how well I can control my blood sugar levels. This was tricky since my company did not send out my set of Dexcom sites in time and this was my last one. Usually I do have not trouble inserting it, but this one essentially "got stuck" during the insertion process. Thankfully, this is not a gory story, and ends happily. After a lot of maneuvering the applicator and attempting to detach it, my husband and I resigned ourselves to the fact that we might be doing a lot of manual checks. As a last ditch effort, my husband told me that an engineer in a diabetes forum had experienced the same problem and resolved it by gently hitting the site of the applicator with the blunt side of a screwdriver. I have no idea what my face looked like when he said that, and I am positive I could not replicate it for any amount of money in the world. However, Mr. Engineer, if I ever find you, I owe you my sanity sir. Because that is possibly the wackiest hack I have ever heard of. And it freaking worked.

The adventures did not end there, though. In changing my insulin site, unfortunately the cannula bent and over the course of two hours with no insulin, my blood sugar soared over normal limits. Really not ideal for a quarantine situation. An injection of rapid act insulin and two new site changes later, my sugar starting falling into the normal range...then past the normal range into the "low" range. After scarfing down several carbs and closely monitoring my sugar and any potential ketones (excess sugar in the urine-which I did not have), we finally crawled into bed. Shoutout to the gluten-free cereal brands who have my back dealing with low blood sugar and celiac at the same time.

Despite going to bed late last night with a very low blood sugar and needing to eat two bowls of frosted flakes to bring it up around 3:30 AM, I woke up just a little past my regular wake up time. Unfortunately, even with a CGM (continuous glucose monitor), I had a spike and woke up with high sugar again. With some insulin, and after a debate about opening one of our rationed GatoradeZero bottles to regulate my electrolytes, I am back in the normal range!

Today has felt like a regular Sunday in many ways. My husband and I slept in, played with our sweet little pup, and had a nice low-key morning as we waited for my sugar to level off. He taste-tested our banana-cream pie we made in honor of pie day (and because some of our groceries were about to expire) yesterday. I am am excited for a small bite whenever my sugar drops again!

We have enjoyed having some quiet time for intentional time to pray and have spiritual bible study (Catholic + Unitarian bible study is always an interesting time!) Since we come from different faither backgrounds, our intentional prayer time takes many forms, from reading scripture from the Bible, to meditating, to reading aloud from the Dao De Ching. As I am writing, he is preparing lesson plans and we are planning to have a longer yoga practice today to stretch out from our big cardio day yesterday.

Here is where we shift over to some of the words that are being tossed around today from the outside. Many people are confused about what protocols are being implemented to stop, or at least slow down, the infection rates of the coronavirus in the USA and in other nations. Due to the rapidly shifting landscape of the COVID-19 virus, the CDC is implementing several different strategies to slow the spread of the contagion and minimize exposure of people who are "carriers" (not displaying symptoms, but able to infect others). As of right now, the original statistics surrounding severity of the virus put out by experts in the Wuhan province in China are almost identical in all other reporting countries. Roughly 80% of people who contract the virus either have mild cases that can be treated at home or, in some rare cases, are completely asymptomatic.

The remaining 20% of the population seems to be more susceptible and in need of more intensive care ranging from prescribed medications to help open airways and battle cough + fever, to hospitalizations with assistance breathing, sepsis (infection of the blood), organ failure, and even death. But, hold on. Hang with me for second, because that list sounds downright frightening. And for those of us in high-risk demographics--whether due to age, pre-existing medical conditions, or other extenuating circumstances--fear is amplified even more. That being said, the *actual* mortality rate from this disease does not appear to be increasing since it started to be monitored a couple of months ago. That means that of all the cases that have been reported globally, about 5,000 people have been killed by complications from this virus. The last thing I want to do is reduce people to numbers and statistics. Each of these people had a mother, a father, family, friends, community, dreams, goals...and likely never saw a pandemic as the way that they would leave the planet. That being said, when news outlets start to highlight the terrible consequences of COVID-19 on individual health it is paramount to remember that the biggest threat is the infectious nature of the disease for 80% of the population. In other words, it spreads. Fast. And if we do not globally take action to impede the spread, the population will contract it too fast and will overrun hospitals and caregiving facilities that have the ability to successfully manage and combat the symptoms of COVID-19 in smaller numbers of cases. Okay...so what does that mean? How do we not overrun the hospital system? How do we get care when we need it? Good questions, friends! And researchers are doing a great job breaking it down for us.

There are a lot of terms being thrown around right now in terms of what is medically necessary in different states, nations, even continents. As of today, Italy, Spain, and France are making headlines with being in "lockdown." Let's break that down. For all intents and purposes right now, countries that are in lockdown are trying to mitigate what is called "community spread." Community spread is pretty much what it sounds like-the virus being rapidly transmitted due to its infectious nature through communal activities (e.g. having breakfast at a cafe, picking up Starbucks at a drive-through, shaking hands or hugging a friend). Many countries are also "closing borders," which is again what is sounds like. In order to lessen the spread of the virus to other countries, countries closing borders are not only trying to contain the disease in their respective area, but also prevent it leaving to infect other countries to slow infection rates in places where people and/or goods may be transported via place, car, boat, etc.

In the USA, we have not yet taken this step, but many other protocols went into effect last week. It is important to break down the terms to understand what we can do to help with slowing the progression and also understand what the situation is like where you are living. The lowest level is social distancing, which describes a person who is intentionally avoiding all nonessential travel, working from home remotely if possible, maintaining at least three meters between themselves and other people when they go out, and taking other "distancing" steps to ward off infection without staying exclusively at home. Two main forms of slowing the spread of the coronavirus here are one tier above that and are called self- and social-isolation. Self-isolation refers to people who are isolating themselves after having potentially come into contact with a person who has a strong likelihood of having COVID-19. Social-isolation is typically being viewed as a more voluntary step that people are taking to stay indoors as someone would in self-isolation and avoiding going out at all (except to see one's doctor) in an attempt to remove them from the group of people who can be infected by community spread. One level above that is quarantine. Quarantine is typically mandated for people who are at extremely high risk (eg. me!), people who have tested positive for COVID-19, or people who have definitely come into contact with a person carrying COVID-19. This requires staying entirely indoors at your home and not interacting with anyone outside of your home to reduce your chance as much as is possible of either spreading or contracting COVID-19. Again, this is a virus that most can recover from with mild symptoms. However, if everyone in one country contracts it very quickly, there simply will not be enough resources to help every person with all available treatments like there would be if we titrate the number of cases at once. Think of it this way:

By "flattening the curve," the community stays within the healthcare capacity limits and allows all people infected to be treated with the best possible care. If this is a bit too much as a graph, I personally find this one to be much easier on the eyes:

Either way you slice it, by following the protocols originally set up over a century ago for pandemics like this one, we give everyone a better chance. The first time these protocols were used were in 1918-19 with the outbreak of the Spanish Flu. At that time, the protocol was referred to as "cordon sanitaire," better known as protective sequestration.

I cannot, and choose not, to speak for a group of people in my demographic. However, I can tell you that I have seen and heard Darwinian jokes about "survival of the fittest"--or blatantly seen people I personally know say "well, if it's only going to affect the sick and old people..."

Stop it.

Just, stop it. We are better than that. A person's value is not based on their age, immune system, or other mitigating factors that put him/her into "low risk" or "high risk" patients. Comments like this are some of the worst examples of ableism and ageism that I have ever come across. As an immunocompromised person, I am absolutely terrified knowing every day that I am in the 20% part of the statistic in the beginning of this post. It is hurtful and further isolating to read others' thoughts on just how expendable you may or may not be. I do not care if you are trying to make a joke. It isn't funny, and it benefits no one while harming many.

That being said, the more people can socially isolate, the slower this thing will spread, and the better outcomes will be for ALL communities on ALL levels. As a person who knows that COVID-19 is not just in my state, but also my city, I am really grateful that I was mandated to quarantine early to protect both myself and others.

Travel bans continue to roll out for the USA, and there is talk that there may be borders put up in some, or all, state-to-state travel depending on how "hot spot" areas continue to evolve. In the meantime, here are some ways that you can prepare if you, or a family member is mandated to quarantine according to the CDC:

• What to have in an emergency kit if you are quarantined in your home

o 2 week supply of food especially dry and canned goods (non-perishable)

-I would add here to add any food that you feel good eating that can boost your immune system and throwing a probiotic in there as the gut biome is so important in fighting off viruses like this one!

o At least one gallon of water per day for each person and pet

-Let's not forget our furry/scaly/other family members!

o Hygienic products like soap, hand sanitizer and toilet paper (if you can find it!)

o A first aid kit to treat common injuries w/antibiotic ointment and bandages, etc.

o A 30 day supply of prescription meds and OTC supplies (e.g. fever reducers)

Consider using networks in your area using the "what can you give, what do you need" system while you are healthy and other may need support, or if you are sick and need help more immediately. People are good, people. Reminders are streaming in daily. Perhaps one of my favorite headlines today was seeing that The New York Times will be offering free information services to everybody who would like to be informed about not only the COVID-19 updates, but also the positive news of the day. Let's make that go-do I dare say-viral?

Until next time, take Jimmy Kimmel up on his advice and embrace the #elbump (elbow high-five) if you MUST greet someone. In fact, watch all of the excellent late-night hosts who are now performing without studio audiences and are absolutely providing the right cocktail of humor and accuracy to regain a sense of new normalcy. If you really need a good laugh, just turn to Trevor Noah, Jimmy Kimmel, Steven Colbert, and many others cracking up with their staff (the new audience separated out throughout the room) as they perform their "rehearsals" of the show live for us. Better yet, check out that footage that C-SPAN forgot to cut both before and after the presidential address...sometimes laughter really is the best medicine, friends.

Prepare, don't panic.

-Allison