“Follow a clear algorithm of actions”: the doctor - about COVID-19 against the background of obesity, diabetes and other endocrine diseases

- Natalya Georgievna, it was repeatedly reported that today in the context of the COVID-19 pandemicin a special risk zone are people who have background diseases, including obesity, diabetes and other endocrine disorders. Is it so?

- That's right. People with endocrinopathies are at risk. First of all, these are patients with systemic lesions, with diabetes mellitus (DM), multiple organ disorders. At risk are also patients with adrenal disease and autoimmune diseases.

In our country, almost 8 million people are obese. Prediabetes in 19 million people. Plus another 30 million - at risk due to obesity. About 40% of the Russian population have thyroid tumors, and this is largely due to iodine deficiency.

The mortality rate of such patients in the current pandemic is 2–4 times higher than in healthy people. This is due to widespread damage to the cardiovascular system, kidneys, a decrease in immune status and the body's resistance to infection.

- And what additional problems does COVID-19 cause in overweight people? Is the virus more contagious if the person is obese? Or does the disease develop faster?

- No, the risk of becoming infected with COVID-19 has nothing to do with the weight of the person. Another thing is that overweight people have impaired respiratory function, which leads to additional problems. The body’s need for ventilation increases, compliance of the walls of the chest and the elasticity of the lung tissue decreases, the diaphragm is disrupted, and airway obstruction decreases. The worst changes are characterized by a third degree of obesity.

- How does the coronavirus disease in people with endocrine disorders generally proceed? Do they need special equipment, drugs, special care?

- Of course, in case of infection with COVID-19, people with endocrine diseases may need treatment correction. Patients with diabetes mellitus should be evaluated every 4 hours, especially in the absence of compensation, that is, with an increase in glycemia above 15 mmol / L. The ideal level of glycemia in the range of 6-10 mmol / l.

People with type 2 diabetes who are receiving pill therapy against a coronavirus infection may need to reduce the dosage of metformin or temporarily discontinue it, but with a mandatory replacement for an alternative treatment after consulting a doctor. If the blood glucose level in people with type 2 diabetes becomes too high (more than 13-15 mmol / l), then it may be necessary to switch to insulin therapy.

• In case of COVID-19 infection in patients with diabetes mellitus, glycemia level should be assessed every 4 hours
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• © andriano_cz

In adrenal insufficiency, an increase in temperature and the appearance of diarrhea require an increase in the dose of glucocorticoids. Such patients are at risk of a life-threatening condition - acute addison crisis, when the level of cortisol in the blood is lower than the need. 

People taking systemic glucocorticoid drugs have an increased susceptibility to infections, including coronavirus. In connection with the anti-inflammatory effect of such drugs, the infection may be asymptomatic in them. Patients taking glucocorticoids and having endocrine diseases should not forget to inform their doctors.

Patients with primary mild hyperparathyroidism do not require a special observation regimen. But with severe forms of hypercalcemia, they need increased attention and therapy. Hypercalcemic crisis in such patients is an indication for urgent surgery. However, with COVID-19 it is advisable to stabilize the patient's condition and postpone surgical treatment.

Patients with endocrinopathies need to follow a clear algorithm of actions when the first symptoms of COVID-19 occur. Explanatory materials are posted on the website of our center, a recording for telemedicine consultation is provided. We also organized a round-the-clock hotline 8 (495) 700-02-00 for all patients with endocrine diseases.

-  In your center there is an infectious case for patients with COVID-19. How is it arranged? 

- During the pandemic, we restructured the work of the thousandth team, promptly deployed an infectious corps for patients with suspected coronavirus and a confirmed diagnosis of pneumonia.

The new site includes all the necessary functional areas (“red” and “green”), sanitary inspection rooms for disinfection of medical staff, rooms with consoles for oxygen supply, necessary diagnostic equipment, high-tech intensive care units, intensive care rooms and operating rooms. Purchased all the necessary medicines, supplies and a full range of personal protective equipment. 

More than 250 medical workers of the Research Center for Endocrinology, involved in the work of the infectious disease corps, underwent mandatory and additional training, are regularly tested for coronavirus.

In the infectious diseases unit, eight medical teams work in shifts for eight hours. The logistics of all services, the routing of patients with suspected infection and the actions of the admissions department are strictly regulated.

- How is the shift in the “red” zone of the infectious body? What new problems did you encounter? How is your team doing?

- Most of the employees work without a break, not leaving the “red” zone at all during the work shift for all 8 hours.The conditions are not simple: it is very hot in overalls, a mask, a respirator, a hood, there is no way to rest or, for example, to wipe glasses. Hands in two layers of gloves, which extremely complicates the usual documentation, conducting basic manipulations. Work goes to the limit of both physical and emotional human capabilities. But all processes are gradually being debugged; it becomes somewhat easier for employees morally and physically.

- Do your experts monitor the development of a pandemic in the world?

-Of course, our endocrine community, the core of which is world-famous academics, monitors all the medical aspects associated with the pandemic. The center has a special responsibility to be a legislator in terms of clinical endocrinology, treatment of patients with hormonal disorders, and disease prevention. We have a great scientific potential.

Our team has processed a huge amount of information about the disease caused by the new SARS-CoV-2 coronavirus. Based on the information received, recommendations were developed to Russian endocrinologists on the management of their patients and a clear algorithm of actions prescribed for patients with endocrinopathies in case of symptoms of COVID-19. 

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• © Ilya Pitalev

In addition to clinical practice, we conduct scientific monitoring, identify causal relationships, and study the behavior of the internal secretion glands under the influence of this little-studied virus.

- What changes in endocrinology can the pandemic experience bring? Is it possible to say that coronavirus will make many people think about the right lifestyle, about a healthy diet?

“I think the consequences of the pandemic will force the scientific medical community to focus more on the development of specialized programs and new drugs for the diagnosis and effective treatment of chronic diseases.” I am sure this work will be done promptly.

I hope that certain changes will occur in the minds of our citizens, who do not follow the principles of good nutrition and do not like to visit medical facilities regularly, because any disease is easier to prevent than to treat. The COVID-19 pandemic has clearly demonstrated that only a healthy body is able to withstand new infections and get out of the battle with viruses with the least loss. So let's take care of our health, not thoughtlessly waste our natural arsenal, but strengthen it with regular physical activity, healthy nutrition, and good rest.   

- During self-isolation, overweight people and other metabolic disorders have a doubly hard time. They need to move more, and all movements are now limited. Your advice and recommendations to people with endocrine problems during this difficult time.

- Indeed, forced stay in self-isolation during the COVID-19 epidemic can have long-term effects on body weight, exacerbate the problem of obesity, related diseases and conditions. In such conditions, it is important to comply with sleep and wakefulness, a rational and balanced diet, and adequate water intake. All this is extremely important for health, especially in a situation where the reserves of the immune system are mobilized to fight the infection.

To facilitate the calculation of the energy intensity of food, there are many applications where you can easily calculate your norm in the given conditions of low physical activity. It’s enough for some people to keep a diary during the week to learn how to independently manage this “math” in the future. Today there is time to devote to your health.

The spring period is accompanied by a deficiency of essential vitamins and minerals. It's time to take vitamins, coordinating their list and dosage with your doctor. If this is not possible, choose drugs that are recommended by your age category or that your doctor previously prescribed.

The antiviral activity of vitamin C has been proven, the main source of which is currently seasonal citrus fruits and the well-known sauerkraut. It is worth paying attention to the seasonal deficiency of vitamin D. Unfortunately, by using foods it is impossible to achieve the targets, so you need to add vitamin D to your diet in the form of drugs in parallel with food.

We must not forget about physical activity. WHO recommends 150 minutes of moderate or 75 minutes of intense physical activity per week. The combination of these activities should be reasonable. These recommendations can be followed at home in the absence of special equipment and even in tight spaces.