An estimated 48 million people are living with diabetes in the International Diabetes Federation (IDF) North America and Caribbean (NAC) Region, which covers 29 countries and territories. Over 1.5 millions cases of COVID-19 have been recorded across the region and various restrictive measures have been put in place by national authorities to manage and prevent the spread of the virus.
People with diabetes and health professionals in the region have been impacted in many ways. We asked IDF NAC Region Chair, Dr. Timotheus Dorh to share his insights on what the impact has been and how, in the longer term, COVID-19 will shape the lives of people with diabetes and health professionals in the region.
What has been the impact of COVID-19 on people living with diabetes in your region?
The majority of cases of COVID-19 within the region have come from the United States, Mexico, and Canada. We have also had quite a few cases in Trinidad and Tobago and Jamaica. The number of deaths has also been quite high. Regarding the impact on people with diabetes, a few countries have provided estimates that indicate that close to 40,000 deaths concerned people living with diabetes.
Within the majority of our countries, there has been a scale down in the level of support for everybody, including people with diabetes. Clinics and hospitals have been shut down, except for life threatening and emergency cases and all ambulatory procedures have been canceled. At the community level, the majority of clinics have also reduced their care. People living with diabetes have been undoubtedly affected by the scale down. However, physicians and nurses are still providing care and people living with diabetes can get prescription refills and access care for urgent but not life-threatening emergency issues.
People living with diabetes are doing the best they can in terms of stocking up on medication and trying to avoid going out in public. We have been in touch with many of our members and they have been giving us positive information, sending videos to show that they are maintaining social distance, wearing masks as recommended and trying their best to keep as healthy as possible. We know that it is a challenging situation and I believe that there may probably be a need for mental health assessments and care.
What has been the impact of COVID-19 on diabetes health professionals in your region?
From what I’ve understood, many private offices were ordered to close down for a certain period as part of the national lockdown measures put in place to contain the virus. That has had an impact on the number of cases in each country. Governments also set up respiratory clinics, and health professionals, particularly those in a private setting, have left their practices to help their government and country fight the virus. There has been a shift in focus from all general medical issues to COVID-19. Governments have also placed requirements on people, not only those in the health sector, but also in public service to reduce their salaries to finance the needs of the countries. All of these measures have affected healthcare workers, who are putting in extra time to help with the situation.
The role of nurses and support staff has been very important. They have been optimal in helping maintain control and structure. Nurses have a lot of contact time with patients. They are the ones who are always there to make sure that things are done well within the clinic and hospital setting. Without nurses, without the support staff, people providing food especially, I do not think any of this would have been possible. I think the system would be broken.
How have national authorities responded to the situation?
Every country has responded similarly in a slightly different way. Some countries, I believe, based on what they have done, have had better outcomes than other countries. You have some countries who have not had a positive case in over 30 days, and you have other countries who have had a continuous rise in the number of cases. One problem that seems to be plaguing every single country within the region is the availability of testing. Without testing, you cannot really know what number of cases you have in an island or country. Given the resources available, given the structures and given the procedures that have been followed, I believe national authorities have been doing as best as they could.
How has the pharmaceutical industry and civil society responded?
I am extremely pleased that most of our pharmacies have been able to maintain supply. There are some countries that have experienced minor issues which have been resolved, some are still evolving, but for the most part, access to medical supplies remains stable throughout the region. I think the pharmaceutical industry has been working well to ensure that countries maintain the required amounts of important medication and supplies for people with diabetes.
Our member associations have also been playing their part in ensuring that their members received the correct information from the start. People are receiving information from many different sources about the virus, much of which is not true. Therefore, our member associations have been ensuring that people are directed to the correct information to stay updated. Many webinars have been organised to provide updates on the virus and simple advice on things like how to take care of your mask, how to clean your house and what to do if you go outside. Our member associations have been doing well in ensuring that this information has been circulating.
What do you think will be the longer-term impact of the COVID-19 pandemic on people with diabetes and health professionals?
I believe that COVID-19 has really forced us to think about the way that we offer medical care, particularly to people living with diabetes. When you are under some form of quarantine, you need to find ways of getting care to those who need it. We will therefore probably see an increase in digital health services, and we may see an increase in the number of training sessions to help people with diabetes self-manage their condition. This may be costly and being able to attract funding will probably be difficult. I hope this will not be the situation because the issues with diabetes and its complications, with our without COVID-19, will remain.
I am also expecting the confinement to have a longer term impact on the delivery of care. People will now probably have to wait two to four weeks more than usual to get medical care. This is a new dynamic that may cause more problems for us and more problems for the person with diabetes. We need to start thinking of ways to mitigate this now so that if and when the COVID-19 situation does disappear, we do not end up with a sudden surge in the number of diabetes complications.
