The COVID-19 pandemic is the defining global health crisis and it has become the greatest challenge we have recently encountered. Based on currently available information obtained from clinical studies, conclusive evidence indicating that patients with diabetes or cardiovascular disease are more susceptible to the infections has not been derived yet. Nevertheless, several researches reveal that patients who have certain preexisting medical conditions, especially uncontrolled diabetes and cardiovascular disease are at higher risk for severe illness if they become infected with COVID-19. Besides following all preventive measures, keeping blood sugar under control while remaining of a healthy weight can significantly reduce risks of developing serious complications in case of infections.

Diabetes and COVID-19

Although, there are inadequate data to indicate whether people with diabetes are more likely to get infections with COVID-19 than the general population, clinical researches have suggested that patients with uncontrolled diabetes are firmly associated with an increased risk of COVID-19 complications or severe symptoms.

When patients with uncontrolled diabetes develop a viral infection, it can potentially result in severe symptoms. Higher-than-normal blood sugar levels weaken the immune system, causing an impaired immune response. As a result, it becomes more difficult to fight against the virus effectively. Without adequate immune response, viruses can exponentially multiply and spread rapidly. Meanwhile, viral infections induce inflammation, leading to an elevated blood sugar in patients with diabetes. Poor blood sugar control effects the immune system and fluid balance as well as worsens the co-morbidity and diabetes complications that patients already have had Moreover, having diabetes-related complications or other comorbidities in addition to diabetes increases the chance of getting seriously ill from COVID-19.

Current studies demonstrate that among patients with diabetes the mortality rates significantly increase, up to 2-3 times of the overall population. Despite the similar treatment guideline of COVID-19, treatment complexity appears in diabetic patients. While maintaining blood sugar levels in an optimal range, certain medications pose some limitations. Special precaution and close monitoring are further required. In some cases with high blood sugar levels, dosage regimen adjustment in combination with insulin administration might be urgently needed.

Diabetes is a chronic, long-lasting health condition. The longer the patients have diabetes and the less controlled blood sugar, the higher the risk of complications. Therefore, to minimize the risk of diabetes-related complications, it is crucial to control blood sugar levels within desired targets. Besides taking all medications as prescribed, lifestyle modification that helps to maintain blood sugar levels include: consume healthy foods, keep your weight in a healthy range, exercise regularly, keep blood pressure and cholesterol under control and pay attention to the feet and legs. It is essential for diabetic patients to keep their vaccinations up to date while following all appointments as scheduled. 

Cardiovascular disease and COVID-19

Apart from respiratory symptoms, COVID-10 can substantially aggravate cardiovascular conditions, leading to an increased risk of death among patients with cardiovascular diseases. Based upon medical evidence currently obtained, patients with cardiovascular diseases do not appear to be more prone to COVID-19, compared to general population. However, similar to diabetic patients, if patients with cardiovascular conditions are infected with COVID-19, they are at greater risk of developing serious illness regardless of type of cardiovascular diseases. Once the virus enters into the body, our immune system is activated to fight against the infection. Immune responses are produced through different mechanisms including an elevation in body temperature, causing fever and the release of a variety of pro-inflammatory substances as the first line of defense against viral infection. Nonetheless, theses immune responses can trigger inflammations in the body and exacerbate preexisting conditions. In patients with heart diseases such as myocardial infarction –a damaged heart muscle caused by decreased blood flow, excessive inflammation can potentially worsen their symptoms, leading to adverse cardiac remodeling and heart attack.

Treatment of COVID-19 in patients with cardiovascular diseases

Once the viral multiplication reaches certain levels, a large amount of virus starts causing cell destruction and spreading to adjacent organs. As virus speedily multiplies, organ damages progressively continue. Without prompt and appropriate treatments, it might lead to a fatal consequence due to multiple organ failure. COVID-19 can cause lung damages. The effect of COVID-19 on respiratory system mainly involves lung infections, resulting in an impaired oxygen exchange process. Once the lung tissue become damaged and cannot be oxygenated adequately, the oxygen level in the blood significantly reduces. As a result, heart needs to work extensively in order to maintain adequate blood supply to other organs. Particularly in patients with underlying heart diseases, infections can lead to multiple organ failure in which intensive treatments are urged. These often include respiratory support e.g. mechanical ventilators, cardiac stimulant agents and vasopressors used to increase blood pressure. Due to prolonged hospitalization and serious complications, mortality rates considerably increase among these patients.   

Similar to general populations, common clinical manifestations of COVID-19 in patients with cardiovascular disease are fever, cough, shortness of breath, impaired taste and smell. Nevertheless, if existing symptoms e.g. chest pain and difficulty breathing are provoked after exposure to suspected or confirmed cases, immediate medical assistance must be sought without delay to role out the exact cause, allowing for timely and effective treatment.

To minimize the risk of infection while keeping the disease confined, following preventive measures must be strictly complied with:

1. Wash your hands frequently with soaps or hand sanitizers.
2. Wear a face mask at all times while in public.       
3. Avoid touching your face, eyes, nose and mouth since the viruses can be transmitted to the body through these routes.
4. Maintain social distancing and refrain from going to crowded places., especially for elderly people aged over 60 or patients with underlying conditions.

Patients with heart diseases need to abide by all instructions advised by their cardiologists. These include influenza vaccine and pneumococcal vaccine against pneumococcal bacteria that commonly cause pneumonia, meningitis and sepsis.