Sarah Hannigan is a fellow member of the diabetes online community. When I saw she was also a fellow New Yorker, who was putting her own life at risk for us, I just had to reach out and thank her. Sarah tells us about her recent experiences with becoming infected with COVID-19 during the ongoing pandemic. Thank you, Sarah, for everything you do and for taking the time to share your experiences with us!
How long have you been type 1?
I am Sarah, a nurse practitioner in a New York City hospital. I have practiced in a hospital for over 14 years as a nurse, ICU nurse and now nurse practitioner for the last five years. I am married, live in NJ and have two young boys. Some of my hobbies include traveling, weightlifting, Zumba, and yoga.
I have had type 1 diabetes for 20 years now. I have been on an insulin pump for 16+ years and have been using a continuous glucose sensor for about nine years. When I was pregnant, I kept my A1cs in the 5.3-5.7% range, but my normal control is typically 6.4-6.7% for the past decade. Prior to that, I spent some years in the low to mid 7s.
Did that play into your decision to become a nurse practitioner?
Yes, I would say that being a person with diabetes played a role in me going into the medical field. Considering various careers, having a chronic disease makes it very important to have stable employment with good health insurance. I also got to see what nurses can do. No one in my family was a nurse and I didn’t really know how autonomous you can be. I also researched being a nurse practitioner and that seemed to be like a great combination of having a nurse background, but being able to diagnose, prescribe medications and radiographic studies, and do important disease prevention education. It seemed like a good way to connect with people and be able to prevent and treat diseases.
When you heard about COVID-19 heading our way, were you nervous? For your family? And for your work as a nurse practitioner during this pandemic? Did you feel your hospital was prepared for the outbreak?
At first, like many people, I didn’t know what to think. My hospital, as with many places (in my opinion, because of our country’s poor leadership and lack of proper prevention strategies) kept functioning as usual business until mid-March when we started decreasing visitors significantly, stopping nursing and medical students, decreasing nonessential staff in the hospital. We were still doing elective surgeries. It seemed like it could help, but truthfully the virus was already in NYC; it was just that it was extremely difficult to get tested. This was evident by the skyrocketing numbers we saw when testing was more prevalent. As health care providers, we were actually beginning to wonder who had had it in the previous month.
I didn’t know what to think at that point; I knew my job was going to change, but it was unclear when and how. Since then, we have had to adapt to multiple changes since this is something we have never been exposed to at all. Resources, including doctors and nurses, have been redistributed to better manage the influx and we are constantly adjusting. We have stopped doing elective surgeries and the ways we diagnose and progress patients have drastically changed.
I was the most nervous for me in my house since I am the immunocompromised one who is working in a hospital. Children seem to do well with this disease and my children are very healthy. They don’t have any asthma or other respiratory illnesses. My husband is also healthy. I do know that anyone can get very sick as I have seen many scenarios as a provider for other diseases, but excessive worry is also not good for the immune system, so I have tried not to worry.
Most people were going out and buying hand sanitizer and disinfecting wipes, but I was just trying to prep my immune system as much as possible. I increased my fruit and vegetable consumption, eating smoothies and salads every day, and was more careful with blood sugar control. I did have my husband buy some frozen food and supplies in case we are unable to leave the house for a few weeks, but I didn’t do any excessive buying.
At what point did you find out that you have COVID-19? Do you know how you contracted it?
It was either a co-worker or a patient who I contracted it from. I was in the room for the patient for 30 minutes. I worked closely with the co-worker for two shifts and then he left for the day with a high fever. I wasn’t going crazy at this point because I thought he could have something else, but I put it on my radar.
It took five days after I was in close contact with the patient for her to come back positive. It was seven days before I knew the co-worker had it. Testing took a long time to result. Before I knew they had it, I started feeling a little sick. I had a sore throat and felt like I was getting a sinus infection, but I didn’t immediately go to COVID since I didn’t have a cough or fever.
At the same time, my husband was feeling like he had a fever. He tried to get tested, but since he had no known contacts and wasn’t sick enough to require a hospital, they wouldn’t test him. Since my youngest had had a cold for over two weeks, I thought he could have given us something.
Once I heard the patient tested positive, though, I started being suspicious. I talked to my supervisor and she told me to do a telehealth visit to see if they would test me. I didn’t have classic symptoms; I had lost my sense of smell and taste, was very fatigued, and had mild body aches. I didn’t have a cough or fever. Being a person with diabetes, I also had the clue of needing more insulin. My basal was up 20-30% and I need more with mealtime insulin also. This was suspicious to me because normal colds don’t require more insulin.
I did the telehealth visit and the doctor placed an order for me to get the test, but the first appointment was five days away. By the time I was to get tested, I had symptoms for ten days. In the meantime, I took my younger child to the pediatrician since his cough had gotten severe; he was having trouble sleeping at night. Like my husband, they were only willing to test my son if I had tested positive.
It wasn’t good enough for me to say that I had been closely exposed to two people [who have tested positive]. This was frustrating to me because my testing was so delayed and by now I could have given it to my whole family and frankly, no one seemed to care. This, I believe, is how COVID-19 got so widely spread so quickly. It was so rare to get tested, so we, as a society couldn’t know who had it or didn’t. Even though I was social distancing, I still went to the grocery store and drugstore, thinking I was trying to protect myself from other people, not knowing it was the opposite.
Finally, I was tested at work; the test resulted quickly, and was positive. It was quite a turn around to go from having a hard time getting anyone in my house tested to my local public health department calling me and asking every place I had gone for the past two weeks, who I had seen, and the transportation I took to get there.
Did anyone else in your family get it? If so, what were their symptoms?
I am pretty sure that everyone in my family had it, but it is unclear. When I called the pediatrician back, they were not interested in testing G since he was doing better. My husband got better much quicker than me and then wasn’t interested in getting tested since I told him how painful the test is.
How long were you (and any family members) sick for?
T, my husband was sick for five days. He had mild shortness of breath, moderate muscle aches, and significant fatigue. He said he felt like he did when he had the flu. (I have never had the flu so I can’t compare it to that). My young son had a bad cough. My older son had cold symptoms including a cough and runny nose. I am assuming they had it, but I won’t be able to know unless they get tested for antibodies.
Everyone was exposed because I really didn’t think I had it well into me being contagious. We are a very cuddly family, so we are always snuggling and hugging. Despite trying, I couldn’t get them tested. I didn’t self-quarantine because I honestly felt like I had exposed them all already and I assumed T and I had it and someone needed to take care of them.
What is the main concern you have as a nurse practitioner and someone that has had COVID-19?
The biggest concern after having it myself is that so many people are walking around with it and we have no idea. I didn’t have the classic symptoms and it was so hard to get anyone in my house tested. I feel like it is so widespread and we have no way of knowing how far it extends.
As someone with type 1 who gets diagnosed with COVID-19, what was the first thing you did in order to prepare for your illness?
I just was trying to be extra health focused. A chronic illness makes you more susceptible because no matter how well controlled you are, you are not about to fully mimic your pancreas. I have exercised on some level which helps me keep up my energy. Only on the days of my worst fatigue did I take a break from working out. I think that helps me keep my immune system operating at a higher level.
Is there anything to have on hand that you would recommend to other people living with diabetes?
Keeping a healthy lifestyle! I would try to have other people go to the store for you as much as possible, washing fruits/vegetables well and quarantine other foods for a few days before you bring them into your house (COVID can be on the package).
I can’t imagine how stressful this time has been for you. How have you been able to rest, take care of your family and your patients?
My husband is very good at letting me take naps and workout when I need. I try to get one or two things accomplished before I let myself rest and veg out. When I am at a high energy time, I try to go with it and make dinner if need be. It can be reheated later.
Self-care is so important, how has working on the front lines affected your mental and emotional health right now? What are you doing to make sure you take care of yourself?
My goal for this week is to find a mental health professional to talk to on a video chat. I know there is help out there and I (and I think most medical professionals) could use some help right now. Our jobs are so different and the stress is challenging. I have been trying to listen to my body; I try to take a break from everything COVID every few days because it is making me anxious to be immersed in it all the time. I am working out or doing yoga every day because it makes me feel better.
Were you able to take off from work once you find out you were diagnosed? At what point did you go back?
Ironically I was on vacation for the first ten days of my symptoms. NYSDOH and my job recommend healthcare providers stay home for the first seven days after symptoms, so I haven’t had to miss work. I want to take care of the COVID patients since I have had it. I would hate to see any of my coworkers getting very sick from it.
Being on the front lines, what is the most concerning thing you have seen from the COVID-19 patients?
The lack of knowledge and resources has been difficult to deal with. Hospitals are functioning for lack of a better term like war zones. No visitors are allowed. We have to function with what we have. There is no bed. We have to figure out how to manage the patient until they do. There are a lot of different precautions we need to follow to keep staff and patients safe.
What do the symptoms you see range from?
I am in the hospital so patients have to be pretty sick to get admitted. Mild COVID-19 patients, I do not get exposure to. In hospitalized patients, we are watching their oxygenation. They usually require oxygen supplementation in varying degrees. When the oxygenation gets low enough despite non-invasive measures, they have to be intubated and go on a ventilator. Frequently patients have fevers, nausea, and low appetite. It would be unlikely for me to see only mild symptoms because we would have them manage at home since hospital beds are a limited resource.
People are very afraid, being that you have type 1 diabetes and now have survived COVID-19, what would you like to tell our readers? Any words of wisdom on how to feel about this whole terrible situation?
Be vigilant about social isolation, hand hygiene, and good infection control, but try not to be scared. There is only so much you can do and being afraid isn’t good for your immune system. The biggest advice I have is controlling your blood sugars. Good diabetes management when you are sick cannot be overstated. Refilling prescriptions and obtaining your testing/pump supplies as much as you can is good prep as well.
Diabetes doesn’t mean that you are going to be worse off if you get COVID-19. Healthy people are dying from it. Alternately, diabetes doesn’t make COVID-19 a death sentence. I have diabetes and was less sick than my co-worker who is healthy. It is hard to predict, so take care of yourself!
Thanks so much for taking the time to talk to me! I am so glad you are okay and feeling better. And from all of us here at Diabetes Daily, thank you for all you do!
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