FDA Approves SalivaDirect via Emergency Use Authorization


Last update: 08/17/2020

The less invasive, lower cost SalivaDirect COVID-19 diagnostic test was issued an emergency use authorization by the FDA on 8/15/2020. This new test collects saliva in any sterile container, and does not require a separate nucleic acid extraction step. This saves time and money, and offers a real hope for expanded testing throughout the country. Here’s the link to the FDA notice;  https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-issues-emergency-use-authorization-yale-school-public-health


Overview: Diabetic Self-management and Emergencies During Coronavirus

In most cases people can take steps on their own to correct when blood sugar is too low or high. Those steps are outlined later in this article. Sometimes, people need help. If you are close with someone who has diabetes, consider having a discussion with them about what they want in case of an emergency.

Diabetes and Illness

People with diabetes who get sick with the flu or common cold should stay home and limit contact with others. Other recommendations from the Centers for Disease Control (CDC) include:

  1. Continue taking diabetes medication and insulin.
  2. Test blood glucose every four hours.
  3. Drink extra (calorie-free) liquids.
  4. Eat as normally as possible.
  5. Weigh yourself daily
  6. Check your temperature daily.

The CDC recommends that you contact a health care professional or go to the nearest hospital emergency department if any of the following occur:

  1. Your too sick to eat.
  2. You are not able to keep food down for 6 hours or more.
  3. You are having severe diarrhea.
  4. You have lost 5 pound or more.
  5. You have a fever over 101 degrees F.
  6. Your blood sugar level is < 60 mg/dl or > 300 mg/dl.
  7. You have ketones in your urine.
  8. You have trouble breathing.
  9. You feel sleepy or are not thinking clearly.

Diabetes and Coronavirus

We are learning more about Coronavirus every day. People with Type 2 diabetes are at increased risk of severe illness from COVID-19, and people with Type 1 diabetes may be at greater risk as well.  You can not ensure you have no risk of infection from Coronavirus. When protective measures and strict social distancing can not be maintained, people with diabetes should seriously consider avoiding activities.[i]

High blood sugar (over 250 mg/dl) and low blood sugar (under 70 mg/dl) can be dangerous, and symptoms can turn into an emergency quickly. Knowing the symptoms and what to do when your blood sugars are high or low may save your life.

High Blood Sugar; ( > 250 mg/dl )

The problem with high blood sugar is that your body can start burning fat instead of blood glucose and/or you blood can become acidic in a way that damages vital organs. This can cause medical emergencies that can be fatal.

When your blood sugars regularly exceed 180 mg/dl you should work with your health insurance provider and doctor to find and schedule an appointment with an Endocrinologist.  An Endocrinologist specializes in Diabetes and get help you develop a treatment and management.  You can find one in your area by searching The American Association of Clinical Endocrinologists website.

There is also an uncommon and very serious problem called Hyperosmolar Hyperglycemic Syndrome (HHS) when blood sugar is extremely elevated ; > 600 mg/dl. According to WebMD, HHS happens mostly in older people with uncontrolled diabetes who are sick or have an infection, and often occurs over days or weeks.[ii]


Frequent urination, a fruity smell on your breath, extreme thirst, nausea, vomiting, and stomach pain. Any sudden or unexplained symptom is a signal to contact a doctor. At a minimum you should use a home test or dipstick test to check your urine for ketones. If ketones are present, you should contact your doctor for next steps

Treatments for High Blood Sugar

Drink water – to help your body release urine. You should discuss this method with your health care providers because you can drink too much water; specially if you have heart or kidney issues.

Administer Insulin – discuss with your doctor how much rapid acting insulin to inject when your blood sugar level is too high and check your blood sugar again after 30 minutes to ensure your blood sugar is going down.

Exercise – your body will burn sugar when your heart pumps faster than usual. Any exercise should be discussed before-hand with your health care providers, especially if you are a Type 1 Diabetic.

Low Blood Sugar; ( < 70 mg/dl )

Blood sugar can also be too low. This is called hypoglycemia. Without treatment, low blood sugar can also become life threatening. Blood sugar most often drops too low because a person takes too much insulin, consumes too much alcohol, misses meals, or does too much exercise.

Many times people with diabetes can feel when their blood sugar is too low. However, that’s not always the case. Even for people who have had diabetes for a long time. Symptoms of low blood sugar to be aware of include confusion, dizziness, nausea, hunger, nervousness, sweating, weakness, tiredness, tingling in extremities, and headache. More sever symptoms include seizures and a loss of consciousness.

Treatment for Low Blood Sugar

If at any time a person loses consciousness someone should call 911.

If a person is experiencing mild symptoms or knows that they have low blood sugar they should eat a high carb snack like a glucose tablet, candy, sweet juice, sugar. The American Diabetes Association recommends that you take 15 grams of a carbohydrate and test yourself after 15 minutes. If levels are still below 70 mg/dl take another 15 grams of carbs and test yourself again after 15 minutes.  Once blood sugar levels rise above 70 mg/dl eat a meal. If symptoms continue after eating 30 grams of carbohydrates seek medica help.

In an Emergency

Signs of a possible emergency include the persistence of any of the symptoms outlined above for a prolonged time. Symptoms indicating that the problem is overwhelming the body include chest pain, difficulty breathing, a sudden fever, a severe headache, weakness in a part of the body, seizures, and loss of consciousness.

When any of these symptoms are experienced a call to 911 or trip to the hospital emergency department is needed.  WebMD states that you should give them a glucagon shot to raise their blood levels. aPatientsPlace.com does not support untrained people giving medications to people unless there are no other options.

Diabetes also makes people 2 to 4 times more likely to have a heart attack. Know the common signs of a heart attack and call 911 immediately or go to a hospital emergency department when needed. Stroke risk is also increased with diabetes. Know the symptoms and how to seek emergency care.

In the Emergency Department the primary goals are rapid evaluation and stabilization.[iii] Once the person is stabilized their primary care doctor and Endocrinologist, if they have one, should be contacted for post-discharge follow up and diabetes management care planning.


[i] Centers for Disease Control and Prevention. July 30, 2020. People with Certain Medical Conditions. Accessible at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html

[ii] WebMD Medical Reference. Nov. 19, 2018. Diabetes Emergencies: How You Can Help. Accessible at https://www.webmd.com/diabetes/diabetes-emergencies-what-to-do

[iii] Ford W, Self WH, Slovis C, McH=Naughton CD. Diabetes in the Emergency Department and Hospital: Acute Care of Diabetes Patients. Current Emergency and Hospital Medicine reports. 2013; 1(1):1-9. Doi:10.1007/s40138-012-0007-x


We must protect our healthcare workers; now!

We can’t allow our health care and public health workers to remain in short supply of personally protective equipment (PPE). It’s not enough for the administration and state governments to say that “plans to increase global manufacturing are underway,” as the CDC states in its recent guidance on the matter.

If our Emergency Department, hospital, clinic, home care, public health, and other front-line workers are not fully protected, we risk having our hospitals and health providers overwhelmed, our work force becoming patients with some dying, and leaving even fewer qualified professionals to care for our COVID-19 and regular care needs.

This is not only possible, it’s happening today in Balsamo, Italy. In a community where a 1,000-bed hospital has been completely overwhelmed, and where doctors are now treating other doctors and peers for COVID-19 because of the sheer volume of daily cases and the limited supply of personally protective equipment. They are in sheer crisis mode with virtually every citizen caught in the cross-hair of this situation; with no immediate end in sight. The same is happening at a 400-bed in Milan, and in many other places as well.

Finger-pointing and blame for inadequate testing capabilities must give way to action to take care of our healthcare workers. This is an avoidable scenario that need not happen. We’ve seen the outcome of inaction. The administration and state leaders will be to blame and should be voted out of office this fall if we don’t do whatever it takes to increase production and get PPE in the hands of our front-line healthcare workers.


8 Takeaways from Wuhan, China – Coronavirus

Thank you to Bill Frist, MD for sharing highlights of his conversation with three top Chinese physicians leading the Coronavirus response in China.

I’ll summarize here. However, consider watching the video shared by Dr. Frist on LinkedIn.

Lessons learned;

1. Early control of local transmission depends on rapid diagnosis and hospitalization of those with the disease. Failure to do this results in a spike in local cases.

2. Disciplined social distancing allowed for a peaking of cases in Wuhan within 10 days after first being reported. The number of new cases remained elevated for 6 days, followed by a rapid fall in reported new cases.

3. The most common feature of serious infection appeared to be fever, which was present in 98.6% of pneumonia cases reported in Wuhan. Other common symptoms included fatigue, dry cough, and muscle soreness.

4. Viral load, the measure of the virus present in the blood stream, had a direct impact on the severity of the disease.

5. COVID-19 was confirmed with two positive PCR performed one after the other.

6. Chest x-rays and CT scans were not precise in identifying COVID-19.

7. The main incubation periods, the average time from initial infection to onset of infection, in China was about 6 1/2 days.

8. No anti-viral drug has been proven effective against COVID-19. That said, trials are underway on Lopinavir, Retonavir, Remdisivir.

I encourage you to listen to the entire video on LinkedIn.

NEW UPDATEs: 3/16 – Coronavirus; (COVID-19)

Last revised: March 16, 2020
Great information on “How to protect yourself” and “What to do if you think your sick.”
Rewritten in part from the Centers for Disease Control and Prevention.

If you would like to get regular updates on COVID-19 from the CDC click here, and complete the form in the left column in the middle of the page.

If you would like to learn about the Clinical Management and Treatment click here.

The Interim Guidance for Healthcare Facilities from the CDC to prepare for community transmission can be found by clicking here. Senior housing communities would be well advised to follow these Guidelines as well.

The following symptoms often appear 2 – 14 days after exposure to Coronavirus (COVID-19); fever, cough, shortness of breath.

To get tested call your doctor. At this point, due to the shortness of tests, most states still require a doctor’s order to get tested.

Steps for Prevention

  1. Stay home except for medical care, and avoid public areas and transportation.
  2. As much as possible, separate yourself from other people and animals in your home. If you have contact with others or pets in your home wash your hands before and after contact and wear a face mask if possible.

Click here for additional information on preventing the spread of Coronavirus Disease in Homes and Residential Communities.

If you would like to learn how Coronavirus spreads click here.