Can touching a barbell in the gym get you sick with the coronavirus?

[Michael Scally MD]

[OA] Urological implications of SARS CoV-19

Introduction: The novel coronavirus disease 2019 (COVID-19), pandemic has afflicted > 3.3 million people around the world since December 2019. Though, more than 1000 publications have appeared in scientific journals addressing a plethora of questions, there is a considerable hiatus in understanding of the behavior and natural history of the virus and its impact on urology. Also, a modified approach is the need of hour in taking care of patients as urologists should safeguard their teams, families, and patients.

Material and methods: The authors have used guidelines from USA, Canada, UK, Europe and India for making recommendations to help urologist define their own policies that may have to be fine-tuned on the basis of continued and evolving challenges they would encounter and the local resources at their disposal.

Results: COVID-19 do effect genitourinary system from kidney to testis. The authors provide scientific basis to urologists to help identify patients by remote consultation who are likely to be harmed by coming to the hospital, and not to miss those who need hospitalization for diagnostic or therapeutic interventions. There is uncompromised need of specific precautions during surgery to safe guard the surgeon and his team along with the patient.

Conclusions: Urological operations during COVID-19 pandemic should be limited to emergency cases during the acute phase with an exit strategy planned in a staggered manner, based on the scientific risk stratification. Telemedicine (e-clinics or virtual clinics) would help achieve the goal of risk stratification.

Tyagi V, Sharma AK, Bhandari M. Urological implications of SARS CoV-19. Can J Urol. 2020;27(3):10205-10212. CJU International - Article Abstract:

 

[Michael Scally MD]

[OA] Dave DM, Friedson AI, Matsuzawa K, Sabia JJ, Safford S. Black Lives Matter Protests, Social Distancing, and COVID-19. National Bureau of Economic Research Working Paper Series 2020;No. 27408. http://www.nber.org/papers/w27408

Sparked by the killing of George Floyd in police custody, the 2020 Black Lives Matter protests have brought a new wave of attention to the issue of inequality within criminal justice. However, many public health officials have warned that mass protests could lead to a reduction in social distancing behavior, spurring a resurgence of COVID-19.

This study uses newly collected data on protests in 315 of the largest U.S. cities to estimate the impacts of mass protests on social distancing and COVID-19 case growth. Event-study analyses provide strong evidence that net stay-at-home behavior increased following protest onset, consistent with the hypothesis that non-protesters’ behavior was substantially affected by urban protests. This effect was not fully explained by the imposition of city curfews.

Estimated effects were generally larger for persistent protests and those accompanied by media reports of violence. Furthermore, we find no evidence that urban protests reignited COVID-19 case growth during the more than three weeks following protest onset. We conclude that predictions of broad negative public health consequences of Black Lives Matter protests were far too narrowly conceived.

DEMONSTRATING CAN be a dangerous activity, even in the best of circumstances. During a pandemic, it can be lethal. When mass protests against police brutality broke out in America earlier this month, following the death of George Floyd at the hands of policemen in Minneapolis, public-health experts worried they would lead to a surge in infections. Anthony Fauci, a leading member of the White House’s coronavirus task-force, called the protests “the perfect set-up” for the spread of the virus. Eric Garcetti, the mayor of Los Angeles, warned that the gatherings could become “super-spreader events”.

This was more than scaremongering. SARS-CoV-2, the virus which causes covid-19, is spread through droplets of moisture produced when an infected person speaks, coughs or sneezes. Large, crowded gatherings can contribute to the spread of the virus, especially when those involved are shouting and chanting slogans—projecting droplets farther into the air. Police tactics such as spraying tear-gas, herding protesters into contained areas and rounding up troublemakers into police vans and jail cells also increase the risk of infection.

 

[Michael Scally MD]

Characteristics of Adult Outpatients and Inpatients with COVID-19 — 11 Academic Medical Centers, United States, March–May 2020
Characteristics of Adult Outpatients and Inpatients with COVID-19 ...


Summary

What is already known about this topic? Exposures to SARS-CoV-2 have commonly been described in congregate settings rather than broader community settings.

What is added by this report? In a multistate telephone survey of 350 adult inpatients and outpatients who tested positive for SARS-CoV-2 infection, only 46% reported recent contact with a COVID-19 patient. Most participants’ contacts were a family member (45%) or a work colleague (34%). Two thirds of participants were employed; only 17% were able to telework.

What are the implications for public health practice? Case investigation, contact tracing, and isolation of infected persons are needed to prevent ongoing community transmission, given the frequent lack of a known contact. Enhanced measures to ensure workplace safety, including social distancing and more widespread use of cloth face coverings, are warranted.

 

[Michael Scally MD]

It’s troubling, though not surprising, to see covid-19 cases spiking across the American South and Southwest, where public officials delayed lockdowns, rushed to reopen businesses, or refused to require people to wear masks.

But what’s the matter with California? The nation’s most populous state was the first to enact statewide shelter-in-place rules, took decisive steps to build up the recommended testing and case tracing capacity, and has hammered the public health message on social distancing and masks.

Yet new cases are rising sharply in pockets throughout the sprawling state, even as they’re flat or falling across much of the East Coast. Positive tests over the last seven-day period have risen 45%, regularly topping 5,000 a day, Governor Gavin Newsom said during a press conference on Monday. Hospitalizations and intensive care unit admissions are both up around 40% over the past few weeks as well, threatening to overwhelm health-care systems.

In turn, Newsom has pressed Imperial County—the southernmost part of the state, where skyrocketing case loads have forced officials to move hundreds of patients to hospitals in neighboring areas—to fully reinstate stay-at-home orders. He’s also recommended or required that more than a dozen counties shut down their bars, including Los Angeles and Santa Clara, the home of Silicon Valley. Meanwhile, San Francisco’s mayor halted the city’s reopening plan on Friday.

So what’s driving the outbreaks in a state that supposedly did things right? Why weren’t its ambitious testing and contact tracing programs adequate to prevent the recent surge in cases?

…

But pretty much all of this has been known from the start. Californians need to recognize that the dangers haven’t passed, even as regions relax certain rules. Everyone still has to maintain their distance from others, vigorously wash their hands, and abide by the one public health decree that may help the most.

“Wear masks,” UCSF’s Rutherford says.

 

[Michael Scally MD]

While much about the COVID-19 pandemic remains uncertain, we know how it will likely end: when the spread of the virus starts to slow (and eventually ceases altogether) because enough people have developed immunity to it. At that point, whether it’s brought on by a vaccine or by people catching the disease, the population has developed “herd immunity.”

“Once the level of immunity passes a certain threshold, then the epidemic will start to die out because there aren’t enough new people to infect,” said Natalie Dean of the University of Florida.

While determining that threshold for COVID-19 is critical, a lot of nuance is involved in calculating exactly how much of the population needs to be immune for herd immunity to take effect and protect the people who aren’t immune.

At first it seems simple enough. The only thing you need to know is how many people, on average, are infected by each infected person. This value is called R0 (pronounced “R naught”). Once you have that, you can plug it into a simple formula for calculating the herd immunity threshold: 1 − 1/R0.

…

Ultimately, the only way to truly escape the COVID-19 pandemic is to achieve large-scale herd immunity — everywhere, not just in a small number of places where infections have been highest. And that will likely only happen once a vaccine is in widespread use.

In the meantime, to prevent the spread of the virus and lower that R0 value as much as possible, distancing, masks, testing and contact tracing are the order of the day everywhere, regardless of where you place the herd immunity threshold.

“I can’t think of any decision I’d make differently right now if I knew herd immunity was somewhere else in the range I think it is, which is 40-60%,” said Lipsitch.

Shaman, too, thinks that uncertainty about the naturally acquired herd immunity threshold, combined with the consequences for getting it wrong, leaves only one path forward: Do our best to prevent new cases until we can introduce a vaccine to bring about herd immunity safely.

 

[Michael Scally MD]

 

[Dr JIM]

[OA] Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo’

On the 21st of February 2020 a resident of the municipality of Vo’, a small town near Padua, died of pneumonia due to SARS-CoV-2 infection1. This was the first COVID-19 death detected in Italy since the emergence of SARS-CoV-2 in the Chinese city of Wuhan, Hubei province2.

In response, the regional authorities imposed the lockdown of the whole municipality for 14 days3. We collected information on the demography, clinical presentation, hospitalization, contact network and presence of SARS-CoV-2 infection in nasopharyngeal swabs for 85.9% and 71.5% of the population of Vo’ at two consecutive time points.

On the first survey, which was conducted around the time the town lockdown started, we found a prevalence of infection of 2.6% (95% confidence interval (CI) 2.1-3.3%). On the second survey, which was conducted at the end of the lockdown, we found a prevalence of 1.2% (95% Confidence Interval (CI) 0.8-1.8%).

Notably, 42.5% (95% CI 31.5-54.6%) of the confirmed SARS-CoV-2 infections detected across the two surveys were asymptomatic (i.e. did not have symptoms at the time of swab testing and did not develop symptoms afterwards). The mean serial interval was 7.2 days (95% CI 5.9-9.6).

We found no statistically significant difference in the viral load of symptomatic versus asymptomatic infections (p-values 0.62 and 0.74 for E and RdRp genes, respectively, Exact Wilcoxon-Mann-Whitney test).

This study sheds new light on the frequency of asymptomatic SARS-CoV-2 infection, their infectivity (as measured by the viral load) and provides new insights into its transmission dynamics and the efficacy of the implemented control measures.

Lavezzo, E., Franchin, E., Ciavarella, C. et al. Suppression of a SARS-CoV-2 outbreak in the Italian municipality of Vo’. Nature (2020). https://doi.org/10.1038/s41586-020-2488-1

How did this study define a "BLM protest"?

Ans: It didn't

Can the study be extrapolated to other forms of social unrest that have spread throughout the US ?

Ans: NO

Make no mistake about it, bc COVID-19 is a highly transmissible virus, crowded environments whether they be protests, a tavern with intoxicated patrons, or a packed beach, etc are responsible for the recent surge.

And to that end how fortunate most US citizens would rather avoid the contentious environment that is a part of protests by staying home.

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Dr JIM]

Yet before joining the cavalier crowds at taverns, protests, restaurants and at some recreational centers a forewarning seems appropriate, immunity from mild disease remains UNPROVEN.
JIM

It's a small cohort yet the results are less than reassuring, as innate antibody related immunity dissipated relatively early.

That being said as adaptive T-cell changes were not assessed the impact of asymptomatic or mild COVID-19 disease on long term immunity remains uncertain.

JIM
JIM

 

[Dr JIM]

How did this study define a "BLM protest"?

Ans: It didn't

Can the study be extrapolated to other forms of social unrest that have spread throughout the US ?

Ans: NO

Make no mistake about it, bc COVID-19 is a highly transmissible virus, crowded environments whether they be protests, a tavern with intoxicated patrons, or a packed beach, etc are responsible for the recent surge.

And to that end how fortunate most US citizens would rather avoid the contentious environment that is a part of protests by staying home.

For those who would like to review the BLM protest study see attachment. IMO based upon the methodology the title should be changed to; Impact of Protests on Neighborhood Social Distancing.

JIM

 

[Michael Scally MD]

I’m a restaurant critic. It’s my job to dine out. Yet even though the restaurant shutdown ended nearly a month ago on Long Island, where I’ve been living since March, I still haven’t ordered anything except takeout. In fact I haven’t sat down for dine-in service in over 122 days, with no plans to change course. Resurgent COVID-19 infections prompted Gov. Andrew Cuomo to announce today that he’s pushing back the onset of indoor dining in the city. That’s a good start, but if you care about the safety of your fellow humans amid a pandemic that has killed over half a million globally and sickened many more — myself included — you should consider a stronger measure. You might consider not drinking or dining out at all, not even outdoors.

You should instead stick to takeout. I make that suggestion with a heavy heart. After COVID-19 wrecked my body in March — I lost 10 pounds in a week — I spent the following three months dreaming about falling back into my old routines: sipping daiquiris at a local Hell’s Kitchen bar, or gorging on vaca frita while a live Latin jazz band plays on stage. It appeared for a while that New Yorkers were about to return to such everyday indulgences. But as states throughout the country loosened restrictions on their hospitality industries and larger economies, the virus came back hard, threatening the progress we’ve made in the five boroughs.

For a patron with a sudden craving, no plate of duck wings or fluke ceviche is worth getting catastrophically sick over, especially if one can order those dishes more safely via takeaway. For a staffer with little alternative but to work, no economic benefit outweighs the reality of getting infected with COVID-19, which can bring with it chronic health repercussions, devastating financial consequences, and death.

 

[Michael Scally MD]

Hundreds of thousands of seriously ill coronavirus patients who survive and leave the hospital are facing a new and difficult challenge: recovery. Many are struggling to overcome a range of troubling residual symptoms, and some problems may persist for months, years or even the rest of their lives.

Patients who are returning home after being hospitalized for severe respiratory failure from the virus are confronting physical, neurological, cognitive and emotional issues.

And they must navigate their recovery process as the pandemic continues, with all of the stresses and stretched resources that it has brought.

“It’s not just, ‘Oh, I had a terrible time in hospital, but thank goodness I’m home and everything’s back to normal,’” said Dr. David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City. “It’s, ‘I just had a terrible time in hospital and guess what? The world is still burning. I need to address that while also trying to sort of catch up to what my old life used to be.’”

It is still too early to say how recovery will play out for these patients. But here is a look at what they are experiencing so far, what we can learn from former patients with similar medical experiences, and the challenges that most likely lie ahead.

 

[SteroidsBro]

[OA] An Insight into the Sex Differences in COVID-19 Patients: What are the Possible Causes?

Studies have reported a sex bias in case fatalities of COVID-19 patients. Moreover, it is observed that men have a higher risk of developing a severe form of the disease compared to women, highlighting the importance of disaggregated data of male and female COVID-19 patients.

On the other hand, other factors (eg, hormonal levels and immune functions) also need to be addressed due to the effects of sex differences on the outcomes of COVID-19 patients.

An insight into the underlying causes of sex differences in COVID-19 patients may provide an opportunity for better care of the patients or prevention of the disease. The current study reviews the reports concerning with the sex differences in COVID-19 patients.

It is explained how sex can affect angiotensin converting enzyme-2 (ACE2), that is a key component for the pathogenesis of COVID-19, and summarized the gender differences in immune responses and how sex hormones are involved in immune processes.

Furthermore, the available data about the impact of sex hormones on the immune functions of COVID-19 cases are looked into.

Maleki Dana P, Sadoughi F, Hallajzadeh J, et al. An Insight into the Sex Differences in COVID-19 Patients: What are the Possible Causes? [published online ahead of print, 2020 Jun 18]. Prehosp Disaster Med. 2020;1-4. doi:10.1017/S1049023X20000837 An Insight into the Sex Differences in COVID-19 Patients: What are the Possible Causes?

Studies involving a virus that doesn't exist are really stupid and a complete joke.

 

[Michael Scally MD]

[Saved by COVID-19: "It's a gym so it's been closed."]

A three-story building housing a gym collapsed today in Carroll Gardens.

FDNY confirmed to Gothamist that 348 Court Street, where Body Elite Gym was located, collapsed around 4:40 p.m. on Wednesday. Dozens of firefighters are currently at the scene, and could not confirm whether or not anyone was injured in the collapse. We'll update as we learn more information.

Sara Pekow, a resident in the neighborhood, said she witnessed the collapse. She told Gothamist, "I just went out of my building to go to the car and saw the building collapse and a big storm of dust rise in its place—sounded like what you'd expect."

When asked if anyone was in the building, Pekow said she "wasn't close enough to see. It's a gym so it's been closed, but I have seen an employee or two in there in the past, not today though. Often it's barred closed with window gates and nobody inside."

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]