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

[Michael Scally MD]

[OA] Global Evaluation of Echocardiography in Patients with COVID-19

Aims - To describe the cardiac abnormalities in patients with COVID-19 and identify the characteristics of patients who would benefit most from echocardiography.

Methods and results - In a prospective international survey, we captured echocardiography findings in patients with presumed or confirmed COVID-19 between 3 and 20 April 2020. Patient characteristics, indications, findings, and impact of echocardiography on management were recorded. Multivariable logistic regression identified predictors of echocardiographic abnormalities.

A total of 1216 patients [62 (52–71) years, 70% male] from 69 countries across six continents were included. Overall, 667 (55%) patients had an abnormal echocardiogram. Left and right ventricular abnormalities were reported in 479 (39%) and 397 (33%) patients, respectively, with evidence of new myocardial infarction in 36 (3%), myocarditis in 35 (3%), and takotsubo cardiomyopathy in 19 (2%).

Severe cardiac disease (severe ventricular dysfunction or tamponade) was observed in 182 (15%) patients. In those without pre-existing cardiac disease (n = 901), the echocardiogram was abnormal in 46%, and 13% had severe disease.

Independent predictors of left and right ventricular abnormalities were distinct, including elevated natriuretic peptides [adjusted odds ratio (OR) 2.96, 95% confidence interval (CI) 1.75–5.05) and cardiac troponin (OR 1.69, 95% CI 1.13–2.53) for the former, and severity of COVID-19 symptoms (OR 3.19, 95% CI 1.73–6.10) for the latter. Echocardiography changed management in 33% of patients.

Conclusion - In this global survey, cardiac abnormalities were observed in half of all COVID-19 patients undergoing echocardiography. Abnormalities were often unheralded or severe, and imaging changed management in one-third of patients.

Dweck MR, Bularga A, Hahn RT, et al. Global evaluation of echocardiography in patients with COVID-19. European Heart Journal - Cardiovascular Imaging 2020. Global evaluation of echocardiography in patients with COVID-19

 

[Michael Scally MD]

[OA] Does androgen deprivation therapy protect against severe complications from COVID-19?

Currently, there is a paucity of effective treatments to address the remarkably high morbidity and mortality associated with SARS-CoV-2 coronavirus disease-19 (COVID-19). This letter highlights a potential therapeutic strategy based on known biology of SARS-CoV-2 cellular entry and replication.

SARS-CoV-2 relies on surface expression of ACE2 and TMPRSS2 for cellular entry and replication in the respiratory epithelium. In in vitro and mouse models, TMPRSS2 inhibition limits respiratory cell damage and reduces severity of infection. TMPRSS2 is commonly expressed in prostate cancer cells and is known to be regulated by androgens. Hence, androgen deprivation therapy (ADT) may theoretically reduce TMPRSS2 expression limiting SARS-CoV-2 cellular entry and preventing severe complications from COVID-19.

In fact, a recent report from Alimonti and colleagues demonstrated a lower rate of infection in prostate cancer patients on ADT, compared to those not on ADT. Herein, we report our observational study of all patients in a single New York City health system with COVID-19 and prostate cancer to determine the impact of ADT on COVID- 19 clinical outcomes. To our best knowledge, this is the largest study to report severity of COVID-19 in patients receiving ADT.

…

Patel VG, Zhong X, Liaw B, et al. Does androgen deprivation therapy protect against severe complications from COVID-19? [published online ahead of print, 2020 Jul 9]. Ann Oncol. 2020;S0923-7534(20)39933-6. doi:10.1016/j.annonc.2020.06.023 https://www.annalsofoncology.org/article/S0923-7534(20)39933-6/pdf

 

[Michael Scally MD]

[OA] Understanding The Complex Relationship Between Androgens and SARS-CoV2

In the United States (US), 54% of hospitalizations for COVID-19 are among men. In Italy, men represent 70% of COVID-19-related deaths. Additionally, there is a relative lack of pre-pubertal infection. The reason for these higher rates of infection and mortality in men, and the correspondingly low rates in pre-pubertal children remains unknown. It is possible that an androgen-dependent process may help account for these epidemiological findings, which is a topic of intense focus currently.

An androgen-mediated protein (Transmembrane serine protease 2: TMPRSS2) plays a critical role in priming the virus’ spike proteins for entry into the host cell as one of the first steps involved in infection. To enter the cell, the SARS-CoV-2 virus uses primed spike proteins to bind cellular angiotensin converting enzyme receptor 2 (ACE2), which leads to cell entry and infection.

TMPRSS2 activity is essential for spike priming, and its activation is dependent on androgens. Additionally, TMPRSS2 may interact directly with ACE2 receptors allowing for augmented viral entry. Because of its critical role in the process of viral infectivity, an understanding of TMPRSS2 is essential in explaining the gender disparities associated with COVID-19.

Knowledge gained from prostate cancer research revealed the androgen dependent nature of TMPRSS2: an activated androgen receptor (AR) upregulates TMPRSS2 mRNA,9 while androgen deprivation therapy (ADT) suppresses it. …

Ory J, Lima TFN, Towe M, et al. Understanding The Complex Relationship Between Androgens and SARS-CoV2 [published online ahead of print, 2020 Jul 9]. Urology. 2020;S0090-4295(20)30812-8. doi:10.1016/j.urology.2020.06.048 https://www.goldjournal.net/article/S0090-4295(20)30812-8/pdf

 

[Michael Scally MD]

 

[Michael Scally MD]

[OA] Love in the Time of COVID-19: Sexual Function and Quality of Life Analysis During the Social Distancing Measures in a Group of Italian Reproductive-Age Women

Background: The beginning of 2020 was characterized by the COVID-19 pandemic. The world governments have adopted restrictive measures to reduce the spread of infection. These measures could affect the sexual function and quality of life of women living with their partner.

Aim: The aim is to assess the impact of the social distancing measures caused by the COVID-19 pandemic on sexual function and quality of life of noninfected reproductive-age women, living with their sexual partner.

Methods: Observational analysis on sexually active women, living with their partner, and without COVID-19 infection was performed. The population previously answered FSFI, FSDS, and SF-36 questionnaires. 4 weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for an evaluation during the COVID-19 outbreak.

Main outcome measures: The primary endpoint was the assessment of the women's sex function change during the social restriction period, by analyzing the FSFI and FSDS questionnaires. The secondary endpoint was the evaluation of the impact on the quality of life calculated by the SF-36 questionnaire.

Results: 89 patients were considered. The median age was 39 (28-50) years. Mean sexual intercourses/month decreased from 6.3 ± 1.9 to 2.3 ± 1.8, mean difference: -3.9 ± 1.2. FSFI decreased significantly (29.2 ± 4.2 vs 19.2 ± 3.3, mean difference: -9.7 ± 2.6) and FSDS increased significantly (9.3 ± 5.5 vs 20.1 ± 5.2, mean difference: 10.8 ± 3.4). The SF-36 showed a significant change from 82.2 ± 10.2 to 64.2 ± 11.8 4 weeks after the introduction of the restrictive measures; mean difference: -17.8 ± 6.7.

The univariable analysis identified working outside the home, university educational level, and parity ≥1 as predictive factors of lower FSFI. In multivariable analysis, working outside the home and combination of working outside the home + university educational level + parity ≥1 were the independent factors of a lower FSFI.

Clinical implication: The negative impact of the COVID-19 epidemic period on sexual function and quality of life in women shows how acute stress might affect the psychological state. Thus, psychological or sexual support could be useful.

Strengths and limitations: To our knowledge, this study is the first that analyzes the change in sexual activity in women during the COVID-19 outbreak period. The limitations were the low number of the analyzed participants, psychological tests were not included, and no data were collected on masturbation, self-heroism, solitary, and nonpenetrative sex.

Conclusion: The COVID-19 epidemic and the restrictive social distancing measures have negatively influenced the sexual function and quality of life in not-infected reproductive-age women who live with their sexual partners.

Schiavi MC, Spina V, Zullo MA, et al. Love in the Time of COVID-19: Sexual Function and Quality of Life Analysis During the Social Distancing Measures in a Group of Italian Reproductive-Age Women [published online ahead of print, 2020 Jul 8]. J Sex Med. 2020;S1743-6095(20)30709-8. doi:10.1016/j.jsxm.2020.06.006 https://www.jsm.jsexmed.org/article/S1743-6095(20)30709-8/pdf

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

At Stockholm University, Tom Britton, the dean of mathematics and physics, thinks that a 20 percent threshold is unlikely, but not impossible. His lab has also been building epidemiological models based on data from around the globe. He believes that variation in susceptibility and exposure to the virus clearly seems to be reducing estimates for herd immunity. Britton and his colleagues recently published their model, demonstrating the effect, in Science. A mathematical model reveals the influence of population heterogeneity on herd immunity to SARS-CoV-2

“If there is a large variability of susceptibility among humans, then herd immunity could be as low as 20 percent,” Britton told me. But there’s reason to suspect that people do not have such dramatically disparate susceptibility to the coronavirus. High degrees of variability are more common in things such as sexually transmitted infections, where a person with 100 partners a year is far more susceptible than someone celibate. Respiratory viruses tend to be more equal-opportunity invaders. “I don’t think it will happen at 20 percent,” Britton said. “Between 35 and 45 percent—I think that would be a level where spreading drops drastically.”

Models like Britton’s and Gomes’s also assume that, after infection, people obtain immunity. This is a clear caveat that all the researchers make. COVID-19 is a new disease, so no one can be sure that infected people become immune reliably, or how long immunity lasts. But Britton noted that there are no clear instances of double infections so far, which suggests that this virus creates immunity for at least some meaningful length of time, as most viruses do.

Lipsitch also believes that heterogeneity is important to factor into any model. It was one reason he updated his prediction, not long after we spoke in February, of what the herd-immunity threshold would be. Instead of 40 to 70 percent, he lowered it to 20 to 60 percent. When we spoke last week, he said he still stands by that, but he is skeptical that the number lands close to the 20 percent end of the range. “I think it’s unlikely,” he said, but added, “This virus is proving there can be orders-of-magnitude differences in attack rates, depending on political and societal decisions, which I don’t know how to forecast.”

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]

 

[Michael Scally MD]