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



France set a record for Covid-19 infections this weekend, and Italy has announced new restrictions, such as closing bars and restaurants at 6 p.m. The feared fall coronavirus surge has arrived in Europe and also in the U.S., where cases continue to rise. It’s time to consider a limited and temporary national mask mandate.

Consider hospitalizations, which reached 42,000 on Saturday, up from 30,000 a month ago. This increase comes even as hospital admission criteria have become more stringent, with more patients managed at home. It’s true that more testing reveals more cases. But most tests are done because people have Covid symptoms or come into contact with someone who is sick. Total hospitalizations, which are on pace to eclipse totals from the spring, are an objective measure of a rampant epidemic.

As deaths rise this winter, policy makers will have to take new steps to slow the rate of spread. There is no support for reprising this spring’s stay-at-home orders. It will be essential to use standard interventions, including limits on crowded settings such as bars and continuing to test and trace contacts. But on the current trajectory these measures won’t be enough to keep hospitals from being overwhelmed in some areas.

Masks would help. As a practical matter, it’s easier to wear a mask in the winter than the summer. A mandate can be expressly limited to the next two months. The inconvenience would allow the country to preserve health-care capacity and keep more schools and businesses open. Studies show widespread use of masks can reduce spread. But even if masks are only incrementally helpful, they are among the least economically costly and burdensome options for reducing spread.

It’s long been known that masks can reduce the spread of flu, and the same logic applies to the coronavirus. People are most contagious before showing symptoms, and many never develop symptoms at all. Data show that masks can trap many droplets that carry infectious particles. Everyone wearing a mask in public would help reduce asymptomatic spread.
 


Introduction: Coronavirus disease-19 (COVID-19) has caused a marked increase in all-cause deaths in the United States, mostly among adults aged 65 and older. Because younger adults have far lower infection fatality rates, less attention has been focused on the mortality burden of COVID-19 in this demographic.

Methods: We performed an observational cohort study using public data from the National Center for Health Statistics at the United States Centers for Disease Control and Prevention, and CDC Wonder. We analyzed all-cause mortality among adults ages 25-44 during the COVID-19 pandemic in the United States.

Further, we compared COVID-19-related deaths in this age group during the pandemic period to all drug overdose deaths and opioid-specific overdose deaths in each of the ten Health and Human Services (HHS) regions during the corresponding period of 2018, the most recent year for which data are available.

Results: As of September 6, 2020, 74,027 all-cause deaths occurred among persons ages 25-44 years during the period from March 1st to July 31st, 2020, 14,155 more than during the same period of 2019, a 23% relative increase (incident rate ratio 1.23; 95% CI 1.21-1.24), with a peak of 30% occurring in May (IRR 1.30; 95% CI 1.27-1.33).

In HHS Region 2 (New York, New Jersey), HHS Region 6 (Arkansas, Louisiana, New Mexico, Oklahoma, Texas), and HHS Region 9 (Arizona, California, Hawaii, Nevada), COVID-19 deaths exceeded 2018 unintentional opioid overdose deaths during at least one month. Combined, 2,450 COVID-19 deaths were recorded in these three regions during the pandemic period, compared to 2,445 opioid deaths during the same period of 2018.

Meaning: We find that COVID-19 has likely become the leading cause of death (surpassing unintentional overdoses) among young adults aged 25-44 in some areas of the United States during substantial COVID-19 outbreaks.
 
[OA] The Prostate Cancer Connection

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the first worldwide pandemic in over 100 years. The disease caused by this newly discovered novel corona virus has been named COVID-19 (Corona Virus Disease 2019). This disease runs the spectrum from mild upper respiratory symptoms through respiratory and multiorgan failure and death.

There appears to be disparities regarding COVID-19 and gender. In addition to the documented age and comorbidities risk factors for COVID-19, male gender increases risk for more severe forms of the disease with death rates of men higher than in women. These preliminary sex disparity observations almost immediately opened the possibility that androgens could worsen the disease and that estrogens could be protective.

Early published data sparking the most interest in this area was from a study in the Veneto region of Italy, one of the hardest hit regions early in the pandemic.1 In a study of over 9,000 patients first reported on-line in May 2020, when considering ICU admissions 78% of men versus 22% of women required intensive care with more men dying than women (62% versus 38%). They also noted that cancer patients overall had an increased risk of SARS-CoV-2 infections compared with non-cancer patients.

Surprisingly, prostate cancer patients receiving ADT had a significantly lower risk of SARS-CoV-2 infection compared with men who did not receive ADT. The greatest difference in infection risk was seen when comparing prostate cancer patients receiving ADT versus patients with any other type of cancer. This was one of the first clinical suggestions that prostate cancer patients on ADT were offered some level of protection from SARS-CoV-2 infections. Could men with prostate cancer on ADT experience lower COVID-19 morbidity and mortality because of lower androgen levels?

While the major focus on COVID-19 strategies is currently on vaccine development, the concept of androgen blockade-based therapies is now being tested in numerous clinical trials. …

Gomella LG. COVID-19 and The Prostate Cancer Connection. Can J Urol. 2020 Oct;27(5):10346. PMID: 33049184. https://canjurol.com/article.php?ID=3610
 


October was a good month for Gilead Sciences, the giant manufacturer of antivirals headquartered in Foster City, California. On 8 October, the company inked an agreement to supply the European Union with its drug remdesivir as a treatment for COVID-19—a deal potentially worth more than $1 billion. Two weeks later, on 22 October, the U.S. Food and Drug Administration (FDA) approved remdesivir for use against the pandemic coronavirus SARS-CoV-2 in the United States—the first drug to receive that status. The EU and U.S. decisions pave the way for Gilead’s drug into two major markets, both with soaring COVID-19 cases.

But both decisions baffled scientists who have closely watched the clinical trials of remdesivir unfold over the past 6 months—and who have many questions about remdesivir's worth. At best, one large, well-designed study found remdesivir modestly reduced the time to recover from COVID-19 in hospitalized patients with severe illness. A few smaller studies found no impact of treatment on the disease whatsoever. Then, on 15 October—in this month’s decidedly unfavorable news for Gilead— the fourth and largest controlled study delivered what some believed was a coup de grâce: The World Health Organization’s (WHO’s) Solidarity trial showed that remdesivir does not reduce mortality or the time COVID-19 patients take to recover.

Science has learned that both FDA’s decision and the EU deal came about under unusual circumstances that gave the company important advantages. FDA never consulted a group of outside experts that it has at the ready to weigh in on complicated antiviral drug issues. That group, the Antimicrobial Drugs Advisory Committee (ADAC), mixes infectious disease clinicians with biostatisticians, pharmacists, and a consumer representative to review all available data on experimental treatments and make recommendations to FDA about drug approvals—yet it has not convened once during the pandemic.
 
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