QUESTION: I’ve heard that men are more likely than women to die from COVID-19. Is this true, and what accounts for the difference?
ANSWER: We have known for some time that older folks and those with pre-existing medical conditions – such as heart disease, diabetes and obesity – face an elevated risk of suffering a severe and potentially fatal reaction if they become infected with the novel coronavirus that causes COVID-19.
But a growing body of evidence from COVID-19 hot spots around the world suggests that a person’s sex is also a significant factor in determining their chance of survival.
In China, 64 per cent of the recorded deaths were among men, compared with only 36 per cent among women. A similar pattern has emerged in other countries. In Italy, for instance, men accounted for 71 per cent of deaths, while in Germany, they represented 66 per cent.
Officially known as SARS-CoV-2, this cornonavirus is so new that researchers cannot say with any certainty why infected men are at a greater risk of death than women.
“This is all very speculative,” says Dr. Cara Tannenbaum, scientific director of the Institute of Gender and Health at the Canadian Institutes of Health Research in Montreal.
Some experts believe that the reason for the stark divergence in mortality rates might be found in the fact that the immune systems of men and women are not identical.
Previous research has clearly identified sex-based immune-system differences, says Juan Carlos Zuniga-Pflucker, a senior scientist at Sunnybrook Health Sciences Centre and chair of the Department of Immunology at the University of Toronto.
One key reason for sex-based differences is pregnancy – a time when a woman essentially has a foreign entity growing inside her body. Without the ability to modify or dampen its response, the immune system would reject the developing fetus, he explains.
Overall, “women tend to have a more distinctly regulated version of the immune system,” he says. This tendency can sometimes increase a woman’s chances of getting certain diseases such as lupus and multiple sclerosis. “But it may be beneficial in responding to a virus like this one,” he adds.
Indeed, an overactive or overaggressive immune response appears to be contributing to many COVID-19 deaths – and that may account for a higher number of fatalities among men. It might also explain why some relatively young and apparently healthy individuals are brought down by the illness.
At this point, it’s worth reviewing what we do know about COVID-19.
The infection usually starts when the virus enters the upper airway. It invades a cell and then takes over the cellular machinery to start churning out copies of itself. In some patients, there may be limited viral replication in the upper airway, but in others replication may include the lungs and be associated with more severe disease.
The lungs are extremely vulnerable. The virus can damage the air sacs called alveoli where blood normally picks up oxygen to be distributed to the rest of the body.
As the infection gains steam, the immune system starts marshalling its resources for a counterattack.
The immune system is made up of numerous specialized cells. Many of them produce cytokines, which are chemical messengers that help direct a co-ordinated assault on the microbial invader. But for reasons that are not fully understood, the immune system sometimes produces too many, leading to what is called a “cytokine storm.”
As more and more immune cells converge on the lungs, they generate additional cytokines that then call for reinforcements. They create a “feedback loop” that intensifies the immune response, Dr. Zuniga-Pflucker says.
“Under these circumstances, the cytokines end up causing collateral damage and normal cells end up being harmed,” says Dr. Samira Mubareka, an infectious-diseases physician and virologist at Sunnybrook.
At the same time, cytokines cause vascular leakage from surrounding tissues and fluid begins filling the lungs.
“It becomes harder and harder for patients to get enough air into their lungs,” Dr. Mubareka says. Some of these people will develop a life-threatening condition called acute respiratory distress syndrome (ARDS).
But the lungs are not the only parts of the body harmed by the virus. Many patients experience heart, kidney and liver problems, as well as gastrointestinal and central nervous system abnormalities. Whether the virus is directly invading these other tissues isn’t yet clear. They might be compromised simply because oxygen levels in the blood are plummeting. Whatever the cause, patients can develop another potentially life-threatening condition: multiorgan system failure.
Although men, in general, are more likely than women to succumb to COVID-19, there is still a lot of individual variability. After all, some infected men die, some don’t. So, that suggests the infected person’s genetics may play a role.
“We won’t know which [genetic] variants are important until we do large-scale population-wide genome studies where we compare a lot people who had serious outcomes to those with mild disease,” Dr. Mubareka says.
Plans are already under way to do such studies. But it will take some time before we have a full understanding of why this illness is not an equal-opportunity killer.
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London-Middlesex may enter Stage 3 of reopening near the end of July: MLHU – Globalnews.ca
London-Middlesex is on its way to enter Stage 3 of Ontario’s novel coronavirus reopening plan, according to London’s chief medical officer of health.
Dr. Chris Mackie said Monday that he’s hopeful the region will be given the green light to move ahead with the province’s reopening plan within the next few weeks.
“I think (we) could see a move to Stage 3 over the next two to three weeks. I would not be surprised at all to see that,” said Mackie.
“I also think that it’s likely the province will choose to do a regional approach as they did with the Stage 2 reopening.”
Mackie also commented on Leamington and Kingsville in Essex county entering Stage 2 as of Tuesday, saying it is a sign that “this region is really getting COVID-19 under control.”
According to the Province of Ontario, in Stage 3 the province will consider opening more workplaces, dine-in restaurants, and indoor and outdoor recreational facilities, including playgrounds.
Casinos, fitness facilities and amusement parks are also on the list, all with added public health measures in place.
London-Middlesex has not seen any new cases of COVID-19 for two days in a row. The last reported death in the region related to the virus was June 12.
As of Monday, there are 630 confirmed cases in the region, which includes 57 deaths and 515 recoveries.
Coronavirus: Ontario health minister says there’s ‘hope’ for move to stage 3 soon
© 2020 Global News, a division of Corus Entertainment Inc.
VCH warns of COVID-19 exposure at Downtown Vancouver club – Vancouver Is Awesome
Vancouver Coastal Health is notifying people who visited the bar and nightclub areas of the Hotel Belmont about a possible exposure to COVID-19 during the nights of Monday, June 27 and Wednesday, June 29.
In a release, VCH states that individuals who tested positive for COVID-19 attended these areas of the Hotel Belmont (654 Nelson Street) on those dates.
However, the health authority adds that there is no known risk to anyone who attended the Hotel Belmont outside these two dates. In addition, there is no ongoing risk to the community.
As a precaution, VCH advises people who attended the bar and nightclub areas of the Hotel Belmont during the nights of Monday, June 27 and Wednesday, June 29 to monitor themselves for 14 days. As long as they remain healthy and do not develop symptoms, there is no need to self-isolate and they should continue with their usual daily activities.
If you have no symptoms, testing is not recommended because it is not accurate or useful. If you develop any of these symptoms of COVID-19, please seek COVID-19 testing and immediately self-isolate. Please call ahead and wear a mask when seeking testing.
In June, VCH warned of a possible exposure to COVID-19 to people who were at Brandi’s Exotic Show Lounge between 9 p.m. and 3 a.m. from June 21 to 24. It says a number of people who tested positive for COVID-19 attended the lounge on those dates. However, the club has since passed a health inspection and reopened.
COVID-19 is spread by respiratory droplets when a person who is sick coughs or sneezes. It can also be spread when a healthy person touches an object or surface (e.g. a doorknob or a table) with the virus on it, and then touches their mouth, nose or eyes before washing their hands. Most people who get COVID-19 have only mild disease, but a few people can get very sick and may need to go to hospital. The symptoms of COVID-19 may include fatigue, loss of appetite, fever, cough, sore throat, fatigue, runny nose, sore throat loss of smell and/or diarrhea.
Scientists warn of overlooked danger from coronavirus-spreading airborne microdroplets – CTV News
Physical distancing and frequent handwashing are not enough to fully protect against airborne transmission of the novel coronavirus, hundreds of scientists say.
Virus-carrying microdroplets pose more of a danger than is currently being communicated, the scientists argue in a new medical commentary, and the result is that poor ventilation is easing the path of the pandemic.
The commentary has been accepted for publication in the journal Clinical Infectious Diseases. It is signed by 239 scientists from 32 countries and a wide variety of science and engineering disciplines, according to a statement from the Queensland University of Technology (QUT) in Australia.
“We are concerned that people may think they are fully protected by following the current recommendations, but in fact, additional airborne precautions are needed to further reduce the spread of the virus,” lead author and QUT air quality expert Lidia Morawska said in the statement.
It is not controversial to say that the virus that causes COVID-19 can spread through exhaled airborne droplets. This is why physical distancing was one of the earliest individual measures urged to stop the spread of the virus, because putting space between people allows for particles to fall to the ground rather than latch on to another person.
It is also normal for viruses to be passed through droplets. Measles, for example, has an airborne transmission pathway that poses far more of a danger than has thus far been found with COVID-19.
“I can be in a room with measles, and leave, and somebody walks in hours later and they can get measles,” Dr. Sumon Chakrabati, an infectious diseases physician based in Missisauga, Ont., said Monday on CTV News Channel.
The World Health Organization says the droplets that carry SARS-CoV-2 can be spread through actions including coughing, sneezing and speaking, and recommends that everyone keep a one-metre distance from others. Many countries, including Canada, have gone farther, recommending a distance of two metres.
However, there are signs that the smallest microdroplets can travel beyond the two-metre limit. One American study found that they can move three metres in 12 seconds, and a fourth metre as they linger in the air for up to a minute. Morawska said that there is significant evidence that microdroplets can travel even farther – into the tens of metres – especially when indoors.
“Studies by the signatories and other scientists have demonstrated beyond any reasonable doubt that viruses are exhaled in microdroplets small enough to remain aloft in the air and pose a risk of exposure beyond [one to two metres] by an infected person,” she said.
“Hand-washing and social distancing are appropriate, but … insufficient to provide protection from virus-carrying respiratory microdroplets released into the air by infected people.”
‘IS THERE A DANGER THERE?’
Advice from public health experts in Canada and elsewhere has largely downplayed the risk of airborne transmission of the virus, even as evidence mounts that it is a real threat. In one study cited in the commentary as an example, droplets were found to be the most likely source of transmission among three dining parties at a restaurant in China, in a case where surveillance video footage showed no direct or indirect contact between the groups.
The debate over droplets has been playing out since the pandemic took hold. Dr. Colin Furness, a Toronto-based infection control epidemiologist, described it as “a pretty serious fight, intellectually,” but said the commentary is unlikely to lead to significant changes in virus protection thinking.
“The concern is ‘Are we ignoring those small droplets? Is there a danger there? Are our interventions maybe not enough?'” he said Monday on CTV News Channel.
“It could be that a smaller dose, those smaller droplets, actually matter for [COVID-19] because it’s so good at getting a toehold in your body once it gets in there.”
In Chakrabati’s view, the possibility of airborne transmission is overshadowed by the evidence that Canada and other countries have been able to slow the spread of the virus with the current precautions and restrictions.
“Are there situations where the two metres is a bit too little, for example a karaoke bar or a choir, where you’re singing and your voice is propelling? Perhaps,” he said.
“But I think for the most part, the recommendations that have been there since the beginning are the ones that are truly preventing the spread of this virus.”
REDUCING THE RISK
Morawska said that effective ventilation systems are the best way to reduce the spread of microdroplets. She said the most effective systems minimize the use of recirculated air by bringing in as much clean air from outdoors as possible, and that even opening doors and windows can make a major difference.
These ventilation techniques can be augmented with the use of air filtration and exhaust devices, as well as ultraviolet (UV) lights that kill germs. Another way to lessen the risk of microdroplet transmission is to avoid situations of overcrowding, especially on public transport and in public buildings, Morawka said.
Furness agreed with the suggestion to use UV lights in air filtration systems, saying that there could be a “renaissance” in this practice because the light can be effective against the virus in a way that physical filters cannot.
“I think we will probably see a resurgence in the use of UV light within air circulation systems, because UV light will kill viruses and it doesn’t really matter how small they are,” he said.
Face masks do not play a role in protecting against microdroplets, Furness said, because the droplets are so small that they can fit through the holes in most masks.
“If we were really concerned about aerosol, if we were really concerned about airborne, we would also be finding that wearing face coverings typically didn’t have that much of an effect – but the evidence says that they do,” he said.
“It’s not that we dramatically need to change what we are doing, it’s a question of trying to better understand our adversary and better understand what some of those risks may be.”
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