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Should men be worried about coronavirus because of their testicles? – Haaretz

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Men have a higher mortality rate than women from COVID-19, studies from different countries have consistently shown. Moreover, men remain infectious for longer than women, other studies have amply demonstrated. But why are men more at risk?

Because men were slower to clear the virus from their bodies than women. That may be because the virus could be hiding in their testicles, suggests a new study co-written by researchers of the Albert Einstein College of Medicine in New York and the Kasturba Hospital for Infectious Diseases in Mumbai, India. The paper, published in MedRxiv, has not been peer-reviewed yet.

Not every country has kept statistics on male/female deaths from COVID-19, the disease caused by the SARS-CoV-2 virus, known to humankind since about November 2019. But among those that have, including Italy and China, the death rate for males is roughly double or more than that of females. In Wuhan, the original epicenter of the virus, men accounted for almost 73 percent of the deaths ascribed to COVID-19. (By the way, COVID-19 means “coronavirus disease 2019,” and not the 19th coronavirus we know).

Various explanations have been suggested for the higher mortality rate of men. One proposes that men are more prone to risk-taking behavior, so they are more likely to indulge in counter-survivalist activities, such as smoking and (in the age of coronavirus) group gatherings. But a Chinese study suggests that the answer does not lie in the demon tobacco: Half of Chinese men smoke but smokers comprised only somewhere between 1.4 to 12.6 percent of the male deaths , and similar results were found in New York, according to Forbes.

Another suggestion is that women have generally stronger and more efficient immune systems than men, which on the downside renders women more prone to auto-immune disease.

All this could be spot-on and contribute to the higher male mortality rate from COVID-19. But it wouldn’t explain why men clear SARS-CoV-2 from their bodies more slowly than women.

Checking 68 symptomatic subjects, 40 men and 20 women, the joint Amercian-Indian paper found an average of a two-day delay for symptomatic males to produce “clean” swab-test results compared with symptomatic females.

“Furthermore, examination of 3 families with both male and female patients followed serially, demonstrated that female members of the same household cleared the SARS-CoV-2 infection earlier in each family,” the team wrote.

Where the coronavirus docks

How might the testicles be involved? To infect a cell, a coronavirus has to “dock” onto a specific protein on the target cell wall, called an ACE2 receptor – which stands for angiotensin-converting enzyme 2. Cell types with copious levels of ACE2 on their surfaces would theoretically be most susceptible to infection. Which cells copiously produce ACE2 receptor proteins? Lungs and kidneys (the renal proximal tubule; COVID-19 is also associated with kidney trouble in severe cases) – and certain testicular tissue.

Manuel Silvestri/Reuters

Specifically, a separate paper published in Nature on Monday  detailed that ACE2 is highly expressed in the seminiferous ducts of testis, adult Leydig cells (which produce hormones and are adjacent to those ducts) and in the prostate.

In the kidneys, the receptor is highly expressed in the epithelial cells of the renal tubule, which probably explains why some people with severe cases of COVID-19 have been developing kidney damage.

Conversely, ovaries do not express much ACE2, the Bronx-Mumbai study explains.

So it seems plausible that men are clearing the virus more slowly than women because they have an extra reservoir that women do not possess. It must be stressed that this has not been proven. But it is consistent with this hypothesis that gonadal loss-of-function has been reported in SARS-CoV-2 patients, indicating damage to testicular cells – especially the ones producing hormones – during infection.

On exactly the same grounds – testicular and nephritic susceptibility to coronavirus – a comment published in Nature Reviews, Urology this week urges monitoring the urogenital tract of COVID-19 patients.

“Most patients with severe COVID-19 present with pneumonia-related symptoms, but some patients with severe disease could develop serious urinary complications including acute kidney injury,” writes Shangqian Wang, Xiang Zhou, Tongtong Zhang and Zengjun Wang from the First Affiliated Hospital of Nanjing Medical University.

“Furthermore, male reproductive systems are vulnerable to infection; dramatic changes in sex hormones in patients with COVID-19 have been observed, suggesting gonadal function impairment,” the team writes. Which is a euphemism for infertility.

The changes in the sex hormones are a side effect of inflammation resulting from the immune system fighting the virus, the paper explains: “Inflammatory cytokines that are locally or systematically produced by these cells can activate the autoimmune response, destroying the seminiferous epithelium, which leads to autoimmune orchitis [inflammation of the testicles].”

The team notes that SARS, a different coronavirus, could and did attack the testicles, inducing orchitis. The SARS virus was discovered in the outer cells of testicular seminiferous tubules and Leydig cells, which produce testosterone.

Now, SARS-CoV-2 isn’t the same as SARS-CoV. But both viruses have receptors in the testicles. So while COVID-19 chiefly attacks the respiratory system, doctors should watch out for urogenital complications, the team urges.

They also have a sobering word of advice for men who contracted COVID-19, recovered, and want children: “After recovery from COVID-19, young men who are interested in having children should receive a consultation regarding their fertility.”

This seems to be one thing that China already knew. As early as mid-March, China Daily was warning men who recovered from COVID-19 to have their fertility tested. (It’s worth mentioning that a steady diet of junk food or keeping a smartphone next to boys may have similar effects.)

The authors of the study published in MedRxiv are Aditi Shastri, Justin Wheat, Kith Pradhan, Mendel Goldfinger, Noah Kornblum, Ulrich Steidl, and Amit Verma from the Albert Einstein College of Medicine with Sachee Agrawal, Nirjhar Chaterjee and Aditi’s mother Jayanthi Shastri from the Kasturba Hospital for Infectious Diseases in Mumbai.

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Face masks remain recommended – The North Bay Nugget

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But they could become mandatory, health unit warns

Postmedia File

The North Bay Parry Sound District Health Unit is not mandating the use of face coverings in the district at this time, Dr. Jim Chirico, medical officer of health, stated in a release, Thursday.

However, the health unit will continue to monitor local data and will reassess the situation, if necessary.

“It is my hope that the use of facial coverings during the COVID-19 pandemic voluntarily becomes widespread and the social norm rather than being mandated,” Chirico is quoted.

“If this does not occur in a timely manner, we will be asking the provincial government to issue a directive under the Emergency Management and Civil Protection Act to ensure consistency throughout the province, rather than having health units and municipalities legislate the use of facial coverings.”

The health unit recommends the public use face coverings when physical distancing, a space of two metres, cannot be maintained, especially in an indoor setting.

If worn properly, a face covering, in addition to other protective health measures, can help protect others from infectious droplets, it states.

“A face covering does not replace physical distancing and other protective health measures such as hand washing, and isolating yourself when you have symptoms or have come in close contact with someone with COVID-19 or suspected to have COVID-19,” Chirico is quoted. “I recommend using face coverings when physical distancing cannot be maintained, especially when in an indoor setting, on public transit, and when receiving essential or close-contact services.”

Mayors from the Greater Toronto and Hamilton area asked Premier Doug Ford on Monday to make masks mandatory across Ontario, but the premier rejected the idea.

Torontonians riding public transit must now wear face coverings to prevent the spread of COVID-19.

And Toronto city council voted to make wearing masks mandatory in public indoor settings, with the bylaw coming into effect on July 7.

Mayor John Tory said the temporary bylaw will not affect social gatherings.
Transit riders, as well as staff and customers at some businesses, in London and Middlesex County will be required to mask up starting July 20.

It’s the answer to growing calls for a mandatory mask order in the region to help prevent the spread of the coronavirus, including future outbreaks or a potential second wave as restaurant patios, hair salons and other businesses reopen.

“The combination of the local data and the strength of research indicates that now’s the time to issue a mandatory order for masks in some specific situations,” Middlesex-London medical officer of health Chris Mackie said Thursday.

“We think masking can play an important role in those businesses where close contact is the business model and can’t really be changed or eliminated.”

Starting July 20, people who have close contact inside a business — including hairdressers, nail salons and other personal service businesses — for more than 15 minutes will be required to don face coverings.

The order differs greatly from mask rules in place or coming in other communities, including Toronto, Windsor-Essex — plagued by COVID-19 flare-ups among farm workers — and Kingston, which had very low infection numbers for weeks until a recent outbreak centred around a nail salon. All of those communities require masks to be worn by those in many or all indoor settings.

North Bay Mayor Al McDonald said mandatory face coverings will be difficult to enforce.

“Southern Ontario locations hit hard by COVID-19 have put an order in place, but have recognized publicly that it is almost impossible to enforce,” he said. “Should our medical officer of health recommend to us the mandatory use of face coverings we would call a special meeting of council to pass a bylaw.”

With files from Postmedia and Canadian Press

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Public health issues order to farms that employ temporary foreign workers – KitchenerToday.com

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Under the direction of Ontario’s Medical Officer of Health, the health department in Waterloo Region has issued an order to employers of temporary foreign workers to ensure measures to prevent, or reduce the spread of COVID-19 are in place.

Waterloo Region’s acting medical officer of health told a media briefing on Friday it doesn’t mean the operators have not already put the measures in place, public health just wants to be proactive.

That order was issued at 15 farms in the area earlier this week.

“At this time we have not detected any cases among temporary foreign workers in our community, on such farms … this order allows us to provide farms with clear information on the strict measures that they need to ensure are in place, to prevent, or reduce the spread of COVID-19.” said Dr. Hsiu-Li Wang.

The measures include:

  • making sure workers isolate for 14 days upon arrival in Canada
  • notifying public health if a worker develops any COVID-19 symptoms during self-isolation
  • conduct daily active screening of employees
  • ensure that surfaces in the employee accommodations of the farm are cleaned and disinfected regularly including surfaces in bathrooms, kitchens and common areas on a daily basis, or more often as required, and that a log be maintained

Dr. Wang said they are working with the Ministry of Labour, Training and Skills Development, who are currently conducting on-site assessments of the farms that employ temporary foreign workers here and across the province.

It’s estimated the virus has already infected hundreds of migrant workers in Ontario.

with files from Erin Anderson

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Health unit instructing commercial businesses to ramp up face covering – Sudbury.com

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As of Wednesday, July 8, all commercial establishments in Sudbury and districts will be required to ramp up their efforts to prevent the spread of COVID-19. 

As part of COVID-19 prevention efforts, Dr. Penny Sutcliffe, Medical Officer of Health for Public Health Sudbury & Districts, is issuing instructions to owners and operators of commercial establishments, as well as public transit, to have policies in place to stop people from entering if they are not wearing a face covering. 

The instructions are being issued under the authority of the provincial Emergency Management and Civil Protection Act.

“The face covering requirement for commercial premises that are open to the public is in addition to the diligent work many are already doing to ensure physical distancing and hand sanitizers. Face coverings are extra protection to prevent COVID-19 spread, they also send a message that the wearer wants to protect others,” said Sutcliffe. 

“As we successfully re-open across the province, we also increase the risk of spreading the virus. Establishing common expectations about routine face covering helps reduce this risk now and will pave the way to successful Stage 3 re-opening. It will also help protect us against a potential second wave in the fall and keep businesses and services up and running,” said Dr. Sutcliffe.

Commercial establishments are expected to use their best efforts to implement their face covering policies. This means that signs and verbal reminders are used but there is not a requirement that a business must turn away the customer. 

This is in line with the “good faith” enforcement framework of the Public Health Sudbury & Districts instructions which builds on education and reminders.

In Friday’s instruction letter, all employers are reminded of their ongoing responsibilities to maintain two metres distance between employees and clients, to screen employees and members of the public for COVID-19 symptoms, and to promote excellent hygiene practices including handwashing.

For owners or operators of commercial establishments or of public transit, the additional face covering responsibility comes into effect at 12:01 a.m., Wednesday, July 8. A face covering means a medical or non-medical mask or other face coverings such as a bandana, a scarf or cloth that covers the mouth and nose. Certain exemptions apply, for example, based on age or medical circumstances.

“I encourage everyone to be kind, patient, and respectful to one another. How we navigate this pandemic is our individual and our shared responsibility. These latest instructions continue to count on everyone’s best intentions and my confidence is well placed. I fully expect we will show the province and the world how to do this right,” said Sutcliffe.

Accumulating epidemiological evidence indicates that the widespread use of face coverings by all persons decreases the spread of respiratory droplets, and expert opinion supports the widespread use of face coverings to decrease transmission of COVID-19.

Public Health is reminding residents to follow public health guidance—wash your hands; cover your cough or sneeze with your arm or a tissue; avoid touching your eyes, nose and mouth; stay two metres apart from others; wear your face covering, and stay home when ill.

If you have any COVID-19 symptoms, get tested. People who are asymptomatic, who are concerned that they have been exposed to COVID-19 are also encouraged to contact an assessment centre and get tested.

For more information please visit phsd.ca/COVID-19 or call Public Health Sudbury & Districts at 705-522-9200 (toll-free 1-866-522-9200).

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