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 The paper, published in MedRxiv, has not been peer-reviewed yet.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.
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.
What you need to know about COVID-19 in B.C. on May 29, 2020 – CBC.ca
- Health officials will give their daily update in a written statement at 3 p.m. PT.
- To date, 2,558 cases of COVID-19 have been confirmed in B.C.
- 164 people have died of the illness.
- 2,153 people have recovered.
- There are currently 241 active cases of COVID-19.
- As of Thursday, 33 patients were in hospital with COVID-19, including six in intensive care.
B.C. has now had 2,558 confirmed cases of COVID-19, but less than a 10th of those are still active.
As of Thursday, there were 241 active cases in the province, while 2,153 people have recovered. Sadly, 164 people have now died from the novel coronavirus, including 93 residents of long-term care homes.
The number of COVID-19 patients in hospital has fallen to 33, including six who are in intensive care.
However, officials continue to be concerned about the impact of the pandemic on the elderly and care home residents, and specialized response teams have been sent in to deal with outbreaks at two facilities in the Fraser Health region.
Top COVID-19 stories today
Health officials widely agree the most important thing you can do to prevent coronavirus and other illnesses is to wash your hands regularly and avoid touching your face.
The World Health Organization said more than 80 per cent of COVID-19 infections are estimated to be mild.
What’s happening elsewhere in Canada
As of 10 p.m. PT on Thursday, Canada had 88,512 confirmed and presumptive coronavirus cases, with 46,480 considered resolved or recovered. A CBC News tally of deaths based on provincial health data, regional information and CBC’s reporting stood at 6,963.
The numbers are not a complete picture, as they don’t account for people who haven’t been tested, those being investigated as a potential case and people still waiting for test results.
For a look at what’s happening across the country and the world, check the CBC interactive case tracker.
What are the symptoms of COVID-19?
Common symptoms include:
But more serious symptoms can develop, including difficulty breathing and pneumonia.
What should I do if I feel sick?
Stay home. Isolate yourself and call your local public health authority or 811. Do not visit an emergency room or urgent care centre to get tested.
Non-medical information about COVID-19 is available in B.C. from 7:30 a.m.-8 p.m. PT, seven days a week at 1-888-COVID19 (1-888-268-4319).
What can I do to protect myself?
- Wash your hands frequently and thoroughly. Keep them clean.
- Keep at least two metres away from people who are sick.
- When outside the home, keep two metres away from other people.
- Avoid touching your eyes, nose and mouth.
- Masks won’t fully protect you from infection, but can help prevent you from infecting others.
More detailed information on the outbreak is available on the federal government’s website.
If you have a COVID-19-related story we should pursue that affects British Columbians, please email us at email@example.com
What you need to know about COVID-19 in Ottawa on Friday, May 29 – CBC.ca
What’s happening today?
Families of people living at the Almonte Country Haven long-term care home just west of Ottawa say they asked for staffing help early in the pandemic, but didn’t get it.
All but 10 of the home’s 82 residents contracted COVID-19 and 28 died. The home’s administrator says it met Ontario’s staffing standards at all times.
WATCH: Staffing at hard-hit care home
Canadian Blood Services needs more people who have recovered from COVID-19 to donate plasma for a project to see if they have antibodies that could potentially help treat the virus.
Ottawa epidemiologist Raywat Deonandan is calling on the city to open up more public washrooms during the pandemic, even with the portable toilets installed downtown.
WATCH: How to keep public washrooms safe
How many cases are there?
There have been 1,930 confirmed cases of COVID-19 in Ottawa and 240 deaths linked to the respiratory illness. There are more than 3,070 known cases across eastern Ontario and western Quebec.
More than 2,300 people in the region have recovered from COVID-19.
The deaths of 49 people in Leeds, Grenville and Lanark counties and 32 more in the wider region have also been tied to the coronavirus.
Confirmed cases are just a snapshot because not everyone can be tested and results take time to process, though testing criteria are being expanded.
What’s open and closed?
This Sunday, the farmers market at Lansdowne Park reopens for preordering and picking up at a designated time.
So can national parks and historic sites across Canada, which includes Rideau Canal lockstations.
Quebec elementary schools outside Montreal are open. Schools for its older students and all Ontario schools are closed through summer.
Distancing and isolating
The coronavirus primarily spreads through droplets when an infected person coughs or sneezes. People don’t need to have symptoms to be contagious.
That means physical distancing measures such as working from home and staying at least two metres away from anyone they don’t live with.
Ottawa Public Health now wants people to think about how to safely do certain things and recommends people wear a fabric or non-medical mask when they can’t always stay two metres from strangers, such as at a grocery store.
Anyone who has symptoms, travelled recently outside Canada or, specifically in Ottawa, is waiting for a COVID-19 test result must self-isolate for at least 14 days.
The same goes for anyone in Ontario who’s been in contact with someone who’s tested positive or is presumed to have COVID-19.
People 70 and older or with compromised immune systems or underlying health conditions should also self-isolate.
What are the symptoms of COVID-19?
COVID-19 can range from a cold-like illness to a severe lung infection, with common symptoms including fever, a dry cough, vomiting and the loss of taste or smell.
Less common symptoms include chills, headaches and pink eye. The Ontario government says in rare cases, children can develop a rash.
If you have severe symptoms, call 911.
WATCH: What it’s like to be new to Canada during the pandemic
Where to get tested
In eastern Ontario:
Tests are done at the Brewer Arena from 9 a.m. until 3:30 p.m., seven days a week, or at 595 Moodie Dr. and 1485 Heron Rd. those same hours on weekdays.
Testing has also expanded for local residents and employees who work in the Eastern Ontario Health Unit area.
There is a drive-thru test centre in Casselman and assessment centres in Hawkesbury and Winchester that don’t require people to call ahead and others in Rockland, and Cornwall that require an appointment.
In Kingston, the assessment centre at the Kingston Memorial Centre is open Monday to Friday from 10 a.m. to 6 p.m. and on weekends from 9 a.m. to 12:30 p.m. for anyone with symptoms.
Napanee‘s test centre is open 9 a.m. to 3 p.m. daily for people who call for an appointment.
The Leeds, Grenville and Lanark unit asks you to get tested if you have a symptom or concerns about exposure.
It has a walk-in site in Brockville open seven days a week at the Memorial Centre and testing sites in Smiths Falls and Almonte which require an appointment.
WATCH: The National‘s nightly COVID-19 Q&A
The public health unit in the Belleville area is asking people to call it at 613-966-5500, their family doctor or Telehealth if they have symptoms or questions.
If you have no symptoms, you can arrange a test in Bancroft, Belleville or Trenton by calling the centre, or in Picton by texting 613-813-6864. You can also call Picton’s number as a backup.
You may also qualify for a home test.
Renfrew County is also providing home testing under some circumstances. Residents without access to a family doctor can call 1-844-727-6404 if they have health questions, COVID-19-related or not.
If you’re concerned about the coronavirus, take the self-assessment.
In western Quebec:
Outaouais residents should call 819-644-4545 if they have symptoms. They could end up being referred to Gatineau’s testing centre.
WATCH: Quebec’s latest projections show need to follow rules
Local communities have declared states of emergency, put in a curfew or both.
Akwesasne has opened a mobile COVID-19 test site available by appointment only. Anyone returning to Akwesasne who’s been farther than 80 kilometres away is asked to self-isolate for 14 days.
Anyone in Tyendinaga who has symptoms can call 613-967-3603 to talk to a nurse.
Pikwakanagan‘s council planned to let businesses reopen as of today and Kitigan Zibi is keeping schools closed through the summer.
For more information
What's open Ottawa: H&M reopens Rideau Street store | CTV News – CTV News
Malls remain closed in the capital, under provincial orders, but stores with street entrances are allowed to reopen, and that means a popular fashion brand has reopened one of its stores in Ottawa.
H&M announced Thursday that its store at the Rideau Centre would reopen via its Rideau Street entrance.
Only 15 people will be allowed in the store at one time. The hours are to 11 a.m. – 7 p.m.
There are markers on the floor for physical distancing. Fitting rooms have been closed and there is no garment recycling program for now.
Hand sanitizer is being provided.
While the store accepts cash, they are encouraging card use. There is one line for cash users and one line for card users at the registers.
Employees will be wearing masks, and will be behind barriers at the register. The store will be cleaned more often.
H&M will still accept returns, but says it will hold all returned items for at least 24 hours before putting them back on the sales floor.
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