The COVID-19 column
May 2021 #2

A-   Prior to the pandemic, suicide risk was twice as high among female nurses compared to American women. A new study in the healthcare community showed that a female nurse older than 30, was found to be 70% more likely to die by suicide than a female physician. Data were drawn from the National Violent Death Reporting System.

The study was performed by Matthew Davis, an associate professor in the department of Systems, Population and Leadership at the University of Michigan. He tried to explain the rate of suicide by the high job demands and the lower autonomy compared to physicians, the avoidance of mental health services by fear of stigma as well as a greater access to prescription drugs. More, the pandemic has added more stress to the healthcare professionals especially the nurses.

159,000 suicides were reviewed between 2007 and 2018 and 2,400 involved nurses and 8 on 10 were women (80%). 850 suicides were found among physicians with 85% were men. The remaining 156,000 were found in the general public with a higher incidence in men with ¾ of those cases.

He concluded that the suicide incidence among nurses was 17.1 per 100,000 compared to 8.6 per 100,000 for women in the general population, doubling the risk. The number of suicides among male nurses was insignificant.

Davis thinks that the suicide rate among physicians was not found to be significantly higher than the rate found in the general population. He also noticed that when nurses or physicians take their lives, drugs are often involved. A 17% of suicide is noted in the general population due to drugs but among physicians or nurses nearly a quarter (25%) of the case have drug involved. Antidepressant, Barbiturates, Opioids and Benzodiazepine were the most involved medications.

B-   Anybody who has received their two doses of Pfizer or Moderna vaccine or the one dose of Johnson and Johnson vaccine are considered fully vaccinated two weeks after receiving the shots. These fully vaccinated persons can resume their pre-pandemic activities.

These vaccines virtually eliminate any chances of contracting or spreading the virus. You can attend activities like going to the marketplace mask-less because you are not at meaningful risks in catching the virus. If you come with flu like symptoms, you may consider to stay at home.

Although Dr Fauci announced as well as President Biden to be free of mask, the CDC has advised vaccinated people to continue wearing it especially when visiting hospitals, nursing homes, homeless places, travelling etc. The recommendations go to the immunocompromised patient to continue wearing the masks.

In families fully vaccinated who still have not reached the two weeks post injection, the wear of mask seems to be reasonable and protective against other unvaccinated members especially the 12- and 15-year-old or when engaging with the outside world.

It may be also well on the way to declare that anybody who had receive the vaccine, will need a booster shot in a year or so. Both Pfizer and Moderna have already started working on the booster. Although, soon Soon we will reach 300 million of vaccine doses distributed to the public.

C-   Young men who suffered with the COVID-19 infection were found to have nearly six time the risk of developing erectile dysfunction while inversely, men with erectile dysfunction were also found to have five times more chance to catch the SARS-CoV-2 virus. This study was performed by Emmanuel A Jannini MD, a professor in endocrinology and medical sexology at the university Rome Tor Vergata in Rome, Italy.

Erectile Dysfunction can be either a short term or a long-term complication of the disease although Diabetes, old age, smoking or high body mass can present with endothelial dysfunction. A biomarker will help in making the diagnosis in COVID-19. Men now have a compelling reason to become preceptive to the vaccine because they potentially could become poor performers in the bedroom.

The Coronavirus is already known to damage blood vessels, especially vessels supplying the penis can’t make any exception to the rule. Researchers have discovered with the electronic microscope, the virus in penises tissue taken from patients infected with COVID-19. This study was recently published in the last issue of the “World Journal of Men’s Health”.

Erectile dysfunction can be also the hallmark of a non-obstructive coronary artery disease especially when asymptomatic patients who suffered from the disease may present with undetected small blood vessels problems. A professor at the University of Miami Miller school of Medicine, Ranjith Ramasamy found out that the blood vessels themselves were unable to provide enough blood to satisfy an erection. He even thinks that those effects may represent permanent changes because the study was performed on the two patients who developed COVID-19 and subsequent impotence which forced them later to benefit from a penile prosthesis.

D-   COVID-19 cases in the USA are dropping and recently, mandates on the wear of masks were lifted. Soon to come with the summer camps, the CDC has stated that vaccinated staffers and adolescents will not need to wear masks during camp activities. Not too many scientists are agreeable with these measures because if we were convinced already that taking the vaccine would be the first step, we are far from approaching the 70% of vaccinated people needed to reach the herd immunity. Only 35% of the population has already received both doses; Many are still hesitant and while the vaccine is extended to the adolescents 12 to 15 in age, parents are not seeing much the reason to have their kids take the vaccine. We do continue to have a problem with the hesitancy.

The inoculation of children may look like it is a key to achieving our goal while we are facing a fourth wave with the virus attacks. Dropping masks for a population at risk, partially vaccinated may be not responsible although Americans are tired of these restrictions in their life and would to regain more freedom in their activities. They want to be able to go to the movie, assist or participate in games or simply attend concerts.

E-  Another study found that more than 99% of hospitalized patients with COVID-19 during the last 3 months in 2021 were not vaccinated. The mRNA vaccine of Pfizer and Moderna were more than 96% effective against the infection. The same experience was repeated at the Cleveland clinic last month showing 76% not vaccinated catching the disease. The study was extended to 47,000 employees at the clinic and less than 2000 tested positive for the virus but 99.7% of the one who contacted the virus weren’t vaccinated.

F-  The CDC has done what was already prone by many members of the senate (Senator Ran Paul) fighting the right to be free of not wearing masks like they have done in countries like Israel for the last two months. It was announced officially today on 5-13-2021 that the wear of masks was not mandatory anymore.

Parallelly, all kids aged 12 to 15 are eligible to take the vaccine. Children are known to be COVID-19 virus spreaders. We hope to see less hesitancy. If you are fully vaccinated against the virus, it is now official that you do not need to wear a mask inside or outdoor anymore. We still will need 70% of our population to reach this level of her immunity.

We have to remember that last week the CDC was releasing the new guidelines for the wear of mask while Dr Fauci was giving his testimony in the senate without wearing a mask. Senator Ran Paul was pounding him with questions about the need to wear one. The CDC demonstrated the benefits one would have in wearing it outside in exaggerating that outdoor activities were responsible for less than 10% of most transmission of the infection. So much confusion for a population already frustrated. In fact, less than .1% is encountered in the outdoors.

A recent survey from the Robert Wood Johnson Foundation and the Harvard TH Chan School of Public Health on 1300 people in March 2021, showed that only 54% of the population thrust any decision taken by the FDA, CDC and Dr Fauci or the NIH. They are more likely to thrust clinical physicians and nurses than the public health agencies and Institutions. The FDA has the lowest approval with 48%.

G-   We continue to find cases of COVID-19 in recipients who have received both doses. In New-York, seven professional baseball players 3 coaches and four staff members have tested positive after having been fully vaccinated with the Johnson and Johnson vaccine and only one was symptomatic.

We have seen cases following vaccination in many states as well and the explanation was that the patients discovered post vaccination to have COVID-19 already had contact with the virus prior to take the vaccine. I am still awaiting the explanation of the two vaccinated teachers and her students who all tested positive for the virus last month.

H-   Nationwide vaccination is open for the 12-15 across the country and CVS Health is involved in the distribution at 5600 locations. Less than 2 million of COVID-19 cases were found in children aged 11-17 as reported by the CDC. They are at lower risk to develop the disease and if they become sick, they will present symptoms in a milder form. But some have also exhibited a rare inflammatory syndrome which requires hospitalization. Some have also died from it during the last year of the pandemic. The FDA analyzed the safety of the shots.

About this rare and dangerous disorder occurring in children with COVID-19, it could improve the treatment of the disease. About one child in 1,000 will have symptoms of this rare condition associated with the SARS-C0V-2 within four to six weeks: “The multisystem inflammatory syndrome” (MIS-C) consisting in fever, abdominal pain and vomiting or diarrhea. There may be also rashes and cardiac or neurological problems. Once the symptoms are recognized, they need to be treated with steroids but if left untreated or unrecognized, it can become fetal. They also appear less at risk to spread the disease.

An assistant-professor of Immunology at Yale University in New Haven CT, tried to explain the MIS-C syndrome in those children who presented with no antiviral response to the disease. They noted a high level of “alarmins” molecules generally found in the innate immune system responding to all infections. The innate system of the children is the reason why they present milder symptoms during the pandemic.

In the MIS-C syndrome, the investigators found that the kids have shown as well an elevation in the adaptive immune response generally responding to the attack of viruses, fungi, bacteria or parasites. Paradoxically, their own immune system attacks their own host tissue, like it is seen in any autoimmune disease.

I-    As per John Hopkins University, there are more than 161 million of cases and more de 3.5 million deaths, around the world. In the United States, there are 33 million of cases and more than 585 million deaths. Haiti has 14,182 confirmed cases and 302 deaths.

J-  The pandemic is not over because of the persistent hesitancy in the population where one American on three remains skeptical and refuses to take the vaccine including the older person at risk. The Kaiser Foundation found out that 13% of the adult population refuses categorically to take the vaccine. Another 6% will agree if it mandated by their employers but 15% will wait the effects of the vaccine on others. This is mainly why the United States continues to trail England and Israel in the distribution of the vaccine. If now around 600 Americans die everyday because of the COVID-19, one can understand why a large number of Americans over the age of 40 remain unvaccinated. This is the main reason with the hesitancy for not expecting the death rate to fall near “zero”.

More around the world, vaccination remains at an extremely low rate especially in the poor countries unable to afford a vaccine. In Haiti, we have not started any program of vaccination and we are not sure if the population will be too receptive to it either. More deaths have been recorded recently and Haitians understand the seriousness of the pandemic. In spite of these facts, there are encouraging signs of declining death rate due to COVID-19 in Africa where only 1% of the population has received one dose of vaccine or in Asia for reasons that scientists are unable to explain so far. One will also remember the recent outbreak in India but as of last week, there is a decline in the death rate. 

Maxime Coles MD
Boca Raton FL


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