May 3, 2020: Roundup & Myth Busting 

Intro and Disclaimer

QM would like to help you make sense of information being circulated by: 1. Translating data into digestible language, 2. Dispelling misconceptions and linking to evidence, and 3. Curating relevant data, and articles on a weekly basis. Our Round Up/ Mythbusting projects are intended to help our QM family make sense of information being circulated. Taking control of our health as a queer community includes making institutional knowledge accessible to the public. 

Disclaimer: Although this information has been evaluated and determined to be accurate by Queering Medicine (QM), we at QM do not want to give the impression that we are the sole gatekeepers of medical knowledge. As a collective, QM members bring professional and personal qualifications that allow us to research and share credible knowledge. Our goals for this weekly round up and myth busting is to translate data into digestible information, dispel misinformation, and curate relevant data for the Lansing queer community. We encourage the community to question knowledge found outside of reputable sources, however, Queering Medicine will gladly help facilitate this process. If evidence or recommendations change, or any inaccuracies are found, we will correct them and explain the changes. If you have any questions about our methodology and sources, or you would like to point out any inaccuracies, please let us know!

Michigan Anti-Discrimination Health Care Policies

On April 29th, the Governor of Michigan issued a new COVID-19 Executive Order that mandates that "health care providers shall take all necessary steps to ensure non-discrimination ... in the delivery of critical care and allocation of other medical resources to those in need of treatment for physical and psychiatric illnesses.” It also requires hospitals (and entities that hospitals use for surge capacity) to develop protocols that “probihit medical decision-making based on social stigma or stereotypes regarding age, color, criminal history, disability, ethnicity, familial status, gender identity, height, homelessness, immigration status, incarceration status, marital status, mental illness, national origin, poverty, race, religion, sex, sexual orientation, socio-economic status, substance abuse disorder, use of government resources, veteran status, or weight" [emphasis added]. While there have been suggestions that federal health care protections for queer and trans people may be removed, this Executive Order will help protect Michigan residents from such discrimination during the COVID-19 crisis.

Michigan Executive Order 2020-64 (COVID-19): 

• https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-527592--,00.html 

CDC Adds 6 Symptoms to its COVID-19 Symptom List

In addition to cough, shortness of breath or difficulty breathing, and fever, the CDC added the following symptoms to their list of COVID-19 related symptoms:

• • Chills (Chills are feelings of coldness accompanied by shivering. They may arise with or without fever)

  • Repeated shaking with Chills

  • Muscle pain

  • Headache

  • Sore throat

  • New loss of taste or smell

Symptoms may still widely range depending on reporting, but these are the current symptoms to be most wary of according to the CDC. 

Also to note, according to the website, having a fever must also be accompanied by at least one other symptom. This applies to the 6 new symptoms listed above as well. Cough and/or shortness of breath still stand alone, and having just one of these may still lead to a diagnosis of COVID-19. Fever is not expected to be a symptom for everyone. The CDC website was last reviewed on March 20, 2020 as of this publication.

Article:

• https://www.npr.org/sections/coronavirus-live-updates/2020/04/27/845321155/cdc-adds-6-symptoms-to-its-covid-19-list 

Link to CDC Symptom website for COVID-19:

• https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html 

Clarification on Remdesivir Receiving Emergency Approval

Remdesivir, an antiviral drug, has recently been granted emergency approval for use as treatment for patients with severe COVID-19 if they may benefit. The decision comes after a clinical trial showed patients with severe COVID-19 who were given Remdesivir were discharged from the hospital four days earlier than those who were given a placebo. Whether or not Remdesivir results in reduced death in patients is still unclear and needs to be further studied. 

The next step is for researchers outside of the clinical trial to critically analyze the data, which has yet to be formally peer reviewed and published, to better understand the possible benefits and/or side effects the drug might give COVID-19 patients. Guidelines for its use may change pending the review of data, and as more research is conducted. 

Remdesivir was originally developed as a potential treatment for Ebola but was considered unsuccessful against the Ebola virus. As a broad-range antiviral, Remdesivir is designed to prevent viruses, like SARS-CoV-2 (the virus that causes COVID-19), from replicating its genetic material in human cells, thus preventing the spread of the virus within the body. 

NOTE: To reduce circulating literature that may be confusing we are not sharing the links to the articles. However, they are available upon request. 

Estrogen May Decrease COVID-19 Severity

A new line of research is examining whether giving estrogen and progesterone to cisgender men with COVID-19 may improve outcomes. This is based on data from cisgender individuals (examining sex differences) suggesting males have more severe COVID-19 symptoms compared with females. There is currently no evidence that hormones play a role as many factors may lead to this difference between males and females. Even if research supports the use of estrogen to decrease COVID-19 severity, this does not mean it is expected to induce immunity or be considered a cure. Trans people taking estrogen shouldn't consider themselves immuneOther sex differences are also being examined. We will continue to provide updates on this story as they become available. 

Helpful Links

• Article: https://www.them.us/story/scientists-hormones-covid-19-treatment 

• Article: https://www.nytimes.com/2020/04/27/health/coronavirus-estrogen-men.html

• Medical survey of COVID-19 patient characteristics and outcomes suggesting males have more severe outcomes: https://doi.org/10.1016/S0140-6736(20)30566-3

• Information on sex difference research: https:/doi.org/10.1038/509282a

• Other sex differences related to COVID-19 will be examined, as well: https://doi.org/10.1016/j.metabol.2020.154252 

Strokes in Younger Patients

Claim: Covid-19 can cause stroke in younger patients

Verdict: Maybe, more data is needed.  At least three studies have indicated that Covid-19 may be linked to stroke in younger patients. Stroke is fairly uncommon in patients who are less than 50 years old; statistics vary from country to country, ranging from <5% to 20%

A recent report from the New England Journal of Medicine describes large vessel stroke as the presenting feature of Covid-19 in five patients between the ages of 33-49. All patients were diagnosed with Covid-19 upon admission. Major symptoms, signs, and symptoms of stroke reported by patients included a reduced level of consciousness and hemiplegia on either the right or left side and. Two patients included in this report did not have any of the commonly accepted Covid-19 symptoms; the other three had been experiencing cough and lethargy. In a retrospective, observational analysis of 211 Covid-19 patients admitted to Union Hospital, Wuhan, China, 5% developed acute ischemic stroke. Investigators concluded that acute cerebrovascular disease is not uncommon in Covid-19.   Another report from a hospital in Strasbourg, France, found neurological findings in 58 patients who were Covid-19 positive. These findings included encephalopathy, agitation. Additionally, out of 13 patients that underwent Magnetic resonance imaging (MRI), 3 showed cerebral ischemic stroke.

It is important to note that these reports are observational studies that are subject to confounding variables. Furthermore, two of them have not yet been peer-reviewed. The association between stroke and Covid-19  requires further evaluation and investigation as data is still limited.

NOTE: Resources and journal articles available upon request.

Pets and COVID-19

A pug in North Carolina may be the first dog in the United States that has tested positive for COVID-19. Along with the two cats that have tested positive in New York as well as the tiger, these are the only known reports of animals/pets testing positive for the COVID-19 virus. The symptoms for both the pet cats and dog were reportedly mild. Guidelines have not changed and remain the same: Pets and pet owners should adhere to social distancing measures. Proper hygiene with regards to handling pets should still be practiced. If you have been exposed to the virus or know you have COVID-19, current recommendations state that you should refrain from interacting with your pets.

Pug in North Carolina Tests Positive for COVID-19:

• https://www.usatoday.com/story/news/nation/2020/04/28/north-carolina-pug-tested-positive-coronavirus-possibly-first-dog/3039221001/

Two cats test positive for COVID-19 in New York:

• https://www.nytimes.com/2020/04/22/health/cats-pets-coronavirus.html

CDC COVID-19 and Animals website:

• Updated as of April 30, 2020, with interim guidance links added.

• Source: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html

Evaluation for SARS-CoV-2 Testing in Animals

• • Routine testing is not recommended

  • The decision to test an animal (including companion animals, livestock, and wild or zoo animals) should be agreed upon using a One Health approach between appropriate local, state, and/or federal public health and animal health officials.

  • This document provides recommendations to guide priorities for animal SARS-CoV-2 testing given limited resources.

  • Veterinarians are strongly encouraged to rule out other, more common causes of illness in animals before considering SARS-CoV-2 testing

  • Source: https://www.cdc.gov/coronavirus/2019-ncov/php/animal-testing.html

CDC If You Have Pets and COVID-19 Website

• Updated as of April 30, 2020

• What to do if you own pets:

  • Do not let pets interact with people or other animals outside the household.

  • Keep cats indoors when possible to prevent them from interacting with other animals or people.

  • Walk dogs on a leash, maintaining at least 6 feet (2 meters) from other people and animals.

  • Avoid dog parks or public places where a large number of people and dogs gather.

• Protect your pets if you are sick with COVID-19

  • When possible, have another member of your household care for your pets while you are sick.

  • Avoid contact with your pet including, petting, snuggling, being kissed or licked, and sharing food or bedding.

  • If you must care for your pet or be around animals while you are sick, wear a cloth face covering and wash your hands before and after you interact with them.

  • If you are sick with COVID-19 and your pet gets sick, do not bring your pet into the vet yourself

• Stay healthy if you are around animals

  • Wash your hands after handling animals, their food, waste, or supplies.

  • Practice good pet hygiene and clean up after pets properly.

  • Talk to your veterinarian if you have questions about your pet’s health.

  • Be aware that children 5 years of age and younger, people with weakened immune systems, and people 65 years of age and older are more likely to get sick from germs some animals can carry.

• Source: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/pets.html

What does this mean for the public, how should you use this new information: 

• • Proper hygiene practices around pet/animals still stand and remain the same

  • Pets and Pet owners should adhere to social distancing measures, same as before

  • If you are sick with COVID-19, avoid interacting with your pet and have somebody else in the household take care of your pet if possible

  • If you must continue to care for your pet, wear a cloth mask if possible when doing so and wash your hands before and after caring for your pet

Some Michigan Businesses Allowed to Reopen

Effective May 1, 2020:

A new executive order states that certain low-risk businesses, including construction, real estate, and those that are primarily outdoors (like landscaping), may resume operations as early as May 7, 2020. Business that are permitted to resume must do the following:

• Prohibit gatherings of any size in which people cannot maintain six feet of distance from one another.

• Limit in-person interaction with clients and patrons to the maximum extent possible, and barring any such interaction in which people cannot maintain six feet of distance from one another.

• Provide personal protective equipment such as gloves, goggles, face shields, and face masks as appropriate for the activity being performed.

• Adopt protocols to limit the sharing of tools and equipment to the maximum extent possible and to ensure frequent and thorough cleaning of tools, equipment, and frequently touched surfaces.

Construction sites must abide by additional rules.

The Stay-Home-Stay-Safe order is still under effect for all others until the current deadline of May 15, 2020 at 11:59pm. 

Press Release:

• https://www.michigan.gov/whitmer/0,9309,7-387-90499_90640-527845--,00.html?fbclid=IwAR0pHrDCsVi0XijYX_KJr2yGk1sD5shIzfRtuVWP6hUCb_oije7PSJXaixI

Full executive order:

• https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-527847--,00.html 

Myth: Emerging societies eating wild animals are to blame for all new viruses that come from animals (also called Zoonosis). (FALSE)

Verdict: False. 

Zoonosis is the transfer of a disease from animals to humans. It has been suggested that the virus causing COVID-19 originated from people consuming wildlife in China. Because of this, many people are blaming societies that eat wildlife for zoonosis. However, zoonosis can occur when consuming animals from agricultural sources. Importantly, increases in zoonosis are not directly due to consuming the animals. Human activity like animal trafficking and habitat destruction has made it difficult for wild animals to manage/gain immunity to introduced and quickly mutating viruses. Modern agricultural methods are also causing similar difficulties for domesticated animals. Additionally, wildlife is routinely consumed throughout the US and Europe. Humans interact with wildlife and domestic animals through many different channels, preventing just one thing will not prevent zoonosis. These generalizations can produce negative stereotypes and often dehumanize a very large population across Africa and Asia that rely on wild animals for food, leading to both racism and xenophobia. 

Link: https://www.counterpunch.org/2020/04/24/humans-arent-the-virus/

Many factors influence the spread of zoonosis:

• The loss of habitat for agriculture and urbanization

• Water diversion

• Climate change

• Industrialized agricultural practices

• Species loss and population loss

• Animal trafficking

• Animal consumption (agricultural and wild)

• Invasive/introduced species

• Emphasis on reactive health policies

These factors cause zoonosis by:

• Increasing the spread of novel viruses through forced migration

• Decreasing genetic variation and therefore decreasing the number of animals with different immunities. 

• Wildlife and animals in agriculture are losing their ability to fight of new viruses or viruses that change quickly

• Increasing interactions between humans and animals, wildlife and domestic. 

Some zoonoses come from industrial agriculture

• Swine Flu

• Salmonella

• Bovine Spongiform Encephalopathy/New Variant Cruezfeldt-jakob disease (otherwise known as Mad Cow)

Helpful links:

• https://doi.org/10.1016/j.ijpara.2008.05.005

• https://doi.org/10.3390/ijerph16152799

• https://doi.org/10.1265/ehpm.10.263

Challenges for the Deaf and Hard-of-Hearing

Those who are deaf or hard of hearing face additional challenges during this pandemic. Masks obscuring mouths and faces can lead to difficulty communicating or miscommunication for those who lip-read. Facial expressions are an important part of communication with American Sign Language, so even those who know ASL may struggle with communication. Many folks also do not lip read and usually rely on a pen and paper or other methods of communication that are not viably shared during these times. Below are some resources that may help:

CDC ASL Video Playlist with captions:

• • Some of the videos include;

    • COVID-19 Prevention tips in ASL

    • 10 Things You Can do to Manage COVID-19 at Home

    • Managing Stress and Anxiety

    • Parents Supporting Children

    • When to get Medical Care for COVID-19

    • Source: https://www.youtube.com/playlist?list=PLvrp9iOILTQatwnqm61jqFrsfUB4RKh6J

COVID-19 Medical Communication Access for Deaf and Hard-of-Hearing 

• Masks and in-person interpreters are some of the barriers that those who are deaf, hard-of-hearing, or deafblind may face during current medical visits

• This resource is to help those who are dead and/or hard-of-hearing to prepare for a medical visit if necessary

• The steps provided by the National Association of the Deaf are listed below:

• Print out a page saying you are deaf, hard of hearing, or DeafBlind and need hospital staff to communicate with you differently. A sample page is at the end of this document.

• If you have a smartphone, load the apps you need to communicate, and bring your smartphone with you.

  • Before you go to the hospital, download several VRI apps and/or speech-to-text apps. Some of those apps are free.

  • A list of apps is available at the end of this document.

  • Test the apps at home before you go to the hospital.

  • Keep in mind you may have to use your smartphone using your cellular connection only[1] in case the hospital does not have WiFi.

  • When you get to the hospital, ask hospital staff to let you use their WiFi, and to put you in an area with strong WiFI.

  • Tell hospital staff to communicate with you through your smartphone with VRI or speech-to-text apps.  

• If you do not have a smartphone, bring or ask hospital staff for something to write on and pens or markers.

• Bring an emergency bag with items you need to communicate. Label the bag and items with your name. Leave space on the label to add your hospital room number. The emergency bag can include:

  • Paper and pens or markers

  • Plugs and chargers for your smartphone

  • Tablets and/or laptops and chargers

  • A cellular hotspot in case the hospital WiFi is not working

  • An extension cord or power strip in case your bed is far from an outlet

  • Extra eyewear supplies you might need, such as reading glasses to read the speech to text on a phone app

  • Extra batteries for your hearing aid, cochlear implant, or assistive listening device

  • A copy of your advance medical directive, if you have one. You can find more information and instructions to make an advance directive on AARP’s website

  • Emergency contact information for family members or friends

  • For DeafBlind people, Braille device and charger and extra gloves for an interpreter to use

• Source: https://www.nad.org/covid19-communication-medical-access-for-deaf-hard-of-hearing/

List of Apps and other tools to aid in communication (including video interpreting, speech-to-text, and typing-back apps):

• https://www.nad.org/covid19-communication-medical-access-for-deaf-hard-of-hearing/#tools

Article "New Coronavirus Safety Measures Pose Challenges For The Deaf And Hard-Of-Hearing": 

• https://www.npr.org/2020/04/29/847925057/new-coronavirus-safety-measures-pose-challenges-for-the-deaf-and-hard-of-hearing?utm_source=facebook.com&utm_campaign=npr&utm_medium=social&utm_term=nprnews&fbclid=IwAR3lHXm9sFY5xhsc4z-7rcyxxhZj0fPHonYLk5hbezjMQVvyMjjjrp0QAYk

Wear Your Mask! Claim: The surgeon general is telling people to stop wearing masks. (FALSE)

Verdict: False. An article from January describing a tweet by the surgeon general that says to no longer wear masks is being shared again. The article claims that the masks don’t work but this is because people may be using them improperly. Masks are an effective barrier when used properly and new requirements for mask use should be followed. 

Article: https://www.marketwatch.com/story/the-cdc-says-americans-dont-have-to-wear-facemasks-because-of-coronavirus-2020-01-30

Tenant Rights

Under the current COVID-19 Executive Orders in Michigan, non-payment of rent is not grounds for eviction or entering the premises for removal of tenants, other than under extreme circumstances where the tenant, vendee, or person in the location poses a substantial risk to another person or imminent and severe risk to the property. Sheriffs and other officers must abide by this under the executive order as well. This is effective until May 15, 2020 at 11:59pm, subject to changes regarding the COVID-19 crisis.

• Another article on the same thing: https://www.forbes.com/sites/shaharziv/2020/04/19/some-landlords-are-illegally-spying-on-tenants-stimulus-check-status/#165891ca25fd

• A resource that summarizes the executive order: https://michiganlegalhelp.org/self-help-tools/housing/covid-19-coronavirus-and-eviction-cases

Transphobia Impacts COVID-10 Outcomes in Trans People

Vulnerabilities within the transgender community during COVID-19 are complex, many factors increase health burdens within the transgender community. Transgender individuals face greater health challenges compared with cisgender peers due to transphobia within healthcare and society. Some trans people may encounter transphobia when seeking care for COVID-19, which may also influence the level of care received. Transphobia also leads to greater financial insecurity within the transgender community. These factors discourage transgender individuals so they put-off seeking care. Most importantly, the risk factors leading to greater COVID-19 severity like smoking, hypertension, and diabetes are confounded due to barriers to care created by transphobia. It is important when highlighting health risk and negative health outcomes in vulnerable and marginalized populations that we underscore they are not due to inherent traits of individuals. 

Helpful links:

• What to do if you’re trans and need to go to the ER: http://www.newnownext.com/transgender-er-prep-coronavirus/03/2020/

• Vulnerabilities to COVID-19 among transgender adults in the US

  • https://williamsinstitute.law.ucla.edu/wp-content/uploads/Trans-COVID19-Apr-2020.pdf

  • https://www.them.us/story/many-trans-americans-ex

COVID-19 Scams

CAUTION: While we like to believe there is a deep sense of humanity in all of us, there are those who take advantage of crises to exploit marginalized people.

• Coronavirus-related scams: “While we have not heard of specific instances in Lansing, please be aware of Coronavirus-related scams. The IRS has provided a list of tips & resources to help taxpayers catch impersonation calls/texts/emails about COVID-19 Economic Impact Payments.” — City of Lansing

• City of Lansing Twitter: https://mobile.twitter.com/lansingmichigan/status/1254849053243969536 

IRS website: https://www.irs.gov/newsroom/taxpayers-should-be-aware-of-coronavirus-related-scams

COVID Testing Site Update

There are a variety of drive-through testing locations in Lansing and its suburbs [COVID-19 Test Finder]. For those outside the Lansing area, check with your city or county health department, and also note that some pharmacies in rural areas (e.g., some Rite Aid locations) may also offer testing.

Some people may have heard that RiteAids are now providing testing in Michigan, including Lansing. As of right now, Rite Aid locations in Lansing and East Lansing are not providing tests that we know of. If you believe you may need to be tested for COVID-19, begin by calling your primary care provider or local health department for screening and to set up an appointment for testing if recommended.

Rite Aid Michigan testing press release:

• https://www.riteaid.com/corporate/news/-/pressreleases/news-room/2020/rite-aid-expands-covid-19-on-site-testing-with-seven-new-locations-across-four-states

QM Mythbusters (in no particular order): 

• Mauricio Franco (he/him/his), M.S.- Global Medicine, Third year medical student.

• Andrew-Huy Dang (he/him/his), Third year medical student, B.S. Microbiology.

• Wyatt Shoemaker (he/him/his), Third year medical student.

• Antonio Flores (he/him/his), Second year medical student, B.S. Public Health Sciences.

• Daniel Pfau (they/them/theirs), Neuroscience PhD, Biological Sciences MS, Homeschool Teacher.

• Francis Yang (he/him/his), M.S.-Global Medicine, First year medical student.

• Kryssia Campos (she/her/hers), First year medical student.

• Alessandra Daskalakis (she/her/hers): First year medical student, B.S. Biology, B.A. Comparative Literature

• Grey L. Pierce (they/them); M.A., Cognitive Psychology; Assistant Director, Michigan State University (MSU) Usability/Accessibility Research and Consulting; Project Manager, State of the State Survey, MSU Institute for Public Policy and Social Research