April 26, 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!

Claim: Ingesting or injecting disinfecting products cleans the body from COVID-19 (FALSE)

Verdict: FALSE. Consuming or ingesting any disinfecting or cleaning products does not kill the virus that causes COVID-19 in the body. These products are meant to be used on exterior surfaces and can cause serious damage to the body if used inappropriately and can even lead to death. 

Bleach, a common disinfectant, can cause irritation in the eyes, mouth, lungs, and on skin when not diluted appropriately. Bleach causes irritation and cell death by protein denaturation and its effects are more severe in the more sensitive tissues such as the respiratory system and eyes.

Benzalkonium chloride, a common ingredient in household disinfectants, may cause nervous system depression, muscular weakness, corrosive injuries to the gastro-intestinal tract, kidney damage, and death if ingested orally. All disinfecting products should be used according to the instructions.

If you or someone you know ingests or injects bleach or other cleaners, call the Poison Control Help Line at 1-800-222-1222 or visit their website (https://www.poisonhelp.org/help) immediately for assistance! For more information, visit the American Association of Poison Control Centers website (https://aapcc.org/).

Sources:

• https://www.nytimes.com/article/coronavirus-disinfectant-inject-ingest.html

• https://www.ncbi.nlm.nih.gov/books/NBK441921/

• http://www.tjfmpc.gen.tr/2014_4/5_29-1406791026_TYP.pdf

• https://aapcc.org/

Claim: “People are sharing hormones on Google Docs and turning to 'grey market' pharmacies to get gender-affirming care during the pandemic” 

Clarification: If you were receiving care for hormone replacement therapy before the pandemic, and are currently still insured, the shutdown of services should not affect your access to hormone replacement therapy. Queering Medicine recommends you contact your provider and pharmacy to clarify any changes in hours and procedures for scheduling appointments and re-filling prescriptions. If you have recently lost your insurance, call your local Federally Qualified Health Center- like Forest Community Health Center or free clinic to know your options. Turning to alternate market sources for medications and healthcare products are a direct result of institutional and societal oppression. Transgender and non-binary people seeking hormone-replacement therapy often face discrimination. Individuals have been turning to the “grey markets” well before the coronavirus pandemic because of these barriers. If we cannot eliminate the disparity and inequality that drives people to use “grey markets,” at the very least, we can provide support and safety as folks use these outlets. Being able to affirm yourself and live authentically is critical to feeling whole. Harm-reduction and risk-reduction practices are essential as folks navigate hormone replacement therapy outside of medical care. When sharing hormones, it’s important to always use clean needles. Each person should have their own set of clean/sterile needles. For free access to needles contact the Lansing Syringe Access organization or your nearby identified North American Syringe Exchange Network resource. 

Key takeaways from the Insider article: 

• • “The spread of the virus means many people have lost income, health insurance, or easy access to their doctor's office, all of which has made it more difficult for some to access hormone-replacement therapy.”

  • “While the pandemic has highlighted the practice, hormone sharing isn't new. Many transgender and nonbinary people have long lacked access to gender-affirming care because of systemic factors such as classism, racism, and medical transphobia.”

Article

• https://www.insider.com/transgender-people-turn-to-grey-market-for-hormones-during-pandemic-2020-4 

Resources:

Forest Community Health Center 

• http://hd.ingham.org/seekingcare/communityhealthcenters/locationshours/forestcommunityhealthcenter.aspx

  • Number: 517-887-4302

Lansing Syringe Access

• https://www.facebook.com/lansingsyringeaccess 

North American Syringe Exchange Network

Details on COVID-19 complications: Blood clots, kidney failure, and other issues causing deaths in COVID-19 patients (not just respiratory complications) 

There have been wide-ranging complications reported from COVID-19 patients, including symptoms of stroke (numbness, tingling, inability to move), heart damage, gastrointestinal symptoms such as nausea and emesis, and seizures. Pre-existing blood vessel damage seems to be a risk factor for poorer COVID-19 outcomes, given that patients with diabetes, hypertension, obesity, and normal aging are at an increased risk for developing worse COVID-19 infections. Due to the increased blood clotting levels seen in patients with COVID-19, this may translate to damage to specific organs, explaining why such a wide-range of symptoms may exist. In addition, ACE2 receptors are found in a variety of cells in the body, including the gut, which could explain the reports of as much as 20% of diarrhea symptoms in COVID-19 patients.

Links:

• https://www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes 

• https://www.cnn.com/2020/04/17/health/coronavirus-kidney-dialysis-need/index.html

• https://7news.com.au/lifestyle/health-wellbeing/covid-19-can-cause-sudden-strokes-in-young-adults-doctors-say-c-994178 

Directly From The World Health Organization (WHO):

Source: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters 

Claim: The “curve is flattening,” so it’s safe to end stay-at-home orders and reopen businesses.

Verdict: While it is certainly good news that the curve is flattening in some areas of the United States, we should continue to stay vigilant and listen to the recommendations from our public health experts on adapting to a careful “new normal.”  The curve is one metric on how effective our social distancing practices are at preventing our healthcare systems from being overburdened resulting in more saved lives. Flattening the curve does not mean that the virus that causes COVID-19 has been eliminated from our communities. This virus manufactures more of itself in human hosts and spreads mainly from person-to-person. As long as there are a couple of people infected with the virus, it’s entirely possible for our communities to see new outbreaks. This is especially true when there are asymptomatic transmissions, inadequate widespread testing, and the lack of a vaccine and treatment for the COVID-19. If the 1918 Pandemic has taught us anything, we know that social distancing works and that relaxing these practices prematurely may result in rebound outbreaks and unnecessary deaths. In the figure shared below, Michigan imposed social distancing measures during the 1918 Pandemic which resulted in a flattening of the curve (reduced excess deaths). Michigan prematurely relaxed these social distancing measures in several counties which resulted in new outbreaks and prolonged the pandemic. Reopening America will most likely be slow, careful, and systematic as to mitigate the risk of resurgence and protect our most vulnerable. In the meantime, continue to social distance, wash your hands, and disinfect. We know it’s difficult to be away from your loved ones, or adjust to unforeseen COVID-19 related circumstances. Please feel free to reach out to QM if you are having difficulty connecting to resources. We are strong together on this.

References:

• Chandra, Siddharth. “What Can We Learn from the 1918 Influenza Pandemic?” HM 619/553: CLINICAL KNOWLEDGE, ETHICS, EPIDEMIOLOGY IN PANDEMICS. 2020, East Lansing, Michigan State University College of Human Medicine. (https://www.justintimemedicine.com/CurriculumContent/p/6641)

• https://www.theatlantic.com/ideas/archive/2020/03/interview-francis-collins-nih/608221/ 

• https://www.whitehouse.gov/wp-content/uploads/2020/04/Guidelines-for-Opening-Up-America-Again.pdf 

Claim: An alkaline diet will protect you from getting the virus that causes COVID-19 (FALSE)

Verdict: False. An alkaline diet, or any attempts to change your body’s pH, will NOT protect you from getting the virus that causes COVID-19. There are negative health implications from having an imbalanced body pH. Doctors often use your body’s pH as a measurement of your body’s ability to respond to health insults. It is difficult for a diet alone to change your body’s pH because this is a tightly regulated process. Before trying any diet for therapeutic reasons, check in with your healthcare provider. As of today’s posting, “there are no drugs or other therapeutics approved by the US Food and Drug Administration to prevent or treat COVID-19.” The best way to prevent illness is to avoid being exposed to the virus. The CDC recommends that everyone clean their hands often, avoid close contact, cover your mouth and nose with a cloth face cover when around others, cover coughs and sneezes, and clean and disinfect frequently touched surfaces.

The myth cited a research paper published in the American Society of Microbiology Journal of Virology in 1991. The paper originally reported that altering the pH, or changing the acidity, of the cell’s environment may inhibit viral entry. The paper also added that this pH dependence was highly variable. There are several flaws with drawing connections between the virus that causes COVID-19 and these findings. The study was performed on the coronavirus mouse hepatitis virus type 4 (MHV4) which is not the virus that causes COVID-19 in humans. Additionally, the researchers studied the impact of pH alteration in a lab that does not reflect the complex environment of the human body. The human body’s pH is very tightly regulated so that the cells are able to function optimally. Any changes to the body’s pH will be short lived due to the body’s tendency to correct back. For these reasons, the myth made incorrect inferences from the research paper.

References:

• • https://www.reuters.com/article/uk-factcheck-coronavirus-alkaline/false-claim-bicarbonate-soda-and-lemon-juice-can-help-prevent-coronavirus-infection-idUSKBN20X2BV

  • https://www.cdc.gov/coronavirus/2019-ncov/hcp/therapeutic-options.html

  • https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

  • https://jvi.asm.org/content/jvi/65/4/1916.full.pdf

  • https://www.mdanderson.org/publications/cancerwise/alkaline-diet--what-cancer-patients-should-know.h00-159223356.html

Update on Executive Order: Michigan Covid restrictions

Governor Whitmer has lifted some restrictions and added others per the newest executive stay-at-home order, which is now extended until May 15. The order continues to require a distance of at least 6 feet while in public to decrease chances of COVID-19 transmission. A new requirement is that those who can “medically tolerate” wearing a mask that covers the face and nose must wear one in enclosed public spaces, such as grocery stores and post offices. In addition, employers must provide in-person workers with a mask. For both the general public and essential workers, there will not be a criminal penalty for not wearing a mask, although some stores already mandate that workers wear one. Per Governor Whitmer’s newest orders, there will continue to be restrictions on the number of people allowed in a store at one time. From a medical research standpoint, it is unclear whether masks reduce transmission of COVID-19 in a public setting because there hasn’t been time to produce the quality and strength of a study to demonstrate this point, given how relatively new COVID-19 is. However, medical journals have advised that given the seriousness of COVID-19, a more cautious approach should be adopted, and the general public should wear face masks because of their potential effectiveness and low cost. 

No penalties for violating mask policy: 

• Lansing police say they will not be penalizing individuals who do not wear masks

• https://www.lansingcitypulse.com/stories/no-penalties-for-violating-michigan-face-mask-order,14278

View Executive Order here: 

• https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-526894--,00.html 

Direct from the Michigan.gov COVID-19 FAQs:

I think I was exposed to COVID-19, what do I do?

If you think you have been exposed to someone who is sick with COVID-19, you should stay home and away from other people. If you develop symptoms (cough, fever, shortness of breath), and are concerned about your health, contact your healthcare provider to discuss your symptoms.

If your local health department contacts you, you should follow their directions carefully.

Information for more specific experiences can be found below based on the person you may have interacted with and if you were in close contact with that person.

A) I have been around someone who is sick. Do I need to self-quarantine? 

If you have been around someone who is sick with respiratory illness (cough, fever, shortness of breath) you should try to self-quarantine to the best of your ability (try to stay home and away from others). You should continue frequently washing your hands, covering your coughs and sneezes, and cleaning and disinfecting high-touch surfaces.

B) I’ve been around someone who has been diagnosed with COVID-19. Do I need to self-quarantine? 

• If you were not considered a close contact:

In general, it is encouraged that people stay home right now, as much as possible. Of course, if you develop symptoms (cough, fever, shortness of breath), and are concerned about your health, contact your healthcare provider to discuss your symptoms.

• If you are a close contact:

You should self-quarantine away from others for 14 days since the last day you had contact with that person. It is possible that your local health department will call you to discuss your risk, you can also reach out to your local health department. If you develop symptoms of respiratory illness (fever, cough, shortness of breath), and are concerned about your health, please call your healthcare provider.

Close contact is defined as:

1. Being within approximately 6 feet (2 meters) of a COVID-19 case for a prolonged period of time.

or –

2. Having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on).

• If you are a healthcare worker, follow your facility’s guidance.

C) Someone I was in close contact with was in contact with someone who tested positive (3rd party exposure). For example, a close friend of my spouse has been diagnosed, and they recently spent time together.

You should monitor yourself for symptoms of respiratory illness (cough, fever, shortness of breath) and remember to practice good social distance, but quarantine is not required. If you develop any symptoms (fever, cough, shortness of breath), you should self-isolate at home and contact a healthcare provider if you are concerned about your health.

D) Someone in my household was exposed (as a close contact) to someone who tested positive for COVID-19. What should I do?

Have that person in the household self-quarantine for 14 days while monitoring for symptoms. Follow appropriate precautions for cleaning, hand hygiene, respiratory etiquette. If you receive any instructions from that person’s employer or the local health department, follow them carefully.

You should monitor yourself for symptoms of respiratory illness (cough, fever, shortness of breath) and remember to practice good social distancing. If you develop any symptoms (fever, cough, shortness of breath), you should self-isolate at home and contact a healthcare provider if you are concerned about your health.

https://www.michigan.gov/coronavirus/0,9753,7-406-98810-524163--,00.html

How do I monitor myself for COVID-19 symptoms?

Screen yourself for symptoms of respiratory illness such as cough, fever, and shortness of breath. If you develop symptoms and are concerned about your health, contact your healthcare provider. If you are under an isolation or quarantine order, you will need to report your symptoms to the local health department.

 If your local health department or healthcare provider has instructed you to quarantine, stay home and away from others to the extent possible.

• If the local health department has instructed you to isolate, you are required to stay home.

• Under the Stay Home, Stay Safe Executive Order, everyone is required to stay home except for essential needs.

https://www.michigan.gov/coronavirus/0,9753,7-406-98810-524141--,00.html

What do I do if I think I need to be tested for COVID-19?

If you are experiencing respiratory illness or other severe or concerning symptoms and you are concerned about your health, call your healthcare provider to discuss your symptoms.

Your healthcare provider might ask you to come in for an appointment or set up a virtual appointment. They will decide if you need to be tested based on signs and symptoms of respiratory illness and your potential exposure. They also try to rule out other causes for respiratory illness.

• If your healthcare provider decides it is necessary to test for COVID-19, they will take the sample and order testing. You will receive your results from your healthcare provider.

• If your healthcare provider decides it is not necessary to test for COVID-19, and you do not agree, you could consider getting a second opinion.

• If your healthcare provider does not offer COVID-19 testing, and you are concerned about your health, you should contact a different healthcare provider.

Testing is prioritized for high-risk individuals and those that may pose a risk to the public according to the guidelines released by the U.S. Department of Health and Human Services.

Where can I get tested for COVID-19?

COVID-19 Test Finder link: Please be aware that most locations will need to screen via phone to determine need for testing. Most testing will require a lab order from a physician or provider. 

https://www.michigan.gov/coronavirus/0,9753,7-406-98189---,00.html

What do I do if I am sick and do not have a healthcare provider?

Call an urgent care center to discuss your symptoms (Below are two frequently used clinics)

• Sparrow Urgent Care- MIchigan Avenue: (517) 364-9790 

• Lansing Urgent Care: (517) 999-2273

https://www.michigan.gov/coronavirus/0,9753,7-406-98810-524170--,00.html

A co-worker tested positive for COVID-19, should I be concerned?

If you’ve been in close contact with the co-worker: You should self-quarantine away from others for 14 days since the last day you had contact with that person. Monitor yourself for respiratory illness symptoms (cough, fever, shortness of breath) and contact your health provider if you are concerned about your health.

If you have not been in close contact with your co-worker: Monitor yourself for respiratory illness symptoms (cough, fever, shortness of breath) and contact your health provider if you are concerned about your health.

https://www.michigan.gov/coronavirus/0,9753,7-406-98810-524164--,00.html

Are some people at greater risk for getting the COVID-19 virus?

COVID-19 is a new disease and there is limited information regarding risk factors for severe disease. Based on currently available information and clinical expertise, older adults and people of any age who have serious underlying medical conditions might be at higher risk for severe illness from COVID-19.

Based on what we know now, those at high-risk for severe illness from COVID-19 are:

• People aged 65 years and older

• People who live in a nursing home or long-term care facility
   

People of all ages with underlying medical conditions, particularly if not well controlled, including:

• People with chronic lung disease or moderate to severe asthma

• People who have serious heart conditions

• People who are immunocompromised

  • Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications

• People with severe obesity (body mass index [BMI] of 40 or higher)

• People with diabetes

• People with chronic kidney disease undergoing dialysis

• People with liver disease

Reminder: It is important to remember that stigma and discrimination occur when people associate an infectious disease, such as COVID-19, with a population or nationality. COVID-19 does not target people from specific populations, ethnicities, or racial backgrounds.

https://www.michigan.gov/coronavirus/0,9753,7-406-98810-524145--,00.html

Is there something I can do to help? Are volunteers needed?

For healthcare workers: Michigan Volunteer Registry is the system used to pre-identify and preregister credentialed healthcare workers. If you are not currently registered, and want to be prepared to serve, register MIVolunteerRegistry.org.

Local communities may have needs for food distribution and other support services. If you are not sure how to get connected to local volunteer projects, you can call 2-1-1 to find out.

To ask about donating material, email the Michigan Community Service Commission at COVID19Donations@Michigan.gov.

https://www.michigan.gov/coronavirus/0,9753,7-406-98178_98811---,00.html

How do I apply for Unemployment Insurance benefits?

The Michigan Web Account Manager (MiWAM) is the Unemployment Insurance Agency’s (UIA) system for filing your unemployment insurance claim and managing your UIA account online.

Below is the link to the full FAQ containing links to MiWAM as well as additional information on unemployment

• https://www.michigan.gov/coronavirus/0,9753,7-406-98810-526396--,00.html

Link to MiWAM

• https://miwam.unemployment.state.mi.us/ClmMiWAM/_/

Unemployment 101

• https://www.michigan.gov/documents/leo/UIA_101_3-20_draft_4_FINAL_684758_7.pdf

What can I do if my employer is not adhering to the CDC recommendations/guidelines (e.g. providing PPE, disinfecting workplace, working with sick or exposed workers?

Unless an executive order has made following Center for Disease Control (“CDC”) guidelines mandatory, such as for nursing homes (EO 2020-50), CDC materials on COVID-19 are not mandatory. Nevertheless, Michigan Occupational Safety and Health Administration (MIOSHA) may take enforcement action against employers for not following CDC recommendations/guidelines in certain situations. If an employee files a complaint with MIOSHA, MIOSHA staff will contact management representatives and communicate the CDC guidance to determine whether the employer has implemented them.

The FAQ link is below with additional information on PPE usage and CDC guidance

https://www.michigan.gov/coronavirus/0,9753,7-406-98810-526711--,00.html

Can I be fired for refusing to come to work if I’ve tested positive?

Even if you have been designated as a critical infrastructure worker, you cannot be compelled to work if you have testified positive for COVID-19 and have been instructed by your medical care provider or public health authority to quarantine. During the quarantine period an employer should not require an employee to work outside of the employee’s home or work against physician’s orders. 

https://www.michigan.gov/coronavirus/0,9753,7-406-98810-524769--,00.html

Link to All FAQ’s

https://www.michigan.gov/coronavirus/0,9753,7-406-98810---,00.html?page=1&limit=25&filterCategories=&searchQuery=

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.

• 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