May 17, 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!

High-dose chloroquine/hydroxychloroquine used for the treatment of COVID-19 carries a higher risk of toxicities 

Despite initial optimism over the possibility of repurposing chloroquine/hydroxychloroquine for the treatment of COVID-19, neither drug appears to be the silver bullet that was hoped for, and neither is expected to be able to be used as a treatment for the disease. Chloroquine and hydroxychloroquine were originally FDA-approved medications to treat or prevent malaria, a mosquito-borne infectious disease. These drugs garnered major attention from early studies that showed in vitro (in a lab environment) antiviral activity against the virus that causes COVID-19 when used in high concentrations. Published recently, a JAMA (Journal of the American Medical Association) study investigated the safety and efficacy of high-dosage chloroquine in a randomized controlled trial of 81 adult patients who were hospitalized with COVID-19. The researchers concluded that the higher chloroquine dosage when compared to low-dosage was associated with a higher risk of cardiac toxicities (i.e., it poses significant health and safety risks). In response, the National Institute of Health (NIH) “recommends against using high-dose chloroquine for the treatment of COVID-19.” The NIH is an agency of the United States government that provides treatment guidelines based on biomedical and public health research.

Key takeaway: Without a doubt, there is a dire need for effective COVID-19 treatment; however, any medical intervention must be supported by evidence of its efficacy and safety. There are countless times where effective drugs initially backed by positive clinical observations were withdrawn because they were later demonstrated to be unsafe. While it is disheartening to learn about the results of this JAMA study, we remain hopeful that a safe and effective intervention will be discovered or developed that takes us beyond just supportive care for COVID-19.

Sources:

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

• https://www.covid19treatmentguidelines.nih.gov/whats-new/

• https://www.fda.gov/safety/medical-product-safety-information/hydroxychloroquine-or-chloroquine-covid-19-drug-safety-communication-fda-cautions-against-use

“COVID Toes”

In recent weeks, there have been reports of  “COVID Toes,” which some people suspect is another possible symptom amongst the wide range of possible symptoms for COVID-19 that have been reported thus far. “COVID Toes” refers to lesions in the toes and possibly fingers of people with the disease. These lesions may initially appear red and raised, then over time may appear more flat and rash-like. Reports have stated that these resemble chilblains, lesions that are typically triggered by repeated exposure to cold environments. They result in painful inflammation of extremities such as in your toes and fingers, and may present with itching, red patches, swelling, and blistering. Most cases so far have been reported in younger COVID-19 patients. There are also multiple hypotheses surrounding “COVID Toes,” such as this reaction being a potential sign of mild infection, with it being an immune response to the virus. More information is being researched on this topic, but so far reports state that it is not an indicator of severe COVID-19 disease, presents more in younger populations, and that the lesions disappear on their own. Some physicians, however, have argued that having these symptoms should be grounds for possible testing, and that if you have “COVID Toes,” it can be an indicator of COVID-19 infection. It is still recommended that if you suspect you have COVID-19 you should contact your primary care physician or a healthcare provider. 

So, what does this mean?

• New symptoms continue to be recognized, demonstrating that those infected with the virus that causes COVID-19 do not all present the same. As such, we should continue to stay aware of new signs and symptoms. This pandemic continues to be VERY REAL and medical professionals and scientists continue to conduct research and learn about it. 

• “COVID Toes” seem to be more common in younger populations who are at lower risk of severe disease.

• To date (according to our searches), there have been no lost toes or extremities that are related to “COVID Toes,” nor has there been any need for amputation related to it.

• “COVID Toes” could still be an indicator of being seropositive for COVID-19 and grounds for testing; contact a healthcare provider if you suspect you may have COVID-19.

The CDC COVID-19 Symptoms page lists the following symptoms as of May 13, 2020:

• • Cough

  • Shortness of breath or difficulty breathing

  • Fever

  • Chills

  • Muscle pain

  • Sore throat

  • New loss of taste or smell

  • Less common symptoms include gastrointestinal symptoms like nausea, vomiting, or diarrhea.

The CDC website also gives the following guidelines on when to seek emergency medical care:

Look for emergency warning signs* for COVID-19. Seek emergency medical care immediately if someone is showing any of these signs

• Trouble breathing

• Persistent pain or pressure in the chest

• New confusion

• Inability to wake or stay awake

• Bluish lips or face

*This list is not all possible symptoms. Please call your medical provider for any other symptoms that are severe or concerning to you.

Call 911 or call ahead to your local emergency facility: Notify the operator that you are seeking care for someone who has or may have COVID-19.

Sources: 

• Are COVID Toes and Rashes common symptoms of COVID-19?
  https://health.clevelandclinic.org/are-covid-toes-and-rashes-common-symptoms-of-coronavirus/

• What is “COVID Toe?” Maybe A Strange Sign of Coronavirus Infection
  https://www.nytimes.com/2020/05/01/health/coronavirus-covid-toe.html

• 'COVID Toes' and 'Kawasaki' Rash: 5 Cutaneous Signs in COVID-19
  https://www.medscape.com/viewarticle/930180

• CDC COVID-19 Symptoms Page
  https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

Isolation Fatigue is Real

Our frustrations are real, our anger and sadness are real, our sense of loss and longing are real, and the want to get outside with our loved ones is real! 

Queers have always been creative at finding new ways to connect, to exist, and to build community. Now is the time to challenge ourselves to work through this longing and discover new ways of building meaning with one another. 

We recognize that too often those sharing data and critical knowledge do not always frame things in ways that are easy to understand or digest, but we are doing our best to help translate things for a broader audience. Many aspects of this pandemic data can be fatiguing and overwhelming, much like impacts of physical distancing and stay-at-home orders. Every week we research myths, claims, recommendations, and articles so that our Queering Medicine community does not feel overwhelmed by having to sort through the endless information floating around on their own. We firmly believe that the “Stay Home, Stay Safe” order is the best way to flatten the curve and contribute to reducing the spread of the virus to protect our families, neighbors, friends, and community. To do otherwise puts the most vulnerable at risk. It puts our immunocompromised community members at risk, our elders, and anyone else living with chronic illness. Together, we can continue to keep one another safe. Together, by following stay-at-home orders, we can save lives. 

Like other public health crises, risk reduction is also key, and is critical during these times. So as you contemplate the stay-at-home order, consider the idea that this will be our “new normal” for some time, and as such, we need to find strategies and coping mechanisms that work best for ourselves. Your mental health is extremely important, and should not be neglected. Some folks are using this time as a way to connect with folks virtually, finish a project they never really had the time to do before, teach themselves a new skill, or refocus their life goals all while respecting social distancing practices. We recognize not everyone can do these things, and not everyone has the capacity or living circumstances to explore new ideas. While we hope everyone continues to keep safe distances, limiting times out in public and keepings from being in groups is not an all-or-nothing situation. It is important that we recognize there are systems, factors, and leaders (at domestic and global levels) that have failed to keep us safe; and it is their job just as much as our personal responsibility to end this pandemic. 

It is important to acknowledge that watching community members break stay-at-home practices (such as not wearing masks in public, not keeping 6 feet apart from others, and meeting up in groups with others in public places, to name a few) can be frustrating. “Essential” workers and those that are high risk to COVID-19 do not have that option as they would put others and themselves at risk. People are suffering and dying from COVID-19, and people are being put at higher risk due to the actions of others. People have a right to be angered when they see people ignore some or all aspects of physical distancing requirements. The answer is not shaming the anger folks have in these moments or ableism, nor is policing peoples’ isolation practices. Reasons for frustration and bending social distancing practices may not always be clear to us. Instead, open and honest conversations, calling-in (the practice of pulling someone aside to share feedback), and talking about how decisions to break stay-at-home orders are dangerous are essential in changing these dangerous behaviors. Breaking stay-at-home orders, like protesting outside of the capitol, is not the answer. Our hope is that QM promotes a safe space, a space to learn more about this pandemic, and most importantly a space for folks to feel connected. We uplift the practice of queer folk practicing stay-at-home and physical distancing measures with love, with patience, and with honest communication with their kin.

Point of clarification: 

• Quarantine is only imposed on those known to be exposed to a contagion, and is a total lock-down (i.e., you cannot leave your home for any reason, other than to go to a hospital). 

• Stay-at-home orders are broader in who they impact, and far less restrictive (e.g., you can go out for a walk, you can pick up groceries, etc.).

Suggested article: 

• https://www.theatlantic.com/ideas/archive/2020/05/quarantine-fatigue-real-and-shaming-people-wont-help/611482/ 

Key takeaways: 

• Public health experts have known for decades that an abstinence-only message doesn’t work for sex. It doesn’t work for substance use, either. Likewise, asking people to abstain from nearly all in-person social contact indefinitely is not the solution, though doing so may be necessary for several months in order to get a handle on things.

• Policymakers and health experts can help the public differentiate between lower-risk and higher-risk activities; these authorities can also offer support for the lower-risk ones when sustained abstinence isn’t an option. 

• Scientists still have a lot to learn about this new virus, but early epidemiological studies suggest that not all activities or settings confer an equal risk for coronavirus transmission.

• What people need now is advice and support on how to have a fulfilling and healthy life during a pandemic.

Buildings Closed by COVID-19 can be contaminated with Legionella  

The COVID-19 pandemic has led to the closure of buildings for many weeks. Stagnant or standing water can increase Legionella growth, a bacterium that can cause a severe type of lung infection (pneumonia), also known as Legionnaires' disease. In addition, it can cause Pontiac fever, which is a mild flu-like illness that causes fever and muscle aches.  This bacterium usually lives in freshwater environments and can grow in a building's water systems when there is decreased water flow, which leads to changes in water temperature and insufficient levels of disinfectants such as chlorine.

A person can become infected with Legionella when they breathe in the droplets from the contaminated water. The CDC recommends that buildings take the following steps before opening:

1. Develop a comprehensive water management program (WMP) for your water system and all devices that use water. 

2. Ensure the water heater is properly maintained by checking manufacturer recommendations and set it to at least 140°F.

3. Flush hot and cold water system through all points of use (sinks, showers, faucets, etc.), and flush with hot water until water reaches its maximum temperature in all fixtures

4. Clean any decorative water features, such as fountains, and ensuring they are free of slime or visible film

5. Clean hot tubs/spas

6. Ensure cooling towers are clean and well-maintained

7. Ensure safety equipment including fire sprinkler systems, eye wash stations, and safety showers are clean and well-maintained by flushing and disinfecting them

8. Maintain the water system, and reach out to the local water department to inquire about recent disruptions or problems in your area

For detailed information on the above, please visit the following website: https://www.cdc.gov/coronavirus/2019-ncov/php/building-water-system.html

Speaking (not just coughing) can spread the virus

Why this matters: 

• 1. This study shows how important it is to wear masks and is a reminder that asymptomatic transmission is a big risk to the community. 

  2. Coughing is not a reliable measure for determining safety -- you can still get infected even if nobody is coughing. 

  3. Having close interactions and conversations with others poses a risk for transmission. 

Links

• https://www.nejm.org/doi/full/10.1056/NEJMc2007800?query=featured_coronavirus 

• https://www.usatoday.com/story/news/nation/2020/05/13/closed-environments-high-risk-coronavirus-infections/5186862002/

COVID-19 and Semen

A recent study discovered the virus that causes COVID-19 in the semen of COVID-19 patients. Of the 38 participants in the study, all of whom had COVID-19, 6 patients had the virus in their semen. Four of the patients were in the early stage of disease and two patients were in recovery when their semen was collected and tested. The study was limited in the length of its follow up, so it is unclear how long the virus can be detected in semen during and/or after recovery. Further research is needed to explore whether or not the virus can be transmitted person-to-person via semen, other sexual fluids, or sexual contact. The testes, where sperm is produced, are a part of the human reproductive system that some viruses can use to hide from the immune system. As of the writing of this post, the CDC has not given any formal recommendations or updated their information to reflect the results of this study. Regardless of whether or not COVID-19 can be transmitted via semen, it is important to remember that COVID-19 infection can’t be prevented by traditional “safe sex” practices—if you’re sharing the same air as someone, you’re at risk.

Key takeaways: 

• Although viral particles have been found in the semen of COVID-19 patients during sickness and during recovery, it is too early to tell if the viral materials found in semen can spread the virus. 

QM continues to advocate and support SEX positivity. Risk reduction, conversations around risk, and consent are always SEXY! Take a look at our recommendations on sex during the pandemic: QM SEX during a pandemic 

• https://www.cnn.com/2020/05/07/health/coronavirus-semen-china-health/index.html

• https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765654

• https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-sex-guidance.pdf

• https://youtu.be/a4IYkVkFLkg

COVID-19 and Sewage

The question has recently been raised whether the virus in feces poses a potential infection threat to people through water contamination, especially those working at wastewater plants and those living near recreational water areas and drinking water reservoirs that are vulnerable to sewage overflow. Previous research shows that viral genetic material has been found in patients 30+ days after symptoms have subsided, and fecal-oral transmission is still being studied. Other coronaviruses have proven to be viable in sewage for up to 14 days, depending on environmental variables. 

As of now there is no evidence of transmission via sewage aerosols or contaminated drinking water. Although the virus has been detected in sewage, there has not yet been research to confirm that the detected viral genetic material is capable of infecting people. Standard water treatment and sanitation procedures at large facilities make the risk of transmission via drinking water low, according to the CDC. Private wells do not appear to apply to the current concerns because they do not connect to communal infrastructure. Researchers, water experts, and community groups are advocating for more research, financial support and precautions to ensure the safety of workers at water and sewage treatment facilities, as well as residents in areas without clean water and/or with aging infrastructure.

Key Takeaway: 

•  Various experts and community groups are advocating for more research to better understand if viral materials in sewage pose a risk for infection. 

• People are wanting to see if sewage overflow into recreational water areas and drinking water reservoirs may need additional attention and precautions in order to prevent the spread of COVID-19. 

• Sewage under high pressure at treatment facilities may produce aerosols with the virus, but research has not been done to identify if this is happening and/or if there are any risks. 

Links: 

• https://www.sciencedaily.com/releases/2020/05/200506133603.htm

• https://truthout.org/articles/spills-from-outdated-sewers-pose-coronavirus-risk-to-drinking-water/ 

• https://www.cdc.gov/coronavirus/2019-ncov/php/water.html

• https://www.wef.org/news-hub/wef-news/coronavirus-and-water-systems/

• https://www.smithsonianmag.com/science-nature/how-wastewater-could-help-track-spread-new-coronavirus-180974858/

Stay-At-Home Order Challenged in Court

Republicans in the Michigan State Senate and House of Representatives filed a lawsuit claiming that Governor Whitmer does not have the power to unilaterally extend the stay-at-home order. The dispute centers on the Emergency Powers of Governor Act of 1945 (which some argue was intended only for local emergencies) and the Emergency Management Act of 1976 (which requires legislative approval to extend a state of emergency beyond 28 days, but does not explicitly state that a new order cannot be issued to restart the clock). Many legal experts have said the Governor's stay-at-home orders appear to be legal, and fall within the powers granted by the two Acts, but only the courts can decide the matter. The legislature may also attempt to pass a law to restrict the Governor's powers, but the Governor has promised to veto any such legislation.

Oral arguments in the case were heard by the Michigan Court of Claims on May 15th, and while a ruling is likely to come later next week, it is not expected to be final, as the case will almost certainly be appealed to the Michigan Supreme Court.

In the meantime, the stay-at-home order is considered legal and must be followed. The mere presence of a court case (as opposed to a ruling or injunction) has no bearing on the legality or enforceability of an existing law or executive order (major actions by the Governor and legislature are frequently challenged in court, but are rarely overturned).

Additionally, while the Wisconsin Supreme Court recently overturned that state’s stay-at-home order, the ruling has no bearing on the case in Michigan. Different states provide different powers to their governments, and the laws allowing the Governor of Michigan to issue a stay-at-home order are entirely different from those in Wisconsin. 

More information: 

• https://www.freep.com/story/news/local/michigan/2020/05/15/whitmers-coronavirus-emergency-order-michigan/5198336002/ 

Increased COVID-19 Risk for Transgender People; Telemedicine as Healthcare Option 

UCLA’s Williams Institute reported that about 1 in 4 of the estimated 1.2 million transgender people in the US are at an increased risk for COVID-19 due to underlying lung or heart disease, being age 65 or over, being immunocompromised, or being a current smoker. However, this number is likely to be higher given that poorer outcomes have been linked with lower socioeconomic status and with delays in treatment for medical conditions (which can occur due to fear of being rejected). Additionally, an estimated 1 in 10 transgender individuals report being uninsured. 

QM is sharing this data, not to alarm queer communities, but to underscore the need for queer health to be uplifted. One way to do this is to bring visibility to queer healthcare needs. This speaks to our commitment to queers taking their health into their own hands by seeking sustainable healthcare system changes.

Healthcare providers have routinely used telemedicine and telehealth appointments to see their patients, and this might be a better option for individuals who have underlying health conditions like the ones listed above, who want to minimize exposure to the public, or who have difficulty finding an affirming provider within driving distance. Ask your provider or insurance company if telemedicine is an option for you. If you do not have insurance and are wondering if you may qualify for a health plan sponsored by the state government, see the following websites: 

• https://www.michigan.gov/healthymiplan/0,5668,7-326-67875---,00.html

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

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