May 24, 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!

Changes to Stay-at-Home Order

Governor Whitmer has issued several new Executive Orders that loosen the restrictions of the stay-at-home order. The most significant changes are:

• • The stay-at-home order has been extended through June 12.

  • "Individuals may leave their home or place of residence, and travel as necessary...To attend a social gathering of no more than 10 people," so long as they follow social distancing recommendations (e.g., staying at least six feet apart).

  • "permitting retailers and motor vehicle dealerships to see customers by appointment, beginning on May 26, 2020".

  • "Individuals may...leave the home or place of residence to secure medication or to seek medical or dental care for themselves or a household or family member" and to seek veterinary services (until now, nonessential medical, dental, and veterinary care was not permitted).

  • All changes are still subject to the requirement that "All individuals who leave their home or place of residence must adhere to social distancing measures recommended by the Centers for Disease Control and Prevention (“CDC”), including remaining at least six feet from people from outside the individual’s household to the extent feasible under the circumstances." Additionally, “any individual able to medically tolerate a face covering must wear a covering over his or her nose and mouth—such as a homemade mask, scarf, bandana, or handkerchief—when in any enclosed public space.”

It is important to keep in mind that the pandemic is not over and the loosening of restrictions does not mean that the risk has been eliminated. COVID-19 cases still exist throughout Michigan; an average of 547 new cases were reported per day from May 15-May 22 alone. The virus is still present in our communities, we still do not have widespread testing, and we still do not have a vaccine to prevent COVID-19 infections or a medication to treat it. It is likely that new infections will result from the loosening of restrictions, and epidemiologists warn of a second spike in cases will follow. The loosening of restrictions is effectively a test - we won't know how safe it is for at least two weeks (it takes time for new cases to appear). Patience is critical: As a state, we are taking baby steps to see what can and cannot be done safely. Rushing into major changes (e.g., abandoning social distancing and trying to get back to exactly how we lived before the pandemic) would constitute an unacceptable risk to our communities, which is why it is essential that we still follow social distancing guidelines (like staying six feet apart and wearing a mask), even as we are allowed to have small gatherings.

Individuals who are concerned about catching or spreading COVID-19 may choose not to change their behavior yet (e.g., still remaining at home and not seeing friends or family in person). People, particularly those who are high-risk due to medical conditions, age, or other factors, should be cautious; being on the front lines of public exposure to see how much the virus is spreading is a significant risk with potentially deadly consequences. Additionally, disparities in vulnerability to COVID-19 related to socioeconomic status, access to health care, race, LGBTQ+ status, etc. continue to be present, and will likely continue to cause a greater number of infections and deaths among some populations. Do not pressure or shame people who do not want to take the risk of COVID-19 exposure. This is still a deadly virus, and staying isolated to avoid the risk of exposure is very reasonable, especially since we don't have widespread testing, a vaccine, or effective treatments.

It is critical that those who do choose to attend small social gatherings or elect to venture out to retail establishments adhere to social distancing and mask guidelines. Remaining six feet apart includes not hugging or shaking hands with each other, which can be emotionally difficult in times like these. Talking while wearing a mask and standing six feet apart may be annoying and uncomfortable, but it may be the only way to have conversations right now without putting ourselves and our friends, families, and communities at risk. Remember that we are still in the midst of a pandemic, and the new normal may not be the same as the old one for a long time.

Key recommendations: 

• Continue to stay at least 6 feet away from anyone that isn’t a member of your household

• Continue to wear a mask in public spaces, whether indoors or outdoors

• Continue to practice good hand hygiene (wash your hands and don’t touch your face)

• Do not gather in groups of more than 10 people, and remember to stay 6 feet away and wear a mask if you do visit with others

• Stay updated; changes are being made often and it is important to be aware of how they affect you

More information:

• “Whitmer extends stay-at-home order through June 12”: https://www.detroitnews.com/story/news/local/michigan/2020/05/22/whitmer-extends-stay-home-order-through-june-12/5247671002/ 

• “Whitmer allows doctor visits, auto sales by appointment, gatherings of 10 or less”: https://www.detroitnews.com/story/news/local/michigan/2020/05/21/governor-gretchen-whitmer-addresses-state-coronavirus-response-midland-flooding/5235067002/ 

• Executive Order 2020-96: https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-529860--,00.html 

• Executive Order 2020-97: https://www.michigan.gov/whitmer/0,9309,7-387-90499_90705-529864--,00.html

• Michigan COVID-19 Infection and Death Data: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html 

Carbon Dioxide Toxicity

Wearing a mask for prolonged periods of time will not result in breathing in dangerous levels of carbon dioxide. Oxygen and carbon dioxide gas molecules are very small, even smaller than the coronavirus, and can freely pass through surgical masks, N95s, cloth masks, and other recommended face coverings, allowing people to breathe safely. Individuals with chronic respiratory or cardiovascular conditions should speak with their health care provider if they are concerned about wearing a mask.

Helpful Link:

• https://www.forbes.com/sites/victoriaforster/2020/05/12/wearing-a-mask-to-reduce-the-spread-of-coronavirus-will-not-give-you-carbon-dioxide-poisoning/#5987caac17f5

Claim: Different strains of the virus causing COVID-19 have different severities (FALSE)

• Verdict: False

• There is currently no evidence that there are actually different strains of the virus causing COVID-19 and it will take more research to figure out whether different strains exist and if they influence symptoms. While there have been variations found in the genetic code of the virus, this is a normal part of genetic variation, and doesn’t yet point to a new strain with significantly different characteristics (even identical twins typically have slightly different genomes). 

• Source: https://www.theatlantic.com/health/archive/2020/05/coronavirus-strains-transmissible/611239/

Claim: Vitamin D reduces COVID-19 severity

Verdict: Mixed

• Vitamin D’s main function is to promote bone health. Researchers have been studying the role Vitamin D has on other aspects of promoting good health. It is not fully understood, but it has been shown to be an important molecule for your body's immune response. Having deficient vitamin D levels can lead to several issues, including inhibiting your immune response. Researchers found that individuals with low vitamin D had more severe COVID-19 outcomes, but this does not mean having higher than normal vitamin D levels will increase your immune response or decrease COVID-19 severity. The researchers did not examine vitamin D supplementation. If you are worried that your vitamin D levels are too low, you can ask your doctor to do a blood test to determine levels and then, if necessary, treat the deficiency. 

Key takeaways:

• Vitamin D Protects your bones

• Vitamin D has a role in our immune response, but the specifics are not well understood. 

• QM does not recommend you exceed your daily recommended intake of Vitamin D- increasing your Vitamin D levels beyond normal values can also have negative effects. 

Links:

• News: https://www.sciencedaily.com/releases/2020/05/200507131012.htm 

• Article: https://link.springer.com/article/10.1007/s40520-020-01570-8 

Children are developing a novel health condition associated with COVID-19 that resembles Kawasaki disease

Children in Los Angeles and New York were recently found to have symptoms resembling Kawasaki disease (Kawasaki disease is a form of vasculitis—a family of rare disorders characterized by inflammation of the blood vessels), but research shows that it may be a new condition associated with COVID-19. This condition, now called MIS-C (Multisystem Inflammatory Syndrome in Children), is an inflammatory disorder in children that leads to similar symptoms but is not Kawasaki disease. It was also formerly known as PIMS (Pediatric Inflammatory Multisystem Syndrome).. MIS-C’s’ relation to inflammation is how this has been connected to COVID-19, which is well-known for inducing a widespread inflammatory response in the body. Symptoms of MIS-C include high fever, rash, red eyes, red tongue, swollen hands and feet, and cracked lips. 

• If you think your child has MIS-C, contact your doctor or pediatrician as soon as possible

• Your child’s doctor or pediatrician is likely to discuss several symptoms with you, and will be particularly alert to children who have experienced a high fever for four or more days combined with other symptoms that may include:

  • Abdominal pain without another explanation

  • Both eyes appearing pink or red

  • Enlarged lymph node (“gland”) on one side of the neck

  • Fever for seven or more days in an infant, for which no other explanation is identified

  • Red, cracked lips or red tongue that looks like a strawberry

  • Rash

  • Swollen hands and feet, which might also be red

• Seek emergency care right away if your child is showing any of these emergency warning signs of MIS-C

  • Trouble breathing

  • Pain or pressure in the chest that does not go away

  • New confusion

  • Inability to wake or stay awake

  • Bluish lips or face

  • Severe abdominal pain

Helpful Links

• • https://6abc.com/kawasaki-disease-covid-19-coronavirus-in-kids-mysterious-illness-children/6166771/ 

  • https://www.latimes.com/california/story/2020-05-08/coronavirus-kawasaki-disease-children-hospital

  • https://www.chla.org/blog/health-and-safety-tips/multisystem-inflammatory-syndrome-children-mis-c-what-parents-should

  • https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html

Directly from the World Health Organization (WHO)

Surfaces are not the primary means of transmission

Current research suggests that the virus that causes COVID-19 is primarily spread through close person-to-person contact and that surface contamination is possible, but is not the main source of infection. The risk of infection after touching contaminated surfaces depends on what the surface is made of, how much virus is on the contaminated surface, and how long the viral particles have been there. A person must then touch their mouth, nose, or eyes with a contaminated finger in order to be infected by  the virus. Over time, the amount of virus on the surface able to cause infection declines. Larger amounts of virus, whether on surfaces or in the air, are associated with a greater risk of infection, which is why person-to-person contact and conversations within close proximity, or in poorly ventilated areas, increase the risk of spreading the virus. As we continue to learn more about how the virus is spreading, the CDC continues to recommend routine hand washing and disinfecting frequently used surfaces, as well as maintaining six feet of distance from others and wearing a mask in public spaces. COVID-19 is spread through droplets produced when people speak and cough. These droplets can then land on people, objects, or be inhaled. As of now, research suggests the virus can live on some hard metal surfaces and plastic for up to 72 hours, and on cardboard for up to 24 hours. 

Primary takeaways:

• Touching surfaces contaminated with coronavirus and then touching your mouth, nose or eyes is not the main way the virus is spreading, but we still need to be diligent in cleaning and disinfecting surfaces because there may still be a risk of transmission. CDC guidelines for preventing surface transmission have not changed. 

• Close person-to-person contact is the main way the virus is spreading, so it continues to be critical for people to social distance. 

Helpful Links

• https://www.usatoday.com/story/news/health/2020/05/20/coronavirus-does-not-spread-easily-surfaces-objects-cdc/5232748002/

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

• https://www.nejm.org/doi/full/10.1056/NEJMc2004973

Reinfection and Recovery from COVID-19

There continues to be conflicting evidence as to whether individuals can be reinfected with COVID-19, and for how long the virus is detected after not showing symptoms of COVID-19 infection.

South Korea’s leading health commission released a report indicating that patients who have had with COVID-19 do not remain infectious after recovering, even if they later re-test as being positive for COVID-19. This data prompted the recommendation to not have recovered patients in quarantine, even if they re-test positive. A possible explanation is that around 13% of individuals infected with COVID-19 seem to have the virus detectable in their serum for longer than others, which a recent study from the University of Wisconsin showed. Researchers in this study indicated that this doesn’t necessarily imply that these individuals are infectious, but that this might be part of the natural course of the immune system’s response to the virus. 

According to another recent report, U.S. sailors that had previously had and recovered from COVID-19 have tested positive for COVID-19 again (and have again had symptoms of the disease) after being in two weeks of isolation and previously feeling well. This adds to other reports of individuals showing symptoms of COVID-19 again after recovering from it. 

While there are more questions than answers that arise in these circumstances, experts point to inaccuracy of some diagnostic testing as well as the time course of active COVID-19 cases that differs from person to person.

Key takeaway: 

• While more data is being gathered, Queering Medicine believes it is best to err on the side of caution. Therefore, if showing symptoms with COVID-19, regardless of prior infection with COVID-19, continue to practice good hand hygiene, wear a mask, refrain from being in large groups of people and consider yourself still at risk of transmitting or becoming ill with the virus that causes COVID-19. We simply do not know enough; and we want all our QM community to stay safe. 

More information:

• “Isolation unnecessary for recovered COVID-19 patients: KCDC”: http://www.koreaherald.com/view.php?ud=20200518000772 

• "Covid Patients Testing Positive After Recovery Aren’t Infectious, Study Shows": https://www.bloomberg.com/news/articles/2020-05-19/covid-patients-testing-positive-after-recovery-aren-t-infectious 

• “Sailors on sidelined carrier get virus for second time”: https://apnews.com/0cae34376380ab4150002a58bd9934b9 

• “South Korean Study Shows No Evidence Recovered COVID-19 Patients Can Infect Others”: https://www.npr.org/sections/goatsandsoda/2020/05/22/861061727/south-korean-study-shows-no-evidence-recovered-covid-patients-can-infect-others 

Pennsylvania Now Collecting LGBT Data with COVID-19 Testing

The state of Pennsylvania announced that it will track sexual orientation and gender identity (SOGI) data related to COVID-19 testing. Queering Medicine has previously communicated of the increased risk of infection or death from COVID-19 that the LGBTQ+ community faces for a variety of reasons, including disproportionate high prevalence of pre-existing medical issues, less access to healthcare and health insurance, and historically being less likely to seek healthcare due to fear of discrimination. According to a press release from the Pennsylvania’s governor office, the move to include SOGI data came in an effort to try to provide “equitable care,” regardless of SOGI status. The move to record SOGI data in COVID-19 comes with the support of Pennsylvania’s Governor and its Secretary of Health, Dr. Rachel Levine, who is the first transgender person ever to lead the pubic health services for the state. There has been increased support for including SOGI data in COVID-19 data to show how COVID-19 has impacted queer communities. 

Michigan, like most other states, does not record SOGI data in their COVID-19 basic demographic information. Historically, the LGBTQ+ community has been reticent about sharing their personal information due to fear of being discriminated against, but the collection and reporting of anonymized data is necessary to provide clear evidence of disparities, which, in turn, is critical to advocating for policy, practice, and culture change. If you’re interested in advocating for SOGI data to be collected in the state of Michigan’s standard COVID-19 reporting, you can contact your state legislator, the governor’s office, and/or state LGBTQ+ advocacy groups.

More information:

• https://www.governor.pa.gov/newsroom/gov-wolf-announces-inclusion-of-gender-identity-sexual-orientation-or-expression-in-covid-19-data-collection/

• https://www.inquirer.com/news/rachel-levine-health-secretary-pennsylvania-transgender-coronavirus-20200425.html

• https://www.sfchronicle.com/politics/article/LGBTQ-people-left-out-of-California-s-focus-on-15281995.php

• https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html

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