Seems like they factored in the obvious stuff, i.e. men having poorer health outcomes in general, so I wonder if this has something to do with reproduction? By that I mean women's immune systems reacting more strongly to protect a (possible) baby?
Not to mention scratching their groins. Some kind of immune response is involved in that, I'm sure. No need for the free clinic to get it cured when you're paid as much as an MLB player.
Yeah there are sex differences in the immune system in general. For example, women get stronger immunity from vaccinations but also have more problems with autoimmune diseases.
BMI isn't exactly comparable between the sexes, since males and females have different distributions of adipose and visceral fat, and the impacts of these are clearly different.
Those kinds of effects would presumably count as "gender-specific differences". Previous investigations never really took body mass into account at all, which was...bad.
And that could maybe contribute to something. There were other studies, though, which didn't take BMI into account at all, even though high BMI is a known risk factor, and generally more men are obese than women.
I saw this study from southern California. They provide risk ratios for different factors. Seems just being male have a higher risk ratio than being overweight.
My pet idea that I would be interested in ways to test ultimately links back to what shared restrooms for men look like. Since they have made such a big show of how much we can detect this in wastewater, I am curious if standing urinals and such contribute to higher spread.
Would amusingly fit in with many of the "why aren't crowds getting this?" It is largely crowded places with large communal restrooms that have associated outbreaks.
Pardon me, but most men aren't splashing around in the urinals. If you're really curious what it looks like you could just go in one and have a look around... :)
I'm not accusing us of literally stepping into the urinal. I thought the data was fairly clear that men are worse at washing their hands than women are. And it seems a safe claim that splash back from the urinal is not zero.
That said, I'm calling this my pet idea, in large because I think it is a silly one. Do I think it is in the realm of plausible? I mean, yeah. But I don't think it has stepped into the realm of likely.
Forget washing hands, the urinals are very close to each other and there are no barriers to exhaled air. Someone sneezes, it bounces off the wall to the adjacent users.
In men's restrooms, you are almost certainly getting urine on you from the previous person to use the urinal. I'd be curious to see studies that quantify this.
Is this a joke? Just wanted to check because my own shocking results show that we're urinating all over ourselves and without doubt many droplets reach those on neighboring urinals. I bought a nice pair of wool designer shorts by D.gnak $250 and for whatever reason they have the incredible property of causing water to bead up in a way I've never seen before. While wearing them one day, I went to wash my hands and realized I was covered in 20-30 beads of liquid. Yes after using the urinal. I was horrified, soaped up a paper towel and cleaned it. I thought it was a one off event but soon realized it is IMPOSSIBLE no matter how carefully, softly, and at what angle one fires at the urinal to actually get less than 20 beads of pee on oneself. I tried for months, shocked every time. With any other type of clothing the beads don't form but the same liquid is instead instantly absorbed into the fibers.
Men’s immune systems weaken with increased testosterone - speculation is that this allows them to have less immune response so they can keep hunting and fighting.
Most of "feeling sick" isn't the actual bacteria/virus causing problems, it's your immune system doing things like raising your internal temperature to fight off the virus or generating boatloads of phlegm to do whatever that does.
Interesting; when my wife and I both get sick we always note this recurring theme where I get this intense but brief bout of illness, and her's are more drawn out and prolonged but significantly less intense. Timewise we're talking about 1-3 day sickness for me and 1-2wk sickness on her end. That recurring observation has caused a bunch of speculation between us about evolutionary protections and stuff where perhaps the man being down has more immediate risks that can threaten the family in the protecting role or something like that. Not sure entirely but fun to imagine about.
As far as I know, pregnancy suppresses the immune response in order to keep the body from attacking the baby itself. That’s why doctors recommend pregnant women not to eat under cooked eggs, sushi and other high risk food items. Flu shots are also heavily encouraged for the same reason - the flu is a lot tougher to beat.
And then extremely anecdotally: the only people I personally know who have gotten sick† in my ~25–35-year-old social circle have been guys who are, as they say, “on the bike”. Geared up, if you know what I mean.
†and they’ve all recovered well; they had about a week of pretty nasty flu-like symptoms, but then bounced back with bed rest
I wonder if guys who are taking steroids are also guys who are less careful about social distancing, and perhaps they are people who go to a public gym or work out in groups in private ones.
You'd almost expect this; taking steroids, particularly without medical supervision, is inherently rather dangerous, so it's fairly reasonable to assume that people who do it are on average more reckless than normal people.
You might expect some difference, but I think people who take steroids for recreational or cosmetic purposes or to cheat at sports are a bit different; base jumpers would generally know and accept that base jumping is dangerous, but do it because they enjoy it, whereas steroid abusers are often self-deluding; they don't acknowledge that it's dangerous at all.
That's a lot of broad generalizations about the personalities and intelligence of a lot of different people. It would be more fair to say that with both base jumping and steroid abuse, each person personally find the risk (as they perceive it) worth the potential benefits (as they perceive them).
Steroid risks are maybe a bit murkier than the risks of jumping off of things, so it's possible there are more people with inaccurate perceptions of the risks, which might explain your perception of that group.
If I based my risk of death on people I personally knew, I'd believe that I was immune to dying from, say, being hit by a car, and would almost certainly die of either heart disease or suicide. That's a ridiculous way to do things.
I don't know that many people in the steroid-abusing demographics (it was less of a thing in my age demographic than it is with the youth of today), but I am aware that it's dangerous.
A real, robust knowledge of the relative danger of steroids is tough to develop.
Because you can’t plausibly do a long-term blinded trial where you take a healthy population and dope them up. The in vitro data is enough to make any institutional review board blanch.
So you have to rely on self-reported usage. Which is incredibly unreliable, and full of confounds. (My bias, my fairly well-informed bias, is that nobody is just doing steroids. There is always another drug or high-risk activity.)
So yeah. Steroids are dangerous. Do we know exactly how bad, especially in comparison to other drugs of abuse? Not as far as I can tell. But bad enough that you should absolutely be wary of steroids. (Also there’s gradations of dangerous. You stay away from trenbolone.)
Presumably this is an on-the-nose reference to the widespread use of dopants in cycling. In completely unrelated terms, the Tour de France started this saturday :)
I don’t really know the etymology. I have just always seen steroids called “gear”, and then figured “on the bike” derived from that.
But also how dare you suggest that the highest levels of competitive sport, where the margin of victory is razor-slim, and you only have a few years of peak performance, are infested with drugs? How crass. How immoral. I miss the simpler days of my youth, when Hulk Hogan told us we just had to take our vitamins.
it's not because of the Tour de France type of "cycling", but rather because of this:
"Steroids are often used in patterns called "cycling." This involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again."
"Steroids are often used in patterns called "cycling." This involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again."
Read it but it left me curious how it may affect intersex people like XXY and found a better article [0]. So tldr, apparently number of X chromosomes affects cytokine production. "The lower secretion of inflammatory cytokines in women may protect them from an uncontrolled and potentially life-threatening immune response in cases of severe aggression such as sepsis, trauma or extensive burns throughout life."
It seems much more likely that the direct controller is sex hormone levels, not chromosomes. Though chromosomes may affect what levels of sex hormones your body produces naturally, hormones are what actually control dimorphism in the immune system[0]
Quite an important distinction for trans and lots of intersex people (particularly those with receptor insensitivities), though I have not seen anything conclusive supporting one or the other, and usually the research into what is considered edge cases is unfortunately very limited :/
Higher innate immune cytokines in female patients was associated with worse disease progression, but not in male patients. This seem to indicate that the level of sex hormones for men is less relevant for cytokines, or at least those involved with covid-19 immune response.
There's some research showing that estrogen/androgen receptor signalling plays a part in sex-differential disease severity in SARS-CoV-1 and SARS-CoV-2. Incidentally, i love how some suggested pharmacotherapeutic agents include, like, nonsteroidal antiandrogens, GnRHa's, straight-up estradiol, and, of all things, spironolactone.
Haha yeah Spironolactone is certainly a weird one. I don't quite understand how it suppresses testosterone myself, all I know is it made me and everyone I know who takes it crave all the salt in the world and have to pee 2x as much. (Taking it to suppress testosterone of course, I don't know anyone actually taking it to reduce their covid risk)
Have we as an Internet decided to accept this fact now? I remember just a few shorts months ago if you brought up this idea you would get downvoted, banned, and mocked with sarcastic cries of "IT'S ONLY THE FLU BRO".
Are we finally accepting that Covid is just another variation of the flu and not the humanity-ender that some vocal online folks (and power hungry governors) think it is?
> Are we finally accepting that Covid is just another variation of the flu
Oh, FFS. "Flu" is influenza, caused by an influenza virus. COVID-19 is caused by a coronavirus; if you wanted to make glib comparisons to anything you'd probably be better off calling it a really bad common cold.
A strain of flu that was both as infectious and as lethal as covid would, indeed, be very, very bad, and public health authorities have long been worried about such a thing showing up again.
I personally know of 4 people (in 2 different countries) - family, friends, or family of friends, who have died from Covid. None were over 60. I don't know that many people.
This is not the same, stop believing this garbage.
(Just realized my comment is replying to you, but I think a bulk of it is directed at the GP - just wanted to clarify)
Covid is real and I don’t think the numbers lie, but I also think we’re at an unprecedented level of measurement and quantification and it does make me wonder - folks I know who’ve died of pneumonia in old age probably didn’t get “influenza” as a cause of death in recent years even if it was what ultimately kicked off the over all failure of their organs.
There are whole classes of causes of death that just lack data/information to know the set of causes and to correctly attribute them to the mortality.
Anyhow, I’m seeing this as a huge global experiment to quantify a novel virus, and for that reason it’s interesting and exciting while also terrifying and bad.
What I mean by that is, we’re in the middle of the storm, it doesn’t really make sense to compare this to something yet, it’s not over, and not even close to understood, so let’s just treat it with the same caution we’d treat any other uncontrollable global plague until we know better, with extreme caution and suspicion, and we should assume it could kill us all eventually. We’ve never successfully made a coronavirus vaccine. Think about that. Read up on the previous trials - a successful vaccine still brings a lot of scary things, like, what it does in the wild if another novel coronavirus shows up, or the potential for it to turn a mutation into a more lethal or more viral strain.
So yeah, let’s hunker down and hold on until we have this collectively under control and we can START to understand what’s going on.
> We look at death certificates that have pneumonia or influenza causes (P&I), other respiratory and circulatory causes (R&C), or other non-respiratory, non-circulatory causes of death, because deaths related to influenza may not have influenza listed as a cause of death.
Those numbers are used to give estimates. So if the people you know that died of pneumonia (I'm sorry) had that listed on their death certificates, it is likely they were counted as influenza deaths; if not directly by test results then by their death certificates.
I agree with the rest of your comment, however. What was particularly frustrating for me was at the beginning of this pandemic; people were looking at the numbers and saying, "oh only x thousand deaths? That's less than a flu season!" (where x is less than 60) Of course they didn't mention that ~60,000 deaths is the worst flu season in the US, and other seasons see way less numbers than that; and they didn't mention that that's 60,000 deaths in a year. We're now at 183K deaths from covid so far. And the end isn't even in view..
I'm not saying flu == covid, but since we're all talking about anecdotes, my grandmother technically died of the flu.
12-60k Americans die of the flu every year. So far 160k Americans have died of covid. Unless you've only been alive for a few years it's extremely unlikely you know 4 people that have died from covid and none from the flu...
I agree that it's an anectdotal point, but I don't think it's extremely unlikely. Covid affects a greater age range and there may be lifestyle factors at play, some people may know many people at risk of covid and few who are at risk of flu. It may be extremely unlikely in a random sample, but this isn't a random sample.
I see the "but I thought sex was a construct" folks are showing up at the bottom of the thread. I suspect the gender radicals would be quite happy with this study if they just replaced male and female with AMAB and AFAB[1].
I actually think followup studies on gender minorities could be really interesting here - do people taking testosterone get sick like AMAB people who aren't taking hormones? Do AMAB people taking estrogen have better outcomes?
[1] Assigned male at birth and assigned female at birth, respectively.
I agree they aren't the same thing, but I would say that both sex and gender are impacted by biology so I'm not sure that's a useful dividing line. It's true that male and female are two stable sexual categories, but the details of how you identify sex (and how each sex responds to treatments) ends up being very bimodal[1]. So the social categories of male sex and female sex overlay complicated, individual biological systems.
Wether, it's a useful dividing line has more to do with what question one is trying to answer via the line. Different questions are likely to use different concerns yielding different definitions.
That (does estrogen/testosterone intake correlate w/ outcome) is a very interesting question, and I'd be very surprised if anybody studied that.
The transgender community is not usually considered in medical studies. (It's hard to get reliable data just on long-term effects of the various immediately trans-related treatments). And even if it were, it's so disparate socio-economically from the rest of the population that it's very hard to control for that factor. Add to that the fact that being transgender is a fairly rare condition - 1:11,000 is the usual assumption, 3:1000 is the most generous one I've seen - these particular studies aren't that common.
A proxy for that question is "how do subjects pre/peri/post menopause react to this, with and without hormone therapy (a.k.a contraceptives)". There's mild evidence of hormonal status and COVID response being correlated: https://www.medrxiv.org/content/10.1101/2020.07.30.20164921v...
I don't see why we even need a name for gender, men and women can fulfill each others gender roles just fine without being trans so it isn't like gender is important. Why not just use man/woman for sex and just ignore gender completely? Wouldn't that be better?
This is a pretty acrimonious split within modern feminism, with a faction believing that the modern trans movement is reifying gender norms as something concrete and valid instead of arbitrary oppressive constraints on individual expression and behavior.
96 comments
[ 2.9 ms ] story [ 181 ms ] threadhttps://www.nature.com/articles/s41586-020-2700-3
It's funny - when you watch the little league world series, the kids spit too.
https://doi.org/10.1007/s00281-018-00728-x
They controlled for BMI in cohort A, and performed an adjusted analysis in cohort B, so I'm somewhat satisfied on that front.
https://www.acpjournals.org/doi/10.7326/M20-3742#f1-M203742
Would amusingly fit in with many of the "why aren't crowds getting this?" It is largely crowded places with large communal restrooms that have associated outbreaks.
That said, I'm calling this my pet idea, in large because I think it is a silly one. Do I think it is in the realm of plausible? I mean, yeah. But I don't think it has stepped into the realm of likely.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119719/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701921/
And then extremely anecdotally: the only people I personally know who have gotten sick† in my ~25–35-year-old social circle have been guys who are, as they say, “on the bike”. Geared up, if you know what I mean.
†and they’ve all recovered well; they had about a week of pretty nasty flu-like symptoms, but then bounced back with bed rest
Especially since at least one of them was at this early super-spreader event:
https://www.miamiherald.com/news/coronavirus/article24194165...
Steroid risks are maybe a bit murkier than the risks of jumping off of things, so it's possible there are more people with inaccurate perceptions of the risks, which might explain your perception of that group.
I don't know that many people in the steroid-abusing demographics (it was less of a thing in my age demographic than it is with the youth of today), but I am aware that it's dangerous.
Because you can’t plausibly do a long-term blinded trial where you take a healthy population and dope them up. The in vitro data is enough to make any institutional review board blanch.
So you have to rely on self-reported usage. Which is incredibly unreliable, and full of confounds. (My bias, my fairly well-informed bias, is that nobody is just doing steroids. There is always another drug or high-risk activity.)
So yeah. Steroids are dangerous. Do we know exactly how bad, especially in comparison to other drugs of abuse? Not as far as I can tell. But bad enough that you should absolutely be wary of steroids. (Also there’s gradations of dangerous. You stay away from trenbolone.)
But also how dare you suggest that the highest levels of competitive sport, where the margin of victory is razor-slim, and you only have a few years of peak performance, are infested with drugs? How crass. How immoral. I miss the simpler days of my youth, when Hulk Hogan told us we just had to take our vitamins.
"Steroids are often used in patterns called "cycling." This involves taking multiple doses of steroids over a specific period of time, stopping for a period, and starting again."
https://www.drugabuse.gov/publications/research-reports/ster...
https://www.drugabuse.gov/publications/research-reports/ster....
[0]: https://www.frontiersin.org/articles/10.3389/fimmu.2019.0105...
[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4251360/
https://cancerdiscovery.aacrjournals.org/content/10/6/779
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450662/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233687/
https://journals.physiology.org/doi/full/10.1152/ajplung.001...
https://www.medrxiv.org/content/10.1101/2020.08.21.20179671v...
https://www.jimmunol.org/content/jimmunol/198/10/4046.full.p...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7191632/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363620/
https://link.springer.com/article/10.1007/s11906-020-01073-x
https://www.health.harvard.edu/blog/man-flu-really-thing-201...
Have we as an Internet decided to accept this fact now? I remember just a few shorts months ago if you brought up this idea you would get downvoted, banned, and mocked with sarcastic cries of "IT'S ONLY THE FLU BRO".
Are we finally accepting that Covid is just another variation of the flu and not the humanity-ender that some vocal online folks (and power hungry governors) think it is?
Oh, FFS. "Flu" is influenza, caused by an influenza virus. COVID-19 is caused by a coronavirus; if you wanted to make glib comparisons to anything you'd probably be better off calling it a really bad common cold.
A strain of flu that was both as infectious and as lethal as covid would, indeed, be very, very bad, and public health authorities have long been worried about such a thing showing up again.
I personally know of 4 people (in 2 different countries) - family, friends, or family of friends, who have died from Covid. None were over 60. I don't know that many people.
This is not the same, stop believing this garbage.
Covid is real and I don’t think the numbers lie, but I also think we’re at an unprecedented level of measurement and quantification and it does make me wonder - folks I know who’ve died of pneumonia in old age probably didn’t get “influenza” as a cause of death in recent years even if it was what ultimately kicked off the over all failure of their organs.
There are whole classes of causes of death that just lack data/information to know the set of causes and to correctly attribute them to the mortality.
Anyhow, I’m seeing this as a huge global experiment to quantify a novel virus, and for that reason it’s interesting and exciting while also terrifying and bad.
What I mean by that is, we’re in the middle of the storm, it doesn’t really make sense to compare this to something yet, it’s not over, and not even close to understood, so let’s just treat it with the same caution we’d treat any other uncontrollable global plague until we know better, with extreme caution and suspicion, and we should assume it could kill us all eventually. We’ve never successfully made a coronavirus vaccine. Think about that. Read up on the previous trials - a successful vaccine still brings a lot of scary things, like, what it does in the wild if another novel coronavirus shows up, or the potential for it to turn a mutation into a more lethal or more viral strain.
So yeah, let’s hunker down and hold on until we have this collectively under control and we can START to understand what’s going on.
This part specifically covers your question:
> We look at death certificates that have pneumonia or influenza causes (P&I), other respiratory and circulatory causes (R&C), or other non-respiratory, non-circulatory causes of death, because deaths related to influenza may not have influenza listed as a cause of death.
Those numbers are used to give estimates. So if the people you know that died of pneumonia (I'm sorry) had that listed on their death certificates, it is likely they were counted as influenza deaths; if not directly by test results then by their death certificates.
I agree with the rest of your comment, however. What was particularly frustrating for me was at the beginning of this pandemic; people were looking at the numbers and saying, "oh only x thousand deaths? That's less than a flu season!" (where x is less than 60) Of course they didn't mention that ~60,000 deaths is the worst flu season in the US, and other seasons see way less numbers than that; and they didn't mention that that's 60,000 deaths in a year. We're now at 183K deaths from covid so far. And the end isn't even in view..
Edit: Almost every time I comment on HN, I wonder if I sound like a bad GPT-3 implementation.
12-60k Americans die of the flu every year. So far 160k Americans have died of covid. Unless you've only been alive for a few years it's extremely unlikely you know 4 people that have died from covid and none from the flu...
I actually think followup studies on gender minorities could be really interesting here - do people taking testosterone get sick like AMAB people who aren't taking hormones? Do AMAB people taking estrogen have better outcomes?
[1] Assigned male at birth and assigned female at birth, respectively.
[1] https://twitter.com/ScienceVet2/status/1035246030500061184
The transphobic people who inevitably show up in threads like this don't seem to recognize the difference, though.
Transsexuals care strictly about sex.
With that out of the way, let us continue ...
The transgender community is not usually considered in medical studies. (It's hard to get reliable data just on long-term effects of the various immediately trans-related treatments). And even if it were, it's so disparate socio-economically from the rest of the population that it's very hard to control for that factor. Add to that the fact that being transgender is a fairly rare condition - 1:11,000 is the usual assumption, 3:1000 is the most generous one I've seen - these particular studies aren't that common.
A proxy for that question is "how do subjects pre/peri/post menopause react to this, with and without hormone therapy (a.k.a contraceptives)". There's mild evidence of hormonal status and COVID response being correlated: https://www.medrxiv.org/content/10.1101/2020.07.30.20164921v...