Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”

I’m sure it’s no surprise to anyone here that, since about forever, medical studies have limited their subjects to men – or that this has produced a disparity in the quality of medical treatment received by females as opposed to males. Some medical misconceptions about women are comparable to misconceptions about people of color – both groups are assumed (subconsciously – I am not accusing any doctors of doing this deliberately) to be exaggerating their pain. Any woman can tell you stories.

But one positive result of CoViD-19 may be that it has brought attention to a big sex difference in immunity. Roughly equal numbers of men and women get the virus (with symptoms) in every age group. But, in every age group, about twice the percentage of men die. This has immunologists (one of whom wrote this paper) looking hard for answers.
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COVID-19’s deadliness for men is revealing why researchers should have been studying immune system sex differences years ago

Adam Moeser, Michigan State University

When it comes to surviving critical cases of COVID-19, it appears that men draw the short straw.

Initial reports from China revealed the early evidence of increased male mortality associated with COVID. According to the Global Health 50/50 research initiative, nearly every country is now reporting significantly higher COVID-19-related mortality rates in males than in females as of June 4. Yet, current data suggest similar infection rates for men and women. In other words, while men and women are being infected with COVID-19 at similar rates, a significantly higher proportion of men succumb to the disease than women, across groups of similar age. Why is it then that more men are dying from COVID-19? Or rather, should we be asking why are more women surviving?

I am an immunologist, and I explore how stress and biological sex can impact a person’s vulnerability to immune-mediated disease. I study a specific immune cell called the mast cell. Mast cells play a pivotal role in our immune systems as they act as first responders to pathogens and orchestrate immune responses that help clear the invading pathogens.

Our research shows that mast cells from females are able to initiate a more active immune response, which may help females fight off infectious diseases better than men. But the trade-off may be that women are at higher risk for allergic and inflammatory diseases. Recent evidence indicates that mast cells are activated by SARS-CoV-2 which causes COVID-19.

Some clues to why females have higher survival rates may be found in our current understanding of differences in the immune systems of men versus women.

Could sex differences in immune system play a role?

In general, females have a more robust immune response than men which may help females fight off infections better than males. This could be a result of genetic factors or sex hormones such as estrogen and testosterone.

Biological females have two copies of the X chromosome, which contains more immune genes. While the genes on one X chromosome are mostly inactive, some immune genes can escape this inactivation, leading to double the number of immune-related genes and thus double the quantity of certain immune proteins compared with biological men who have only one X chromosome.

Sex hormones such as estrogen and testosterone can also impact the immune response. In one study, researchers showed that activating the estrogen receptor in female mice provided them protection against SARS-CoV. And there is an approved clinical trial that will examine the effects of estrogen patches on the severity of COVID-19 symptoms.

It is, however, interesting that the current data showing that women have better survival rates than men applies to even men and women in the 80-plus age group, when hormone levels in both sexes equalize. This suggests that factors other than adult sex hormone levels are contributing to sex differences in COVID-19 mortality.

Androgens, a group of hormones – including testosterone – that are best known to stimulate the development of male characteristics and can cause hair loss, have also received recent attention as a risk factor for COVID-19 in males. In a study conducted in Italy, prostate cancer diagnosis increased the risk for COVID-19. However, prostate cancer patients who were receiving androgen-deprivation therapy (ADT), a treatment that suppresses the production of androgens which fuels prostate cancer cell growth, had a significantly lower risk for SARS-CoV-2 infection. This suggests that blocking androgens in men was protective against SARS-CoV-2 infection.

It is unknown how ADT works to reduce infection rates in men and whether this has been shown in other countries has yet to be determined. Testosterone, which is an androgen hormone has immune-suppressive effects so one explanation could be that ADT might boost the immune system to combat SARS-CoV-2 infection.

There is also evidence that males and females have different quantities of certain receptors that recognize pathogens or that serve as an invasion point for viruses like SARS-CoV-2. One example is the quantity of angiotensin converting enzyme 2 (ACE2) receptors, which SARS-CoV-2 binds to in order to infect cells. While there is currently no conclusive evidence for a role of ACE2 receptors impacting sex differences and the severity of COVID-19 disease, it remains a potential contributing factor.

Gender, sex and COVID-19 risk

A number of factors can interact with biological sex to increase or decrease one’s susceptibility to COVID-19. Another major factor is gender, which refers to social behaviors or cultural norms that society deems appropriate. Males may be at increased risk for severe disease, because in general, they tend to smoke and drink more, wash their hands less frequently and often delay seeking medical attention. All of these gender specific behaviors may put men at higher risk. While there is no current data yet on how gender plays a role in COVID-19, it will be a critically important factor to account for in order to understand sex differences in mortality.

Age, psychological stress level, coexisting conditions such as obesity, diabetes and cardiovascular disease can also interact with biological sex to increase disease.

While COVID-19 highlights the importance of biological sex in disease risk, sex biases in disease in general is not a new concept. COVID-19 is just another example of a disease that will be added to the growing list of diseases for which males or females are at increased risk.

A history of male-biased research

You might be wondering that if biological sex is so important, then why don’t we know what is causing disparities in disease prevalence between the sexes and why are there no sex-specific therapies?

One major reason is when it comes to being included in scientific research, it is mostly males who have been studied.

This disparity between biological sex differences in research has only recently been remedied. It has only been in the last five years that the National Institutes of Health has required sex difference data to be collected for all newly funded preclinical research grants.

While there may be several reasons for choosing one sex over the other in research, the huge disparity that now exists is likely a major reason why we still know relatively little about sex differences in immunity, including the current COVID-19 pandemic.

This has clearly hindered advancement of women’s health, but also has negative consequences for men’s health. For example, given the biological differences between the sexes, it is very possible that drugs and therapies will have different effects in females than males.

Biological sex is clearly a major factor determining disease outcomes in COVID-19. Precisely how your biological sex makes you more or less resilient to diseases such as COVID-19 remains to be elucidated. Future basic research with animals and clinical trials in people need to consider biological sex as well as interactions with gender as an important variable.

[Get facts about coronavirus and the latest research. Sign up for The Conversation’s newsletter.]

Adam Moeser, Matilda R. Wilson Endowed Chair, Associate Professor of Large Animal Clinical Sciences, Michigan State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Alecto, Megaera, and Tisiphone, as I was reading, I was interested to know whether anyone had compared the death rate of corona virus patients who were prepubertal boys as opposed to the death rate in prepubertal girls … but that was not mentioned. I hope that’s because there are not enough cases to examine – but if so I fear that’s not going to stay valid. At any rate, I hope some good comes of the investigation and research that is being done. Give the researchers some pats on the back, or however you prefer to encourage us poor humans.

The Furies and I will be back.

Experts in autocracies have pointed out that it is, unfortunately, easy to slip into normalizing the tyrant, hence it is important to hang on to outrage. These incidents which seem to call for the efforts of the Greek Furies (Erinyes) to come and deal with them will, I hope, help with that. As a reminder, though no one really knows how many there were supposed to be, the three names we have are Alecto, Megaera, and Tisiphone. These roughly translate as “unceasing,” “grudging,” and “vengeful destruction.”

Living next door to New Mexico, I have an interest in what is going on there, so I subscribe to a New Mexico Daily Political Report. A story I saw there made me want to share it – which is generally OK with them – but this one wasn’t their original work. Tracking it down wasn’t hard. Following all the rules was a challenge. But I am finally there. Sorry it took so long.

The article is shared under s Creative Commons license Attribution-NonCommercial-NoDerivs 3.0 United States (CC BY-NC-ND 3.0 US)

New Mexico and Colorado are not the only states, nor is the US the only country in the world, where there are fire seasons. Many of us live where there are fire seasons, and some of those seasons are coming right up, while CoViD-19 is still an issue. In 2017 New Mexico found itself fighting fires and an outbreak of strep throat at the same time. Much was learned. If you live in a fire season zone, especially if you work or volunteer in firefighting, or have family, or friend, in fire season zones and maybe working to fight fires – you’ll want to know this.
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COVID-19 pandemic complicates 2020 wildfire season

By Elizabeth Miller, New Mexico In Depth | May 12, 2020

The BLM Gila District’s Safford Hand Crew works a burnout operation during the 2017 Frye Fire, Coronado National Forest, AZ. BLM/Kress Sanders.

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One morning in June 2017, while fighting the Frye Fire in southern Arizona, firefighters began visiting the on-site paramedic complaining of body aches, sore throats, fever, and fatigue. The paramedic diagnosed them with strep throat, a bacterial infection that can pass person to person or through food or water, and sent them to the regional medical center.

Then another crew showed up with the same symptoms. And then, a third.

Medical staff estimated nearly 300 people might have been exposed. They risked overwhelming the local hospital and spreading the infection into town.

Instead, sick crews were isolated, and a doctor and antibiotics brought to them. Other staff disinfected gear, dumped water, and tossed out catered food. People were told to stop shaking hands and use hand sanitizer. They considered these measures a success: Only 63 people were diagnosed with strep throat.

The incident and other infectious disease reports shared through the Wildfire Lessons Learned Center, a federally funded database that works to increase wildland firefighter safety, illustrates how infectious diseases can rapidly spread through fire camps — where large numbers of firefighters live for weeks, or months, when fighting fires.

With the looming fire season ripe for starting blazes in the Southwest, state and federal officials face the prospect of the new coronavirus, COVID-19, spreading through fire camps and potentially jumping to nearby towns, or returning home with firefighters. Crews commonly cross state lines, moving from one fire to the next.

“We do transfer these folks around the country as fires spread and as one state needs these folks less and another state needs them more,” said Luke Montrose, an environmental toxicologist and assistant professor at Boise State University. “In an instance where you’re trying to deal with a pandemic virus, this may be the exact type of activity that ends up spreading this around the country.”

To counter the threat, authorities are changing how wildland firefighters live and work as well as how fires will be managed this summer.

In New Mexico, these measures are already being tested in the field. Wildfires started in early May near Carlsbad, Lumberton, Mountainair and Reserve. Forest Service and local crews quickly extinguished or worked to contain all of them.

But the potential for large fires will increase through May, according to National Interagency Fire Center predictions. This month, the Southwest’s fire risk rises from moderate to high. Already, temperatures have run three to five degrees above normal in the northern mountains. The Southwest Coordination Center forecasts an above-average fire year, which often comes to a close when the monsoon arrives in July.

Firefighters working the 2012 Whitewater-Baldy Fire, New Mexico. USFS Gila National Forest.

Fire tactics will shift

Wildfire managers in New Mexico have decided to quickly put out all wildfires this season, rather than letting some burn as they normally would. And the Forest Service intends to call for early aviation support. Fast suppression offers the best chance to keep fires small and, with that, fire camps smaller.

“There’s an emphasis on the initial attack and trying to catch fires before they get big,” Larry (Kaili) McCray, chair of the National Wildfire Coordinating Group (NWCG) Emergency Medical Committee established in response to COVID-19. The NWCG helps organize response to wildfire across the country, moving resources, including personnel, around so no single agency must fight a massive fire alone.

The Forest Service and New Mexico State Forestry Division also canceled prescribed burns, normally run to each year to clear undergrowth that fuels large fires, to spare adjacent communities their smoke. Research from Harvard suggests a link between breathing fine particulate matter, like that in smoke, with worsened outcomes from COVID-19. An animal study showed habitually breathing woodsmoke decreases the lungs’ abilities to clear out pathogens.

But some worry those changes—made to protect public health—might pass those troubles on to firefighters.

Extinguishing every wildfire could add up to a longer fire season and one that subjects firefighters to more smoke, said Montrose, with Boise State University, who began studying the health effects of wildland firefighting a decade ago.

“Fires that firefighters otherwise wouldn’t have been suppressing, now they are going to be, so they may be more heavily, more chronically exposed,” he said.

The National Multi-Agency Coordinating Group’s (NMAC) Southwest regional COVID-19 plan briefly states that, while research hasn’t specifically studied wildland firefighters, exposure to wildfire smoke may lead to increased susceptibility to the virus. The Fire Management Board’s advice agrees and suggests fire managers adjust tactics and objectives with that in mind.

How well firefighters come through the season will be determined in part by how well equipped they are with handwashing stations, mobile shower units, and places to isolate sick firefighters, Montrose said.

With governments already straining under expenses, he worries about shortfalls. More fires will stretch those resources thin, as would a COVID-19 outbreak among firefighters. Much hinges on when and where fires start this season.

Tents at a Las Conchas Fire Camp, New Mexico, 2011.

Overhauling ‘standard operating procedures’ for a pandemic

One of the chief concerns for firefighter health is where they live when they’re on the job: in fire camps. The NWCG describes fire camps as ideal environments for outbreaks of infectious diseases, with their “high-density living and working conditions, lack of access to and use of soap and sanitizers, and a transient workforce.”

Already, wildland firefighters are familiar with “camp crud,” an upper and lower respiratory tract infection accompanied by fatigue and a cough that recurs among firefighters. Incidences often peak toward the season’s end among rundown immune systems. NWCG documents recommend ramped-up sanitation practices to reduce its spread.

“It’s great that they recognize that, but it may not bode well for COVID-19,” said Montrose. “In addition to recognizing that it can spread through a camp, they had recognized and documented incidences where [camp crud] had spread from camp to camp.”

Both New Mexico and federal wildland fire managers say they’re preparing plans to limit the spread of COVID-19.

“We expect that we’re going to have to fight fire,” said McCray. “And in all of the models that we’ve been discussing, we planned for the worst-case scenario.”

Firefighters travel in crew buggies that carry 10 to 15 people at a time and cluster by the hundreds in fire camps, staying for weeks in the woods with little access to running water. These practical realities make it harder for them to abide by Centers for Disease Control and Prevention advice, like keeping distance from others and washing hands frequently.

Still, fire coordination groups have encouraged those practices and instituted daily verbal screenings* that check personnel for signs of COVID-19. Tents will be more spaced out and overall camp sizes kept small. Some support positions — people who manage finances or provide firefighters with maps, for example — will move out of fire camps. Crews will maintain physical distance from one another during briefings, or may do them by radio.

“Fire camp is going to look different this year,” McCray said.

Any new hires will be asked to self-isolate for two weeks, if possible, and monitored to ensure they’re symptom-free. Members of 20-person crews are advised to avoid contact with other crews, outside personnel, and the general public. Camps will be set up so crews can keep to themselves.

These new approaches to outside contact should mitigate concerns within a crew, McCray said, so that when firefighters line up for lengthy hikes, they don’t worry that the person in front of them is exhaling something they don’t want to breathe in.

This season, rapid-containment efforts will strive to keep fires small in part to limit the number of people involved in fighting them. If a fire does grow, Forest Service staff say their goal will be to balance having necessary resources on hand to protect lives and property with minimizing COVID-19’s transmission among both first responders and communities.

If a firefighter does turn up with a temperature above 100.4, that person will be isolated and sent for testing at local health facilities.

The Southwest regional COVID-19 plan says to treat a fever that high as confirmation of a coronavirus infection even if a test is unavailable.

In New Mexico, the state’s Forestry Division is adapting much like its national counterpart. The Forestry Division, which manages 43 million acres, worked with local and tribal partners to create new guidelines for their staff, said Vernon Muller, resource protection bureau chief with the New Mexico Department of Natural Resources.

Those include self-screenings at the start, middle, and end of every shift, even while on active fire assignments, for any signs of sickness. Only two individuals will ride in an engine while a string of chase vehicles transports the rest of the crew.

Crew buggies will carry a fraction of their capacity. Temperature tests will be taken. Meals will be packaged individually instead of served buffet-style. Already, Muller said, two individuals declined an assignment after their self-assessment questionnaire found they or their family members may have been exposed to coronavirus.

But these choices create tradeoffs. Some say it’s still not possible to keep six feet apart, and crowding the roads with almost twice as many vehicles creates a hazard of its own and doubles the workload when it’s time to sanitize trucks and equipment.

And because firefighters are paid only when on-assignment, passing on an assignment because they suspect exposure to COVID-19 cuts into their paycheck.

“That’s a tough one to override in all sorts of employment,” said Travis Dotson, an analyst with the Wildfire Lessons Learned Center. “There’s people that will go to work sick because they need to work, and we will face that as well in fire.”

There’s a cultural challenge, too. Firefighters are accustomed to working long hours, through fatigue, discomfort, and dirt, in the heat, and while shouldering packs of more than 45 pounds.

“‘Gut it out’ culture allows us to be able to do that work, and like so many things, that same culture can promote almost the thing that is going to cause harm, like not reporting an illness,” Dotson said.

He’s seen some change: social media posts of firefighters training while six feet apart from one another and wearing masks.

Some people, Dotson noted, are excited about large fire camps becoming a thing of the past. They’re noisy and crowded, a tough place to stay well and get rest even in good circumstances. A more dispersed model might suit a lot of firefighters, Dotson said, even if it spurs logistical nightmares.

What’ll work best to change behavior, he said, is buy-in at the boots-on-the-ground level.

Firefighter crew meeting during the Las Conchas Fire, New Mexico, 2011.

Learn by doing

As reports about how guidelines are working come in, the Wildfire Lessons Learned Center shares them on a mass email list, through social media, and with regional safety specialists. People also use an online forum to ask questions or share ideas.

One “rapid lesson sharing” report posted on wildfirelessons.net from an April grassfire in Montana said firefighters wore masks during their 90-minute drive to the fire — but found them “hot, distracting, and uncomfortable.”

The supervisor noticed people, including drivers, feeling lethargic as a result and, to avoid touching their faces, not eating or drinking water although both are important components of an “alert and functioning firefighter.” More vehicles meant more drivers, he added, requiring someone who just spent 16 hours sawing trees to drive back to camp — “Is this what we want? I don’t.”

Everything needed to be reconsidered: cleaning bathrooms before and after use. Dodging handshakes from crews reluctant to drop that practice. Not taking back a pen someone had asked to use.

In the future, he noted, they will pack extra bottled water and soap so they’re not applying sanitizer to grit-covered hands, and a bottle of bleach for field cleaning. They received sack lunches, but the calorie content came up short, and because firefighters weren’t allowed in stores when they stopped for fuel, they just went hungry — and concerned about whether the person preparing their food wore personal protective equipment.

In that report, the hotshot crew superintendent wrote that while they had talked about and trained with social distance in mind, “It is damn tough to take these practices to the fireline.”

The supervisor said his assistant summed it up best: the agency can’t manage COVID. It’ll need to be managed within individual crews. “We need to limit the spread from unit to unit,” he said. “This is what will cripple us collectively.”

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Alecto, Megaera, and Tisiphone, I just learned that there have already been two tropical storms/depressions off the United States east and in the Gulf of Mexico which were substantial enough to be given names, and there’s another one out there which may get one – all before the first of June. This is unprecedented. But it’s not entirely unexpected. And more events which are unprecedented are expected, and the cavalier attitude of the U.S. Government is, to say the least, not helping. It would be great if you could persuade the gods, even some of them, to have mercy on us. But I will not be surprised if they are not interested. After all – we did this to ourselves.

The Furies and I will be back.