Biohacking and Optimising Your Health During Covid-19

How to Optimise Your Health During Covid-19 With Biohacking

By Dr Jonathan Seah | 14 Mar 2022

This article is a repost which originally appeared on PRESTIGE

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Dietary biohacks can be used for more efficient recovery from illnesses like Covid-19.

· It is possible to potimize the health beyond functional levels with diet and supplementation.

· Plant based and ketogenic diets are considered optimal for dealing with Covid-19.

For most of the past two years since the start of the COVID-19 pandemic, we’d been relatively fortunate in Hong Kong compared to many other cities in the world, without full lockdowns, mass testings, and most importantly, significant numbers of severely sick and dying people.

Unfortunately, this has all changed these past two months, with almost 500,000 cases and 2,000 deaths[1]. While most of these have been amongst the unvaccinated, elderly or chronically ill, some younger people and even children have been affected. Even though most of my friends are already vaccinated, they wanted to know if there was anything else they could do to improve their chances if infected. So after a chat with some LifeClinic doctors, I’ve summarized some suggested biohacks below – all of which are backed by peer-reviewed scientific research (links to the research papers are at the end).

Before I begin, it might be useful to understand how my medical philosophy differs from that of regular doctors. Most “conventional” doctors were taught, like I was over 30 years ago, that there are essentially only two states of health – either you are sick, or you are not sick. “Functional” medicine doctors, however, who are conventional doctors with extra related training, believe that it is possible to achieve an even better, “optimal” level of health – essentially a super-powered state that will allow you to function better than the average person at both work and play (potentially more energy, better memory, better sex, look younger), and to possibly live longer.

While media attention has focused on Hollywood and Hong Kong movie stars and Silicon Valley billionaires who see functional medicine doctors reverse both their internal and external ageing with advanced treatments like intravenous NAD+, peptides, exosomes, or cytokines, I personally believe that much of the benefits of functional medicine – especially with regards to improving your body’s immune functions to potentially reduce the severity of a COVID-19 infection – can be achieved with relatively inexpensive micronutrients you can purchase yourself[2].

What causes severe Covid-19 disease and death

As we have now seen over the past 2 years, about 80 percent of people who get COVID-19 have no symptoms or only mild symptoms, 14 percent get severe symptoms like pneumonia, and 5 percent get critical symptoms like respiratory distress or multi-organ failure, and about 2 percent die[3]. The mechanism for these bad outcomes is still being investigated, but much of the research points to abnormal immune responses (culminating in what has come to be called a “cytokine storm”) and the presence of chronic inflammation. We believe this is probably why the outcomes are often worse for older people[4], (who typically have aged immune systems), and for those with some pre-existing illnesses that cause systemic inflammation (like diabetes, high blood pressure, and cardiovascular disease)[5].

So, the question then becomes – what are some simple things we do ourselves to reduce the chronic inflammation in our bodies, and to rejuvenate our immune systems?

The best Covid-19 diets: Plant-based and clean keto

An unhealthy diet could increase your risk factors for a severe COVID-19 infection[6]. Over the past year, there have been a few very large research studies that have demonstrated quite clearly that what you eat can affect how your body reacts to COVID-19.

One of the most important was a study conducted amongst almost 3,000 front-line health care workers (doctors and nurses) across 6 countries, which showed that those who followed a largely plant-based diet (mostly vegetables and plant proteins, and less red and processed meats and sweetened beverages and alcohol), had a 73 percent lower likelihood of developing moderate-to-severe COVID-19 infections[7]! This is possibly because a plant-based diet often has more micronutrients that are essential for the proper functioning of the body’s immune system, such as polyphenols, carotenoids, dietary fibre, vitamins A, C, E, and folate, and minerals like iron, potassium, and magnesium. Or because the virus itself is weakened in a nutrient-dense environment[8]! Also, in this same study, those who ate a plant-based diet together with fish had a 59 percent lower chance of moderate-to-severe COVID-19 infection. In this case, it is thought that the mechanism of action might be a reduction of chronic systemic inflammation. Fish is an important source of vitamin D and omega-3 fatty acids, which have anti-inflammatory effects on the body. (Diazepam online)

An even larger study, this time of almost 600,000 people, also showed that those who ate diets characterized by more healthy plant-based foods correlated with a 41 percent lower chance of severe COVID-19 infections[9].

Separately, there has also been a lot of interest in investigating if ketogenic diets could be beneficial in COVID-19 patients. One study conducted in Italy on 102 hospitalized patients showed that those fed with a low-calorie ketogenic diet had a lower admission to the ICU and a lower death rate than those fed on a low-calorie standard (Mediterranean) diet[10]. This could be because a ketogenic diet can better regulate glucose metabolism and reduce systemic inflammation, as the SARS-CoV-2 virus seems to grow more quickly in a high glucose environment[11] and maybe why many diabetics have a severe COVID-19 infection. Additionally, the ketone bodies generated when a body is in ketosis appear to not only serve as fuel but also to promote resistance to oxidative and inflammatory stress[12] which can contribute to severe symptoms. Lastly, over time, ketogenic diets can reduce obesity and hypertension, which could also help improve COVID-19 outcomes.

So what are the key takeaways from this section? To increase your chances of a good outcome in case of infection, try to have a mostly plant-based diet or a “clean” ketogenic diet – that is to say, one that uses mostly plant fats, and fewer animal fats which of course can themselves be very inflammatory.

Biohacking: Your micronutrient heroes

Dietary insufficiency of vitamins and minerals has been observed in high-risk COVID-19 patients, which may account for the increased risk of severe infections. It is also noted that much of the evidence surrounding supportive micronutrient use in COVID-19 utilize doses too high to come just from diet. This is why, given the simplicity, relatively low cost and low risk, supplementation during this period might make sense for many people. The doctors at LifeClinic usually make customized supplement recommendations based on the results of some specialized blood tests and track your micronutrient levels over time. This is because everyone’s biology and needs are different. However, since not everybody will have the opportunity to have this done, I am sharing with you what many functional doctors recommend, and what I take myself! By the way – several of these supplements can also increase sex drive and the ability to achieve orgasm, so think of this as an additional benefit if you are in quarantine with your significant other[13][14].

Vitamin D

Vitamin D is a fat-soluble vitamin, that is both ingested via foods, as well as made by our bodies in the presence of sunlight – another reason my family loves to go hiking! Vitamin D insufficiency could affect almost 50% of the population worldwide[15]. Essential for a healthy lining in our throats to protect against the initial viral entry into our bodies[16], vitamin D is also critical for a healthy immune system. The primary effects of vitamin D in COVID-19 infections are to reduce the viability of the virus and the excessive inflammatory response[17]. In a study conducted on 212 COVID-19 cases, the probability of having a mild disease was correlated to high levels of vitamin D, and, as the vitamin D levels decreased, the risk of severe disease increased. In fact, in COVID-19 hospitalizations with vitamin D deficiencies, treatment with vitamin D shortened the hospital stays and decreased the death rate by more than twice[18]! Yulia and I take 5,000 IU of D3, and we give our son a few drops of D3 liquid every day. You might need more if your levels are low[19].

Vitamin C

Vitamin C is a water-soluble vitamin that cannot be made by humans, which means that it is not well stored in our bodies and must be taken regularly through food or supplements. In addition to being necessary for the body’s outer protective layers (skin and mucosa) and being a powerful antioxidant, it also has critical roles in immunity, including proper white cell movement and antibody production. While most conventional family doctors believe that just 90-120 mg daily[20] of vitamin C is sufficient, I would recommend higher doses to potentially help improve infection recovery times[21], as has been seen with the common cold and even pneumonia[22]. There is even documentation of more than 10,000 mg a day of vitamin C given intravenously (IV) as part of a successful COVID-19 hospital treatment programme[23]. Given that, at home, we can only use oral Vitamin C, Yulia and I take about 1,000 to 2,000 mg a day, and we give our son about 200 mg.

Zinc

Zinc is a key trace mineral that has many potential health benefits against COVID-19 infections, via improving the immune response, minimizing the inflammation, preventing lung injury, and inhibiting viral growth through the interference of the viral genome transcription, protein translation, and attachment[24][25]. It has been shown that zinc supplementation can increase the number of T cells and NK (natural killer) cells in your body – important parts of the immune system, and conversely zinc deficiency can lower the number of white blood cells that fight infections[26]. Several studies are currently ongoing to further investigate the effects of zinc on COVID-19 symptoms and outcomes[27]. We take between 30-50mg of zinc a day.

Quercetin

Quercetin is a natural substance known as a polyphenol. Its main natural sources in food are vegetables like onions and broccoli; fruits like apples, berry crops, and grapes; and some herbs; tea; and wine. It is an antioxidant and anti-inflammatory, can affect human immune functions, and also has antiviral properties. In a recent randomized study with 152 COVID-19 patients, it was found that in those who received quercetin 500 mg twice a day as supportive therapy, there were statistically significant improvements in all the clinical outcomes measured (the length of hospitalization, the need for oxygen therapy, progression to intensive care units, and death). The results also confirmed the very high safety profile of quercetin and its possible anti-fatigue and pro-appetite properties[28]. Yulia and I are currently following this protocol – 500 mg twice a day.

Omega-3 Fish Oil

Omega-3 fish oils are polyunsaturated fatty acids and include both eicosapentaenoic (EPA) and docosahexaenoic (DHA) fatty acids, and are known to have immunity and anti-inflammatory, and antiviral properties, and may even improve oxygenation in COVID-19 patients[29]. In a double-blind, randomized clinical trial conducted on 128 critically ill COVID-19 patients, omega-3 supplementation improved the levels of several parameters of respiratory and renal function[30]. However, on the negative side, there is also a possibility that they can make cell membranes more susceptible to non-enzymatic oxidation, so it is best to not overdo it. Yulia and I take 1,000 mg a day.

Probiotics

Maintaining good gut health is critical for a strong immune system. Our gastrointestinal system has trillions of microorganisms that live in harmony with us (this is known as your “gut biome”). They not only protect against harmful pathogens like the virus causing COVID-19 but also are a major “training ground” for our immune system. With modern living characterized by too much stress, refined carbohydrates, pollutants, medications and antibiotics, this protective lining can be severely weakened. Probiotics strengthen this barrier and can activate various protective immune factors such as IgA antibodies, cytotoxic T-cells and antimicrobial proteins. Recently a research study done right here in Hong Kong showed that there was a distinct correlation between the amount of certain healthy gut bacteria and the level of COVID-19 antibodies that developed after vaccinations[31]. I would recommend including a decent probiotic in your supplementation regime.

Of course, if you suspect your micronutrient levels are very low and you want a quick boost to your immunity, it might not be a bad time to get a consult with a functional medicine doctor or practitioner to evaluate if you might benefit from IV micronutrient therapy. However, if you’ve already been vaccinated and don’t have any major chronic illnesses, the above diet and supplements, in combination with some physical activity, would probably be enough to sufficiently improve your and your family’s chances of having just mild or no symptoms if you were to get COVID-19 infection – which for most of us will inevitably happen at some point! There are a few other micronutrients that you could consider adding, for example, selenium, magnesium and liposomal glutathione, but they’re not as easy to obtain locally. In any case, the very fact that you’ve actually read through this article means that you’re probably already doing all the right things. The very best wishes from our family to yours during this challenging time in Hong Kong!

[1] Centre for Health Protection of the Department of Health, last updated as of 6 March 2022.
[2] Please note that you should not start any type of supplement regime without first consulting a suitably trained professional.
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[29] Rogero MM, Leão MC, Santana TM, Pimentel MVMB, Carlini GCG, da Silveira TFF, Gonçalves RC, Castro IA. Potential benefits and risks of omega-3 fatty acids supplementation to patients with COVID-19. Free Radic Biol Med. 2020 Aug 20;156:190-199. doi: 10.1016/j.freeradbiomed.2020.07.005. Epub 2020 Jul 10. PMID: 32653511; PMCID: PMC7350587.
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Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

Addressing male sexual and reproductive health in the wake of COVID-19 outbreak

J Endocrinol Invest. 2020 Jul 13 : 1–9.
doi: 10.1007/s40618-020-01350-1 [Epub ahead of print]
PMCID: PMC7355084
PMID: 32661947

A. Sansone,1 D. Mollaioli,1 G. Ciocca,2 E. Limoncin,1 E. Colonnello,1 W. Vena,3,4 and E. A. Janninicorresponding author1

This abstract is a repost which originally appeared on PMC-NCBI

Edited for content

Abstract

Purpose

The COVID-19 pandemic, caused by the SARS-CoV-2, represents an unprecedented challenge for healthcare. COVID-19 features a state of hyperinflammation resulting in a “cytokine storm”, which leads to severe complications, such as the development of micro-thrombosis and disseminated intravascular coagulation (DIC). Despite isolation measures, the number of affected patients is growing daily: as of June 12th, over 7.5 million cases have been confirmed worldwide, with more than 420,000 global deaths. Over 3.5 million patients have recovered from COVID-19; although this number is increasing by the day, great attention should be directed towards the possible long-term outcomes of the disease. Despite being a trivial matter for patients in intensive care units (ICUs), erectile dysfunction (ED) is a likely consequence of COVID-19 for survivors, and considering the high transmissibility of the infection and the higher contagion rates among elderly men, a worrying phenomenon for a large part of affected patients.

Methods

A literature research on the possible mechanisms involved in the development of ED in COVID-19 survivors was performed.

Results

Endothelial dysfunction, subclinical hypogonadism, psychological distress and impaired pulmonary hemodynamics all contribute to the potential onset of ED. Additionally, COVID-19 might exacerbate cardiovascular conditions; therefore, further increasing the risk of ED. Testicular function in COVID-19 patients requires careful investigation for the unclear association with testosterone deficiency and the possible consequences for reproductive health. Treatment with phosphodiesterase-5 (PDE5) inhibitors might be beneficial for both COVID-19 and ED.

Conclusion

COVID-19 survivors might develop sexual and reproductive health issues. Andrological assessment and tailored treatments should be considered in the follow-up.

Keywords: COVID-19, SARS-CoV-2, Erectile dysfunction, Sexual dysfunction, Male hypogonadism, Cardiovascular health

Introduction

The global outbreak of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents an unprecedented challenge for healthcare. Despite social distancing and isolation measures, the number of affected patients is growing daily. Hyperinflammation and immunosuppression are prominently featured in COVID-19 [, ], resulting in a cytokine storm [] ultimately leading to development of micro-thrombosis and disseminated intravascular coagulation (DIC). This cytokine storm is strongly associated with the development of interstitial pneumonia (IP) []; however, although lungs are the primarily targeted organs, the cardiovascular system is globally affected. Evidence in this regard supports the notion that the exaggerated production of early response proinflammatory cytokines, such as tumor necrosis factor (TNF), interleukin-1β, -6, and -10 (IL-1β, IL-6, and IL-10, respectively), increases the risk of vascular hyperpermeability, possibly progressing to multiple organ failure and, ultimately, death []. The presence of vascular dysfunction at multiple levels, including pulmonary embolisms, alveolar hemorrhage, microangiopathy and vasculitis has been ascertained in post-mortem examination [, ]. Additionally, both venous and arterial thromboembolic complications, including endothelial inflammation, have been reported [, ]. Indeed, a growing body of evidence seems to support the theory that the endothelium is targeted by the SARS-CoV-2 []; most importantly, the endothelium expresses the protein angiotensin-converting enzyme 2 (ACE2) [, ], through which the virus can access host cells []. Endothelial dysfunction is, therefore, a pivotal determinant of COVID-19 symptoms [, ].

As of June 12th, 2020, more than 7.5 million COVID-19 cases have been confirmed worldwide, with more than 420,000 lives lost due to the disease []. More than 3.5 million subjects have recovered from COVID-19; however, the long-term consequences of the disease are still largely unknown. Data from 2002–2004 epidemics of SARS suggest that cardiovascular sequelae, such as microangiopathy, cardiomyopathy and impaired endothelial function, are to be expected also in COVID-19 patients [, ]. However, while similarities with SARS have been identified, COVID-19 is largely more prevalent due to its high transmissibility, and its consequences, even for recovered patients, are likewise more worrying. Additionally, new evidence is suggesting that autoimmune conditions, such as type 1 diabetes mellitus, might be triggered by the onset of COVID-19 [], therefore, worsening the risk profile for survivors.

These findings can be extremely relevant for male sexual health: indeed, based on these premises, there is quite enough evidence to hypothesize that consequences of COVID-19 can extend to sexual and reproductive health. We investigated the current literature to understand the long-term clinical complications for COVID-19 survivors, aiming to provide adequate information for clinicians to plan adequate and timely intervention measures.

Testosterone and COVID-19: friend or foe?

It is well established that ACE2 is the entry point for the SARS-CoV-2 in host cells []. In males, adult Leydig cells express this enzyme, therefore, suggesting that testicular damage can occur following infection []. Testicular damage in COVID-19 might, therefore, induce a state of hypogonadism as proven by decreased testosterone-to-LH ratio in patients with COVID-19, suggestive of impaired steroidogenesis resulting from subclinical testicular dysfunction [, ]. Post-mortem examinations of testicular tissue from 12 COVID-19 patients showed significantly reduced Leydig cells, as well as edema and inflammation in the interstitium []. A recent report on 31 male COVID-19 patients in Italy identified that some patients developed hypergonadotropic hypogonadism following the onset of the disease []. In the same study, lower levels of serum testosterone (total and free) acted as predictors of poor prognosis in SARS-CoV-2 men []. Whether this state of hypogonadism is permanent or temporary is a question so far left unanswered. Testosterone acts as a modulator for endothelial function [] and suppresses inflammation by increasing levels of anti-inflammatory cytokines (such as IL-10) and reducing levels of pro-inflammatory cytokines such as TNF-α, IL-6 and IL-1β []. It can, therefore, be hypothesized that suppression of testosterone levels might be one of the reasons for the large difference in terms of mortality and hospitalization rate between males and females and might also explain why SARS-CoV-2 most commonly infects old men.

On the other hand, androgens seem to play a pivotal role in COVID-19 by promoting the transcription of the transmembrane protease, serine 2 (TMPRSS2) gene. The encoded protein primes the spike protein of SARS-CoV-2, therefore, impairing antibody response and facilitating the fusion between the virus and the host cells []. This hypothesis could explain the higher prevalence of COVID-19 in men, although it would fail to explain the rationale for the higher mortality rates, as well as the worse clinical outcomes, for elderly patients.

Additional studies would, therefore, be needed to understand whether testosterone treatment might be beneficial or deleterious for the clinical course of the disease. However, independently of whether testosterone is a friend or foe for COVID-19, it should be acknowledged that the testis is a target for SARS-CoV-2 and the possibility for long-lasting consequences on the endocrine function exists, even for recovered patients.

COVID-19 and the endothelium

Solid evidence accumulated in the last decades support the notion that erectile function is an excellent surrogate marker of systemic health in general, and vascular performance in particular [], sharing plenty of risk factors with cardiovascular disease. This is described by the equation ED = ED (endothelial dysfunction equals erectile dysfunction, and vice versa) []. Vascular integrity is necessary for erectile function [], and vascular damage associated with COVID-19 is likely to affect the fragile vascular bed of the penis, resulting in impaired erectile function [, ]. COVID-19 features a state of hyperinflammation promoted by TNF-α, IL-6 and IL-1β []; the same inflammatory cytokines have been associated with clinical progression of sexual dysfunction []. It is worth noticing that the pro-inflammatory cytokines are also closely tied to testosterone levels: as previously stated, hypogonadal patients have higher concentrations of TNF-α, IL-6 and IL-1β as a result of impaired suppression. This ultimately worsens the endothelial dysfunction, further impairing erectile function. However, whether testosterone replacement therapy (TRT) would improve endothelial function is still debated, while largely beneficial in the treatment of hypogonadal men, TRT has known harmful effects if inappropriately prescribed [], and a meta-analysis study did not find any conclusive evidence of a potentially therapeutic effect of testosterone administration, neither acute nor chronic, on endothelial function []. While erection is—of course—a trivial matter for patients in Intensive Care Units (ICUs), there is reason to suspect that impaired vascular function might persist in COVID-19 survivors and even become a public health issue in the next few months. Moreover, given that erectile function is a predictor of heart disease [, ], investigating whether COVID-19 patients develop ED might also be a good surrogate marker of general cardiovascular function, improving patient care and quality of life.

A COVID eclipse of the heart: potential for cardiovascular burden

Besides the effects on endothelium, SARS-CoV-2 infection can also dramatically affect the heart and exacerbate underlying cardiovascular conditions. Reports of myocarditis in COVID-19 patients have piled up in the last months [–]; similarly, arrhythmias and acute cardiovascular events have been described in other coronavirus and influenza epidemics [–] and are likely to be expected for SARS-CoV-2 as well []. COVID-19 survivors are, therefore, more likely to develop severe cardiovascular consequences. However, treatment is not exempt from possible side effects, among which sexual dysfunctions are remarkably common. Drugs such as β-blockers and antihypertensive agents, routinely used in COVID-19 patients, have the potential to impair sexual function []; therefore, both the cardiovascular consequences and their treatment might ease progression from subclinical to a clinically overt ED [, ].

It is also worth mentioning that several cardiovascular risk factors involved in sexual dysfunctions, such as smoking [], diabetes [] and hyperhomocysteinemia [–], are also possible predictors of worse outcomes in COVID-19 patients.

Additionally, as stated in the III Princeton Consensus Panel [], sexual activity should be delayed until the cardiac condition has been stabilized in high-risk patients. Such patients include those with uncontrolled hypertension, recent myocardial infarction or high-risk arrhythmia, which are all conditions closely associated with COVID-19 [].

Reproductive health and COVID-19

Another reason for worry lies in the reported testicular damage from COVID-19 infection. In fact, ACE2 is highly expressed in the testis, suggesting the possibility of testicular infection since the early stage of the disease []. Being expressed in both Sertoli and Leydig cells [, ], ACE2 plays key roles in spermatogenesis and in the regulation of steroidogenesis. Due to the involvement of Sertoli cells, reproductive function might similarly be affected. Additionally, ACE2 is also expressed by spermatogonia, therefore, increasing the risk of SARS-CoV-2 presence in seminal fluid [, ].

Studies investigating the presence of SARS-CoV-2 in seminal fluid have, for the largest part, found no evidence of the virus [–]. However, as other studies have shown different results [], the topic of reproductive health is still largely debated. In post-mortem examinations, seminiferous tubular injury was reported despite no evidence of the virus in the testis []. Identification of SARS-CoV-2 in semen is of the utmost importance, as sperm cryopreservation is an undelayable necessity for many men, such as those who are about to start gonadotoxic treatments []. In Italy, cryopreservation procedures for oncological patients have continued during the COVID-19 pandemic, using utmost care to limit the risk of transmission; for non-oncological patients, the prospects of biological parenthood could be compromised as a consequence of delaying diagnostic semen analysis and sperm banking []. At the beginning of the pandemic, discontinuation of reproductive care except was recommended by international societies for reproductive medicine, with only the most urgent cases allowed; as containment and safety strategies have mitigated the spread of the disease, several centers for assisted reproductive technology have resumed their activity, although with very precise rules for operators [, ].

Further studies should, therefore, be designed with the aim to clarify this point, above all among “COVID-19 asymptomatic” men requiring assisted reproductive technology (ART).

The psychological burden of COVID-19

Increased rates of post-traumatic stress disorder (PTSD), depression and anxiety are expected in the general population, and even more in COVID-19 survivors, following the pandemic [–]. A parallel can be drawn between the psychological consequences of COVID-19 and those coming from similar disasters, such as the 9/11 attacks [] or earthquakes [], and similar short- and long-term treatment strategies are, therefore, needed to provide adequate care. Confinement and the illness in itself are both causes of stress; while only a minority of individuals might be more vulnerable to psychological trauma, there is no doubt that most people would experience some degree of emotional distress following isolation, social distancing, loss of relatives and friends, difficulties in securing medications, as well as the obvious economic consequences of lockdown. Sexual activity is closely associated with mental and psychological health; it is, therefore, unsurprising that sexual desire and frequency have declined in both genders during this pandemic [, ]. There is, therefore, reason to suspect that psychological suffering might exacerbate pre-existing subclinical sexual dysfunctions []. Additionally, the potential for SARS-CoV-2 transmission by kissing might lead to increased distress in the couple [], with the resulting negative effects on sexual health and on couple dynamics. Additionally, the hypogonadal state reported in COVID-19 could lead to a significant worsening in sexual desire and mood [, ].

Pulmonary fibrosis and the effects of hypoxia

It has been suggested, with on the basis of interesting evidence, that there could be substantial fibrotic consequences following SARS-CoV-2 infection [, ]. Indeed, pulmonary fibrosis is a well-acknowledged consequence of acute respiratory distress syndrome (ARDS), with further evidence coming from survivors of the 2003 SARS outbreak (caused by the SARS-CoV) [, ]. Pulmonary fibrosis impairs the physiologic lung mechanisms, reducing the pulmonary gas exchange and, therefore, impairing oxygen saturation [, ]; functional disability has been proven in ARDS patients several years after the acute phase of the disease []. There is currently no evidence concerning the possible long-term impairment of lung function following SARS-CoV-2 infection; however, considering the scale of the current pandemic and the similarities between SARS-CoV and SARS-CoV-2 [], there is sufficient reason to suspect a high rate of fibrotic lung function abnormalities in COVID-19 survivors. In such patients, the impaired oxygen saturation could impair erectile function; some evidence in support comes from animal models [, ] as well as from clinical reports [, ]. From a pathophysiological standpoint, this is hardly surprising, as oxygen is one of the substrates required for the synthesis of nitric oxide (NO) by the enzyme NO synthase, whose activity is severely blunted in hypoxia [].

Phosphodiesterase-5 inhibitors in COVID-19

Phosphodiesterase-5 (PDE-5) belongs to the PDE superfamily of enzymes, the last step of the NO/cGMP/PDE pathway and is one of the key elements in drug treatment of ED. NO activates guanylate cyclase in responsive cells, such as endothelial cells, resulting in increased concentrations of the second messenger cGMP (cyclic guanosine monophosphate), which in turn induces relaxation of smooth muscle. PDE acts downstream and reduces effects of cGMP by catalyzing its degradation: PDE inhibitors prevent degradation of cGMP, resulting in prolonged or enhanced action [].

PDE-5 is highly expressed in vascular smooth muscle cells [], and, at high concentrations, in those of the penile corpora cavernosa []; therefore, thanks to their action and due to their high affinity for the specific type 5 isoform [], PDE-5 inhibitors have been approved for their use in treatment of ED since 1998. However, a growing body of evidence has also proven their usefulness as therapeutic agents in different conditions due to their anti-inflammatory and antioxidant actions, as reported in diabetes [], hypertension and chronic kidney disease []. Sildenafil, the first PDE-5 inhibitor approved for the treatment of ED following its serendipitous discovery [], has also been investigated as a treatment for COVID-19 patients; indeed, Sildenafil improves pulmonary hemodynamics, as shown in idiopathic pulmonary fibrosis [], by reducing vascular resistance and remodeling in the pulmonary circulation []. Additionally, by inhibiting neointimal formation and platelet aggregation, sildenafil also might prove beneficial in regard to the risk of vascular injury and thrombotic complications in COVID-19 patients []. Evidence from new trials will prove fundamental to assess the clinical benefits of PDE-5 inhibition on the overall burden of COVID-19 [].

Conclusions

In conclusion, there is quite enough reason to suspect that male sexual and reproductive health could be affected in the survivors, by the sequelae of the COVID-19, both in the short and long terms (Fig. 1). Erectile function, as a surrogate marker of cardiovascular/pulmonary health, could also become extremely valuable as a quick and inexpensive first-line assessment of the pulmonary and cardiovascular complications for COVID-19 survivors. In this regard, evidence coming from diagnostic procedures, such as penile color-doppler ultrasound [] and hypothalamic-pituitary–testicular axis evaluation [], will be necessary to assess the extent to which COVID-19 has been able to impair erectile, and finally vascular, function, the former being an efficient predictor of complete restitutio ad integrum. Additionally, tailored psychological interventions would be necessary to adequately support patients who develop sexual dysfunction consequently to the containment measures.

An external file that holds a picture, illustration, etc. Object name is 40618_2020_1350_Fig1_HTML.jpg

Graphical overview of the involvement of SARS-CoV-2 in the pathogenesis of erectile dysfunction

Acknowledgements

Open access funding provided by Universitá degli Studi di Roma Tor Vergata within the CRUI-CARE Agreement. The authors are in debt with Dr. Tarek Hassan (Pfizer, New York, NY) for discussion on the role of PDE5 and of PDE5i in COVID-19 management. This paper is partially supported by the PRIN Grant #2017S9KTNE_002.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This manuscript is a review of the literature and does not contain original research either on animal or on human subjects.

Research involving human participants and/or animals

This article does not contain any studies involving animals and/or human participants performed by any of the authors.

Informed consent

For this type of study, informed consent is not required.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Blood clots cause 4-hour erection in man with coronavirus | Miami Herald

Did coronavirus cause a man to have a 4-hour erection? Doctors studied it to find out

By Katie Camero
July 02, 2020 02:30 PM

Edited for content

This article is a repost which originally appeared on The Miami Herald

Doctors in France believe the novel coronavirus could be to blame for a man’s erection that lasted more than four hours, a new case study says.

Blood clots found within the 62-year-old’s penis caused a painful case of priapism — the medical term for a prolonged erection — and is thought to have been triggered by the disease, according to the report published in June in The American Journal of Emergency Medicine.

The case appears to be the first that links penile erections to COVID-19, the team of doctors said.

“The clinical and laboratory presentation in our patient strongly suggests priapism related to SARS-CoV-2 infection,” the doctors said in the study. “This medical emergency should be recognized by healthcare professionals and treated promptly to prevent immediate and chronic functional complications.”

A significant number of coronavirus patients admitted to intensive care units form dangerous clots in their blood, several reports have shown. They are causing patients to have heart attacks, strokes, rashes and swollen fingers and toes, and can be found in the lungs, liver, kidneys and bowels, according to WebMD.

Some scientists speculate clotting is the result of an exhausted immune system that ends up turning against itself, causing a condition called “disseminated intravascular coagulation, where patients both bleed uncontrollably and clot too much at the same time,” the outlet said.

Others theorize the virus could be causing the clotting directly, but more research is needed to understand the phenomenon, experts say.

But when the patient visited a doctor feeling feverish and weak with a dry cough and diarrhea, there were no signs of a problematic erection, the study said. Clinicians gave the man antibiotics for what they thought was a bacterial infection.

Two days later, he was having breathing troubles and went to the hospital where he was “promptly intubated and mechanically ventilated,” the researchers said.

The patient’s blood pressure spiraled out of control and chest scans showed abnormalities in his lungs, but still no sign of an erection. It wasn’t until the patient was admitted into the ICU with fluid in his lungs that a “physical examination revealed previously unidentified priapism,” the study said.

Doctors drew blood from the man’s penis and found “dark blood clots and high carbon dioxide and low oxygen contents,” which means the clots were blocking blood from flowing out of the penis, Bruce Lee, a professor of health policy and management at the City University of New York, wrote in Forbes.

“When blood stays in the same place and can’t return to the lungs, it gets depleted of oxygen and loaded more and more with carbon dioxide,” Lee wrote.

Doctors injected medicine into the man’s penis which helped his condition, the study said.

“Although the arguments supporting a causal link between COVID-19 and priapism … are very strong in our case, reports of further cases would strengthen the evidence,” the researchers said.

Priapism is diagnosed when an erection goes on for more than four hours or isn’t related to sexual stimulation, according to the Mayo Clinic. It’s uncommon yet usually painful, and occurs in men in their 30s or older with certain conditions such as sickle cell anemia.

“Prompt treatment for priapism is usually needed to prevent tissue damage that could result in the inability to get or maintain an erection (erectile dysfunction),” the Mayo Clinic said.