Breathing issues, brain fog and a lingering loss of taste are just some of the long-term effects seen in coronavirus patients. Now, experts are warning that COVID-19 could also make it difficult to get an erection.
Image: Axel Bueckert/Zoonar/picture alliance
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As the world awaits a coronavirus vaccine, experts in Italy and the US are warning of another potential long-term consequence of COVID-19:erectile dysfunction.
During a recent interview with the US broadcaster NBC, American physician Dena Graysonsaid there was growing concern that COVID-19 could cause long-term difficulty getting an erection.
"We know that it causes issues in the vasculature," Grayson said. "So this is something that is of real concern—not just that this virus can kill, but can actually cause long-term, lifelong potential complications."
Both a risk factor and a consequence
A study out of Italy in July found that erectile dysfunction was both a risk factor for COVID-19 pneumonia and also a "likely consequence" of the disease for survivors, making it a "worrying phenomenon" among elderly patients in particular.
"Erectile dysfunction is a perfect biomarker of general physical and psychological health," said the study's lead author,EmmanueleJannini, professor of endocrinology and medical sexology at the Tor Vergata University of Rome. As COVID-19 affects both mental and physical well-being, he said, erectile dysfunction is not necessarily a surprising consequence of the disease.
People infected with coronavirus who have previously suffered erectile dysfunction may also be more prone to developing COVID-19 pneumonia, according to Jannini.
That's because pneumonia entails the same comorbidities that are often associated with erectile dysfunction, he said, including respiratory difficulties, inflammation, hormonal issues, stress, anxiety, depression and endothelial dysfunction — or when the lining of the small arteries constricts.
"Erectile dysfunction is a bona fide marker of risk for pneumonia from coronavirus. But it is not necessarily a risk factor for getting the infection, that remains to be seen," Jannini said.
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Damage to blood vessels a cause for concern
Erectile dysfunction occurs when blood flow to the penis is limited — the causes of which can be complex and varied, both physiological and psychological. Many different factors affecting the cardiovascular system, nervous system and endocrine system can cause or contribute to issues with getting an erection.
One risk factor that stands out for coronavirus patients is the damage done to the vascular and respiratory systems.
The coronavirus has been found to attack the inner walls of blood vessels — called the endothelium — throughout the body, including those in the penis, which can cause vascular blockages.
Although large blood clots can cause heart attacks and strokes, the heart damage caused by COVID-19 is believed to stem mostly from very small clots that block tiny blood vessels in the heart muscle.There are particularly small blood vessels in the penis which can quickly become blocked when the arterial blood flow is restricted.
While this may explain some presentations of erectile dysfunction among coronavirus patients, experts stress that more research needs to be done to determine its link to COVID-19, and this is likely to differ among individuals.
Preventing long-term COVID-19 effects
Although the vast majority of people seem to recover from COVID19 — the disease caused by the coronavirus infection — multiple long-term effects have been observed.
According to the Centers for Disease Control and Prevention in the US, some of the reported long-term complications of COVID-19 include heart palpitations, brain fog, acute kidney injury and impaired lung function. Erectile dysfunction is not listed, but, as Grayson points out, experts are still learning about the disease as infection numbers grow and patients are monitored long-term.
"As time goes on, and more and more people are infected, we're going to unfortunately see more and more of these long-term negative consequences of infection," she said.
Experts say the best way to prevent the potential long-term consequences of COVID-19 is to avoid getting infected with coronavirus in the first place.
The World Health Organization recommends wearing a mask in public place, keeping at least 2 meters (6 feet) away from other people, frequently washing hands and avoiding crowds and poorly ventilated spaces.
Coronavirus rules: How much physical distancing is enough?
Physical distancing is important. But a set distance rule does not do justice to the way viruses actually spread, British researchers say. And the CDC warns: Infections can occur after only a few minutes of exposure.
Image: Reuters/M. Darlington
Keep your distance, please!
These are the coronavirus rules as we know them: Keep a distance of 1.5 to 2 meters (5 to 6 feet) from others, observe good hygiene and wear a mask. But this does not do justice to the complex reality of how aerosols spread, researchers from Oxford and London (UK) and Cambridge MA (US) have written in an analysis published in the British Medical Journal in late August.
Image: picture-alliance/dpa/J. Büttner
This much? Or more?
British Prime Minister Boris Johnson has tried to show schoolchildren how it should be done. But what does his gesture mean exactly? Do his fingertips have to be 1.5 meters away from the fingertips of another person? That would be a reasonable interpretation of the regulations. But two arm lengths alone measure 1.5 meters, so distances of 4.5 meters or more could easily result.
Image: picture-alliance/dpa/Evening Standard/L. Young
Are sheep lengths better?
The Icelandic Association of Sheep Breeders has established its own rules: Two sheep lengths are appropriate to avoid infection. One may wonder if face masks are also supposed to be knitted from real sheep's wool. This young shepherd in Senegal may be trying to find out how long a sheep is by pulling its hind leg. The Icelanders already know — exactly 1 meter.
Image: AFP/J. Wessels
Natural spacers
Of course, this could also work. The standard length of a dog leash corresponds pretty exactly to the current coronavirus rules. Could it be a coincidence that a six-foot leash is usually prescribed for places where leashes are compulsory?
Image: picture-alliance/chromorange
Where does the 2-meter rule come from?
The authors led by Lydia Bourouiba, an expert in fluid dynamics and disease transmission at MIT, writes that the rule is outdated. Two meters was the distance recommended by the German physician C. Flügge in 1897. Visible droplets that he had caught within this distance were still contagious. A 1948 study showed that 90% of streptococci coughed out in droplets flew no further than 1.7 meters.
Image: picture-alliance/dpa/PA/Jordan
Two meters are not enough
The 1948 study was published in the American Medical Journal. It also showed that 10% of streptococci flew much further: up to 2.9 meters. If that were the case, perhaps the people on this lawn on the banks of the Rhine in Dusseldorf would be safe — if every other circle remained free. But wait a minute — we are not dealing with streptococci (bacteria) here, but with viruses.
Image: picture-alliance/dpa/M. Becker
Viruses spread via aerosols
Viruses are much smaller than bacteria, so they can float around for hours and spread better in the air. This is why the researchers recommend that the distance between people should not be the only safety criterion but that other factors should be considered, too: How well a room is ventilated, whether people are wearing masks, and whether they are silent, speaking softly or singing and shouting.
Image: picture-alliance/dpa/Bayerischer Rundfunk
Do not sing or cough
Numerous studies have also shown that coughing can propel veritable parcels of viruses up to 8 meters through the air. Speaking or singing loudly also spread a lot of aerosols and droplets about the room. If, however, people only speak quietly, as in a library, and sit in the fresh air, safe distances can be smaller again.
Image: Getty Images/AFP/A. McBride
How long should I stay in the room?
The duration of a stay in a contaminated room and how many people are in that room are also decisive factors when assessing the risk of infection. The researchers have used those factors to develop a traffic light model. The clear result: In rooms with a high occupancy, you should generally stay only for a short time, make sure they are well aired, wear a mask and speak quietly.
Image: picture-alliance/dpa/S. Hoppe
One minute is enough to get infected
Even very brief contact can be enough to transmit SARS-CoV-2. The US Center for Disease Control (CDC) had to tighten its rules on October 21, after a prison guard caught SARS-CoV-2 from prisoners with whom he had only had contact with for a few minutes at a time. Now, "close contact" is defined as being within 2 metres of an infected person for at least 15 minutes cumulatively within 24 hours.
Image: picture-alliance/empics
No mask needed here
Here, however, the traffic light of the UK-US research team would show green. Outside, people can be safe for long periods of time even without a mask, provided there are few people around, everything is well ventilated and no one talks much. But even so, will the distance between deck chairs being measured here be enough?
