DISCUSSION
In December 2019, the first cases of pneumonia of unknown etiology were
detected in Wuhan, China. A previously unknown betacoronavirus was
detected in the respiratory samples of these patients [1]. World
Health Organization named the virus as SARS-CoV-2, while the disease it
caused was called COVID-19 and announced it as a pandemic on March 11,
2020.6 COVID-19, which is still spreading in the
world, infected approximately 1 million 709 thousand people in the world
as of April 11, 2020, while the total number of deaths is over 103
thousand people. As of March 1, the mortality rates of this very
contagious pandemic disease were reported to be (5.6% and 15.6%) in
China and non-Chinese countries, respectively.7 The
first case in our country was diagnosed in the city of Istanbul on March
11, 2020. Until April 11 2020, the number of cases exceeded 47000 and
1006 people died in a period of 1 month. Mortality rate in our country
is currently 2.19%.
BPH is a major cause of lower urinary tract symptoms among aging males,
affecting approximately 210 million men all over the
world.8 An estimated 50% and 75% of men have
histologic evidence of BPH by the age of 50 and 80 years, respectively,
with approximately 50% of them having clinically considerable
symptoms.8 Current studies found that nearly half of
COVID-19 patients are over the age of 50 and men are more likely to be
infected than women and the mortality rate in males is higher than that
in females.9 Considering the frequency of BPH disease
in older men, we thought it was important to investigate the course of
COVID-19 disease in these BPH patients. When the literature is
researched, the association and course of COVID-19 disease with many
diseases have been investigated, but there are no studies on the course
of the disease in BPH patients. In our study, we found a low mortality
rate in COVID-19 patients who are known to have BPH and who have been
diagnosed with medical treatment. We think that the rapid development of
systemic complications after the onset of COVID-19 in our single patient
who died, and the fact that the patient was elderly and had more than
two comorbidities which led to death. All the patients receiving
standard COVID-19 therapy during follow-up also continued to use alpha
blockers and/or five alpha reductase inhibitors due to BPH. None of the
patients experienced negative drug interactions and complications. Less
than half of patients (n: 6, 33.3%) required low-flow oxygen therapy,
and none of the patients needed invasive ventilation or extracorporeal
membrane oxygenation.
Since SARS-CoV-2 is a recent virus, currently, there is no vaccine or
therapeutic antibody to prevent the infection, and more time is required
to develop an effective immune strategy against the pathogen. In
addition to supportive treatments, medical treatments (antivirals,
antibiotics, corticosteroids, hydroxychloroquine etc.) are applied.
Unfortunately, a standard treatment protocol applied worldwide has
unfortunately not yet been developed. Many treatment options have been
tried in China and other countries and their effects on the virus have
been published. Russell et al.10 suggested that
corticosteroid therapy should not be used other than SARS-CoV-2 induced
lung injury or shock therapy. In another study had identified 4 small
molecular drugs (prulifloxacin, nelfinavir, bictegravir, tegobuvir) with
high binding capacity with SARS-CoV-2 main protease.11In addition, remdesivir and chloroquine have been shown to effectively
inhibit SARS-CoV-2 in vitro and have been reported as potential
treatments for COVID-19 as well as baricitinib.12,13The fact that it is seen later in our country compared to other world
countries has been an advantage in terms of applying the most effective
treatment. The scientific committee formed by our Ministry of Health has
determined treatment algorithms according to the severity of the disease
by considering the current literature and updating it continuously. We
applied treatment to our patients according to this algorithm in our
clinic.
Conventional ways of transmission of SARS-CoV-2 are thought to be
similar to other contemporary coronavirus syndromes. However, detection
of SARS-CoV-2 in the gastrointestinal tract, saliva, and urine may
suggest other potential portals of transmission as
well.14 Transmission of COVID-19 is mainly through
respiratory droplets from cough or sneeze, direct contact and aerosol
transmission is also possible. Droplets can be deposited in the mouths,
noses, or eyes of people nearby or be inhaled into the lungs of those in
close proximity. In the light of this information, measures including
strict precautions, adequate protective devices, and infection control
training should be implemented for all hospital workers, especially
assistants and cleaners who handle the excreta of these patients and
toilet disinfection. When the transmission path in our study was
examined, 10 patients were infected in hospital environment (hospital
worker, during admission to the outpatient clinic as a patient or during
a visit to the patient), while 5 patients were transmitted through
direct contact due to a COVID-19 patient diagnosed in the patient’s
family. We think that these patients were infected during the period
when COVID-19 was not seen commonly in hospitals and individuals did not
take adequate measures and surgical masks was not used widely in our
country.
COVID-19 is mainly manifested as fever, accompanied by cough, fatigue,
muscular soreness, chest depression, shortness of breath, diarrhea and
other symptoms.15 In accordance with the literature,
fever, fatigue, muscle and joint pain, dry cough, headache and throat
pain, sudden loss of taste and smell in our patients were also
determined. Most of our patients had normal or decreased white blood
cell count and low lymphocyte count.
This study has several limitations. Lack of a prospective, comparative
study with control group and low number of cases can be listed as the
main limitations. Another limitation is that follow-up times are very
short. Despite all these limitations, we know that our study is the
first and only study on this subject, and we think that it may be
helpful in this period. Although there are deficiencies, it can be a
guide for the studies to be carried out and contribute to the
information about COVID-19 disease that is still spreading rapidly.