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.