{"id":81,"date":"2020-05-19T18:02:23","date_gmt":"2020-05-19T18:02:23","guid":{"rendered":"http:\/\/publichealth.sdsu.edu\/covid-19\/?page_id=81"},"modified":"2023-11-02T18:56:38","modified_gmt":"2023-11-02T18:56:38","slug":"human-organs","status":"publish","type":"page","link":"https:\/\/vryheid.sdsu.edu\/index.php\/human-organs\/","title":{"rendered":"Human Organs"},"content":{"rendered":"<h2><strong>Starting Infection<\/strong><\/h2>\n<p>[Publication date of latest article cited: October 26, 2023]<\/p>\n<p>The number of pathogens entering the body that can start infection is called the \u201cinfectious dose.\u201d Scientists\u2019 estimates of the infectious dose for SARS-CoV-2 in hamsters,ferrets, an humans range between 5 (<a href=\"https:\/\/doi.org\/10.1080\/22221751.2020.1858177\" target=\"_blank\" rel=\"noopener\">Rosenke et al.<\/a>), 10 (<a href=\"https:\/\/doi.org\/10.1073\/pnas.2018995118\" target=\"_blank\" rel=\"noopener\">Bazant &amp; Bush<\/a>), or 100 (<a href=\"https:\/\/doi.org\/10.1017\/S0950268821000790\" target=\"_blank\" rel=\"noopener\">Karimzadeh et al.<\/a>), or 60,000 (<a href=\"https:\/\/doi.org\/10.1016\/j.biochi.2023.03.006\" target=\"_blank\" rel=\"noopener\">Poydenot et al.<\/a>).\u00a0 When measured in plaque forming units (PFU), an indirect way of quantifying viruses, as low as 1.8 X 10<sup>3<\/sup>\u2009PFU infected hamsters (<a href=\"https:\/\/doi.org\/10.1099\/jgv.0.001567\" target=\"_blank\" rel=\"noopener\">Monchatre-Leroy et al.<\/a>), and 500 PFU infected a ferret\u00a0 (<a href=\"https:\/\/doi.org\/10.1039\/d3cs00417a\" target=\"_blank\" rel=\"noopener\">Qiu G, Zhang X, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1038\/s41467-020-20439-y\" target=\"_blank\" rel=\"noopener\">Ryan et al.<\/a>). If many less than that enter, the immune system can probably fight them off.\u00a0 If many more than that enter, then that might cause greater numbers of the viruses to multiply in the body, which might cause more severe disease in some people (<a href=\"https:\/\/doi.org\/10.1017\/S0950268821000790\" target=\"_blank\" rel=\"noopener noreferrer\">Karimzadeh et al.; <\/a><a href=\"https:\/\/www.nytimes.com\/2020\/05\/29\/health\/coronavirus-transmission-dose.html\" target=\"_blank\" rel=\"noopener noreferrer\">Mandavilli \u201cIt\u2019s not whether\u201d<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/S1473-3099(20)30982-8\" target=\"_blank\" rel=\"noopener noreferrer\">Spinelli et al.<\/a>). If this occurs over 15 consecutive minutes, or a cumulative 15 minutes in one day, it can cause infection (<a href=\"https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/php\/contact-tracing\/contact-tracing-plan\/appendix.html#contact\" target=\"_blank\" rel=\"noopener noreferrer\">Centers for Disease Control and Prevention \u201cCoronavirus Disease 2019 (COVID-19) Appendices\u201d<\/a>; <a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/69\/wr\/mm6943e1.htm\" target=\"_blank\" rel=\"noopener noreferrer\">Pringle et al.<\/a>).\u00a0 The new Delta variant is more transmissible than the original version of SARS-CoV-2, because Delta causes higher viral loads (the density of viruses in the infected body) and shorter incubation periods (<a href=\"https:\/\/www.nature.com\/articles\/d41586-021-01986-w\" target=\"_blank\" rel=\"noopener\">Reardon<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.eclinm.2021.101129\" target=\"_blank\" rel=\"noopener\">Wang Y, Chen R, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.46234\/ccdcw2021.148\" target=\"_blank\" rel=\"noopener\">Zhang M, Xiao J, et al.<\/a>).<\/p>\n<p>Spike proteins on the outside of the virus attach to a protein called angio-tensin converting enzyme 2 (ACE2) on the outside of some kinds of human cells.\u00a0 ACE2 normally regulates other molecules on the cells, and maintains blood pressure, electrolyte and fluid balance, and allows inflammation and apoptosis cell death (<a href=\"https:\/\/doi.org\/10.1080\/21505594.2021.1929800\" target=\"_blank\" rel=\"noopener\">Alshamarry et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fcell.2021.659809\" target=\"_blank\" rel=\"noopener\">An et al.<\/a>; <a href=\"https:\/\/doi.org\/10.21873\/invivo.12672\" target=\"_blank\" rel=\"noopener\">Gintoni et al.<\/a>; <a href=\"http:\/\/doi.org\/10.1155\/2021\/6949902\" target=\"_blank\" rel=\"noopener\">Liu Y, Wu Q, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1073\/pnas.2111544118\" target=\"_blank\" rel=\"noopener\">Ornes<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3390\/medicina57060523\" target=\"_blank\" rel=\"noopener\">Salas Orozco et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1021\/acs.chemrev.1c01062\" target=\"_blank\" rel=\"noopener\">Saville et al.<\/a>; <a href=\"https:\/\/www.nature.com\/articles\/d41586-021-02039-y\" target=\"_blank\" rel=\"noopener\">Scudellari \u201cHow the coronavirus Infects cells\u201d<\/a>). \u00a0The virus also exploits other molecules on the outside of human cells to enter the cells, especially transmembrane protease serine 2 (TMPRSS2), which normally helps the cell take proteins apart, so the cell can use the amino acid parts to make other proteins. \u00a0To enter cells, this virus also uses transmembrane protease serine 4 (TMPRSS4), which normally helps to bind proteins (<a href=\"https:\/\/doi.org\/10.3892\/ijmm.2021.4897\" target=\"_blank\" rel=\"noopener noreferrer\">Katopodis et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3390\/medicina57060523\" target=\"_blank\" rel=\"noopener\">Salas Orozco et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1021\/acs.chemrev.1c01062\" target=\"_blank\" rel=\"noopener\">Saville et al.<\/a>; <a href=\"https:\/\/www.nature.com\/articles\/d41586-021-02039-y\" target=\"_blank\" rel=\"noopener\">Scudellari \u201cHow the coronavirus Infects cells\u201d<\/a>). \u00a0 The virus&#8217;s spike protein also binds to neuropilin-1 (NRP1) on the outside of cells, in order to enter the cells, which are abundant inside the nose (<a href=\"https:\/\/science.sciencemag.org\/content\/370\/6518\/856\" target=\"_blank\" rel=\"noopener noreferrer\">Cantuti-Castrelvetri et al.<\/a>; <a href=\"https:\/\/science.sciencemag.org\/content\/370\/6518\/861\" target=\"_blank\" rel=\"noopener noreferrer\">Daly et al.<\/a>; <a href=\"https:\/\/science.sciencemag.org\/content\/370\/6518\/765.full\" target=\"_blank\" rel=\"noopener noreferrer\">Kielian<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3390\/medicina57060523\" target=\"_blank\" rel=\"noopener\">Salas Orozco et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/978-3-030-59261-5_5\" target=\"_blank\" rel=\"noopener\">Shojaee et al.<\/a>).\u00a0 The protease furin normally helps take proteins out of cells (<a href=\"https:\/\/www.sciencedirect.com\/topics\/neuroscience\/furin\" target=\"_blank\" rel=\"noopener\">Molloy et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/B978-0-12-394447-4.20037-0\" target=\"_blank\" rel=\"noopener\">Stockli et al.<\/a>). \u00a0After SARS-CoV-2 binds to a cell, it uses furin to enter the cell (<a href=\"https:\/\/doi.org\/10.1038\/s41564-021-00908-w\" target=\"_blank\" rel=\"noopener\">Peacock et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fmed.2020.594495\" target=\"_blank\" rel=\"noopener\">Salamanna et al.<\/a>).\u00a0 So, SARS-CoV-2 infects cells which have ACE2, TMPRSS2, NRP1, furin, and other proteases.\u00a0 The viruses replicate in the cell\u2019s endoplasmic reticulum (ER) and Golgi complex, exits the cell, and causes cell death which results in COVID-19 disease (<a href=\"https:\/\/doi.org\/10.1080\/21505594.2021.1929800\" target=\"_blank\" rel=\"noopener\">Alshamarry et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1021\/acs.chemrev.1c01062\" target=\"_blank\" rel=\"noopener\">Saville et al.<\/a>; <a href=\"https:\/\/www.nature.com\/articles\/d41586-021-02039-y\" target=\"_blank\" rel=\"noopener\">Scudellari \u201cHow the coronavirus Infects cells\u201d<\/a>).<\/p>\n<p>Genes associated with cells having molecules susceptible to SARS-CoV-2 are in the nose, mouth, lungs, heart, intestines, nerves, kidney, placenta, testes, and prostate, especially the epithelial cells inside these organs which are exposed to the outside air (<a href=\"https:\/\/doi.org\/10.1038\/s41591-021-01296-8\" target=\"_blank\" rel=\"noopener\">Huang N, P\u00e9rez, et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/978-3-030-59261-5_5\" target=\"_blank\" rel=\"noopener\">Shojaee et al.<\/a>; <a href=\"https:\/\/scarface.cells.ucsc.edu\" target=\"_blank\" rel=\"noopener noreferrer\">Singh et al. \u201cA Single Cell RNA Expression Map. Cornell\u201d<\/a>;\u00a0 <a href=\"https:\/\/www.cell.com\/cell-reports\/pdf\/S2211-1247(20)31164-5.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Singh et al. \u201cA Single Cell RNA Expression Map. Cell Reports\u201d<\/a>; <a href=\"https:\/\/news.cornell.edu\/stories\/2020\/09\/study-reveals-possible-new-coronavirus-entry-points\" target=\"_blank\" rel=\"noopener noreferrer\">Wiegand<\/a>), and the pulmonary endothelial cells (<a href=\"https:\/\/doi.org\/10.21873\/invivo.12672\" target=\"_blank\" rel=\"noopener\">Gintoni et al.<\/a>).\u00a0 Fewer ACE2 and TMPRSS2 molecules are on the endothelial cells exposed to internal channels, such as blood vessels, so SARS-CoV-2 probably cannot infect them (<a href=\"https:\/\/doi.org\/10.1182\/blood.2021012250\" target=\"_blank\" rel=\"noopener\">Flaumenhaft et al.<\/a>;\u00a0<a href=\"https:\/\/doi.org\/10.1002\/cti2.1350\" target=\"_blank\" rel=\"noopener\">Schimmel et al.<\/a>).\u00a0 The genes controlling ACE2 vary; some genotypes are associated with more severe disease (<a href=\"https:\/\/doi.org\/10.21873\/invivo.12672\" target=\"_blank\" rel=\"noopener\">Gintoni et al.<\/a>).<\/p>\n<h2>Mouth, Nose, and Respiratory System<\/h2>\n<p>[Publication date of latest article cited: August 2, 2023]<\/p>\n<p>When someone inhales SARS-Cov-2 in droplets and aerosols, the viruses can infect the cells inside the mouth and nose, which have much ACE2 and other receptors (<a href=\"https:\/\/doi.org\/10.1002\/path.1570\" target=\"_blank\" rel=\"noopener\">Hamming et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1038\/s41591-021-01296-8\" target=\"_blank\" rel=\"noopener\">Huang et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fcell.2020.00618\" target=\"_blank\" rel=\"noopener\">Li H, Wang Y, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1111\/ina.12970\" target=\"_blank\" rel=\"noopener\">Nazaroff<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.ebiom.2020.102976\" target=\"_blank\" rel=\"noopener\">Ortiz et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fmed.2020.594495\" target=\"_blank\" rel=\"noopener\">Salamanna et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3390\/medicina57060523\" target=\"_blank\" rel=\"noopener\">Salas Orozco et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.celrep.2020.108175\" target=\"_blank\" rel=\"noopener\">Singh et al.\u201cA Single Cell RNA Expression Map Cell Reports\u201d;<\/a> <a href=\"https:\/\/doi.org\/10.1126\/science.abd9149\" target=\"_blank\" rel=\"noopener\">Wang C, Prather K, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fmed.2020.580796\" target=\"_blank\" rel=\"noopener\">Zhong M et al.<\/a>).\u00a0 People can also put SARS-CoV-2 inside their noses by touching the inside of their noses (<a href=\"https:\/\/doi.org\/10.1371\/journal.pone.0288352\" target=\"_blank\" rel=\"noopener\">Lavell et al.<\/a>). \u00a0SARS-CoV-2 can infect salivary glands, which can produce saliva with SARS-CoV-2 (<a href=\"https:\/\/doi.org\/10.1111\/joa.13560\" target=\"_blank\" rel=\"noopener\">Zhu F, Zhong Y, et al.<\/a>), which can then infect another person via droplets and aerosols. SARS-CoV-2 infects and destroys large numbers of nose cells, reducing the ability to smell, called anosmia (<a href=\"https:\/\/doi.org\/10.1007\/s12070-022-03401-w\" target=\"_blank\" rel=\"noopener\">Shamsundara et al.<\/a>). SARS-CoV-2 can float past the cilia and mucous membranes, enter the lungs, and infect the alveoli air sacs (<a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMc2009324\" target=\"_blank\" rel=\"noopener noreferrer\">Meselson<\/a>; <a href=\"https:\/\/doi.org\/10.1111\/ina.12970\" target=\"_blank\" rel=\"noopener\">Nazaroff<\/a>; <a href=\"https:\/\/doi.org\/10.1126\/science.abd9149\" target=\"_blank\" rel=\"noopener\">Wang C, Prather K, et al.<\/a>).\u00a0 The circulatory system can then carry SARS-CoV-2 to the intestines, lungs, and other organs having ACE2 (<a href=\"https:\/\/doi.org\/10.1182\/blood.2021012250\" target=\"_blank\" rel=\"noopener\">Flaumenhaft et al.<\/a>; <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/path.1570\" target=\"_blank\" rel=\"noopener noreferrer\">Hamming et al.<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/ebiom\/article\/PIIS2352-3964(20)30352-2\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Ortiz et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3390\/medicina57060523\" target=\"_blank\" rel=\"noopener\">Salas Orozco et al.<\/a>; <a href=\"https:\/\/cells.ucsc.edu\/?ds=scarface\" target=\"_blank\" rel=\"noopener noreferrer\">Singh et al. \u201cA Single Cell RNA Expression Map Cornell\u201d<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.celrep.2020.108175\" target=\"_blank\" rel=\"noopener noreferrer\">Singh et al. \u201cA Single Cell RNA Expression Map Cell Reports\u201d<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/ebiom\/article\/PIIS2352-3964(20)30380-7\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Yang et al.<\/a>).\u00a0 SARS-CoV-2 replicates competently in bronchus and lung cells (<a href=\"https:\/\/www.thelancet.com\/journals\/lanres\/article\/PIIS2213-2600(20)30193-4\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Hui et al.<\/a>).\u00a0 Infected people of all ages have the viruses in their nasopharynx (nose and throat), but small children have more of the viral RNA, indicating (but not completely proving) that they might transmit to others more than older children and adults transmit (<a href=\"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2768952\" target=\"_blank\" rel=\"noopener noreferrer\">Heald-Sargent et al.<\/a>).\u00a0 So, the infection usually starts in the nose and eyes, spreads through the respiratory system, and then to many organs (<a href=\"https:\/\/erj.ersjournals.com\/content\/early\/2020\/07\/23\/13993003.01948-2020\" target=\"_blank\" rel=\"noopener noreferrer\">Chen M, Shen et al.<\/a>; <a href=\"https:\/\/www.scientificamerican.com\/interactive\/inside-the-coronavirus\/\" target=\"_blank\" rel=\"noopener noreferrer\">Fischetti et al.<\/a>; <a href=\"https:\/\/scitechdaily.com\/new-evidence-that-cells-in-the-nose-are-key-entry-point-for-sars-cov-2-covid-19\/\" target=\"_blank\" rel=\"noopener noreferrer\">Johns Hopkins Medicine<\/a>; <a href=\"http:\/\/Matheson NJ, Lehner PJ. How does SARS-CoV-2 cause COVID-19? Science. 369 (6503): 510-511. Published July 31, 2020. DOI: 10.1126\/science.abc6https:\/\/science.sciencemag.org\/content\/369\/6503\/510\" target=\"_blank\" rel=\"noopener noreferrer\">Matheson, Lehner; <\/a><a href=\"https:\/\/www.nature.com\/articles\/d41586-020-02414-1\" target=\"_blank\" rel=\"noopener noreferrer\">Nature<\/a>; <a href=\"https:\/\/www.sciencemag.org\/news\/2020\/04\/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes\" target=\"_blank\" rel=\"noopener noreferrer\">Wadman et al.<\/a>;\u00a0<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2768391\" target=\"_blank\" rel=\"noopener noreferrer\">Wiersinga et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.jtos.2020.06.007\" target=\"_blank\" rel=\"noopener noreferrer\">Zhou L, Xu, et al.<\/a>).<\/p>\n<p>SARS-CoV-2 multiplies rapidly in the epithelial and endothelial cells in the internal surfaces of the respiratory system. SARS-CoV-2 binding to ACE2 may contribute to vasoconstriction, oxidative organ damage, and white blood cells releasing proteins called cytokines rushing into the lungs.\u00a0 Excessive reactions like this inflame and damage alveoli air sacs, called a \u201ccytokine storm\u201d (<a href=\"https:\/\/www.mdpi.com\/1422-0067\/21\/13\/4782\" target=\"_blank\" rel=\"noopener noreferrer\">Allegra et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1182\/blood.2021012250\" target=\"_blank\" rel=\"noopener\">Flaumenhaft et al.<\/a>; <a href=\"https:\/\/doi.org\/10.21873\/invivo.12672\" target=\"_blank\" rel=\"noopener\">Gintoni et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/978-3-030-59261-5_10\" target=\"_blank\" rel=\"noopener\">Tavasolian et al.<\/a>; <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apha.13608\" target=\"_blank\" rel=\"noopener noreferrer\">Ye et al.<\/a>).\u00a0 SARS-CoV-2 in the respiratory system are shown in eye-catching photos of hundreds of the virions (whole infectious viruses) on the cilia (hair-like cells), taken by researchers (<a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMicm2023328\" target=\"_blank\" rel=\"noopener noreferrer\">Ehre<\/a>; <a href=\"http:\/\/news.unchealthcare.org\/news\/2020\/september\/unc-researchers-publish-striking-images-of-sars-cov-2-infected-cells\" target=\"_blank\" rel=\"noopener noreferrer\">University of North Carolina<\/a>).<\/p>\n<h2><a id=\"Eyes\"><\/a>Eyes<\/h2>\n<p>[Publication date of latest article cited: September 2, 2023]<\/p>\n<p>SARS-CoV-2 can probably transmit via aerosols and droplets into eyes, infecting them, and spreading into the respiratory system (<a href=\"https:\/\/doi.org\/10.1016\/S2666-5247(21)00040-9\" target=\"_blank\" rel=\"noopener noreferrer\">Coroneo, Collingnon<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fcell.2020.00618\" target=\"_blank\" rel=\"noopener\">Li H, Wang Y, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.47626\/1679-4435-2021-598\" target=\"_blank\" rel=\"noopener\">Matos et al.<\/a>; <a href=\"https:\/\/doi.org\/10.18502\/jovr.v16i2.9087\" target=\"_blank\" rel=\"noopener\">Roshanshad et al.<\/a>; <a href=\"https:\/\/doi.org\/10.7759%2Fcureus.44589\" target=\"_blank\" rel=\"noopener\">Singh K, Pattebahadur et al.<\/a>).\u00a0 Many people spontaneously touch their hands to their eyes often, which could spread SARS-CoV-2 and other pathogens (<a href=\"https:\/\/doi.org\/10.3390\/ijerph18136983\" target=\"_blank\" rel=\"noopener\">Carrillo-Diaz et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.jtos.2021.04.008\" target=\"_blank\" rel=\"noopener\">Spencer et al.<\/a>).\u00a0 In some COVID-19 patients, SARS-CoV-2 might have entered the eyes of those who had not been wearing face shields (<a href=\"https:\/\/bjo.bmj.com\/content\/early\/2020\/08\/10\/bjophthalmol-2020-316263\" target=\"_blank\" rel=\"noopener noreferrer\">Chen X, Yu H, et al.<\/a>; <a href=\"https:\/\/reader.elsevier.com\/reader\/sd\/pii\/S0140673620303135\" target=\"_blank\" rel=\"noopener noreferrer\">Lu CW, Liu, et al.<\/a>). \u00a0Some patients had ocular symptoms (sore eyes, eye irritation, conjunctivitis) before and during having COVID-19 symptoms in other body parts (<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1477893920302994\" target=\"_blank\" rel=\"noopener noreferrer\">Hong N, Yu, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.2147\/OPTH.S336963\" target=\"_blank\" rel=\"noopener\">Leung, Fan, et al.<\/a>; <a href=\"https:\/\/bmjophth.bmj.com\/content\/5\/1\/e000632.full\" target=\"_blank\" rel=\"noopener noreferrer\">Pardhan et al.<\/a>; <a href=\"https:\/\/doi.org\/10.7759%2Fcureus.44589\" target=\"_blank\" rel=\"noopener\">Singh K, Pattebahadur et al.<\/a>). \u00a0RT-PCR found SARS-CoV-2 in the tears and conjunctival secretions of some patients with dry eyes and conjunctivitis (<a href=\"https:\/\/www.nature.com\/articles\/s41433-020-0926-9\" target=\"_blank\" rel=\"noopener noreferrer\">Aiello et al.<\/a>; <a href=\"https:\/\/bjo.bmj.com\/content\/early\/2020\/05\/05\/bjophthalmol-2020-316304.long\" target=\"_blank\" rel=\"noopener noreferrer\">Chen L, Liu M et al.<\/a>; <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7202097\/\" target=\"_blank\" rel=\"noopener noreferrer\">Chen MJ, Chang, et al.<\/a>; <a href=\"https:\/\/bjo.bmj.com\/content\/early\/2020\/08\/10\/bjophthalmol-2020-316263\" target=\"_blank\" rel=\"noopener noreferrer\">Chen X, Yu H, et al<\/a>.; <a href=\"https:\/\/doi.org\/10.1080\/09273948.2020.1869270\" target=\"_blank\" rel=\"noopener\">Ciloglu et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/s42399-020-00499-3\" target=\"_blank\" rel=\"noopener\">Karia et al.<\/a>; <a href=\"https:\/\/doi.org\/10.7759%2Fcureus.44589\" target=\"_blank\" rel=\"noopener\">Singh K, Pattebahadur et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamaophthalmology\/fullarticle\/2764083\" target=\"_blank\" rel=\"noopener noreferrer\">Wu P, Duan, et al.<\/a>; <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/jmv.25725\" target=\"_blank\" rel=\"noopener noreferrer\">Xia et al.<\/a>; <a href=\"https:\/\/reader.elsevier.com\/reader\/sd\/pii\/S1542012420300653\" target=\"_blank\" rel=\"noopener noreferrer\">Zhang X Chen, et al.<\/a>), and some patients without eye symptoms (<a href=\"https:\/\/doi.org\/10.7759%2Fcureus.44589\" target=\"_blank\" rel=\"noopener\">Singh K, Pattebahadur et al.<\/a>; <a href=\"https:\/\/eandv.biomedcentral.com\/track\/pdf\/10.1186\/s40662-020-00189-0\" target=\"_blank\" rel=\"noopener noreferrer\">Xie et al.<\/a>). \u00a0SARS-CoV-2 replicates competently in conjunctiva\u00a0 (<a href=\"https:\/\/bjo.bmj.com\/content\/early\/2020\/08\/10\/bjophthalmol-2020-316263\" target=\"_blank\" rel=\"noopener noreferrer\">Chen X, Yu H, et al.<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/lanres\/article\/PIIS2213-2600(20)30193-4\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Hui et al.<\/a>).\u00a0 The flow of tears to the nasolacrimal system, and the innate immune system, can prevent most pathogens from entering the eyes. \u00a0But if SARS-CoV-2 gets past that, and infect some eye cells via their ACE2 receptors (<a href=\"https:\/\/doi.org\/10.2147\/OPTH.S336963\" target=\"_blank\" rel=\"noopener\">Leung, Fan, et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.jtos.2020.06.007\" target=\"_blank\" rel=\"noopener noreferrer\">Zhou L, Xu, et al.<\/a>), then viruses could flush with tears into the nasopharyngeal space in the nose and throat, and then to the respiratory system (<a href=\"https:\/\/bjo.bmj.com\/content\/early\/2020\/08\/10\/bjophthalmol-2020-316263\" target=\"_blank\" rel=\"noopener noreferrer\">Chen X, Yu H, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/S2666-5247(21)00040-9\" target=\"_blank\" rel=\"noopener noreferrer\">Coroneo, Collingnon<\/a>; <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/aos.14445\" target=\"_blank\" rel=\"noopener noreferrer\">Hong N, Yu, et al.<\/a>; <a href=\"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1269\/htm\" target=\"_blank\" rel=\"noopener noreferrer\">Napoli et al.<\/a>). \u00a0 These events can occur in both children and adults (<a href=\"https:\/\/www.optometrytimes.com\/view\/children-develop-ocular-manifestations-with-covid-19\" target=\"_blank\" rel=\"noopener noreferrer\">Beery<\/a>).\u00a0 SARS-CoV-2 was in tears of 24% of moderate to severe patients (<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0161642020308472\" target=\"_blank\" rel=\"noopener noreferrer\">Arora et al.<\/a>), indicating they potentially could transmit to other people.\u00a0 For these reasons, COVID-19 might be transmitted from an infected person\u2019s eye to others.<\/p>\n<p>Wearing glasses is statistically associated with not getting COVID-19 in several studies during the pandemic, indicating that perhaps glasses prevent SARS-CoV-2 from entering eyes (<a href=\"https:\/\/jamanetwork.com\/journals\/jamaophthalmology\/fullarticle\/2770873\" target=\"_blank\" rel=\"noopener noreferrer\">Maragakis<\/a>; <a href=\"https:\/\/www.nytimes.com\/2020\/09\/16\/well\/live\/does-wearing-glasses-protect-you-from-coronavirus.html\" target=\"_blank\" rel=\"noopener noreferrer\">Parker-Pope \u201cDoes Wearing Glasses Protect\u201d<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamaophthalmology\/fullarticle\/2770872\" target=\"_blank\" rel=\"noopener noreferrer\">Zeng W, Wang, et al.<\/a>). But, a randomized clinical trial among people of whom 77% were vaccinated against COVID-19, found that those assigned to wearing glasses did not have a statistically significant different number of COVID-19 infections, but had lower incidence of other respiratory infections (<a href=\"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.44495\" target=\"_blank\" rel=\"noopener\">Fretheim et al.<\/a>). This shows that wearing glasses had little effect on COVID-19 vaccinated people.<\/p>\n<p>So, people can protect their eyes from SARS-CoV-2 by avoiding touching near their eyes, and wearing face shields, safety glasses, or goggles (<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7202097\/\" target=\"_blank\" rel=\"noopener noreferrer\">Chen MJ, Chang, et al.<\/a>; <a href=\"https:\/\/bjo.bmj.com\/content\/early\/2020\/08\/10\/bjophthalmol-2020-316263\" target=\"_blank\" rel=\"noopener noreferrer\">Chen X, Yu H, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/S2666-5247(21)00040-9\" target=\"_blank\" rel=\"noopener noreferrer\">Coroneo, Collingnon<\/a>; <a href=\"https:\/\/doi.org\/10.2147\/OPTH.S336963\" target=\"_blank\" rel=\"noopener\">Leung, Fan, et al.<\/a>; <a href=\"https:\/\/reader.elsevier.com\/reader\/sd\/pii\/S0140673620303135\" target=\"_blank\" rel=\"noopener noreferrer\">Lu CW, Liu, et al.<\/a>; <a href=\"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1269\/htm\" target=\"_blank\" rel=\"noopener noreferrer\">Napoli et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamaophthalmology\/fullarticle\/2764083\" target=\"_blank\" rel=\"noopener noreferrer\">Wu P, Duan, et al.<\/a>). In response to the pandemic, eye care professionals are taking more precautions in working with patients and biological samples (<a href=\"https:\/\/doi.org\/10.3390\/microorganisms11092220\" target=\"_blank\" rel=\"noopener\">Salvetat et al.<\/a>).<\/p>\n<h2>Stomach<\/h2>\n<p>[Publication date of latest article cited: February 14, 2023]<\/p>\n<p>Fecal-oral transmission possibly contributes to SARS-CoV-2 transmission (<a href=\"https:\/\/doi.org\/10.1007\/s00384-020-03785-7\" target=\"_blank\" rel=\"noopener\">Cuicchi et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fimmu.2021.635471\" target=\"_blank\" rel=\"noopener\">de Oliveira GLV, Oliveira, et al<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/s11356-021-16024-5\" target=\"_blank\" rel=\"noopener\">Giron-Navarro et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.scitotenv.2020.141751\" target=\"_blank\" rel=\"noopener\">Gwenzi<\/a>; <a href=\"https:\/\/doi.org\/10.12688\/f1000research.51592.2\" target=\"_blank\" rel=\"noopener\">Heneghan, Spencer \u201cSARS-CoV-2 and the role of orofecal transmission\u201d<\/a>;\u00a0 <a href=\"https:\/\/doi.org\/10.1016\/j.scitotenv.2020.141364\" target=\"_blank\" rel=\"noopener\">Jones DL et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fcell.2020.00618\" target=\"_blank\" rel=\"noopener\">Li H, Wang Y, et al.<\/a>; <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1385894720330217\" target=\"_blank\" rel=\"noopener noreferrer\">Mohan et al<\/a>.; <a href=\"https:\/\/doi.org\/10.1016%2Fj.hazadv.2023.100259\" target=\"_blank\" rel=\"noreferrer noopener\" data-type=\"link\" data-id=\"https:\/\/doi.org\/10.1016%2Fj.hazadv.2023.100259\">Parsa et al.<\/a>; <a href=\"https:\/\/academic.oup.com\/cid\/advance-article\/doi\/10.1093\/cid\/ciaa925\/5868547\" target=\"_blank\" rel=\"noopener noreferrer\">Qian Q, Fan<\/a>; <a href=\"https:\/\/gh.bmj.com\/content\/bmjgh\/5\/5\/e002794.full.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Wang Y et al<\/a>; <a href=\"https:\/\/www.who.int\/docs\/default-source\/coronaviruse\/who-china-joint-mission-on-covid-19-final-report.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">World Health Organization-China<\/a>; <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/jgh.15047\" target=\"_blank\" rel=\"noopener noreferrer\">Wong et al.<\/a>; <a href=\"https:\/\/www.gastrojournal.org\/article\/S0016-5085(20)30282-1\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Xiao F, Tang M, et al.<\/a>).\u00a0 Almost all people defecate in toilets, so it is unlikely that SARS-CoV-2 often went from feces to foods.\u00a0 SARS-CoV-2 probably entered most patients\u2019 respiratory system, then circulatory, then digestive system (<a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2020.580551\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Anelich et al.<\/a>; <a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S1201971220302733\" target=\"_blank\" rel=\"noopener noreferrer\">Amirian<\/a>; <a href=\"https:\/\/www.sciencemag.org\/news\/2020\/04\/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes\" target=\"_blank\" rel=\"noopener noreferrer\">Wadman et al<\/a>.). \u00a0But stomach and intestinal cells have ACE2 and TMPRSS2, which SARS-CoV-2 uses to enter cells and cause SARS-CoV-2 shedding in feces in about half of COVID patients (<a href=\"https:\/\/doi.org\/10.3389\/fcell.2021.659809\" target=\"_blank\" rel=\"noopener\">An et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.cbi.2021.109583\" target=\"_blank\" rel=\"noopener\">Cao et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.gtc.2022.11.001\" target=\"_blank\" rel=\"noopener\">Friedel et al.<\/a>; <a href=\"http:\/\/doi.org\/10.1155\/2021\/6949902\" target=\"_blank\" rel=\"noopener\">Liu Y, Wu Q, et al.<\/a>).<\/p>\n<p>Some evidence shows that SARS-CoV-2 may have transmitted orally through the stomach in some patients (<a href=\"https:\/\/doi.org\/10.1016\/j.gtc.2022.11.001\" target=\"_blank\" rel=\"noopener\">Friedel et al.<\/a>).\u00a0 People who took proton pump inhibiter (PPI) medicines (which reduce stomach acidity) were more likely to test positive for COVID-19 (<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s40261-020-00963-x\" target=\"_blank\" rel=\"noopener noreferrer\">Charpiat et al.<\/a>), or rotaviruses, influenza, norovirus, and Middle East Respiratory Virus (MERS) (<a href=\"https:\/\/doi.org\/10.14309\/ajg.0000000000000798\" target=\"_blank\" rel=\"noopener noreferrer\">Almario et al.<\/a>), than those who did not take PPI.\u00a0 This indirectly implies that stomach acid is protecting many people from COVID-19 and those other diseases in the gastrointestinal system. But another study did not find a correlation with PPI use (<a href=\"https:\/\/doi.org\/10.1111\/den.13945\" target=\"_blank\" rel=\"noopener\">Miyake et al.<\/a>).\u00a0 SARS-CoV-2 has a rigid outer shell and low shell disorder, which could enable fecal-oral transmission (<a href=\"https:\/\/doi.org\/10.1016\/j.scitotenv.2020.141751\" target=\"_blank\" rel=\"noopener\">Gwenzi<\/a>).<\/p>\n<p>Another indirect indication that SARS-CoV-2 could infect the stomach and intestines is that COVID-19 patients were more likely to have intestinal metaplasia (IM), in which stomach lining cells become similar to intestinal epithelial cells.\u00a0 Some of those patients also had a history of\u00a0 <em>H. pylori<\/em> infection, which can cause IM.\u00a0 Some had enterocytes with ACE2 and TMPRSS2 in their gastric mucosa, the receptor molecules that SARS-CoV-2 uses to enter cells (<a href=\"https:\/\/doi.org\/10.3389\/fmed.2020.597967\" target=\"_blank\" rel=\"noopener noreferrer\">Zhang M, Feng, et al.<\/a>).<\/p>\n<p>A study tested these hypotheses by challenging Rhesus monkeys with SARS-CoV-2 intragastrically or intranasally.\u00a0 They found the resulting infections partly similar.\u00a0 This shows that SARS-CoV-2 entering the stomach can cause infection (<a href=\"https:\/\/doi.org\/10.1053\/j.gastro.2020.12.001\" target=\"_blank\" rel=\"noopener\">Jiao et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1053\/j.gastro.2021.01.005\" target=\"_blank\" rel=\"noopener\">Meng, Liang<\/a>).<\/p>\n<p>SARS-CoV-2 probably can replicate in stomach cells.\u00a0 Scientists modeled this in vitro by generating gastric organoids (mini organs from cells in adult, pediatric, and fetal biopsies).\u00a0 They then infected the organoids, and cultured the resulting viruses (<a href=\"https:\/\/doi.org\/10.1038\/s41467-021-26762-2\" target=\"_blank\" rel=\"noopener\">Giobbe et al.<\/a>).<\/p>\n<p>Whether this can happen in a live person depends on if stomach acid inactivates SARS-CoV-2.\u00a0 The related SARS-CoV-1 is inactivated at acidic pH 1 \u2013 2 (<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/pii\/S016609340400179X\" target=\"_blank\" rel=\"noopener noreferrer\">Darnell et al.<\/a>; <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/elps.202000121\" target=\"_blank\" rel=\"noopener noreferrer\">Scheller et al.<\/a>).\u00a0 SARS-CoV-2 was stable at moderate pH 3 \u2013 10, but that study did not test it at more acidic or basic pH (<a href=\"https:\/\/doi.org\/10.1016\/S2666-5247(20)30003-3\" target=\"_blank\" rel=\"noopener noreferrer\">Chin AWH, Chu JTS, et al.<\/a>).\u00a0 Since these two viruses are mostly similar, SARS-CoV-2 is probably inactivated by acids.\u00a0 So, it probably cannot pass through the stomach gastric acid (<a href=\"https:\/\/journals.lww.com\/nutritiontodayonline\/Documents\/Pressman%20Naidu%20%20Clemens%20-%20COVID-19%20%20Food%20Safety%20(005).pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Pressman et al.<\/a>), when it is usually pH 1.5 \u2013 3.0 (Cole, Kramer).\u00a0 But a full meal can neutralize stomach contents to pH 6, which might allow SARS-CoV-2 to pass (<a href=\"https:\/\/www.tandfonline.com\/doi\/abs\/10.3109\/00365529409092476\" target=\"_blank\" rel=\"noopener noreferrer\">Konturek et al.<\/a>).\u00a0 Scientists should conduct more experiments to find if SARS-CoV-2 is inactivated by pH&lt;3, and by human gastric acid at its full range, 1.5 to 6.\u00a0 Then they could make more definite statements about whether SARS-CoV-2 can pass through the stomach and cause fecal-oral transmission.<\/p>\n<h2>Sexual Organs<\/h2>\n<p>[Publication date of latest article cited: August 20, 2023]<\/p>\n<p>COVID-19 is probably not sexually transmitted, but hypothetically it might rarely occur (<a href=\"https:\/\/www.medwave.cl\/link.cgi\/English\/Original\/Protocols\/8062.act\" target=\"_blank\" rel=\"noopener noreferrer\">Duarte et al.<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(20)30217-0\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Entezami et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594364\/full\" target=\"_blank\" rel=\"noopener noreferrer\">He W, Liu, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.22074\/cellj.2021.7982\" target=\"_blank\" rel=\"noopener\">Hezavehei et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.xfnr.2021.01.002\" target=\"_blank\" rel=\"noopener\">Tur-Kaspa et al.<\/a>; <a href=\"https:\/\/academic.oup.com\/molehr\/article\/26\/6\/367\/5828941\" target=\"_blank\" rel=\"noopener noreferrer\">Yan et al.<\/a>).\u00a0 Some studies found SARS-CoV-2 RNA in semen, which shows it might infect another person (<a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594364\/full\" target=\"_blank\" rel=\"noopener noreferrer\">He W, Liu, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fendo.2021.677701\" target=\"_blank\" rel=\"noopener\">He Y, Wang J, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/s42399-020-00499-3\" target=\"_blank\" rel=\"noopener\">Karia et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2765654\" target=\"_blank\" rel=\"noopener noreferrer\">Li D, Jin, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1111\/and.14145\" target=\"_blank\" rel=\"noopener\">Saylam et al.<\/a>). But others did not find it in semen and expressed prostatic secretions (EPS) of infected men (<a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(20)30217-0\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Entezami et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594364\/full\" target=\"_blank\" rel=\"noopener noreferrer\">He W, Liu, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fendo.2021.677701\" target=\"_blank\" rel=\"noopener\">He Y, Wang J, et al.<\/a>; <a href=\"https:\/\/www.fertstert.org\/article\/S0015-0282(20)30384-8\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Pan F, Xiao et al.<\/a>; <a href=\"https:\/\/doi.org\/10.4103\/aja2021103\" target=\"_blank\" rel=\"noopener\">Pavone et al.<\/a> ).\u00a0 A study tested vaginal fluid and cervical exfoliated cells of infected women, and found no SARS-CoV-2 RNA (<a href=\"https:\/\/doi.org\/10.1016\/j.ajog.2020.04.038\" target=\"_blank\" rel=\"noopener\">Cui et al.<\/a>).\u00a0 ACE2 is expressed in testes, prostate glands, and spermatids in men (<a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594364\/full\" target=\"_blank\" rel=\"noopener noreferrer\">He W, Liu, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fendo.2021.677701\" target=\"_blank\" rel=\"noopener\">He Y, Wang J, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.22074\/cellj.2021.7982\" target=\"_blank\" rel=\"noopener\">Hezavehei et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.xfnr.2021.01.002\" target=\"_blank\" rel=\"noopener\">Tur-Kaspa et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/978-3-030-59261-5_12\" target=\"_blank\" rel=\"noopener\">Vahedian-Azimi et al.<\/a>), and uterus, ovaries, fallopian tubes, vagina, and placenta in women (<a href=\"https:\/\/doi.org\/10.1016\/j.placenta.2022.07.007\" target=\"_blank\" rel=\"noopener\">Gesaka et al.<\/a>;\u00a0<a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>; <a href=\"https:\/\/academic.oup.com\/molehr\/article\/26\/6\/367\/5828941\" target=\"_blank\" rel=\"noopener noreferrer\">Yan et al.<\/a>; ).\u00a0 But most of these organs lack TMPRSS2, which these viruses also use to enter cells (<a href=\"https:\/\/doi.org\/10.1016\/j.xfnr.2021.01.002\" target=\"_blank\" rel=\"noopener\">Tur-Kaspa et al.<\/a>). TMPRSS4 is also expressed in the vagina, cervix, fallopian tubes, ovaries, uterus, and breasts (<a href=\"https:\/\/doi.org\/10.3892\/ijmm.2021.4897\" target=\"_blank\" rel=\"noopener noreferrer\">Katopodis et al.<\/a>).<\/p>\n<p>COVID-19 has harmed some mens&#8217;s reproductive organs (<a href=\"https:\/\/doi.org\/10.1177%2F15579883231193913\" target=\"_blank\" rel=\"noopener\">Abedinzadeh et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fendo.2021.677701\" target=\"_blank\" rel=\"noopener\">He Y, Wang J, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.22074\/cellj.2021.7982\" target=\"_blank\" rel=\"noopener\">Hezavehei et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/s10815-021-02097-1\" target=\"_blank\" rel=\"noopener\">Moshrefi et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.xfnr.2021.01.002\" target=\"_blank\" rel=\"noopener\">Tur-Kaspa et al.<\/a>).\u00a0 There is more ACE2 in testes than ovaries, so testes might serve as reservoirs for SARS-CoV-2, which might explain why more men were severely infected than women (<a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(20)30217-0\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Entezami et al.<\/a>; <a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/path.1570\" target=\"_blank\" rel=\"noopener noreferrer\">Hamming et al;<\/a> <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594364\/full\" target=\"_blank\" rel=\"noopener noreferrer\">He W, Liu, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/s10815-021-02097-1\" target=\"_blank\" rel=\"noopener\">Moshefri<\/a> et al.).\u00a0\u00a0COVID-19 infection has impaired sperm production in some men (<a href=\"https:\/\/doi.org\/10.3389\/fendo.2021.677701\" target=\"_blank\" rel=\"noopener\">He Y, Wang J, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.22074\/cellj.2021.7982\" target=\"_blank\" rel=\"noopener\">Hezavehei et al.<\/a>;\u00a0<a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(20)30348-5\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Li H, Xiao et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/s10815-021-02097-1\" target=\"_blank\" rel=\"noopener\">Moshrefi et al.<\/a>). \u00a0 But it is uncertain if this was caused by fever (<a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(20)30414-4\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Bendayan, Boitrelle<\/a>; <a href=\"https:\/\/doi.org\/10.3389\/fendo.2021.677701\" target=\"_blank\" rel=\"noopener\">He Y, Wang J, et al.<\/a>), or if anti-viral drugs ( <a href=\"https:\/\/doi.org\/10.22074\/cellj.2021.7982\" target=\"_blank\" rel=\"noopener\">Hezavehei et al.<\/a>) or SARS-CoV-2 infection immune reactions damaged the testes and related tissues (<a href=\"https:\/\/doi.org\/10.3389\/fendo.2021.677701\" target=\"_blank\" rel=\"noopener\">He Y, Wang J, et al.<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(20)30415-6\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Zafar, Li<\/a>).\u00a0 SARS-CoV-2 could cause problems for natural reproduction or assisted reproduction technologies (ART) (<a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(20)30217-0\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Entezami et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594364\/full\" target=\"_blank\" rel=\"noopener noreferrer\">He W, Liu, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/s10815-021-02097-1\" target=\"_blank\" rel=\"noopener\">Moshrefi et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.xfnr.2021.01.002\" target=\"_blank\" rel=\"noopener\">Tur-Kaspa et al.<\/a>).<\/p>\n<p>Males and females have different degrees of molecular interactions with SARS-CoV-2 infections. Men have more androgen, which activates ACE2 and related molecules in the renin-angiotensin system (RAS), causing hypertension, inflammation, vasoconstriction, fibrosis, and cell proliferation.\u00a0 But estrogen causes the opposite reactions. \u00a0Males\u2019 androgen receptor (AR) may allow SARS-CoV-2 to use TMPRSS2 to enter more cells. \u00a0Women may have better T cell responses to SARS-CoV-2 (<a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.589060\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Galbadage et al.<\/a>).<\/p>\n<p>Even if COVID-19 is probably not transmitted by sexual intercourse, sexual interactions could transmit it through other routes described above (<a href=\"https:\/\/link.springer.com\/article\/10.1007\/s10508-020-01757-0\" target=\"_blank\" rel=\"noopener noreferrer\">Cipriano et al.<\/a>).\u00a0 The least risky approach would be abstinence, higher risk is partners living together, or regular partners not living together. The next higher risk approach is partners not living together using face masks.\u00a0 Highest risk is having several partners not using masks (<a href=\"https:\/\/www.theatlantic.com\/ideas\/archive\/2020\/05\/no-one-telling-americans-how-reopen-their-lives\/612172\/\" target=\"_blank\" rel=\"noopener noreferrer\">Marcus<\/a>; <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC7233185\/\" target=\"_blank\" rel=\"noopener noreferrer\">Turban, Keuroghlian, Mayer<\/a>; <a href=\"https:\/\/www.canada.ca\/en\/public-health\/news\/2020\/09\/statement-from-the-chief-public-health-officer-of-canada-on-september-2-2020.html\" target=\"_blank\" rel=\"noopener noreferrer\">Tam<\/a>).<\/p>\n<h2>Pregnancy, Newborns, and Breast Feeding<\/h2>\n<p>[Publication date of latest article cited: September 19, 2023]<\/p>\n<p>When COVID-19 infected pregnant women gave birth, almost all infants were not infected (<a href=\"https:\/\/www.karger.com\/Article\/FullText\/509290\" target=\"_blank\" rel=\"noopener noreferrer\">Akhtar et al.<\/a>; <a href=\"https:\/\/www.thelancet.com\/action\/showPdf?pii=S0140-6736%2820%2930360-3\" target=\"_blank\" rel=\"noopener noreferrer\">Chen H, Guo, et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2020.00104\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Chen Y, Peng, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1590\/0034-7167-2020-0849\" target=\"_blank\" rel=\"noopener\">de Oliveiro, de Oliveiro, Wernet, et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2774428\" target=\"_blank\" rel=\"noopener noreferrer\">Edlow et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2774422\" target=\"_blank\" rel=\"noopener noreferrer\">Jamieson, Rasmussen<\/a>; <a href=\"http:\/\/dx.doi.org\/10.18502\/jri.v22i2.5804\" target=\"_blank\" rel=\"noopener\">Kumari et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2020.00276\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Sim\u00f5es e Silva, Leal<\/a>; <a href=\"https:\/\/doi.org\/10.1136\/bmjopen-2022-063052\" target=\"_blank\" rel=\"noopener\">Sturrock et al.<\/a>). Small numbers were infected briefly, however, indicating possible intrauterine vertical transmission from the mother through the placenta to the fetus (<a href=\"https:\/\/doi.org\/10.1016\/S2352-4642(20)30342-4\" target=\"_blank\" rel=\"noopener noreferrer\">Gale et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.placenta.2022.07.007\" target=\"_blank\" rel=\"noopener\">Gesaka et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2774422\" target=\"_blank\" rel=\"noopener noreferrer\">Jamieson, Rasmussen<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/laninf\/article\/PIIS1473-3099(20)30236-X\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Kelvin and Halperin<\/a>;\u00a0 <a href=\"https:\/\/doi.org\/10.1007\/978-3-030-59261-5_4\" target=\"_blank\" rel=\"noopener\">Makvandi et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1007\/s15010-021-01650-5\" target=\"_blank\" rel=\"noopener\">Malshe et al.<\/a>; <a href=\"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/abs\/10.1002\/uog.22014\" target=\"_blank\" rel=\"noopener noreferrer\">Mullins et al.<\/a>; <a href=\"https:\/\/doi.org\/10.12659\/msm.933831\" target=\"_blank\" rel=\"noopener\">Parums<\/a>; <a href=\"https:\/\/www.thelancet.com\/pdfs\/journals\/lancet\/PIIS0140-6736(20)30365-2.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Qiao<\/a>; <a href=\"https:\/\/doi.org\/10.3390\/jpm11060483\" target=\"_blank\" rel=\"noopener\">Saadaoui et al.<\/a>; <a href=\"http:\/\/dx.doi.org\/10.1136\/bmjopen-2021-053036\" target=\"_blank\" rel=\"noopener\">Song et al.<\/a>; <a href=\"http:\/\/www.cidrap.umn.edu\/news-perspective\/2020\/03\/covid-19-may-spread-moms-infants-and-seemingly-healthy-kids\" target=\"_blank\" rel=\"noopener noreferrer\">Van Beusekom &#8220;COVID19&#8221;<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/laninf\/article\/PIIS1473-3099(20)30176-6\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Yu N, Li et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2763787\" target=\"_blank\" rel=\"noopener noreferrer\">Zeng L, Xie, et al.<\/a>; <a href=\"https:\/\/erj.ersjournals.com\/content\/early\/2020\/04\/01\/13993003.00697-2020\" target=\"_blank\" rel=\"noopener noreferrer\">Zhang Z, Yu, et al.<\/a>). \u00a0Most of those infected during pregnancy soon recovered (<a href=\"https:\/\/www.usatoday.com\/story\/news\/health\/2020\/07\/14\/covid-first-baby-reported-get-coronavirus-mom-womb\/5435005002\/\" target=\"_blank\" rel=\"noopener noreferrer\">Rodriguez<\/a>; <a href=\"https:\/\/doi.org\/10.1136\/bmjopen-2022-063052\" target=\"_blank\" rel=\"noopener\">Sturrock et al.<\/a>; <a href=\"https:\/\/www.nature.com\/articles\/s41467-020-17436-6\" target=\"_blank\" rel=\"noopener noreferrer\">Vivanti et al.<\/a>). Risk of neonatal or infant death with maternal SARS-CoV-2 infection was not higher than those of uninfected mothers ( <a href=\"https:\/\/doi.org\/10.1136\/bmjopen-2022-063052\" target=\"_blank\" rel=\"noopener\">Sturrock et al.<\/a>).\u00a0 Some fetuses died when SARS-CoV-2 damaged the placenta and umbilical cord, causing the fetus to asphyxiate even though the viruses did not enter the fetus (<a href=\"https:\/\/doi.org\/10.1016\/j.humpath.2021.12.012\" target=\"_blank\" rel=\"noopener\">Dubucs et al.<\/a>;\u00a0<a href=\"https:\/\/wwwnc.cdc.gov\/eid\/article\/27\/2\/20-3824_article\" target=\"_blank\" rel=\"noopener noreferrer\">Stonoga et al.<\/a>); or caused excessive fluid buildup in the fetus (<a href=\"https:\/\/doi.org\/10.1016\/j.humpath.2021.12.012\" target=\"_blank\" rel=\"noopener\">Dubucs et al.<\/a>; <a href=\"https:\/\/academic.oup.com\/humrep\/advance-article\/doi\/10.1093\/humrep\/deaa367\/6042696\" target=\"_blank\" rel=\"noopener noreferrer\">Shende et al.<\/a>); or replicated in organs and induced thrombosis (<a href=\"https:\/\/doi.org\/10.3389\/fmed.2023.1127529\" target=\"_blank\" rel=\"noopener\">Greco et al.<\/a>).<\/p>\n<p>Some cells and tissues between pregnant women and their fetuses (the maternal-fetal interface) and some fetal organs had angiotensin-converting enzyme 2 (ACE2) receptors, which SARS-CoV-2 uses to enter cells (<a href=\"https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0230295\" target=\"_blank\" rel=\"noopener noreferrer\">Li M, Chen l et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3390\/jpm11060483\" target=\"_blank\" rel=\"noopener\">Saadaoui et al.<\/a>; <a href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2020.594495\/full\" target=\"_blank\" rel=\"noopener noreferrer\">Salamanna et al.<\/a>). Some placentas of SARS-CoV-2 infected infants had SARS-CoV-2 in the fetal side, showing that those viruses could infect some fetuses (<a href=\"https:\/\/www.mdpi.com\/2072-6643\/12\/11\/3570\" target=\"_blank\" rel=\"noopener noreferrer\">Caparros-Gonzalez et al.<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/ebiom\/article\/PIIS2352-3964(20)30327-3\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Facchetti et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.placenta.2022.07.007\" target=\"_blank\" rel=\"noopener\">Gesaka et al.<\/a>; <a href=\"https:\/\/www.ajogmfm.org\/article\/S2589-9333(20)30089-6\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Patan\u00e8 et al<\/a>; <a href=\"https:\/\/www.thelancet.com\/journals\/ebiom\/article\/PIIS2352-3964(20)30359-5\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Schwartz, Thomas<\/a>; <a href=\"https:\/\/academic.oup.com\/humrep\/advance-article\/doi\/10.1093\/humrep\/deaa367\/6042696\" target=\"_blank\" rel=\"noopener noreferrer\">Shende et al.<\/a>; <a href=\"https:\/\/www.nature.com\/articles\/s41467-020-17436-6\" target=\"_blank\" rel=\"noopener noreferrer\">Vivanti et al.<\/a>).\u00a0 But other studies found that human placentas lack ACE2 receptors and transmembrane protease TMPRSS2 which SARS-CoV-2 also uses to enter cells (<a href=\"https:\/\/www.news-medical.net\/news\/20200520\/Main-receptors-used-by-SARS-CoV-2-for-cell-entry-are-absent-in-the-human-placenta.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Me\u0161trovi\u0107<\/a>; <a href=\"https:\/\/elifesciences.org\/articles\/58716\" target=\"_blank\" rel=\"noopener noreferrer\">Pique-Regi et al.<\/a>).\u00a0 Some umbilical cord, amniotic fluid, and other fluid samples also had SARS-CoV-2 RNA (<a href=\"https:\/\/www.mdpi.com\/2072-6643\/12\/11\/3570\" target=\"_blank\" rel=\"noopener noreferrer\">Caparros-Gonzalez et al.<\/a>; <a href=\"https:\/\/wwwnc.cdc.gov\/eid\/article\/27\/2\/20-3824_article\" target=\"_blank\" rel=\"noopener noreferrer\">Stonoga et al.<\/a>).\u00a0 The mothers\u2019 T cell responses to SARS-CoV-2, and inefficient SARS_CoV-2 replication in placentas could be preventing intrauterine infections (<a href=\"https:\/\/doi.org\/10.3389\/fimmu.2021.698578\" target=\"_blank\" rel=\"noopener\">Tallarek et al.<\/a>).\u00a0 So, scientists found that intrauterine transmission rarely went through the placenta, but they do not yet fully understand the biochemical processes.<\/p>\n<p>Early in the pandemic some doctors recommended that pregnant women with COVID-19 have caesarian births, not breastfeed, and stay away from their infants.\u00a0 But studies showed that among women infected with COVID-19 while pregnant, the low rates of infant infection were about the same whether the baby was born vaginally or by caesarian, breastfed or not, or stayed with the mother or not (<a href=\"https:\/\/doi.org\/10.1016\/S2352-4642(20)30342-4\" target=\"_blank\" rel=\"noopener noreferrer\">Gale et al.<\/a>; <a href=\"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/1471-0528.16362\" target=\"_blank\" rel=\"noopener noreferrer\">Walker KF, O\u2019Donoghue et al.<\/a>).<\/p>\n<p>Breast milk probably does not transmit SARS-CoV-2.\u00a0 Among women breast feeding while infected with COVID-19, few or no milk samples had SARS-CoV-2 RNA (<a href=\"https:\/\/www.mdpi.com\/2072-6643\/12\/11\/3570\" target=\"_blank\" rel=\"noopener noreferrer\">Caparros-Gonzalez et al.<\/a> <a href=\"https:\/\/nyaspubs.onlinelibrary.wiley.com\/doi\/full\/10.1111\/nyas.14477\" target=\"_blank\" rel=\"noopener noreferrer\">Centeno-Tablantes et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/10.1001\/jama.2020.15580\" target=\"_blank\" rel=\"noopener noreferrer\">Chambers et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1089\/jwh.2020.8978\" target=\"_blank\" rel=\"noopener\">Luo QQ, Xia L, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1016\/j.placenta.2022.07.007\" target=\"_blank\" rel=\"noopener\">Gesaka et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1128\/mBio.03192-20\" target=\"_blank\" rel=\"noopener noreferrer\">Pace et al.<\/a>; <a href=\"https:\/\/doi.org\/10.3390\/jpm11060483\" target=\"_blank\" rel=\"noopener\">Saadaoui et al.<\/a>). \u00a0When tested, none had viruses that could replicate.\u00a0 When milk with SARS-CoV-2 was treated with Holder pasteurization, RT-PCR found no RNA afterwards.\u00a0 This shows that it was safe for others to use, such as in milk banks (<a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/10.1001\/jama.2020.15580\" target=\"_blank\" rel=\"noopener noreferrer\">Chambers et al.<\/a>).\u00a0 Many milk samples had IgA , IgM, or IgG antibodies, some of which could neutralize SARS-CoV-2, providing some immunity to the baby (<a href=\"https:\/\/doi.org\/10.1089\/jwh.2020.8978\" target=\"_blank\" rel=\"noopener\">Luo QQ, Xia L, et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1038\/s41598-023-42421-6\" target=\"_blank\" rel=\"noopener\">Morniroli et al.<\/a>; <a href=\"https:\/\/doi.org\/10.1128\/mBio.03192-20\" target=\"_blank\" rel=\"noopener noreferrer\">Pace et al.<\/a>).\u00a0 One mother had SARS-CoV-2 in her breast milk for 4 days, and her newborn was briefly infected.\u00a0 It was unclear how the newborn was infected (<a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(20)31181-8\/fulltext\" target=\"_blank\" rel=\"noopener noreferrer\">Gro\u00df et al.<\/a>).\u00a0 If a mother is exposed or infected while breastfeeding or pumping milk, she can probably safely continue to feed her infant (<a href=\"https:\/\/doi.org\/10.1089\/jwh.2020.8978\" target=\"_blank\" rel=\"noopener\">Luo QQ, Xia L, et al.<\/a>), because breast milk includes antibodies to SARS-CoV-2. \u00a0She should clean her breast or pump to prevent transmitting this virus via those surfaces (<a href=\"https:\/\/doi.org\/10.1128\/mBio.03192-20\" target=\"_blank\" rel=\"noopener noreferrer\">Pace et al.<\/a>; <a href=\"https:\/\/jamanetwork.com\/journals\/jamapediatrics\/fullarticle\/2772176\" target=\"_blank\" rel=\"noopener noreferrer\">Sullivan S, Thompson<\/a>).<\/p>\n<p>After a\u00a0 baby is born, the mother and her family could transmit viruses to the baby by the same routes as any other person.\u00a0 So, they should use the same prevention methods as for an adult.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Starting Infection [Publication date of latest article cited: October 26, 2023] The number of pathogens entering the body that can start infection is called the \u201cinfectious dose.\u201d Scientists\u2019 estimates of the infectious dose for SARS-CoV-2 in hamsters,ferrets, an humans range between 5 (Rosenke et al.), 10 (Bazant &amp; Bush), or 100 (Karimzadeh et al.), or [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-81","page","type-page","status-publish","hentry","post"],"_links":{"self":[{"href":"https:\/\/vryheid.sdsu.edu\/index.php\/wp-json\/wp\/v2\/pages\/81","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vryheid.sdsu.edu\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/vryheid.sdsu.edu\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/vryheid.sdsu.edu\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vryheid.sdsu.edu\/index.php\/wp-json\/wp\/v2\/comments?post=81"}],"version-history":[{"count":34,"href":"https:\/\/vryheid.sdsu.edu\/index.php\/wp-json\/wp\/v2\/pages\/81\/revisions"}],"predecessor-version":[{"id":2972,"href":"https:\/\/vryheid.sdsu.edu\/index.php\/wp-json\/wp\/v2\/pages\/81\/revisions\/2972"}],"wp:attachment":[{"href":"https:\/\/vryheid.sdsu.edu\/index.php\/wp-json\/wp\/v2\/media?parent=81"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}