So, right off the bat, if you don’t know what a bike-share is, it’s a program in which many bicycle stations are set up and people can rent a bike to use for a certain time frame and return it at a different station. It’s seen in many cities where cycling infrastructure is growing and is considered an extremely important part of making cycling more accessible to people.
As cycling becomes more and more welcomed as a dominant method of inner-city travel in the first world, we’re going to see more and more of these bike shares, as well as seeing the existing ones expand (hopefully they’ll be expanding my local bike share—there never seems to be a bike available when I need it).
These days, everyone knows Europe is basically the king when it comes to cycling infrastructure, so logically one would assume all the best bike share programs must also be in Europe. While many of them are, the rest of the world has also been stepping their cycling game up in recent decades. Below you’ll find a list of the world’s eight best bike share programs by city. If you’re expecting Europe to dominate this list, then #1 might come as a shock to you.
1. Hangzhou, China
The city of Hangzhou, with a population of around seven million, boasts the world’s largest bike share program. In fact, no other bike share on Earth touches the sheer numbers they have. Let’s take a tally. There are somewhere between 66,500 and 78,000 bicycles in their program, scattered across around 2,700 stations.
There are so many city bikes that, in the downtown of the city, you can’t go five minutes without seeing one. But it gets better; the program is so successful that the local government has invested money to allow the Hangzhou Public Transport Corporation to expand. The invested amount is roughly the equivalent of 18.5 million UK pounds.
Because of the investment, the company has predicted that they will be operating with 175,000 bikes by 2020. Considering the program only started in 2008, I’d consider that some explosive expansion.
Despite the program’s insane success, there has been some minor controversy surrounding it; in 2010 an app was created which told users how many bikes were available at every station. While hailed among users as a real life-saver, Hangzhou Public Bicycle’s staff were not impressed. They claimed the data was taken illegally by the developers and in 2012 they blocked Zhang Guangyu, the developers, from accessing the information, rendering the app useless.
2. Taiyuan, China
Europe may be the main innovators when it comes to cycling infrastructure, but in terms of sheer volume and reach, China’s leading the way. I suppose it’s not really fair, since China’s population is nearly double the entire population of Europe, but Taiyuan is worth mentioning for its position as the current runner up to Hangzhou.
Part of the reason Taiyuan’s bike share belongs on this list is the fact that it’s expanded so much in so little time. In fact, it’s expanded so rapidly that nobody actually knows how many bikes are in their circulation, with estimates ranging from 20,000 to an impressive 41,000 and around 1,000 stations. And it is still growing.
And it’s pretty easy to understand why too; it’s simple to use the bikes and it’s cheap. In fact, it’s free as long as you use the bike for under an hour.
3. Paris, France
When people call it the city of love, I don’t think a love of bicycles is what they have in mind. However, Paris earns the number three spot on this list because of how awesome their bike share program is. It’s not surprising that Paris has such a high spot here; France is one of the hearts of the international cycling community and is a major player in cycling history.
The bike sharing program, called Vélib’, is the largest bike share outside of China, with around 20,000 bikes and more than 1,200 stations in their fleet. Bertrand Delanoë, who served as the mayor of Paris from 2001 to 2014, championed the creation of the bike share, which first debuted in July, 2007.
The program is wildly successful and has set a great example for the rest of the world to follow. In 2011, its daily ridership was roughly 86,000 people and that number has only grown since then. Vélib’ is often the program other cities point to when they attempt to sell the idea of a bike share in their municipality.
Vélib’ is not without its problems however. There is a rampant problem with theft and vandalism. Many bikes are discarded, stripped for parts and/or abandoned in a state of disrepair. Many are stolen and sold elsewhere, with some of the bikes turning up in places as far away as Romania. The costs associated with the theft and vandalism were actually so much higher than originally projected that the program ended up losing money in its first three years in operation.
Despite that, the program has balanced itself out and is now considered a huge success. Delanoë himself considers it one of the biggest triumphs of his political career.
4. Shanghai, China
China is just dominating this list. We’re at number four and China’s been mentioned three times already. Shanghai’s wildly successful bike share program is brought to you by Forever Bike, who supply the city with its iconic (and aesthetically pleasing) orange bikes. The bike share has over 19,000 bikes in service and roughly 600 different stations in use.
The bike share program is very popular among tourists. The system might be a little hard to understand for those who are unfamiliar with how bike shares works, but there are plenty of guides on how to rent one of the Forever Bikes, like this one from Time Out Shanghai.
Shanghai’s bike share benefits from the city’s modern infrastructure and massive population looking to avoid traffic. Like Beijing, part of the success of the bike share comes from the sheer volume of people living in the city. Shanghai has the highest population in the country with the most people on Earth. There is a high demand for bicycles there. Could you imagine if everyone in Shanghai drove a car? And you thought New York had bad traffic.
Like most bike share programs, Shanghai’s comes from a co-operative effort between business and government. Like all bike shares, there are a few downsides to Forever Bike’s orange fleet, but ultimately the program has been profitable and successful.
5. London, England
London’s bike share program started in 2010 and has grown enough to make this list. The London system used Vélib’ as a model, with Serco and the municipal government working together on the project to bring London’s bike share program to life. The program started with only 5,000 Barclays bikes, but now they have over 11,000 bikes (sometimes affectionately named “Boris Bikes” after London mayor Boris Johnson) and are just shy of 750 stations.
The bike share has gotten all kinds of praise for its effectiveness and safety. For reasons that are not entirely clear, cyclists are significantly less likely to be injured while riding one of the Barclays, as opposed to an ordinary bike. The Road Danger Reduction Forum speculates that the reason might be attributed to motorists taking particular care to avoid accidents with these bikes.
In fact, there has only been one city bike rider to be killed while riding and their death sparked a major push towards expanding London’s cycling infrastructure.
The bike share has been the subject of some controversy, however. Critics complained about the numerous start-up glitches that occurred and declared that the service was lacking. They pointed to many flaws with how the service functioned on a fundamental level, including things like how the bikes were required to be docked at a station relatively close to where they were taken from, negating one of the most valuable benefits to cycling in the city and brought up the fact that the original fleet of bikes were rather heavy and cumbersome, making them inconvenient.
Still, Serco addressed these concerns and upgraded their service and their fleet. There are still many critics, but London residents have noticed a vast improvement in the quality of the bikes and the service itself, since its original debut in 2010.
6. New York City, U.S.
New York City was one of the first places in the U.S. to adapt a bike share program on a large scale. While their fleet, numbering at around 6,000 bikes and 330 stations, is nowhere near the size seen in Paris and many Chinese cities, the Citi Bikes have certainly earned their spot on this list for a number of reasons. For starters, it is the largest bike share in the U.S., even though it only started in 2013. There are expansion plans in place, designed to double the number of bikes on the street by 2017, officially making it bigger than London’s bike share.
Modeled after Montreal’s Bixi (which has claimed the number eight spot on this list), the Citi Bikes are efficient and well-received, with many New Yorkers happily welcoming the program. The Citi Bikes are praised for helping alleviate New York’s rampant traffic problems that have been the butt of jokes all around the world (though, in reality, as a frequent visitor to NYC, these days traffic isn’t that bad, as long as you avoid traveling at rush hour).
The Citi Bikes originally began without any subsidy from the municipal government, which is extremely rare for bike share programs. Most programs are a joint effort from local business sponsors and the government. Capitalists and fiscal conservatives have pointed to this as the reason for the Citi Bike’s impeccable quality and maintenance.
Like Paris however, the Citi Bikes have suffered all kinds of problems with vandalism and theft. Critics have also complained that, compared to other bike shares around the world, the Citi Bikes are expensive to use.
7. Barcelona, Spain
Ah, Barcelona. What a beautiful city. And just like how Barcelona is one of the best looking cities in Europe, their bike share bikes also have one of the most stylish designs we’ve seen on this list. Putting that aside however, Bicing, the Barcelona bike share program, didn’t earn a spot on this list for simply looking good.
Modeled after the Paris bike share, Bicing is designed to encourage cycling as a viable means of travel. Part of the reason for Bicing’s popularity is people’s growing concern with the environment. Praised as a powerful initiative to cut down on greenhouse gasses, Bicing has been well-received.
Critics, however, have blasted Bicing for being inaccessible. Indeed, the system is deliberately designed to be prevent tourists from using the bikes. While some feel this protects the Bicing bikes from the rampant vandalism problem that other bike shares face, it raises an important question about whether or not these bike shares should be accessible to as many people as possible or be members-only.
With that being said, Bicing has definitely proven itself as one of the best bike share programs in the world.
8. Montreal, Canada
If you love art, French-Canadian culture and the winter, Montreal is the city for you. But there’s another thing Montreal is known for; cyclists. That’s right, as soon as the snow is cleared, the bikes come out and usually stay out right up until the roads turn into an icy wonderland that puts Disney’s Frozen to shame. But I digress. Montreal, as of Canada’s major bike-friendly cities, naturally decided to fund their own bike sharing system, called Bixi.
Bixi is one of the most well designed and effective bike shares in the world. It’s up there with Vélib’ and Hangzhou’s bike share. It’s so good that many cities in the west have modeled their own bike shares after Bixi, including NYC.
I’m sure you’ve already guessed, but the Bixi bikes have suffered all kinds of troubles with vandalism and theft, like most bike shares (as an aside—what kind of jerk vandalizes a bike? That’s low).
The bike share consists of around 5,200 bikes and 460 stations. Despite seeming small in comparison to other bike shares on this list, Bixi’s annual ridership is more than 3 million, meaning Montreal’s cyclists are definitely getting their money’s worth out of the system.
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By Sherry H-Y. Chou, Aarti Sarwal and Neha S. Dangayach
The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.
When a neurologist examined him, Tom was diagnosed with Guillain-Barre Syndrome, an autoimmune disease that causes abnormal sensation and weakness due to delays in sending signals through the nerves. Usually reversible, in severe cases it can cause prolonged paralysis involving breathing muscles, require ventilator support and sometimes leave permanent neurological deficits. Early recognition by expert neurologists is key to proper treatment.
We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.
Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.
What Is Guillain-Barre Syndrome?
Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.
Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.
To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.
Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.
The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.
Guillain-Barre Syndrome and Pandemics
As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.
Though Guillain-Barre Syndrome is rare, it is well known to emerge following bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses.
Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.
Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?
The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.
Understanding the Association Between COVID-19 and Guillain-Barre Syndrome
While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.
It is certainly possible that there are other cases that have not been reported. The Global Consortium Study of Neurological Dysfunctions in COVID-19 is actively underway to find out how often neurological problems like Guillain-Barre Syndrome is seen in hospitalized COVID-19 patients. Also, just because Guillain-Barre Syndrome occurs in a patient diagnosed with COVID-19, that does not imply that it was caused by the virus; this still may be a coincident occurrence. More research is needed to understand how the two events are related.
Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.
Though the reported cases of Guillain-Barre Syndrome so far all have severe symptoms, this is not uncommon in a pandemic situation where the less sick patients may stay home and not present for medical care for fear of being exposed to the virus. This, plus the limited COVID-19 testing capability across the U.S., may skew our current detection of Guillain-Barre Syndrome cases toward the sicker patients who have to go to a hospital. In general, the majority of Guillain-Barre Syndrome patients do recover, given enough time. We do not yet know whether this is true for COVID-19-related cases at this stage of the pandemic. We and colleagues around the world are working around the clock to find answers to these critical questions.
Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.
Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.
Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.
Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
Reposted with permission from The Conversation.
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"I look forward to working with Vice President Biden to help him win this campaign," the Vermont senator added, "and to move this country forward toward economic, racial, social, and environmental justice."
Biden, for his part, applauded the task forces "for helping build a bold, transformative platform for our party and for our country."
"I am deeply grateful to Bernie Sanders for working with us to unite our party and deliver real, lasting change for generations to come," said the former vice president.
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