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After Sandy, We’re Ignoring the Lessons We Already Learned

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Five years after Sandy, we are ignoring the lessons we paid so much to learn. U.S. Navy / Chief Mass Communication Specialist Ryan J. Courtade

By Rob Moore

Five years after Hurricane Sandy, our nation's leadership is willfully ignoring all the lessons we paid dearly to learn. Instead the nation is now charting a very dangerous course given the powerful storms we will face in the future.

Marking the fifth anniversary of one of the most destructive storms to ever strike the U.S., we see a very different response to Hurricanes Harvey, Irma, Maria and Nate than we saw to Hurricane Sandy five years ago.

After Sandy, there was a recognition that we needed to take action to decrease our vulnerability to the extreme weather events that climate change makes more likely and there was a renewed emphasis to combat the root causes of climate change.


In the aftermath of this year's string of catastrophic hurricanes, which have turned 2017 into one of the most destructive years on record, we've seen a response that borders on ambivalence to the plight of our fellow Americans in Puerto Rico and the U.S. Virgin Islands. And in so many other ways, we are seeing a deliberate attempt to ignore the lessons we paid such a high price to learn.

After Hurricane Sandy made landfall, the images of flooded subways, shorelines full of homes falling into the ocean and a darkened Manhattan skyline provided a much-needed wake-up call to the nation about climate change. We were confronted with the reality of what scientists had been telling us for years: climate change is real and it's placing communities at greater peril.

There was a recognition that we needed to take action to decrease our vulnerability to the extreme weather events brought about by climate change and there was a renewed emphasis on addressing the root causes of climate change. For what now seems like an all too brief window of time, our nation adopted a strategy that was focused on avoiding the unmanageable and managing the unavoidable consequences of climate change.

After Sandy the federal government rolled out a suite of actions that included:

  • The Post Hurricane Sandy Rebuilding Strategy set a new bar for how the federal government would respond to weather related disasters, emphasizing the need to not just rebuild the same way in the same vulnerable places, but to do so in a way that would make communities more resilient to future severe events as well.
  • Federal flood protection standards were updated to ensure that all public infrastructure and facilities built using federal taxpayer dollars would be sited and designed with an additional margin of safety for future flooding, even accounting for future sea level rise.
  • USEPA proposed the Clean Power Plan, charting the nation's pathway to reducing our emissions of pollution that cause climate change.

But since President Trump took office, we've lost that momentum and we have seen our nation regress as it shrinks away from the multitude of challenges posed by climate change. And the error of these misguided actions are all too apparent in the aftermath of Hurricanes Harvey, Irma, Maria and Nate.

Just ten days prior to Hurricane Harvey making landfall in Texas, Trump rescinded federal flood protection standards. These standards would have ensured that public facilities and infrastructure built using federal taxpayer dollars would be built with a greater margin of safety against flooding and future sea level rise. The standards would have also guided the post disaster recovery from recent storms, had they not been rescinded.

Trump has proposed cuts to FEMA programs that are essential to disaster response and preparedness. These include reducing the amount of funding the nation budgets for responding to and preparing for natural disasters. In addition, the administration has proposed that all funding be eliminated for mapping areas vulnerable to flooding and reducing the resources used for weather forecasting and severe weather prediction. These programs are clearly more needed than ever and that need only increases as each year brings increasing risks.

President Trump pulled the U.S. out of the Paris climate accords and is now attempting to roll back the Clean Power Plan.

And our response to the crisis unfolding in Puerto Rico over the past several weeks does not even remotely resemble the way the U.S. is expected to come to the aid of its citizens.

It's become all too clear that climate change has irrevocably changed the nature of weather related disasters in the U.S., but we are failing to heed the lessons that we are being taught. Events like Hurricane Sandy would have been considered a once in a lifetime event in the past. But now, record breaking disasters occur with alarming regularity. Since 2012, the U.S. has experienced some of the most costly flood disasters in the nation's history starting with Hurricane Sandy in 2012, catastrophic floods in Central Louisiana and the Carolinas from Hurricane Matthew in 2016, and now the combined fury of Hurricanes Harvey, Irma, Maria and Nate.

The evidence for action is all too clear, yet our nation's leaders expend far more effort to willfully ignore the evidence that is laid out before them than they expend to address the challenges that are so painfully obvious.

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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. Niq Steele / Getty Images

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.

The first reports of Guillain-Barre Syndrome in COVID-19 pandemic originated from Italy, Spain and China, where the pandemic surged before the U.S. crisis.

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.


Nurses wear PPE prior to caring for a COVID-19 patient in the ICU at Sharp Grossmont Hospital on May 5, 2020 in La Mesa, California. Mario Tama / Getty Images

One of the initial reasons social distancing guidelines were put in place was to allow the healthcare system to adapt to a surge in patients since there was a critical shortage of beds, ventilators and personal protective equipment. In fact, masks that were designed for single-use were reused for an entire week in some hospitals.

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Democratic presidential hopefuls Joe Biden and Senator Bernie Sanders greet each other with a safe elbow bump before the start of the Democratic Party 2020 presidential debate in a CNN Washington Bureau studio in Washington, DC on March 15, 2020. Mandel Ngan / AFP / Getty Images

By Jake Johnson

Unity Task Forces formed by presumptive Democratic presidential nominee Joe Biden and Sen. Bernie Sanders unveiled sweeping party platform recommendations Wednesday that—while falling short of progressive ambitions in a number of areas, from climate to healthcare—were applauded as important steps toward a bold and just policy agenda that matches the severity of the moment.

"We've moved the needle a lot, especially on environmental justice and upping Biden's ambition," said Sunrise Movement co-founder and executive director Varshini Prakash, a member of the Biden-Sanders Climate Task Force. "But there's still more work to do to push Democrats to act at the scale of the climate crisis."

The climate panel—co-chaired by Rep. Alexandria Ocasio-Cortez (D-N.Y.) and former Secretary of State John Kerry—recommended that the Democratic Party commit to "eliminating carbon pollution from power plants by 2035," massively expanding investments in clean energy sources, and "achieving net-zero greenhouse gas emissions for all new buildings by 2030."

In a series of tweets Wednesday night, Ocasio-Cortez—the lead sponsor of the House Green New Deal resolution—noted that the Climate Task Force "shaved 15 years off Biden's previous target for 100% clean energy."

"Of course, like in any collaborative effort, there are areas of negotiation and compromise," said the New York Democrat. "But I do believe that the Climate Task Force effort meaningfully and substantively improved Biden's positions."

 

The 110 pages of policy recommendations from the six eight-person Unity Task Forces on education, the economy, criminal justice, immigration, climate change, and healthcare are aimed at shaping negotiations over the 2020 Democratic platform at the party's convention next month.

Sanders said that while the "end result isn't what I or my supporters would've written alone, the task forces have created a good policy blueprint that will move this country in a much-needed progressive direction and substantially improve the lives of working families throughout our country."

"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.

On the life-or-death matter of reforming America's dysfunctional private health insurance system—a subject on which Sanders and Biden clashed repeatedly throughout the Democratic primary process—the Unity Task Force affirmed healthcare as "a right" but did not embrace Medicare for All, the signature policy plank of the Vermont senator's presidential bid.

Instead, the panel recommended building on the Affordable Care Act by establishing a public option, investing in community health centers, and lowering prescription drug costs by allowing the federal government to negotiate prices. The task force also endorsed making all Covid-19 testing, treatments, and potential vaccines free and expanding Medicaid for the duration of the pandemic.

"It has always been a crisis that tens of millions of Americans have no or inadequate health insurance—but in a pandemic, it's potentially catastrophic for public health," the task force wrote.

Dr. Abdul El-Sayed, a former Michigan gubernatorial candidate and Sanders-appointed member of the Healthcare Task Force, said that despite major disagreements, the panel "came to recommendations that will yield one of the most progressive Democratic campaign platforms in history—though we have further yet to go."

 

Observers and advocacy groups also applauded the Unity Task Forces for recommending the creation of a postal banking system, endorsing a ban on for-profit charter schools, ending the use of private prisons, and imposing a 100-day moratorium on deportations "while conducting a full-scale study on current practices to develop recommendations for transforming enforcement policies and practices at ICE and CBP."

Marisa Franco, director of immigrant rights group Mijente, said in a statement that "going into these task force negotiations, we knew we were going to have to push Biden past his comfort zone, both to reconcile with past offenses and to carve a new path forward."

"That is exactly what we did, unapologetically," said Franco, a member of the Immigration Task Force. "For years, Mijente, along with the broader immigrant rights movement, has fought to reshape the narrative around immigration towards racial justice and to focus these very demands. We expect Biden and the Democratic Party to implement them in their entirety."

"There is no going back," Franco added. "Not an inch, not a step. We must only move forward from here."

Reposted with permission from Common Dreams.

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Grizzly bears in Wyoming and Idaho won't be subject to a trophy hunt thanks to a federal court decision Wednesday upholding endangered species protections for these iconic animals.

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However, it can also be concentrated into an essential oil that's loaded with antioxidants and powerful compounds that have proven health benefits.

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Far-right Brazilian President Jair Bolsonaro, who has presided over the world's second worst coronavirus outbreak after the U.S., said Tuesday that he had tested positive for the virus.

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Although natural gas produces fewer greenhouse gas emissions and other pollutants than coal or oil, it is a major contributor to climate change, an urgent global problem. Skitterphoto / PIxabay

By Emily Grubert

Natural gas is a versatile fossil fuel that accounts for about a third of U.S. energy use. Although it produces fewer greenhouse gas emissions and other pollutants than coal or oil, natural gas is a major contributor to climate change, an urgent global problem. Reducing emissions from the natural gas system is especially challenging because natural gas is used roughly equally for electricity, heating, and industrial applications.

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