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Democratic Candidates Face off on Climate in the Last Debate Before Primary Voting Begins

Politics
Tom Steyer (L-R), Sen. Elizabeth Warren (D-MA), Sen. Bernie Sanders (I-VT), former South Bend, Indiana Mayor Pete Buttigieg and Sen. Amy Klobuchar (D-MN) listen as former Vice President Joe Biden (3rd L) speaks during the Democratic presidential primary debate at Drake University on Jan. 14 in Des Moines, Iowa. Scott Olson / Getty Images

Six Democratic presidential candidates squared off Tuesday night in Des Moines, Iowa for the seventh primary debate of the season and the last before voting begins with the Iowa caucuses Feb. 3. The climate crisis tied with health care for the No. 1 issue important to Iowa voters when choosing a candidate, according to the latest Des Moines Register/CNN/Mediacom Iowa Poll. So how much attention did it get during the debate?


A fair amount, Grist reported. While CNN and Des Moines Register moderators didn't bring it up until the last half hour, the candidates themselves incorporated it into their answers early and often.

"Debate moderators may take ages to get around to climate change in these debates," Zoya Teirstein wrote for Grist, "but the candidates have gotten increasingly adept at weaving the issue into their answers to other questions. This time around, Wolf Blitzer, Abby Phillip, and the Register's Brianne Pfannenstiel could barely keep a lid on the climate action in the first half of the debate."

So how did the candidates stand on various climate-related issues?

National Security

The first climate mentions came in response to the first question, about which candidate was best prepared to be commander-in-chief.

Both former South Bend, Indiana Mayor Pete Buttigieg and Sen. Elizabeth Warren (D-Mass.) listed the climate crisis among new national security issues they would tackle as president, according to a transcript provided by the Des Moines Register.

Philanthropist Tom Steyer brought up the wildfires in Australia when asked how he would use military force as a president, suggesting that the climate crisis might require large international mobilizations.

"[T]here's a gigantic climate issue in Australia, which also requires the same kind of value-driven coalition-building that we actually should be using in the Middle East," he said.

Trade

The next time the candidates brought up climate was during the discussion of a new trade deal struck by President Donald Trump with Mexico and Canada. Sen. Bernie Sanders (I-Vt.) came out strongly against it, largely because it does not mention climate change.

"[E]very major environmental organization has said no to this new trade agreement because it does not even have the phrase 'climate change' in it. And given the fact that climate change is right now the greatest threat facing this planet, I will not vote for a trade agreement that does not incorporate very, very strong principles to significantly lower fossil fuel emissions in the world," he said.

Democratic lawmakers had pushed for a commitment to the Paris agreement to be included in the deal, but that did not make it into the final draft, The New York Times pointed out.

Sanders also fought back when Pfannenstiel tried to shift his answer from climate to trade more narrowly.

"Well, they are the same in this issue," he said, according to the transcript.

Steyer joined Sanders in saying that he would not sign the deal because it failed to mention climate.

'Managed Retreat'

The first question directly raised by the moderators about the climate crisis brought up last spring's disastrous flooding in the Midwest and focused on what candidates would do about farms and factories that could not be relocated.

The question first went to Buttigieg, who spoke generally about the need to act on climate until the moderators repeated the question.

"We are going to have to use federal funds to make sure that we are supporting those whose lives will inevitably be impacted further by the increased severity and the increased frequency," he said.

The question then went to Steyer.

"Look, what you're talking about is what's called managed retreat," Steyer answered. "It's basically saying we're going to have to move things because this crisis is out of control. And it's unbelievably expensive. And of course we'll come to the rescue of Americans who are in trouble."

Fracking

Sen. Amy Klobuchar (D-Minn.) received some pushback from climate activists when she defended her decision not to call for an all-out ban on fracking.

"When it comes to the issue of fracking, I actually see natural gas as a transition fuel. It's a transition fuel to where we get to carbon neutral," Klobuchar said.

Her remarks come less than a week after a study found that new oil and gas emissions projected for the next five years could nearly cancel out the decline in coal emissions, partly enabled by the fracking boom and the falling price of natural gas.

"I cannot believe I am listening to @amyklobuchar talking about fracked gas as a bridge fuel in 2020," Sunrise Movement co-founder Varshini Prakash tweeted in response.

Climate Credentials

Over the course of the debate, the candidates attempted to position themselves as the best person to take on the climate crisis in office.

Steyer emphasized that climate was his top priority.

"And I'm still shocked that I'm the only person on this stage who will say this. I would declare a state of emergency on day one on climate," he said.

Warren, meanwhile, painted herself as the best person to get to the root cause of decades of climate inaction.

"Mr. Steyer talks about it being problem number one," she said. "Understand this, we have known about this climate crisis for decades. Back in the 1990s we were calling it global warming, but we knew what it was. Democrats and Republicans back then were working together because no one wanted a problem. But you know what happened? The industry came in and said, we can make big money if we keep them divided and make no change. Priority number one has to be taking back our government from the corruption. That is the only way we will make progress on climate, on gun safety, on health care, on all of the issues that matter to us."

Sanders, for his part, pointed to his plan for a Green New Deal to transition to 100 percent renewable energy in 10 years.

"If we as a nation do not transform our energy system away from fossil fuel, not by 2050, not by 2040, but unless we lead the world right now β€” not easy stuffβ€” the planet we are leaving our kids will be uninhabitable and unhealthy," he said.

Former Vice President Joe Biden, meanwhile, pointed to his legacy.

"[B]ack in 1986, I introduced the first climate change bill β€” and check PolitiFacts (sic); they said it was a game-changer. I've been fighting this for a long time. I headed up the Recovery Act, which put more money into moving away from fossil fuels to β€” to solar and wind energy than ever has occurred in the history of America," he said.

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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.