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The DOI and EPA Are in Tatters

Politics
Stop Pruitt rally to oppose the EPA administrator nomination, February 2017. Lorie Shaull

By Brian Palmer

As a candidate for president, Donald Trump made exaggerated promises tailor-made for his base. One of those was a vow to eliminate the U.S. Environmental Protection Agency (EPA) "in almost every form." In its most literal sense, the idea seemed ludicrous. "Trump's campaign vow to eliminate the EPA was farcical and naive," said John Walke, director of NRDC's Clean Air Project. "The laws of the United States prevent him from carrying it out, and the vast majority of people in Congress and the country disagree with doing so."


But nearly one year into the Trump administration, what the president actually can do is becoming apparent. Trump is not trying to literally close down the EPA—or the U.S. Department of the Interior, or any other government unit tasked with protecting the natural environment. What he is trying to do is change them so dramatically that they will be completely unable to carry out their intended roles.

Misrepresenting Their Missions

Trump's appointees to head the DOI and the EPA regularly claim they are refocusing their agencies on the "core mission" but then proceed to distort what those core missions actually are, setting the stage for allocations of resources that serve Trump's agenda instead of the environment.

When Interior Sec. Ryan Zinke announced the administration's plan to cut his department's budget by 12 percent, he said, "This budget overall speaks to the core mission of the Department of the Interior. It funds our highest priorities—safety, security, infrastructure."

Since when? "The department's mission is the sustainable management of land and waters," explained Bobby McEnaney, senior deputy director of NRDC's Western Renewable Energy Project. "There's no mandate about security and safety being integral to the DOI's structure." Safety, security, and infrastructure are buzzwords from the Trump campaign, referencing his promise to build a border wall and expand fossil fuel production. But while ostensibly the domain of the Department of Interior, those projects are not its mission, let alone its core mission. Just visit the agency's webpage:

"The Department of the Interior protects and manages the Nation's natural resources and cultural heritage; provides scientific and other information about those resources; and honors its trust responsibilities or special commitments to American Indians, Alaska Natives, and affiliated island communities."

Over at the EPA, Administrator Scott Pruitt rarely attempts to define the agency's core mission; he seems to think it has something to do with Superfunds. In announcing his list of high-priority cleanup sites, Pruitt said such projects would be "restored to their rightful place at the center of the agency's core mission."

Mitigation of toxic accidents is undoubtedly a part of EPA's purpose, but there's nothing in statute or regulation that suggests cleaning up messes is more central than preventing them in the first place. The EPA's core mission is protecting our health and our environment. Regulating air pollution, addressing climate change, and minimizing the use of harmful pesticides are all central parts of EPA's mission, and the country relies on the agency to produce science and rules to protect us from those threats. By talking only about cleanups, Pruitt is diverting resources from prevention.

Downsizing Expertise

Personnel cuts and shrunken budgets have been major features of the first year of Trump. The administration makes specious claims that this is part of an effort to reduce bureaucracy and improve efficiency. At the Department of the Interior, Zinke described his plan to cut personnel by up to one-third in some parts as an effort to "downsize the middle and headquarters management."

Sounds shrewd—except for one thing: Interior has never had a top-heavy structure. "The vast majority of DOI is based in the regions," said McEnaney. "For the size of its mission, the department is clearly understaffed in the D.C. headquarters."

Pruitt tried similar subterfuge. He called his plan to slash the EPA budget and decimate staffing an attempt to "reduce redundancies and inefficiencies." But when he took his case to Congress for review, even Republicans recognized that the budget would "significantly reduce or terminate programs that are vitally important." Regional offices, like EPA Region 5 in the Midwest, immediately pointed out that there was no way to carry out their basic duties—including Superfund cleanups—at the staffing levels Pruitt is pursuing.

The real reason behind these attempted personnel cuts is plain: to rid the agencies of expertise and experience and to remove the people who know how to keep our environment clean and prevent Trump's industrial supporters from having their way with our air and water. And sadly, it's working. The loss of expertise is particularly acute at the EPA, where new environmental regulations are built on the lessons of the last generation of rules. Experience in that iterative process is essential to drafting effective new regulations.

"We are witnessing an unprecedented brain drain from the EPA due to departures by experienced officials and employees," said Walke. "The administration is showing no signs of plans to backfill those departures with new hires. Even if they could, it's impossible to replace that degree of brain drain in the near future."

Centralizing Decision Making

Those in right-wing politics profess to love local control. For example, when Trump announced his plan to shrink the Bears Ears and Grand Staircase–Escalante national monuments, he quipped, "Some people think that the natural resources of Utah should be controlled by a small handful of very distant bureaucrats located in Washington."

The irony: Trump's appointees regularly demonstrate that they seem to believe this, too. DOI staffers around the country traditionally have broad latitude in shaping federal policy in their regions, and the skeleton crew of senior administrators in Washington traditionally relies heavily on the expertise and input of regional staff.

Zinke has reversed that tradition. "The monuments review was done exclusively by a small group of people in Zinke's office," notes McEnaney. "The same was true of the sage grouse conservation review."

At the EPA, sources indicate that career staff aren't being included in meetings, and sometimes they only learn of major decisions in the press. "It's the opposite of the way things have worked in both Democratic and Republican administrations, where there was an orderly process by which the staff experts reported to political heads of a program office, with instructions and information sharing back and forth," said Walke.

In addition, the EPA is required by both statute and tradition to collect and respond to public comments before making changes to regulations. But Pruitt's EPA has shown contempt for that process. The most glaring example was in November, when the agency held a hearing in West Virginia on the fate of the Clean Power Plan. The crowd was overwhelmingly in favor of keeping the rule in place, reflecting the general public support for the Clean Power Plan. Even in states that are suing for its repeal, the public favors the regulation. But Pruitt's procession toward repeal shows no care for the public's concerns about the EPA's many deregulatory actions that will result in unhealthy air, contaminated water, and damaged ecosystems. An attendee at the November meeting described the hearing as a "farce."

It's not all doom and gloom. Trump can decimate the agencies that protect our health and environment, but they will come back. Over the long term, the laws of the U.S.—the statutes passed by Congress, like the Clean Air Act and the Clean Water Act, that are supposed to guide the administration's actions—put conservation first, often regardless of the business interests of polluters, and courts will hold the Trump administration to those obligations.

"I expect to win a lot of lawsuits over the next four years," said Walke.

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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.

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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.


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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.