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One Year Into the Trump Administration, Where Do We Stand?

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U.S. Marine Corps Lance Cpl. Cristian L. Ricardo

By John R. Platt

What a long, strange year it's been.

Saturday, Jan. 20 marks the one-year anniversary of the Trump administration officially taking office after a long and arduous election. It's a year that has seen seemingly unending attacks on science and the environment, along with a rise in hateful rhetoric and racially motivated policies. But it's almost been met by the continuing growth of the efforts to resist what the Trump administration has to offer.


So where do we stand, one year in?

Well, for one thing, we can say that the year has given the administration's actions a visible shape. "These are not isolated incidents at this point," said Jacob Carter, research scientist for the Center for Science and Democracy at the Union of Concerned Scientists, who has been tracking the administration's attacks against science—at least 65 since the president took office. "They're happening so often now that there is definitely a pattern starting to emerge. The administration really wants to undermine the role of science and science-based decision making. They're getting the expertise out of the way to further a political agenda."

Carter said these attempts to remove science from government decision-making—ranging from ending a study of the health effects of mountaintop-removal mining to eliminating the words "climate change" from all EPA grants—"have real consequences on peoples' lives. It's about our health and safety. If we don't listen to the best available science, then our lives are at risk."

But pushing science and scientists aside doesn't mean they go away forever. "Under this administration we know the scientific evidence isn't going to be able to speak for itself, so scientists really have to step up and speak for it," Carter said. And scientists have been doing that in record numbers, starting with last year's March for Science and continuing on multiple fronts ever since. "They're stepping up in an unprecedented number and saying science has got to be used in policy-making decisions." That's not slowing down; Carter recalls how he attended two big scientific conferences last year and "I had tons of scientists coming up and asking me how they can advocate, what they could do to make sure that science is being used and remains in a proper place."

That increased level of activism is not unique to scientists, as people from many walks of live have definitely become more politically engaged in the past year. "Trump's election was a wakeup call in a way," said Gayle Alberda, an assistant professor of politics at Connecticut's Fairfield University, who studies elections, political participation and civic engagement. "Nation-wide, we've seen this huge influx of people wanting to know not only how to run for office, but how to get politically engaged."

Of course, people are rising up on both sides of the political aisle. In addition to the citizens opposing Trump's policies, Alberda said the people who see Trump as representing their ideals have also made their voices louder over the past year. "I think both sides are getting pushed in a way to really engage vastly differently than we have in the past," she said.

Unfortunately, the two sides aren't exactly talking to each other, and that's bad for the country. "We're losing the ability to engage in civil discourse in a way that's healthy for democracy," Alberda said.

Alberda said this has been building for a while, even before the election. "It's almost like you keep throwing firewood onto the fire and you don't realize how big it is until it blows up," she said. "You're like, 'whoa, that's a big fire.' Lots of little things have happened over the years and we're kind of seeing that all of a sudden in our face, because you have all of these questions about the state of democracy today." She said examples such as Trump's attacks on the free press, the Republican push to pass their legislative agenda, and the ongoing investigation into Russian interference in the last election have only served to stoke this fire even further.

So where do we go as we enter the administration's second year? One avenue is to look toward groups that have experience fighting these kinds of regressive activities. "One of the strengths of the movement is solidarity," said Nadia Aziz, program manager of the Stop Hate Project run by the Lawyers' Committee for Civil Rights Under Law. "There are a lot of organizations like ours that have been around for 50 years or more. We've been fighting to secure equal justice for racial and ethnic minorities for a very long time. I think we're very resilient organizations because of that," she said.

That resilience is important, she said, because right now we're at a critical point: "How do you make sure that this movement that we're all in, this resistance, is creating sustainable action and that we all don't get burned out?"

One way Aziz said she keeps herself strong is by seeing and experiencing what others are doing. "There are a lot of a lot of groups are doing such wonderful work," she said. "One of the most inspiring things about my job is being able to connect with people. I think that gives me resiliency, seeing how awesome the people are on the ground what the remarkable work they're doing."

That, in fact, may be one of the lasting legacies of this administration: Local community groups and national groups are connecting with each other, learning from each other, and collectively strengthening their voices. "I do think we're going to keep getting stronger and we're going to keep building out our movement," Aziz said.

As we enter year two of this administration, Alberda said she's looking toward local 2018 elections and the rise of candidates opposing Trump and his policies. "That is going to be really interesting," she said. "We've seen already that Republicans in safe Republican state legislative seats are getting challengers. I think that's indicative that we're going to see some interesting elections."

John R. Platt is the editor of The Revelator. An award-winning environmental journalist, his work has appeared in Scientific American, Audubon, Motherboard, and numerous other magazines and publications. His "Extinction Countdown" column has run continuously since 2004 and has covered news and science related to more than 1,000 endangered species. John lives on the outskirts of Portland, Oregon, where he finds himself surrounded by animals and cartoonists.

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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.

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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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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.