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When the Government Failed Puerto Rico, Local Communities Stepped Up

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Members of environmental nonprofit Casa Pueblo install solar panels in Puerto Rico's Adjuntas community. Arturo Massol

By Coral Natalie Negrón Almodóvar

The Earth began to shake as Tamar Hernández drove to visit her mother in Yauco, Puerto Rico, on Dec. 28, 2019. She did not feel that first tremor — she felt only the ensuing aftershocks — but she worried because her mother had an ankle injury and could not walk. Then Hernández thought, "What if something worse is coming our way?"


Her hunch was right. In the twilight hours of Jan. 7, 2020, a magnitude 6.4 earthquake struck the U.S. territory, with its epicenter near the city of Ponce on the south coast, a few miles from Hernández's hometown. Buildings trembled throughout the territory, but the southwest took the brunt of the quake, with dozens of partially or completely collapsed dwellings, including a school and a church, according to a report from El Nuevo Día. The island's primary power generation plants in the southern area of Puerto Rico failed, immediately plunging the territory into darkness.

As a survivor of Hurricane Maria's devastation in 2017, Hernández was consumed with anxiety and desperation at the prospect of having to live through another natural disaster, and watching the government mismanage the recovery again. "My father's Alzheimer's progressed since the storm, and dealing with an equal emergency was unthinkable," she said, before bursting into tears. She doubted she could maintain her economic stability after the earthquake damaged her nail business in the urban center of Yauco.

A view of a washed out road near Utuado, Puerto Rico, after a Coast Guard Air Station Borinquen MH-65 Dolphin helicopter crew dropped relief supplies to residents Tuesday, Oct. 3, 2017. The locals were stranded after Hurricane Maria by washed out roads and mudslides. U.S. Coast Guard photo by Petty Officer 3rd Class Eric D. Woodall / CC BY-NC-ND 2.0

Help did arrive, although it didn't come from the government initially. Instead, a hyperlocal response made up of disparate nonprofits and volunteers arrived and provided much needed aid, even during continuing aftershocks. Hernández said she was especially thankful for the response from one community organization, Tabernacle Followers of Jesus Christ.

Those volunteer initiatives sparked a feeling of trust in refugee camps, said Víctor Amauri, a social worker and one of the help coordinators with Solidarity Brigade of the West, which is made up of people from many organizations who provided direct response to help communities after Hurricane Maria.

"Strategizing after the hurricane and developing short- and long-term plans was our strong suit," Amauri said. "Now, it isn't straightforward to plan something for tomorrow, because everything changed. Misinformation and lack of transparency from the federal and local governments are preventing us from helping our people as they deserve."

The group leaders of the Solidarity Brigade used to meet in Mayagüez to organize community building projects. They would teach about composting and orchard keeping, and promote grassroots efforts to enhance food security and local agriculture as tools of self-sustainability.

"But in this context, we cannot think ahead," Amauri said. "We are still handling dozens of cases of families that are sleeping on the floor because, even though we are a country prone to hurricanes and, thanks to our location in between fault lines, earthquakes, the authorities never developed an emergency plan response."

A report by the Center of Investigative Journalism of Puerto Rico, the Climate Change Series Project — the culmination of years of requesting public documents — found that despite Puerto Rico's vulnerability, the territorial government had taken limited measures to tackle natural disasters. Even though investigative work in 2017 uncovered evidence that the death toll of Hurricanes Maria and Irma was much higher than the 64 victims claimed by the former governor Ricardo Rossellónearly 3,000 people are estimated to have died, a little less than twice as many as in Hurricane Katrina — and the territory's ability to respond to emergencies has not improved much.

The government's inefficient response has led to the formation of several citizen coalitions that know the needs of their communities. The Single Voice Movement is a conglomerate of local nonprofit and community-based organizations that already developed a two-year response plan for earthquake-affected communities. The projects developed by these entities have a vision that looks inward toward active communities capable of supporting themselves and their neighbors, said Cora Arce Rivera, executive director of Aspira de Puerto Rico.

A group of students from Aspira's Inc. Alternative School in the municipality of Mayaguez ready to go to the town of Cabo Rojo and receive farming instruction. Francisco Acevedo.

Aspira's alternative school in the western town of Mayagüez allows teenagers, most of them school dropouts, to explore the significance of agriculture. The students are learning to cultivate tropical root and tuber crops that can germinate in unfavorable conditions. They are particularly resistant to damage by high wind hurricanes and typhoons, Aspira's agronomist Francisco Acevedo said.

José Esteban López Maldonado, a student at the elite Residential Center of Educational Opportunities in Mayagüez, runs a similar project in the small mountainside municipality of Adjuntas. In 2016, he managed to acquire one of the hundreds of schools closed by the local Department of Education and transformed it into a coworking space where people can learn about hydroponic cultivation, coffee planting, and greenhouses. USDA Rural Development, which offers loans and grants to economic development projects, has offered López help to improve the infrastructure of the school, but local authorities have not been able to provide him a proof of ownership so he can take advantage of the program, he said.

José Esteban in Ponce, Puerto Rico, presenting his new initiative to distribute coffee Caturra, produced in his farm Lírica. Coral Negrón

The island also faces a bankruptcy crisis and austerity measures imposed by the federal Financial Oversight and Management Board. José Caraballo-Cueto, an economist and assistant professor at the University of Puerto Rico, said the bureaucracy around government processes exemplifies how the island is the perfect prey for disaster capitalism. "Restoration doesn't have the impact it deserves on the local economy because the biggest beneficiaries are not locals," Caraballo said. "A private law firm is even handling the cases of lack of proof of ownership post-Hurricane María."

In Puerto Rico, almost 92 percent of houses were damaged by the hurricane, according to a report from the American Bar Association. More than 95 percent of those tenants, about 1.1 million people, applied for the Federal Emergency Management Agency's Individuals and Households Program in 2018, but a FEMA spokesman told NBC News that 335,748 claims were denied because they couldn't provide a deed proving ownership of their homes.

Situations such as this one eroded Puerto Ricans' belief in local and federal institutions, which have promoted new governance models, said Arturo Massol Deyá, the executive director of 40-year-old environmental nonprofit Casa Pueblo.

In 150 locations across the island territory, Casa Pueblo ensured that, after Maria, those with the most urgent need for electricity received solar panels, including hospitals, small bodegas, and the homes of aging residents who required dialysis. In the recent earthquakes, the solar power systems proved to be more resilient than the Puerto Rican Electric Power Authority's electricity grid, which failed again.

In the wake of Hurricane Maria, Massol Deyá acknowledges that people wanted to be helped by their fellow townspeople. "They discovered soon that the true meaning of 'just recovery' is that the resources end up providing services that change the reality of constant vulnerability," he said.

"Energy is the ability to do work," Massol Deyá said. "We are putting the opportunity in the hands of the people; we want them to acquire the power to govern themselves and enjoy their production. It is the maximum self-decolonization scenario because the top-down model has collapsed. … it is not effective."

An upcoming Casa Pueblo project, in collaboration with professors at the University of Michigan, will be to use biomass from coffee production to generate energy. The energy produced will be used to power the coffee plantation to improve the harvest. The technique, Massol said, helps to reduce carbon dioxide emissions. Meanwhile, it will generate employment and provide a more sustainable life for the residents of Adjuntas.

Arturo Massol, executive director of Casa Pueblo de Adjuntas. Omar Alfonso

All these grassroots actions are becoming the backbone of survival in Puerto Rico. For the time being, however, the lives of those residing in earthquake zones are stagnant, said Edward Santiago-Pacheco, a U.S. Army veteran and father of a newborn girl.

He lost his newly purchased house in Yauco in the 6.4 magnitude earthquake and has not heard back from the insurance company, the bank, or any local government agency.

"It is hard to overcome this when you just brought a new life into this world," Santiago-Pacheco said. "FEMA only provided money for two months of rent for temporary housing, but I still must pay my house mortgage. The worst part is that the local government is using our pain in favor of their political propaganda."

On Feb. 10, the Solidarity Brigade learned about Hernández's and Santiago-Pacheco's cases and reached out to them, Amauri said. However, thousands need similar help.

"Two of our members are sociologists (Roberto Vélez and Jacqueline Villegas), and they developed a census to identify all necessities and help people the best possible way. But we need the government to publish relevant information that can help us organize our strategy," he added.

Casa Pueblo's installation of solar panels in a hardware store in Adjuntas. Arturo Massol

Coral Natalie Negrón Almodóvar is a Puerto Rican data journalist, a current grantee of the Center for Cooperative Media at Montclair State University, and Patti Birch for Data Journalism Fellow at the Committee to Protect Journalists.

Reposted with permission from YES! Magazine.

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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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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.