How a Small North Carolina Community Is Pushing Back on Pollution
By Isabella Garcia
On Thanksgiving Day 2019, right after Caroline Laur had finished giving thanks for her home, a neighbor at church told her that a company had submitted permit requests to build an asphalt plant in their community. The plans indicated the plant would be 250 feet from Laur's backdoor.
Laur has a premalignant blood disease, and for the past two years, she has been trying to build up her immune system to prevent the disease from evolving into a terminal form of cancer. "When I heard about this plant," Laur says, "I went to the Duke Cancer Research Center, and a Duke scholar in my illness told me this would be a life-threatening situation for me, and I would have to leave." Having to move from her home, where she has lived for 15 years, would be devastating for Laur, not to mention a monetary loss. Who would buy a home 250 feet from an asphalt plant?
Laur lives in Anderson, North Carolina, a rural township with just over 2,000 people (and zero cell towers). It is one of the many predominantly Black communities in the United States experiencing a perfect storm of injustices threatening the health of residents and their environment.
An informal community survey shows that more than 70% of Anderson residents are Black, while the county and state's populations are 32% and 22% Black, respectively. Predominantly Black neighborhoods in the U.S. have historically been exposed to higher rates of air pollution. Specifically, Black people in America are exposed to about 1.5 times more particulate matter—a form of air pollution known to cause cancer—than White people. This exposure leads to higher incidences of health problems such as heart attacks, asthma, and decreased lung function.
A growing number of studies show polluting facilities are disproportionately located in Black and minority communities, so it's hardly surprising that the asphalt plant was slated for construction in Anderson. A 2018 study from the Environmental Protection Agency concluded that the discrepancy goes beyond geography or poverty, too: Not only are more factories in minority neighborhoods, but these factories are more likely to produce greater emissions than those in non-minority neighborhoods.
These days, the risks are even higher. Because exposure to air pollutants decreases lung function, communities in polluted areas are more susceptible to COVID-19; a recent Harvard study found that people in areas with high particulate matter are 8% more likely to die of the coronavirus than those in areas where the pollution is just one unit lower. That's been borne out in North Carolina, where Black residents make up 33% of the state's 1,568 COVID deaths as of July 15, despite only making up only 22% of the population.
"This is not just an Anderson community health crisis," Laur says. "This is a North Carolina health crisis. It's an American health crisis."
The plant that would threaten Laur's health and home was awaiting the approval of an air permit by the North Carolina Department of Air Quality which, if approved, would basically greenlight the project. "This made me get out and go door to door," Laur says. One by one, she alerted her neighbors to the prospect of the asphalt plant. "I got to meet some of my neighbors I never knew before," she says. "There's no secret that there has always been a pretty strong line between the White community and the Black community here." In the end, three neighbors joined her efforts—the Rev. Bryon Shoffner, Anita Foust, and Bill Compton. Together, they formed the Anderson Community Group to advocate for environmental justice in their community.
"We are all the four corners of the community," Laur says with a laugh. "You've got a sick old White lady, Rev. Shoffner is a disabled vet, you've got Anita, who is a Black woman, and you've got a White, old country farmer. We all come from different faiths, but we've all come together as one."
Suddenly thrust into activism, the group contacted the North Carolina Environmental Justice Network, a coalition that provides resources and connections with other groups. "We advocate, we organize, and we assist communities with whatever actions they are thinking of trying to protect themselves," says Naeema Muhammad, the network's co-director. Muhammad met with the activists from Anderson and recognized their need for legal advice, so she connected them with the Lawyers Committee for Civil Rights Under Law. The legal resources were key when the group determined that the data from the North Carolina Department of Environmental Quality's environmental justice report wasn't adding up.
The report—a requirement for all DEQ permit requests—stated that the Anderson community was 33% minority. That seemed far too low to the residents, so the Anderson Community Group did a census of each house within a 1-mile radius of the proposed plant—the same radius considered in the DEQ's environmental justice report.
"Rev. Shoffner went out into the community and did his own survey and found out that it was more than 70% minority," Laur says. "That was huge, because that changed the situation to a Title VI matter." Title VI is a federal civil rights law that prevents people from being discriminated against on the grounds of race, color, or national origin. Title VI cases require a more rigorous and comprehensive environmental justice report, so recognizing the Anderson community as a Title VI matter increases the strength of their request for a more in-depth report.
The massive difference in race demographics comes down to census data, Laur says. The DEQ was using race data from the 2010 census, which was only completed by about 64% of the population of Caswell County—the county where Anderson is located. Laur says the Anderson population response rate could be even lower because the community is considered "hard-to-count" by the U.S. Census Bureau.
"The people who don't fill it out are rural people who want to keep their land and don't want zoning and minorities," Laur says, which creates skewed race demographics. The Anderson Community Group said that when they brought up this issue with the director of North Carolina DEQ, he said he was aware of the problem.
"So that tells me that all the EJ reports in North Carolina that have been done may not even be valid, just like ours," Laur says. "We were told that we are the first [community members] who have ever doubted it and checked it out."
Determined to have new data collected, the Anderson Community Group rallied in early 2020. After learning from the state Department of Air Quality, the department responsible for approving or rejecting the asphalt air permit, that 100 statements of concern from community members would be sufficient to trigger a public hearing, the Anderson group gathered letters of concern from their community. They submitted more than 108.
"Then we were told there wasn't enough concern to have a public hearing," Laur says. "So, we started inundating the [Department of Air Quality director with emails and phone calls from the community."
Finally, in February 2020, the DEQ declared a public comment period for the issue, effectively placing the air permit for the asphalt plant on hold until a public hearing August 3. The public hearing will be held online because of COVID-19, but Laur says most people in Anderson don't own computers, and won't be able to attend. When the community group filed a complaint regarding accessibility, the DEQ then allowed public comments to be submitted via voicemail.
"Well, we don't have a cell tower out here," Laur says. She has personally never been able to use her cellphone in her home, and even her landline phone drops calls frequently. Even being able to afford a landline is a luxury in Anderson, Laur says.
To make sure community voices are heard, Laur says, the Anderson Community Group is "begging, fighting, scratching, and screaming" for the public comment period to be extended until the hearing can be held in person. The group fears that the community won't be able to properly participate, and as a result, the DEQ will approve the asphalt permit without listening to residents' concerns or considering accurate data.
The health impacts on the community could be huge. During Shoffner's unofficial survey, he also found that more than 90% of those within a 1-mile radius of the proposed plant have health conditions such as asthma, lung disease, and previous strokes and heart attacks that would be exacerbated by polluting industries.
"That's the thing that we feel they are truly missing: They're not allowing data to catch up," Shoffner says. Not only is the existing data outdated and inaccurate, he argues, but even data from 2018 would only provide a partial picture, because it does not account for the effects of COVID-19 on the community. "Of course, our ultimate goal is for them to say they're not going to build a polluting industry in a Black neighborhood, but our next move is to get them to postpone it until they get the data that shows how the asphalt plant and COVID-19 is affecting Black and brown people."
Shoffner says that the pandemic has thankfully slowed down the whirlwind of decisions on the asphalt plant and given the team time to consider what else they can do to halt its construction. For example, in July, the group created a mail-in petition for the North Carolina governor to stop the permit process.
"This team has been able to research and dig and get in a lot of doors," he says, noting that they have had productive conversations with leaders from the North Carolina DEQ. "We're winning as long as we're on the phone and getting conference calls. When they stop taking our calls, that's when we'll start asking what to do now."
CORRECTION: An earlier version of this story incorrectly identified Anita Foust. Text has been updated.
Isabella Garcia is a former solutions journalism intern for YES!.
Reposted with permission from YES! Magazine.
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By Ana Maldonado-Contreras
- Your gut is home to trillions of bacteria that are vital for keeping you healthy.
- Some of these microbes help to regulate the immune system.
- New research, which has not yet been peer-reviewed, shows the presence of certain bacteria in the gut may reveal which people are more vulnerable to a more severe case of COVID-19.
You may not know it, but you have an army of microbes living inside of you that are essential for fighting off threats, including the virus that causes COVID-19.
How Do Resident Bacteria Keep You Healthy?<p>Our immune defense is part of a complex biological response against harmful pathogens, such as viruses or bacteria. However, because our bodies are inhabited by trillions of mostly beneficial bacteria, virus and fungi, activation of our immune response is tightly regulated to distinguish between harmful and helpful microbes.</p><p>Our bacteria are spectacular companions diligently helping prime our immune system defenses to combat infections. A seminal study found that mice treated with antibiotics that eliminate bacteria in the gut exhibited an impaired immune response. These animals had low counts of virus-fighting white blood cells, weak antibody responses and poor production of a protein that is vital for <a href="https://doi.org/10.1073/pnas.1019378108" target="_blank">combating viral infection and modulating the immune response</a>.</p><p><a href="https://doi.org/10.1371/journal.pone.0184976" target="_blank" rel="noopener noreferrer">In another study</a>, mice were fed <em>Lactobacillus</em> bacteria, commonly used as probiotic in fermented food. These microbes reduced the severity of influenza infection. The <em>Lactobacillus</em>-treated mice did not lose weight and had only mild lung damage compared with untreated mice. Similarly, others have found that treatment of mice with <em>Lactobacillus</em> protects against different <a href="https://doi.org/10.1038/srep04638" target="_blank" rel="noopener noreferrer">subtypes of</a> <a href="https://doi.org/10.1038/s41598-017-17487-8" target="_blank" rel="noopener noreferrer">influenza</a> <a href="https://doi.org/10.1371/journal.ppat.1008072" target="_blank" rel="noopener noreferrer">virus</a> and human respiratory syncytial virus – the <a href="https://doi.org/10.1038/s41598-019-39602-7" target="_blank" rel="noopener noreferrer">major cause of viral bronchiolitis and pneumonia in children</a>.</p>
Chronic Disease and Microbes<p>Patients with chronic illnesses including Type 2 diabetes, obesity and cardiovascular disease exhibit a hyperactive immune system that fails to recognize a harmless stimulus and is linked to an altered gut microbiome.</p><p>In these chronic diseases, the gut microbiome lacks bacteria that activate <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">immune cells</a> that block the response against harmless bacteria in our guts. Such alteration of the gut microbiome is also observed in <a href="https://doi.org/10.1073/pnas.1002601107" target="_blank" rel="noopener noreferrer">babies delivered by cesarean section</a>, individuals consuming a poor <a href="https://doi.org/10.1038/nature12820" target="_blank" rel="noopener noreferrer">diet</a> and the <a href="https://doi.org/10.1038/nature11053" target="_blank" rel="noopener noreferrer">elderly</a>.</p><p>In the U.S., 117 million individuals – about half the adult population – <a href="https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/" target="_blank" rel="noopener noreferrer">suffer from Type 2 diabetes, obesity, cardiovascular disease or a combination of them</a>. That suggests that half of American adults carry a faulty microbiome army.</p><p>Research in my laboratory focuses on identifying gut bacteria that are critical for creating a balanced immune system, which fights life-threatening bacterial and viral infections, while tolerating the beneficial bacteria in and on us.</p><p>Given that diet affects the diversity of bacteria in the gut, <a href="https://www.umassmed.edu/nutrition/melody-trial-info/" target="_blank" rel="noopener noreferrer">my lab studies show how diet can be used</a> as a therapy for chronic diseases. Using different foods, people can shift their gut microbiome to one that boosts a healthy immune response.</p><p>A fraction of patients infected with SARS-CoV-2, the virus that causes COVID-19 disease, develop severe complications that require hospitalization in intensive care units. What do many of those patients have in common? <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm" target="_blank" rel="noopener noreferrer">Old age</a> and chronic diet-related diseases like obesity, Type 2 diabetes and cardiovascular disease.</p><p><a href="http://doi.org/10.1016/j.jada.2008.12.019" target="_blank" rel="noopener noreferrer">Black and Latinx people are disproportionately affected by obesity, Type 2 diabetes and cardiovascular disease</a>, all of which are linked to poor nutrition. Thus, it is not a coincidence that <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm" target="_blank" rel="noopener noreferrer">these groups have suffered more deaths from COVID-19</a> compared with whites. This is the case not only in the U.S. but also <a href="https://www.washingtonpost.com/world/europe/blacks-in-britain-are-four-times-as-likely-to-die-of-coronavirus-as-whites-data-show/2020/05/07/2dc76710-9067-11ea-9322-a29e75effc93_story.html" target="_blank" rel="noopener noreferrer">in Britain</a>.</p>
Discovering Microbes That Predict COVID-19 Severity<p>The COVID-19 pandemic has inspired me to shift my research and explore the role of the gut microbiome in the overly aggressive immune response against SARS-CoV-2 infection.</p><p>My colleagues and I have hypothesized that critically ill SARS-CoV-2 patients with conditions like obesity, Type 2 diabetes and cardiovascular disease exhibit an altered gut microbiome that aggravates <a href="https://theconversation.com/exercise-may-help-reduce-risk-of-deadly-covid-19-complication-ards-136922" target="_blank" rel="noopener noreferrer">acute respiratory distress syndrome</a>.</p><p>Acute respiratory distress syndrome, a life-threatening lung injury, in SARS-CoV-2 patients is thought to develop from a <a href="http://doi.org/10.1016/j.cytogfr.2020.05.003" target="_blank" rel="noopener noreferrer">fatal overreaction of the immune response</a> called a <a href="https://theconversation.com/blocking-the-deadly-cytokine-storm-is-a-vital-weapon-for-treating-covid-19-137690" target="_blank" rel="noopener noreferrer">cytokine storm</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">that causes an uncontrolled flood</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">of immune cells into the lungs</a>. In these patients, their own uncontrolled inflammatory immune response, rather than the virus itself, causes the <a href="http://doi.org/10.1007/s00134-020-05991-x" target="_blank" rel="noopener noreferrer">severe lung injury and multiorgan failures</a> that lead to death.</p><p>Several studies <a href="https://doi.org/10.1016/j.trsl.2020.08.004" target="_blank" rel="noopener noreferrer">described in one recent review</a> have identified an altered gut microbiome in patients with COVID-19. However, identification of specific bacteria within the microbiome that could predict COVID-19 severity is lacking.</p><p>To address this question, my colleagues and I recruited COVID-19 hospitalized patients with severe and moderate symptoms. We collected stool and saliva samples to determine whether bacteria within the gut and oral microbiome could predict COVID-19 severity. The identification of microbiome markers that can predict the clinical outcomes of COVID-19 disease is key to help prioritize patients needing urgent treatment.</p><p><a href="https://doi.org/10.1101/2021.01.05.20249061" target="_blank" rel="noopener noreferrer">We demonstrated</a>, in a paper which has not yet been peer reviewed, that the composition of the gut microbiome is the strongest predictor of COVID-19 severity compared to patient's clinical characteristics commonly used to do so. Specifically, we identified that the presence of a bacterium in the stool – called <em>Enterococcus faecalis</em>– was a robust predictor of COVID-19 severity. Not surprisingly, <em>Enterococcus faecalis</em> has been associated with <a href="https://doi.org/10.1053/j.gastro.2011.05.035" target="_blank" rel="noopener noreferrer">chronic</a> <a href="https://doi.org/10.1016/S0002-9440(10)61172-8" target="_blank" rel="noopener noreferrer">inflammation</a>.</p><p><em>Enterococcus faecalis</em> collected from feces can be grown outside of the body in clinical laboratories. Thus, an <em>E. faecalis</em> test might be a cost-effective, rapid and relatively easy way to identify patients who are likely to require more supportive care and therapeutic interventions to improve their chances of survival.</p><p>But it is not yet clear from our research what is the contribution of the altered microbiome in the immune response to SARS-CoV-2 infection. A recent study has shown that <a href="https://doi.org/10.1101/2020.12.11.416180" target="_blank" rel="noopener noreferrer">SARS-CoV-2 infection triggers an imbalance in immune cells</a> called <a href="https://doi.org/10.1111/imr.12170" target="_blank" rel="noopener noreferrer">T regulatory cells that are critical to immune balance</a>.</p><p>Bacteria from the gut microbiome are responsible for the <a href="https://doi.org/10.7554/eLife.30916.001" target="_blank" rel="noopener noreferrer">proper activation</a> <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">of those T-regulatory</a> <a href="https://doi.org/10.1038/nri.2016.36" target="_blank" rel="noopener noreferrer">cells</a>. Thus, researchers like me need to take repeated patient stool, saliva and blood samples over a longer time frame to learn how the altered microbiome observed in COVID-19 patients can modulate COVID-19 disease severity, perhaps by altering the development of the T-regulatory cells.</p><p>As a Latina scientist investigating interactions between diet, microbiome and immunity, I must stress the importance of better policies to improve access to healthy foods, which lead to a healthier microbiome. It is also important to design culturally sensitive dietary interventions for Black and Latinx communities. While a good-quality diet might not prevent SARS-CoV-2 infection, it can treat the underlying conditions related to its severity.</p><p><em><a href="https://theconversation.com/profiles/ana-maldonado-contreras-1152969" target="_blank">Ana Maldonado-Contreras</a> is an assistant professor of Microbiology and Physiological Systems at the University of Massachusetts Medical School.</em></p><p><em>Disclosure statement: Ana Maldonado-Contreras receives funding from The Helmsley Charitable Trust and her work has been supported by the American Gastroenterological Association. She received The Charles A. King Trust Postdoctoral Research Fellowship. She is also member of the Diversity Committee of the American Gastroenterological Association.</em></p><p><em style="">Reposted with permission from <a href="https://theconversation.com/a-healthy-microbiome-builds-a-strong-immune-system-that-could-help-defeat-covid-19-145668" target="_blank" rel="noopener noreferrer" style="">The Conversation</a>. </em></p>
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