
“Stunning, just stunning, just stunning,” said Sheilah Garland, shaking her head as she stared out the window of the bus rolling along a dirt road next to towering black piles of petroleum coke on Chicago’s Southeast Side.
As an organizer of National Nurses United, a labor union representing about 6,000 nurses in Chicago and 185,000 nationwide, Garland has seen a lot. She represents nurses working in grueling and traumatic situations on a daily basis. And the union has picked fights with powerful politicians, including former California Gov. Arnold Schwarzenegger and Chicago Mayor Rahm Emanuel.
But Garland was shocked by the piles of petcoke, about six stories high, located across the street from homes. She was also perturbed to see employees walking onsite without respiratory masks.
The nurses union has joined local residents’ fight to get petcoke transportation and storage banned in Chicago. They see it as a serious public health issue and part of their larger social justice advocacy mission.
Monday, May 12, was a day of activism for the group Global Nurses United, in honor of the 194th birthday of legendary nurse Florence Nightingale. There were events in multiple cities in 11 countries. In Chicago, petcoke was the focus.
Previously the nurses’ union had joined residents marching miles from the petcoke piles to the BP oil refinery in Whiting, IN, that produces most of the petcoke stored in Chicago. And they will be with the struggle for the long haul, they said, in keeping with their national opposition to the Keystone XL pipeline and the growth of tar sands refining—which produces large amounts of the waste material.
On May 17, the nurses will join the Sierra Club, 350.org and other groups in a protest near the BP refinery, which recently completed a $3.8 billion expansion to process more tar sands.
“Nurses take this from a very personal perspective,” Garland said. “We deal with patients one on one, we see it in our hospital beds, in our clinics. When young people are dying of pulmonary issues, this is very real to us.”
The Chicago petcoke piles are also an attractive target for the nurses since they have been pushing for a tax on financial transactions, known as a “Robin Hood Tax,” to pay for more health care and social programs. KCBX, which owns the petcoke piles, is a subsidiary of Koch Industries, often highlighted in the national campaign for the Robin Hood Tax.
‘Babies Aren’t Supposed to Have Asthma’
The Southeast Environmental Task Force has long hosted bus tours, highlighting both sources of pollution and of hope on this heavily industrial swath of the city once home to steel mills and now characterized by landfills, scrap metal yards and the storage of waste materials.
The task force still leads a variety of tours, including a birding expedition in May. But much of their energy is now focused on educating people about petcoke, as leaders Tom Shepherd and Peggy Salazar noted on the bus with the nurses.
The task force’s efforts helped make petcoke a high-profile issue last fall, and Attorney General Lisa Madigan, Gov. Pat Quinn (D-IL) and Mayor Emanuel all made moves to regulate and limit petcoke storage. In late April the Chicago City Council passed an ordinance which limits future petcoke storage and mandates storage safeguards. But local residents say the timeline for that ordinance is too long—allowing piles to stay uncovered for two years—and it allows too much petcoke to remain in the city.
They are demanding a moratorium on petcoke storage and transport in Chicago, as the residents and nurses said in a press conference at City Hall following their tour.
Rolanda Watson is a family practice nurse at a clinic in Robbins, an impoverished, mostly African American Chicago suburb that is also home to heavy industry and near a now-shuttered oil refinery with a notorious record of pollution and accidents. Watson sees the petcoke as part of a larger environmental justice issue.
“The first thing they taught us as nurse practitioners is that we are advocates,” Watson said. “We’ve been seeing a rise in respiratory illnesses. So many colds, sinus problems, bronchitis, COPD, pneumonias. People will say it’s the weather, or something is just going around. But babies aren’t supposed to have asthma. There’s a reason for all this.”
Watson noted that the Affordable Care Act includes a heavy emphasis on prevention of illness through lifestyle improvements. “We’re trying to do prevention at the source, to prevent future exposure and the illness it causes,” Watson said.
On the tour, Shepherd pointed out other industrial landmarks along the Calumet River: a now-closed limestone crushing operation that locals fear will be used as a petcoke storage site, and land owned by Beemsterboer Slag where petcoke piles have been removed since the Attorney General filed a lawsuit and reached a settlement regarding the company’s lack of adequate permits and other violations.
The bus headed across the Indiana state line to the BP refinery. They also drove through Marktown, an historic enclave where BP was in the process of demolishing homes. On Whiting’s quaint main street, lined with pink decorations to raise money for the fight against breast cancer, is a town sign that says, “Refining the Heart of the Community.”
“Killing the heart of the community,” quipped Garland.
Health and Politics
There are numerous serious known health impacts caused by particulate matter, or fine dust, which can blow off petcoke piles. A March study commissioned by the city found that the storage of bulk material can be a “significant source of dust” leading to violations of air quality standards, and that of several materials studied, petcoke was the most problematic. Petcoke also contains known carcinogens and toxic heavy metals.
Residents say that is all reason enough to ban petcoke in Chicago, even without comprehensive studies showing the health impacts of the piles.
KCBX spokesperson Jake Reint said in a statement that the company has invested $30 million in dust suppression and weather monitoring equipment since buying the facility where the piles are stored in 2012.
“KCBX has the utmost respect for our neighbors and we are committed to ensuring that our operations remain compliant with all local, state and federal regulations,” Reint said.
But residents say the dust control measures are not adequate.
“The water doesn’t do anything, the water doesn’t work,” residents called out in the bus as they watched tall spigots spray water over the piles. Shepherd noted that they are also worried about the chemicals mixed with the water for dust suppression.
“I still see dust all the time,” said a local resident named Robert, who asked his last name not be used. “Why does it fall on us to prove it’s a health hazard? It should be their responsibility to prove that it’s not a health hazard.”
Southeast Side resident Marisol Macias works as a caterer and was hired to deliver food to the bus tour. She hadn’t otherwise heard about the campaign around the petcoke piles, but she said she thinks the piles are among the reasons all three of her young children have serious asthma.
“All around here we have aunts and uncles, kids, cousins, relatives, and everyone is getting sick,” said Macias, whose kids are nine months, 18 months and five years old.
On April 28, the Natural Resources Defense Council joined with the Southeast Environmental Task Force in filing a letter notifying the EPA of their intent to sue, alleging the petcoke piles violate the Resource Conservation and Recovery Act (RCRA) which governs waste disposal and storage.
Salazar and other local residents hope the nurses’ involvement will give their grassroots campaign a boost.
“It validates our concerns about health,” said Salazar, who grew up in the Slag Valley neighborhood near the petcoke piles. “You would hope he [Mayor Emanuel] listens—they are the experts.”
The nurses union has already butted heads with Emanuel.
During the 2012 NATO summit in Chicago, the nurses received a permit for a protest march and rally that was revoked at the last minute. After a legal battle the nurses were eventually able to go through with their protest, which included a concert by Tom Morello.
During the Occupy movement protests in Chicago in 2011, Nurses Midwest Director Jan Rodolfo and another nurse were arrested while staffing a First Aid tent to serve the occupiers.
“You have families talking about kids on respirators and not being able to sell their homes,” said Rodolfo, an RN. “And [with the ordinance] the mayor takes the approach of having nothing change for two years. It’s as if the lives affected don’t count."
“The voice of the Koch brothers was listened to and the voice of the community was ignored. It’s crazy they [city officials] are patting themselves on the back when they haven’t done what the community needs.”
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A Healthy Microbiome Builds a Strong Immune System That Could Help Defeat COVID-19
By Ana Maldonado-Contreras
Takeaways
- 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>By Jeff Masters, Ph.D.
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