Research Shows Reproductive Diseases Linked to Environmental Contaminants
Beyond Pesticides
New research is adding to the evidence that some pesticides and industrial chemicals may increase women’s risk of uterine and ovarian diseases, such as endometriosis. The research supports the decades-old theory that hormone-mimicking chemicals impact human reproductive systems.
Scientists have long suspected a link between estrogen-mimicking pollutants and gynecological diseases. According to Environmental Health News, research investigating a link between hormone-disrupting chemicals in the environment and gynecological diseases has had mixed results. But a new study, Persistent Lipophilic Environmental Chemicals and Endometriosis: The ENDO Study, from researchers at the National Institutes of Health and others, found that two groups of women in the Salt Lake City and San Francisco areas—one group with pelvic pain and the other with no symptoms—were more likely to be diagnosed with endometriosis if they had high blood levels of the estrogen-like pesticide hexachlorocyclohexane (HCH) than women with low levels.
HCH, a persistent organic pollutant (POP), and a byproduct of the production of the insecticide lindane (head lice treatments), has been banned as a crop pesticide in the U.S. but it persists in the environment and remains in some food supplies. Endometriosis is a female health disorder that occurs when uterine tissue grows in the ovaries or other parts of the body, often causing pelvic pain and infertility. It affects approximately 10 percent of women of reproductive age.
Similarly, in Italy, women had endometriosis more often if they had higher levels of two chlorinated chemicals that can disrupt hormones—polychlorinated biphenyls (PCBs) or residue of the insecticide DDT, according to a 2009 study, Endometriosis and Organochlorinated Environmental Pollutants: A Case–Control Study on Italian Women of Reproductive Age, which looked at exposure to organochlorine persistent pollutants as a risk factor for endometriosis.
Recent research has uncovered links to other gynecological problems. Women in Greece diagnosed with polycystic ovary syndrome (PCOS)—which causes irregular menstrual periods, infertility, weight gain and excessive hair growth—were more likely to have higher blood levels of the estrogen-mimicking chemical bisphenol A than women without the disease, according to a study published last year.
Another recent study, Environmentally Induced Epigenetic Transgenerational Inheritance of Ovarian Disease, found that female rats exposed in the womb to high doses of several chemicals, including pesticides and plasticizers, develop cysts resembling human polycystic ovarian syndrome and premature menopause. These changes are passed down through three generations—great-granddaughters of the exposed rats also developed cysts and other ovarian problems, even though they were not directly exposed. In this study, vinclozolin, a fungicide commonly used in the wine industry, reprogrammed genes as the rat fetuses developed according to DNA analysis. Other chemicals in this study that caused multi-generational effects were dioxins, a pesticide mixture including permethrin and DEET and a plastic mixture including BPA and two widely used phthalates.
Exposure to many hormone-disrupting chemicals starts in the womb, and some scientists suspect the timing may be important in determining reproductive disease risk later in life. But because decades can pass between exposure during fetal development or early childhood and the manifestation of the disease in adult life, it can be difficult to nail down a link.
Some studies have found no connection between women’s exposure to environmental chemicals and gynecological disease. For instance, among several hundred women in Italy highly exposed to dioxins from a 1976 factory explosion, UC Berkeley scientists found no significant increase in endometriosis linked to their contaminant levels. However, emerging data is beginning to paint another picture regarding environmental contaminants and reproductive health. Previous research documented by Beyond Pesticides has shown that women who drink water containing the widely used herbicide atrazine may be more likely to have irregular menstrual cycles and low estrogen levels, even at concentrations far below federal drinking water standards considered safe by the U.S. Environmental Protection Agency.
The danger of estrogen-like chemicals already has been well-documented with DES, or diethylstilbestrol, a drug that was prescribed to millions of women at risk of miscarriages from 1940 through 1971. Daughters and granddaughters of the pregnant women who took the potent estrogenic drug had an increased risk of endometriosis, uterine fibroids and rare reproductive cancers. In the case of uterine fibroids, the body’s natural estrogens turn genes on and off in the smooth muscle of the uterus that allow the tumors to grow, according to researchers. Investigations are underway to determine whether estrogen-mimicking chemicals in the environment affect these same genes.
“We know from animal models that there are critical periods during early development when cells are rapidly dividing and forming the circuitry through which cells will communicate with each other to form various tissues of the body,” said Retha Newbold, PhD, a reproductive biologist at the National Institute of Environmental Health Sciences in North Carolina. “When chemicals alter this set-up, the changes may not be reversible.”
Pesticides have been linked to a host of diseases and other adverse effects like cancer, Parkinson’s disease and birth defects. Beyond Pesticides’ Pesticide Induced-Disease Database documents these outcomes.
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Supporters cheer before Trump arrives for a rally at the BOK Center on June 20, 2020 in Tulsa, OK. Jabin Botsford / The Washington Post via Getty Images
On Monday and Tuesday of the week that President Donald Trump held his first rally since March in Tulsa, Oklahoma, the county reported 76 and 96 new coronavirus cases respectively, according to POLITICO. This week, the county broke its new case record Monday with 261 cases and reported a further 206 cases on Tuesday. Now, Tulsa's top public health official thinks the rally and counterprotest "likely contributed" to the surge.
<p>"The past two days we've had almost 500 cases, and we know we had several large events a little over two weeks ago, which is about right," Tulsa Health Department Dr. Bruce Dart said in a press conference Wednesday, as <a href="https://www.nytimes.com/2020/07/08/us/politics/coronavirus-tulsa-trump-rally.html#referrer=https://www.google.com" target="_blank">The New York Times reported</a>. "So I guess we just connect the dots."</p>
<div class="rm-shortcode" data-rm-shortcode-id="dce63f86a91daa2c577e22980bb7c3ad"><div class="fb-video" data-href="https://www.facebook.com/video.php?v=1931137487193380" data-allowfullscreen="true"></div></div>
<p>Trump held his rally June 20, and it can take about two weeks for an increased infection rate to show up in new case tallies because of the disease's incubation period.</p><p>Trump's rally made headlines in mid-June when it was revealed that, in order to attend, rally goers had to <a href="https://www.ecowatch.com/trump-rally-coronavirus-risk-2646170476.html" target="_self">agree not to sue</a> the campaign if they contracted COVID-19. Dart had urged the campaign to cancel the rally before it took place.</p><p>"It's the perfect storm of potential over-the-top disease transmission," Dart said, as <a href="https://www.nytimes.com/2020/06/16/us/politics/trump-coronavirus-rally.html" target="_blank">The New York Times reported at the time</a>. "It's a perfect storm that we can't afford to have."</p>
<p>Administration and campaign officials pushed back on the idea that the rally had led to a surge in cases. White House Press Secretary Kayleigh McEnany said she had "no data to indicate" this was the case, as <a href="https://abcnews.go.com/amp/Politics/trump-rally-contributed-surge-covd-19-cases-tulsa/story?id=71680180" target="_blank">ABC News reported</a>.</p><p>And campaign communications director Tim Murtaugh defended the rally's safety precautions.</p><p>"There were literally no health precautions to speak of as thousands looted, rioted, and protested in the streets and the media reported that it did not lead to a rise in coronavirus cases. Meanwhile, the President's rally was 18 days ago, all attendees had their temperature checked, everyone was provided a mask, and there was plenty of hand sanitizer available for all. It's obvious that the media's concern about large gatherings begins and ends with Trump rallies," he said in a widely reported statement.</p><p>While the campaign did conduct temperature checks and distribute masks and hand sanitizer, it did not enforce social distancing inside the arena and most participants did not wear masks, ABC News pointed out.</p>
<p>The rally was much smaller than anticipated, however. Around 6,200 people from across the country attended, but the venue, the BOK Center arena, can seat 19,000, POLITICO reported.</p><p>Tulsa county contract tracers could not confirm whether they had linked any specific cases to the rally because the Tulsa Health Department "will not publicly identify any individual or facility at risk of exposure, or where transmission occurred," spokesperson Leanne Stephens said, according to The New York Times.</p><p>One sign that does point to the rally as an infection source is the fact that cases have increased in rural parts of Oklahoma, Tulsa county commissioner Karen Keith told The New York Times.</p><p>Some high-profile people have tested positive for COVID-19 after attending the rally, ABC reported, including former 2012 presidential candidate Herman Cain and national chair of the Trump Victory Finance Committee Kimberly Guilfoyle. At least eight Trump campaign staffers in Tulsa have also tested positive, and two of them attended the event.</p>
<p>Tulsa is not the only part of Oklahoma seeing a surge in cases. The entire state reported 858 new cases Tuesday and 673 Wednesday.</p><p>"We continue to go up and are at a new peak," lead COVID-19 officer at the University of Oklahoma Dr. Dale Bratzler told ABC News Monday.</p><p>The next Trump rally is scheduled to take place in Portsmouth, New Hampshire Saturday. Once again, attendees will have to promise not to sue if they fall ill. They will have their temperatures checked and be offered masks and hand sanitizer, but mask wearing and social distancing will not be required.</p>
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In the tropics, farmers often slash and burn forests to clear fertile land for crops, but a new method avoids that technique. Inga Foundation video
Rainforests are an important defense against climate change because they absorb carbon. But many are being destroyed on a massive scale.
<iframe style="border: none" src="//html5-player.libsyn.com/embed/episode/id/14740994/height/45/theme/standard/thumbnail/yes/direction/backward/" height="45" width="100%" scrolling="no" allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen></iframe>
<p>In the tropics, farmers often slash and burn forests to clear fertile land for crops. The practice involves cutting down vegetation and burning it. But the soil's fertility does not last long, so the farmers must clear a new patch of forest every few years.</p><p>"People believe it's the only possible way of growing crops," says ecologist Michael Hands.</p><p>But he says there's an alternative. Hands directs the Inga Foundation, which teaches farmers in Honduras and Costa Rica a method called <a target="_blank" href="http://www.ingafoundation.org/alley-cropping/">inga alley cropping</a>.</p><p>The inga is a fast-growing tree with roots that fix nitrogen, so it replenishes the soil.</p>
<p>In alley cropping, farmers plant inga trees in rows. Their shade kills weeds and creates space for planting maize or beans. Then the trees are pruned back so sunlight can reach the crops until harvest.</p><p>"And you can repeat the process the following year," Hands says.</p><p>The ingas' roots keep the soil rich, so the farmer does not need to slash and burn more land. That means less carbon pollution and less labor.</p><p>"It's definitely transforming people's lives," Hands says.</p>
<p><em>Reposted with permission from <a href="https://www.yaleclimateconnections.org/2020/07/farmers-learn-alternative-to-slashing-and-burning-rainforests/" target="_blank">Yale Climate Connections</a>.</em></p>From Your Site Articles
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A truck spreads lime on a meadow to increase the soil's fertility in Yorkshire Dales, UK. Farm Images / Universal Images Group via Getty Images
As we look for advanced technology to replace our dependence on fossil fuels and to rid the oceans of plastic, one solution to the climate crisis might simply be found in rocks. New research found that dispersing rock dust over farmland could suck billions of tons of carbon dioxide from the air every year, according to the first detailed large scale analysis of the technique, as The Guardian reported.
<p>The <a href="https://www.nature.com/articles/s41586-020-2448-9" target="_blank">study</a>, published Wednesday in the journal <em>Nature,</em> found the technique could pull enough carbon dioxide from the atmosphere to remove about half of the amount of that greenhouse gas currently produced by Europe. To put it another way, that would mean pulling more CO2 from the atmosphere than the current total emissions from global aviation and shipping combined, according to a <a href="https://www.newswise.com/articles/applying-rock-dust-to-croplands-could-absorb-up-to-2-billion-tonnes-of-co2-from-the-atmosphere-research-shows" target="_blank">press release</a> from the University of Sheffield where the study was conducted.</p><p>"Spreading rock dust on agricultural land is a straightforward, practical CO2 drawdown approach with the potential to boost soil health and food production, said David Beerling, director of the Leverhulme Center for Climate Change Mitigation at the University of Sheffield and lead author of the study. "Our analyses reveal the big emitting nations – China, the US, India – have the greatest potential to do this, emphasizing their need to step up to the challenge."</p>
<p>The research showed that if the world's three largest emitters of CO2 — China, the U.S. and India — adopted the practice on a large scale, they could collectively clear about 1 billion metric tons of carbon dioxide from the air, as <a href="https://www.washingtonpost.com/climate-solutions/2020/07/08/spreading-rock-dust-ground-could-pull-carbon-air-researchers-say/" target="_blank">The Washington Post</a> reported.</p><p>The technique of spreading rock on the ground is known as enhanced rock weathering. The researchers took a realistic approach to perform a global analysis of the technique. The researchers say their modeling of enhanced rock weathering is the most realistic yet because it factors in how much rock is available and the energy countries would be willing to use for grinding it up, as <a href="https://www.newscientist.com/article/2248222-a-sprinkle-of-rock-dust-could-help-avoid-catastrophic-climate-change/" target="_blank">The New Scientist</a> reported.</p>
<p>Looking at each country's climate, farmland and energy infrastructure, they found that rock dust could remove between 0.5 and 2 gigatons of CO2 annually by 2050. Right now, global dependence on fossil fuels emits around 35 gigatons of CO2 each year, according to The New Scientist.</p><p>Enhanced rock weathering is a system where crushed rock is layered into the soil. As The Washington Post explained, when silicate or carbonate minerals in the dust dissolve in rain, carbon dioxide is drawn from the atmosphere into the solution to form bicarbonate ions. The bicarbonate ions then run off into the ocean, where they form carbonate minerals and store their carbon indefinitely.</p><p>The Guardian noted that while researchers are clear that the most important step to fighting the climate crisis is drastically reducing emissions, a reduction in emissions won't be enough to keep the world from breaking the targets of the Paris agreement keeping global temperature rise below 2 degrees Celsius. In order to achieve lasting success, the excess carbon in the atmosphere also needs to be removed.</p>
<p>"We have passed the safe level of greenhouse gases. Cutting fossil fuel emissions is crucial, but we must also extract atmospheric CO2 with safe, secure and scalable carbon dioxide removal strategies to bend the global CO2 curve and limit future climate change," said James Hansen, a partner in the study and director of the Climate Science, Awareness and Solutions Program at Columbia University's Earth Institute, in a press release. "The advantage of CO2 removal with crushed silicate rocks is that it could restore deteriorating top-soils, which underpin food security for billions of people, thereby incentivizing deployment."</p><p>The researchers say that enhanced rock weathering has several advantages, according to The Guardian. First, many farmers already add limestone dust to <a href="http://www.ecowatch.com/tag/soil">soils</a> to reduce acidification, and adding other rock dust improves fertility and crop yields, meaning the application could be both routine and desirable.</p><p>"CO2 drawdown strategies that can scale up and are compatible with existing land uses are urgently required to combat climate change, alongside deep emissions cuts," said Beerling. "Enhanced rock weathering is a straightforward, practical approach."</p>
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Global heating imposes a harsh cost at the most critical time of all: the moment of spawning. Pxfuel
By Tim Radford
German scientists now know why so many fish are so vulnerable to ever-warming oceans. Global heating imposes a harsh cost at the most critical time of all: the moment of spawning.
<p>"Our findings show that, both as embryos in eggs and as adults ready to mate, fish are far more sensitive to heat than in their larval stage or as sexually mature adults outside the mating season," said <a href="https://www.researchgate.net/profile/Flemming_Dahlke" target="_blank">Flemming Dahlke, a marine biologist</a> with the <a href="https://www.awi.de/" target="_blank">Alfred Wegener Institute at Bremerhaven</a>.</p><p>"On the global average, for example, adults outside the mating season can survive in water that's up to 10°C warmer than adults ready to mate, or fish eggs, can."</p><p>The finding – if it is confirmed by other research – should clear up some of the puzzles associated with fish numbers. There is clear evidence, established repeatedly over the decades, that <a href="https://climatenewsnetwork.net/ocean-heatwaves-drive-more-fish-north/" target="_blank">fish are responding to climate change</a>.</p><p>But almost three fourths of the planet is blue ocean, and <a href="https://climatenewsnetwork.net/hunger-threat-as-tropical-fish-seek-cooler-waters/" target="_blank">at depth is responding far more slowly</a> than the land surface to global heating fueled by fossil fuel exploitation that releases greenhouse gases.</p>
Nearing the Brink
<p>Since <a href="https://climatenewsnetwork.net/abundant-fish-need-cool-seas-and-protection/" target="_blank">fish in the temperate zones already experience a wide variation</a> in seasonal water temperatures, it hasn't been obvious why species such as <a href="https://climatenewsnetwork.net/sardines-swim-into-northern-waters-to-keep-cool/" target="_blank">cod have shifted nearer the Arctic, and sardines have migrated to the North Sea</a>.</p><p>But <a href="https://climatenewsnetwork.net/ocean-warming-spurs-marine-life-to-rapid-migration/" target="_blank">marine creatures are on the move</a>, and although there are other factors at work, including overfishing and <a href="https://climatenewsnetwork.net/fish-cant-smell-well-in-more-acidic-seas/" target="_blank">the increasingly alarming changes in ocean chemistry</a>, thanks to ever-higher levels of dissolved carbon dioxide, temperature change is part of the problem.</p><p>The latest answer, Dr Dahlke and his colleagues report in the journal <a href="https://science.sciencemag.org/cgi/doi/10.1126/science.aaz3658" target="_blank">Science</a>, is that many fish may already be living near the limits of their thermal tolerance.</p><p>The temperature safety margins during the moments of spawning and embryo might be very precise, and over hundreds of thousands of years of evolution, marine and freshwater species have worked out just what is best for the next generation. Rapid global warming upsets this equilibrium.</p><p>The Bremerhaven scientists looked at experiments, observations and recorded data for the life cycles of 694 marine and freshwater species, to decide that oxygen supply is the key decider of reproductive success. Warmer waters carry less dissolved oxygen. Embryo fish have no gills: they cannot simply take in deeper breaths.</p><p>Fish about to mate are busy producing extra mass in the form of sperm and egg cells: this additional body mass also needs oxygen. Even at lower temperatures, piscine cardiovascular systems are under stress.</p><p>So the reasoning follows that, if global heating continues, climate change and rising water temperatures are likely to affect the reproduction of perhaps 60% of all fish species.</p><p>"Some species might successfully manage this change," Dr Dahlke said. "But if you consider the fact that fish have adapted their mating patterns to specific habitats over extremely long timeframes, and have tailored their mating cycles of specific ocean currents and food sources, it has to be assumed that being forced to abandon their normal spawning areas will mean major problems for them."</p>
<p class=""><em>Reposted with permission from <a href="https://climatenewsnetwork.net/warming-oceans-deter-more-fish-from-spawning/" target="_blank">Climate News Network</a>.</em></p>
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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.
When a neurologist examined him, Tom was diagnosed with Guillain-Barre Syndrome, an autoimmune disease that causes abnormal sensation and weakness due to delays in sending signals through the nerves. Usually reversible, in severe cases it can cause prolonged paralysis involving breathing muscles, require ventilator support and sometimes leave permanent neurological deficits. Early recognition by expert neurologists is key to proper treatment.
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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Nurses wear PPE prior to caring for a COVID-19 patient in the ICU at Sharp Grossmont Hospital on May 5, 2020 in La Mesa, California. Mario Tama / Getty Images
One of the initial reasons social distancing guidelines were put in place was to allow the healthcare system to adapt to a surge in patients since there was a critical shortage of beds, ventilators and personal protective equipment. In fact, masks that were designed for single-use were reused for an entire week in some hospitals.
<p>Now, five months into the pandemic, health care workers are raising the same concern. They are facing a shortage of masks, gowns, face shields and gloves, as <a href="https://www.washingtonpost.com/health/2020/07/08/ppe-shortage-masks-gloves-gowns/" target="_blank">The Washington Post</a> reported.</p><p>"We're five months into this and there are still shortages of gowns, hair covers, shoe covers, masks, N95 masks," said Deborah Burger, president of National Nurses United, who cited results from a survey of the union's members, as <a href="https://time.com/5863776/personal-protective-gear-shortage-us/" target="_blank">The Associated Press</a> reported. "They're being doled out, and we're still being told to reuse them."</p><p>In a survey of 23,000 registered nurses, National Nurses United found 85 percent were asked to reuse masks designed for single use, according to The Washington Post.</p>
<p>The new shortage is not just affecting urban hospitals like it did in March. The rising demand for protective gear is now plaguing a broad range of health care facilities across the country, from urgent cares to doctors' offices to nursing homes. Several major medical associations said this was a preventable problem that would have required swift and aggressive action from the federal government in the early days of the pandemic, according to <a href="https://www.nytimes.com/2020/07/08/health/coronavirus-masks-ppe-doc.html?action=click&module=Top%20Stories&pgtype=Homepage" target="_blank">The New York Times</a>. If the government had aggressively procured and distributed critical supplies, this shortage could have been avoided.</p><p>"A lot people thought once the alarm was sounded back in March surely the federal government would fix this, but that hasn't happened," said Burger to The Washington Post</p><p>She, like many health-care workers, blamed the <a href="http://www.ecowatch.com/trump-watch/" target="_self">Trump</a> administration for the lack of equipment. She pointed out that the administration has insisted the responsibility falls to state and local officials, with the federal government playing only a supporting role.</p><p>In a letter to Congress last week, the health department in DuPage County, Illinois, near Chicago, said all its hospitals are reusing protective gear "in ways that were not originally intended and are probably less safe than the optimal use of PPE," as The Associated Press reported.</p>
<p>Neurologists, cardiologists and cancer specialists around the country have been unable to reopen their offices in recent weeks, leaving many patients without care, according to a <a href="https://searchlf.ama-assn.org/undefined/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2020-6-30-Letter-to-Gaynor-re-PPE.pdf" target="_blank">letter</a> from American Medical Association to the the Federal Emergency Management Agency, Vice President Mike Pence and members of Congress.</p><p>"We have kids living with grapefruit-sized abscesses for over three months who can't eat or drink and there's nothing we can do for them because we can't get P.P.E.," said Kay Kennel, the chief officer of Lubbock Kids Dental, to The New York Times. Her clinic serves low-income families in Texas and has a list of 50 children awaiting emergency surgery. "It's been just horrible, and given the growing number of infections here, I'm afraid things are going to get worse."</p>
<p>Rear Adm. John Polowczyk, who is in charge of coronavirus-related supplies for the White House, told Congress last week that more than one-fourth of the states have less than a 30-day supply.</p><p>"It would seem like in less than 30 days, we're going to have a real crisis," said Rep. Bill Foster, an Illinois Democrat, as The Associated Press reported.</p><p>That prompted the American Medical Association to write a <a href="https://searchlf.ama-assn.org/undefined/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2020-6-30-Letter-to-Pence-re-PPE.pdf" target="_blank">letter</a> to the White House, asking it to invoke the Defense Protection Act to require American manufacturers to increase supplies of N95 masks and gowns, as The Washington Post reported.</p><p>Former Vice President Joe Biden said yesterday that he <a href="https://www.documentcloud.org/documents/6982369-Biden-Supply-Chain-Fact-Sheet-07-07-20.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top" target="_blank" title="">would use that law</a> to boost domestic protection of medical gear if elected.</p>
<p>As the New York Times noted, the nation's supply of PPE is trapped in an unsustainable supply chain model. The U.S. remains dependent on overseas manufacturers and various middlemen who raised prices sevenfold amid soaring global demand. There are only a handful of U.S.-based companies still making PPEs and they say they are already at maximum capacity.</p><p>So far, more than 900 health care workers have died of COVID-19, according to a tally by National Nurses United. Burger said many of the deaths have been linked to inadequate protective gear.</p><p>"There are tools at President Trump's disposal and he has failed us," she said to The New York Times. "These deaths are entirely preventable."</p>
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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."
Today the 6 Biden-Sanders Unity Task Forces are unveiling final language. The Climate Task Force accomplished a gr… https://t.co/gz3broq2qe— Alexandria Ocasio-Cortez (@Alexandria Ocasio-Cortez)1594240617.0
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."
We rein in #pharma's greed by: 1) Allowing Medicare to FINALLY negotiate Rx drugs FOR ALL AMERICANS 2) Using Rx d… https://t.co/6k9iUCLMp7— Abdul El-Sayed (@Abdul El-Sayed)1594238411.0
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.
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