By Jacob L. Steenwyk and Antonis Rokas
From the mythical minotaur to the mule, creatures created from merging two or more distinct organisms – hybrids – have played defining roles in human history and culture. However, not all hybrids are as fantastic as the minotaur or as dependable as the mule; in fact, some of them cause human diseases.
When Looking Through a Microscope Isn’t Close Enough.<p>For the last few years, <a href="http://www.rokaslab.org/" target="_blank">our team at Vanderbilt University</a>, <a href="https://www.researchgate.net/lab/Gustavo-Goldman-Lab" target="_blank">Gustavo Goldman's team at São Paulo University in Brazil</a> and many other collaborators around the world have been collecting samples of fungi from patients infected with different species of <em>Aspergillus</em> molds. One of the species we are particularly interested in is <a href="https://doi.org/10.1006/rwgn.2001.0082" target="_blank"><em>Aspergillus nidulans</em>, a relatively common and generally harmless fungus</a>. Clinical laboratories typically identify the species of <em>Aspergillus</em> causing the infection by examining cultures of the fungi under the microscope. The problem with this approach is that very closely related species of <em>Aspergillus</em> tend to look very similar in their broad morphology or physical appearance when viewing them through a microscope.</p><p>Interested in examining the varying abilities of different <em>A. nidulans</em> strains to cause disease, we decided to analyze their total genetic content, or genomes. What we saw came as a total surprise. We had not collected <em>A. nidulans</em> but <em>Aspergillus latus</em>, a close relative of <em>A. nidulans</em> and, as we were to soon find out, <a href="https://doi.org/10.1016/j.cub.2020.04.071" target="_blank">a hybrid species that evolved through the fusion of the genomes</a> of two other <em>Aspergillus</em> species: <em>Aspergillus spinulosporus</em> and an unknown close relative of <em>Aspergillus quadrilineatus</em>. Thus, we realized not only that these patients harbored infections from an entirely different species than we thought they were, but also that this species was the first ever <em>Aspergillus</em> hybrid known to cause human infections.</p>
Several Different Fungal Hybrids Cause Human Disease.<p>Hybrid fungi that can cause infections in humans are well known to occur in several different lineages of single-celled fungi known as yeasts. Notable examples include multiple different species of <a href="https://doi.org/10.1002/yea.3242" target="_blank">yeast hybrids</a> that cause the human diseases <a href="https://rarediseases.info.nih.gov/diseases/6218/cryptococcosis" target="_blank">cryptococcosis</a> and <a href="https://www.cdc.gov/fungal/diseases/candidiasis/index.html" target="_blank">candidiasis</a>. Although pathogenic yeast hybrids are well known, our discovery that the <em>A. latus</em> pathogen is a hybrid is a first for molds that cause disease in humans.</p>
(Left) Candida yeasts live on parts of the human body. Imbalance of microbes on the body can allow these yeasts, some of which are hybrids, to grow and cause infection. (Right) Cryptococcus yeasts, including ones that are hybrids, can cause life-threatening infections in primarily immunocompromised people. Centers for Disease Control and Prevention<p><a href="https://doi.org/10.1371/journal.ppat.1008315" target="_blank">Why certain <em>Aspergillus</em> species are so deadly</a> while others are harmless remains unknown. This may in part be because <a href="https://doi.org/10.1016/j.fbr.2007.02.007" target="_blank">combinations of traits, rather than individual traits</a>, underlie organisms' ability to cause disease. So why then are hybrids frequently associated with human disease? Hybrids inherit genetic material from both parents, which may result in new combinations of traits. This may make them more similar to one parent in some of their characteristics, reflect both parents in others or may differ from both in the rest. It is precisely this mix and match of traits that hybrids have inherited from their parental species that <a href="https://www.nytimes.com/2010/09/14/science/14creatures.html" target="_blank">facilitates their evolutionary success</a>, including their ability to cause disease.</p>
The Evolutionary Origin of an Aspergillus Hybrid.<p>Multiple evolutionary paths can lead to the emergence of hybrids. One path is through mating, just as the horse and donkey mate to create a mule. Another path is through the merging or fusion of genetic material from cells of different species.</p><p>It is this second path that appears to have been taken by our fungus. <em>A. latus</em> appears to have two of almost everything compared to its parental species: twice the genome size, twice the total number of genes and so on. But unlike other hybrids, which are often sterile like the mule, we found that <em>A. latus</em> is capable of reproducing both asexually and sexually.</p><p>But how distinct were the parents of <em>A. latus</em>? By comparing the parts contributed by each parent in the <em>A. latus</em> genome, we estimate that its parents are approximately 93% genetically similar, which is about as related as we humans are with lemurs. In other words, <em>A. latus</em>, an agent of infectious disease, is the fungal equivalent of a human-lemur hybrid.</p>
How A. Latus Differs From its Parents.<p>Elucidating the identity of closely related fungal pathogens and how they differ from each other in infection-relevant characteristics is a key step toward reducing the burden of fungal disease. For example, we found that <em>A. latus</em> was three times more resistant than <em>A. nidulans</em>, the species it was originally identified as using microscopy-based methods, to one of the most common antifungal drugs, <a href="https://www.drugbank.ca/drugs/DB00520" target="_blank">caspofungin</a>. This result provides a clear example of the potential importance of accurate identification of the <em>Aspergillus</em> pathogen causing an infection.</p><p>We also examined how <em>A. latus</em> and <em>A. nidulans</em> interact with cells from our immune system. We found that immune cells were less efficient at combating <em>A. latus</em> compared to <em>A. nidulans</em>, suggesting the hybrid fungus may be trickier for our immune systems to identify and destroy.</p><p>In the midst of the COVID-19 pandemic, our quest to understand <em>Aspergillus</em> pathogens is becoming more urgent. Growing evidence suggests that <a href="https://doi.org/10.1111/myc.13096" target="_blank">a fraction of COVID-19 patients are also infected with <em>Aspergillus</em>.</a> More worrying is that these <a href="https://doi.org/10.3201/eid2607.201603" target="_blank">secondary <em>Aspergillus</em> infections</a> can worsen the clinical outcomes for those infected with the novel coronavirus. That being said, we stress that little is known about <em>Aspergillus</em> infections in COVID-19 patients due to a lack of systematic testing, and none of the infections identified so far appear to have been caused by hybrids.</p><p>So, when it comes to hybrids, some are fantastic (the minotaur), some are helpful (the mule) and some are dangerous (<em>Aspergillus latus</em>). Understanding more about the biology of <em>Aspergillus latus</em> may help in our understanding of how microbial pathogens arise and how to best prevent and combat their infections.</p>
By John Letzing
This past Wednesday, when some previously hard-hit countries were able to register daily COVID-19 infections in the single digits, the Navajo Nation – a 71,000 square-kilometer (27,000-square-mile) expanse of the western US – reported 54 new cases of what's referred to locally as "Dikos Ntsaaígíí-19."
The Navajo Nation covers the corners of three different states. Google Maps
Growing Contribution<img lazy-loadable="true" src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzM3NDY5Ny9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY0NjM4MTgyM30.IuQTKQs1stvYYKD6vaVTrqAyoBsUG0BhDvlhxsyKwPA/img.png?width=980" id="02a05" class="rm-shortcode" data-rm-shortcode-id="2841f82b1785df5d5ed7bf64d3bb882b" data-rm-shortcode-name="rebelmouse-image" />
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EcoWatch Daily Newsletter
By Cathy Cassata
With more than 1.7 million confirmed cases of COVID-19 in the United States and more than 100,000 deaths from the virus, physicians face unprecedented challenges in their efforts to keep Americans safe.
They also encounter what some call an "infodemic," an outbreak of misinformation that's making it more difficult to treat patients.
When Leaders and Doctors Spread Misinformation<p>When people in charge of towns, cities, states, and countries spread misinformation, the potential for belief in misinformation to result in policies can have harmful effects.</p><p><a href="https://www.northwell.edu/find-care/find-a-doctor?q=Bruce+E.+Hirsch%2C+MD&insurance=&location=&query_type=provider&physician_partners=false&default_view=list&gender=&language=&sort=relevancy" target="_blank">Dr. Bruce E. Hirsch</a>, attending physician and assistant professor in the infectious disease division of Northwell Health in Manhasset, New York, says an example of this is when President Trump informed the public he was taking hydroxychloroquine as a preventive measure.</p><p>"To approach this enormous challenge, we need some intellectual honesty and clarity, and to disregard expertise and to make decisions and model decisions based on hunches is inviting us to handle challenges on the basis of rumor and uninformed opinion. The magnitude of that error is epic," Hirsch told Healthline.</p><p>Stukus agrees, noting that the harm of this proclamation is documented.</p><p>"Early on when the president touted the benefits of hydroxychloroquine and azithromycin, people started to hoard this medicine, and state boards had to shut it down because they were getting so many prescriptions for this unproven therapy that it was not available for those who truly needed it, such as those who have lupus and autoimmune conditions," Stukus said.</p><p>He adds that calls to poison control centers increased after the president suggested using disinfectant to prevent contracting the new coronavirus.</p>
Listen to Science, Even When it Changes<p>When recommendations change or evidence flip-flops, skepticism may arise. However, Stukus says change is the beauty of science.</p><p>"That shows us that we can evolve, and if the evidence shows that our prior thoughts were incorrect, we need to be able to change our recommendations and advice based upon the best quality of evidence at the time," he said.</p><p>Pierre agrees.</p><p>"Science is an iterative process, whereby we arrive at facts and truth through repeated and controlled observations. That means that it's inherently self-correcting as we revise conclusions based on ongoing research. Scientific facts aren't immutable dogma chiseled on a tablet. They change based on the best available evidence we have at a given point in time," he said.</p><p>Because research of COVID-19 has only been underway for 6 months, information is evolving rapidly, and new information may contradict old.</p><p>"There's still much we don't know about exactly how [COVID-19] spreads, what effects it has on the body, or how to best treat it. That means that the best available evidence is preliminary, but that doesn't mean that we should ignore it or turn to other sources of information or opinion as if they're just as valid," Pierre said.</p><p>He explains that conspiracy theories based on mistrust lead to vulnerability to misinformation.</p><p>If people mistrust science because it sometimes "changes its mind," Pierre said, "that shouldn't be used to embrace other opinions based on no evidence at all, which are typically selected based on confirmation bias: what we want to believe rather than what the objective evidence supports."</p>
Where to Find the Best Information<p>Stukus says to start with the <a href="https://www.cdc.gov/coronavirus/2019-nCoV/index.html" target="_blank">CDC</a> and <a href="https://www.nih.gov/health-information/coronavirus" target="_blank">NIH</a>. Then check with your local health officials, because COVID-19 guidelines may vary depending on where you live.</p><p>If you can't find information you need or have questions specifically related to you, call your primary care doctor.</p><p>"Your personal doctor should always be a resource for individual specific questions because they know best how to apply all the nuances retaining to your health, and how to incorporate all the other general [COVID-19] recommendations," Stukus said.</p><p><a href="https://www.eehealth.org/find-a-doctor/b/boyd-laura-b/" target="_blank">Dr. Laura Boyd</a>, primary care physician at Edward-Elmhurst Health Center in Elmhurst, Illinois, says her clinic receives a lot of calls about COVID-19.</p><p>"Most doctors' offices are receiving calls and answering questions, and doing phone or video visits to help clarify and/or order testing over the phone based on patients' symptoms. It is always best to call your doctor's office first instead of worrying about symptoms and waiting too long to seek treatment," she told Healthline.</p><p>If your primary care doctor has limited testing, she suggests looking on your state's public health website for available testing sites.</p><p>With a lot of unknowns related to this virus and disease, Boyd says many patients are feeling overwhelmed and anxious for a treatment.</p><p>"Unfortunately, there is no specific medication recommended for COVID for outpatient. There are a lot of ongoing studies with various drugs going on within the hospital setting. Patients should always contact their doctors about their specific symptoms as they can treat the symptoms that go along with COVID, but there is no cure," Boyd said.</p><p>While we wait for treatment and a vaccine, Hirsch, who treats patients hospitalized for COVID-19 complications on a daily basis, says everyone can do their part by washing hands, wearing a mask, and staying 6 feet apart.</p><p>"As an infectious disease doctor working in the hospital, I see the damage of the pandemic and the worst cases of what's happening. We are trying to get the best possible outcome and confronting this overwhelming biologic reality of this terrible epidemic the best we can," Hirsch said.</p><p>Everyone at home can help in the fight too, he adds.</p><p>"Follow information that is science- and evidence-based, and avoid that which is not," he said.</p>
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By Sara Lindberg
Whether you've hit a workout plateau or you're just ready to turn things up a notch, adding more strenuous exercise — also known as high-intensity exercise — to your overall fitness routine is one way to increase your calorie burn, improve your heart health, and boost your metabolism.
However, to do it safely and effectively, there are some guidelines you should follow. Keep reading to learn more about the benefits of vigorous exercise and how to safely dial up the intensity of your workouts.
What Is Considered Strenuous Exercise?<p>When it comes to exercise, the intensity of how hard you work out is just as important as the duration of your exercise session. In general, exercise intensity is divided into three categories:</p><ul><li>low</li><li>moderate</li><li>vigorous or strenuous</li></ul><p>For an activity to be vigorous, you need to work at 70 to 85 percent of your maximum heart rate, according to the<a href="https://www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates" target="_blank"> American Heart Association</a>. Examples of vigorous exercise include:</p><ul><li>running</li><li>cycling at 10 mph or faster</li><li>walking briskly uphill with a heavy backpack</li><li>jumping rope</li></ul><p>Low to moderate exercise is easier to sustain for longer periods since you work below 70 percent of your maximum heart rate and, sometimes, well below that level.</p><p>To reap health benefits, the <a href="https://www.hhs.gov/fitness/be-active/physical-activity-guidelines-for-americans/index.html" target="_blank">Physical Activity Guidelines for Americans</a> recommends that people age 18 and older get one of the following:</p><ul><li><strong>150 minutes</strong> of moderate-intensity aerobic activity per week</li><li><strong>75 minutes</strong> of vigorous aerobic activity per week</li><li><strong>combination of both types</strong> of activity spread throughout the week</li></ul>
Strenuous Exercise Vs. Moderate Exercise<p>Increasing your exercise intensity is fairly simple to do. You can still participate in your favorite activities — just at a more vigorous pace.</p><p>One of the benefits of more strenuous exercise is that you can reap the same rewards as moderate-intensity exercise but in less time. So, if time is of the essence, doing a more strenuous 20-minute workout can be just as beneficial as doing a slower 40-minute workout session.</p><p>Here are some examples of <a href="https://www.cdc.gov/nccdphp/dnpa/physical/pdf/pa_intensity_table_2_1.pdf" target="_blank">strenuous vs. moderate exercise<span></span></a>.</p><table><tbody><tr><th>Moderate intensity</th><th>Strenuous intensity</th></tr><tr><td>bicycling at less than 10 mph</td><td>bicycling at more than 10 mph</td></tr><tr><td>walking briskly</td><td>running, or hiking uphill at a steady pace</td></tr><tr><td>jog-walk intervals</td><td>water jogging/running</td></tr><tr><td>shooting baskets in basketball</td><td>playing a basketball game</td></tr><tr><td>playing doubles tennis</td><td>playing singles tennis</td></tr><tr><td>raking leaves or mowing the lawn</td><td>shoveling more than 10 lbs. per minute, digging ditches</td></tr><tr><td>walking stairs</td><td>running stairs</td></tr></tbody></table>
Benefits of Vigorous Exercise<p>Besides being more efficient, turning up the heat on your fitness sessions can benefit your health in a variety of ways. Let's take a closer look at some of the evidence-based benefits of a higher intensity workout.</p><ul><li><strong>Higher calorie burn.</strong> According to the <a href="https://www.acefitness.org/education-and-resources/professional/expert-articles/5008/7-things-to-know-about-excess-post-exercise-oxygen-consumption-epoc/?utm_source=Rakuten&utm_medium=10&ranMID=42334&ranEAID=TnL5HPStwNw&ranSiteID=TnL5HPStwNw-hYlKnAcfzfixAUsvnO6Ubw" target="_blank">American Council on Exercise</a>, working out at a higher intensity requires more oxygen, which burns more calories. It also contributes to excess post-exercise oxygen consumption (EPOC) or the "afterburn effect" that allows you to continue burning calories even after you finish working out. This means your metabolism will stay elevated for longer after a vigorous exercise session.</li><li><strong>More weight loss.</strong> A <a href="https://www.healthline.com/health-news/interval-workouts-will-help-you-lose-weight-more-quickly" target="_blank">higher calorie burn</a> and an elevated metabolism will help you lose weight more quickly than doing low- or moderate-intensity exercise.</li><li><strong>Improved heart health.</strong> According to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/16377300" target="_blank">2012 study</a>, high- and moderate-intensity exercise appears to offer low chance of cardiovascular events, even in those with heart disease. Cardiovascular benefits may include improvements in:<ul><li><a href="https://www.healthline.com/health/diastole-vs-systole" target="_blank">diastolic blood pressure</a></li><li><a href="https://www.healthline.com/nutrition/15-ways-to-lower-blood-sugar#TOC_TITLE_HDR_1" target="_blank">blood sugar control</a></li><li>aerobic capacity</li></ul></li><li><strong>Improved mood.</strong> High-intensity exercise may also boost your mood. According to a large <a href="https://www.jstage.jst.go.jp/article/jpts/27/4/27_jpts-2014-736/_article" target="_blank">2015 study</a> that analyzed the data of more than 12,000 participants, researchers found a significant link between strenuous exercise and fewer depressive symptoms.</li><li><strong>Lower risk of mortality.</strong> According to a 2015 <a href="https://www.ncbi.nlm.nih.gov/pubmed/25844882" target="_blank">study</a>, researchers found that vigorous activity may be key to avoiding an early death. The study, which followed 204,542 people for more than 6 years, reported a 9 to 13 percent decrease in mortality for those who increased the intensity of their exercise sessions.</li></ul>
How to Measure Exercise Intensity<p>So, how do you know for sure that you're exercising at a strenuous level? Let's look at three ways to measure the intensity of your physical activity.</p><h3>1. Your heart rate</h3><p>Monitoring your heart rate is one of the most reliable methods for measuring exercise intensity. Exercising at 70 to 85 percent of your maximum heart rate qualifies as vigorous exercise intensity.</p><blockquote><strong><strong>WHAT IS YOUR MAXIMUM HEART RATE?</strong></strong>Your maximum heart rate is the fastest your heart can safely beat. To find out what your maximum heart rate is you need to subtract your age from 220. For example, for a 40-year-old person: <ul><li>220 bpm (beats per minute) minus age</li><li>220 – 40 = 180 bpm</li></ul>To work out at a vigorous pace, you'll want to exercise within 70 to 85 percent of your maximum heart rate. For example: <ul><li>180 x 0.70 (70 percent) = 126</li><li>180 x 0.85 (85 percent) = 153</li></ul>For a 40-year-old person, a vigorous training range is 126 to 153 bpm.<br></blockquote><p>You can check your heart rate while you're working out by wearing a heart rate monitor or <a href="https://www.healthline.com/health/how-to-check-heart-rate" target="_blank">taking your pulse</a>.</p>
How to Add Vigorous Activity to Your Workout<p>Adding strenuous activity to your weekly workout routine requires some careful planning. Fortunately, many of the activities that you do at a moderate level can easily be performed at a higher intensity.</p><p>One way of incorporating vigorous aerobic activity into your routine is to do a <a href="https://www.healthline.com/nutrition/benefits-of-hiit" target="_blank">high-intensity interval training (HIIT)</a> workout. This type of workout combines short bursts of intense activity — typically performed at 80 to 95 percent of your maximum heart rate — with recovery periods at 40 to 50 percent maximum heart rate.</p><p>To sustain this level of training, consider following a 2:1 work to rest ratio. For example, a <a href="https://www.healthline.com/health/treadmill-weight-loss#hiit" target="_blank">treadmill workout </a>or outdoor running session could include:</p><ul><li>running at 9 to 10 mph for 30 seconds</li><li>followed by walking at 3 to 4 mph for 60 seconds</li><li>alternating this work-to-rest ratio for 20 to 30 minutes</li></ul><p>Playing a fast-paced sport like soccer, basketball, or racquetball is another effective way to add strenuous activity to your fitness routine. Participating in <a href="https://www.healthline.com/health/benefits-of-a-spin-class" target="_blank">cycling classes</a> or swimming laps are other ways to build more strenuous exercise into your workouts.</p>
Safety Tips<p>Before you turn up the intensity on your workouts, it's important to keep the following safety tips in mind.</p><h3>Check with your doctor</h3><p>If you have a health condition or you haven't been active in a while, make sure you talk to your doctor before you start a high-intensity exercise routine. Your doctor can advise you on a safe level of exercise or how to become more active in the safest way possible.</p><h3>Build up the intensity slowly</h3><p>Going from low- or moderate-intensity workouts to vigorous exercise requires time and patience. While you may be ready to jump in with both feet, the safest way to add more vigorous exercise is to do it in bite-size increments. Pushing yourself too quickly can result in injuries and burnout.</p><p>For example:</p><ul><li><strong>Week 1:</strong> Swap out one moderate-paced cardio session for a HIIT workout.</li><li><strong>Week 2:</strong> Swap one moderate-paced session with a HIIT workout, and also add a circuit strength training session to your weekly routine.</li><li><strong>Week 3 and 4: </strong>Repeat weeks 1 and 2 before you start adding more high-intensity exercise to your weekly routine.</li></ul><p>It's also a good idea to space out your vigorous workouts throughout the week. Try not to do two strenuous sessions back-to-back.</p><h3>Don't forget the recovery time</h3><p>Your body requires more time to recover from a vigorous workout compared to a low- or moderate-intensity session.</p><p>To help your body recover, make sure to always include a cooldown and <a href="https://www.healthline.com/health/exercise-fitness/static-stretching" target="_blank">stretch routine</a> after strenuous physical activity.</p><h3>Stay hydrated</h3><p><a href="https://www.healthline.com/nutrition/7-health-benefits-of-water" target="_blank">Staying hydrated</a> is especially important when you're exercising hard. Not drinking enough fluids can affect the quality of your workout and make you feel tired, lethargic, or dizzy. It may even lead to <a href="https://www.healthline.com/health/dehydration-headache" target="_blank">headaches</a> and <a href="https://www.healthline.com/health/pain-relief/how-to-stop-leg-muscle-cramps" target="_blank">cramps</a>.</p>
The Bottom Line<p>Turning up the intensity of your workout sessions can be an effective way of boosting your overall health and fitness. It's also an easy way to save time when trying to fit a workout into your day.</p><p>To play it safe, always start slow and pay attention to how your body feels.</p><p>While vigorous exercise offers many health benefits, it's not appropriate for everyone. If you have a health condition or you haven't been active in a while, make sure to talk with your doctor before working out at a more strenuous level.</p>
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By Daniel Yetman
Bleach and vinegar are common household cleaners used to disinfect surfaces, cut through grime, and get rid of stains. Even though many people have both these cleaners in their homes, mixing them together is potentially dangerous and should be avoided.
Can You Mix Bleach and Vinegar?<p>Bleach can refer to any chemical that's used to get rid of stains or disinfect surfaces. The most typical form used as a cleaner is sodium hypochlorite. By itself, bleach can damage your skin but is <a href="https://www.ncbi.nlm.nih.gov/books/NBK441921/" target="_blank">non-toxic</a> when inhaled. However, it can become potentially lethal to inhale when mixed with other household cleaners.</p><p>Sodium hypochlorite is made up of a sodium, oxygen, and chlorine atoms. When this molecule is mixed with the acetic acid in vinegar or other types of acid, it releases chlorine gas. <a href="https://emergency.cdc.gov/agent/chlorine/basics/facts.asp" target="_blank">Chlorine gas</a> is extremely dangerous to human health. It's so powerful that Germany used it during World War I as a chemical weapon.</p><p>Vinegar isn't the only cleaner you need to be careful mixing with bleach. Bleach also reacts with <a href="https://www.doh.wa.gov/YouandYourFamily/HealthyHome/Contaminants/BleachMixingDangers" target="_blank">ammonia</a> to create chlorine gas. Bleach can also react to some oven cleaners, insecticides, and hydrogen peroxide.</p><p>Many household cleaners contain a chemical called <a href="https://www.acs.org/content/acs/en/pressroom/presspacs/2019/acs-presspac-october-2-2019/cleaning-with-bleach-could-create-indoor-air-pollutants.html" target="_blank">limonene</a> that gives them a citrus smell. When bleach fumes mix with limonene, they create small particles that may be damaging to both people's and animals' health. However, more research is needed to examine these particles' potential health risks.</p>
Is it Safe to Mix Them in Small Amounts?<p>According to the <a href="https://www.doh.wa.gov/YouandYourFamily/HealthyHome/Contaminants/BleachMixingDangers" target="_blank">Washington State Department of Health</a>, even low levels of chlorine gas, less than 5 parts per million (ppm), is likely to irritate your eyes, throat, and nose. It's never a good idea to mix these two cleaners together.</p><p>Unlike some other dangerous chemicals like carbon monoxide, chlorine gives off a distinctly <a href="https://www.ncbi.nlm.nih.gov/books/NBK537213/" target="_blank">pungent and irritating odor</a>. If you notice a strong smell after mixing cleaners, it's a good idea to immediately leave the area.</p><p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136961/" target="_blank">severity of symptoms</a> you develop after breathing in chlorine gas depends on how concentrated it is, measured in parts per million (ppm), and how long you inhale it.</p><ul><li><strong>0.1 to 0.3 ppm.</strong> At this level, humans can smell the pungent odor of chlorine gas in the air.</li><li><strong>5 to 15 ppm. </strong>A concentration over 5 ppm causes irritation to the mucus membranes in your mouth and nose.</li><li><strong>Over 30 ppm.</strong> At a concentration higher than 30 ppm, chlorine gas can cause chest pain, shortness of breath, and coughing.</li><li><strong>Above 40 ppm.</strong> Concentrations higher than 40 ppm can cause potentially dangerous fluid build-up in your lungs.</li><li><strong>Above 430 ppm</strong>. Breathing in more than <a href="https://www.ncbi.nlm.nih.gov/books/NBK537213/" target="_blank">430 ppm</a> of chlorine gas can be lethal within 30 minutes.</li><li><strong>Above 1,000 ppm</strong>. Inhaling chlorine gas above this level can be deadly immediately.</li></ul>
Can You Combine Bleach and Vinegar in a Washing Machine?<p>Mixing bleach and vinegar in your washing machine is also a bad idea. Chlorine gas may be released from your washing machine when you take your clothes out. It may also leave traces of chlorine gas on your clothes.</p><p>If you use bleach in your laundry, it's a good idea to wait several loads before using vinegar.</p>
Symptoms of Exposure to a Bleach and Vinegar Reaction<p>The severity of the symptoms you'll develop after chlorine exposure depends on the amount of chlorine gas you inhale. Symptoms usually start fairly quickly. <a href="https://www.ncbi.nlm.nih.gov/books/NBK537213/" target="_blank">Most people</a> exposed to low amounts of chlorine gas recover without complications.</p><p>If your exposure to chlorine gas is relatively brief, you may notice irritation of your nose, mouth, and throat. Lung irritation may develop if you breathe in chlorine deeply.</p><p>According to the <a href="https://emergency.cdc.gov/agent/chlorine/basics/facts.asp" target="_blank">Centers for Disease Control and Prevention</a>, if you accidentally breathe in chlorine, you can experience the following:</p><ul><li><a href="https://www.healthline.com/health/eye-health/sudden-blurred-vision" target="_blank">blurry vision</a></li><li>a burning sensation in your nose, throat, or eyes</li><li><a href="https://www.healthline.com/health/cough" target="_blank">coughing</a></li><li><a href="https://www.healthline.com/health/chest-pain" target="_blank">tightness in your chest</a></li><li><a href="https://www.healthline.com/health/breathing-difficulties" target="_blank">trouble breathing</a></li><li><a href="https://www.healthline.com/health/pulmonary-edema" target="_blank">fluid in your lungs</a></li><li><a href="https://www.healthline.com/health/nausea" target="_blank">nausea</a></li><li><a href="https://www.healthline.com/health/vomiting" target="_blank">vomiting</a></li><li><a href="https://www.healthline.com/health/epiphora" target="_blank">watery eyes</a></li><li><a href="https://www.healthline.com/health/wheezing" target="_blank">wheezing</a></li></ul>
What to Do if You Get Bleach and Vinegar on Your Skin or Inhaled Chlorine Gas Vapors<p>There's <a href="https://emergency.cdc.gov/agent/chlorine/basics/facts.asp" target="_blank">no cure</a> for breathing in chlorine gas. The only treatment option is removing the chlorine from your body as quickly as possible and seeking immediate medical attention to treat your symptoms.</p><p>If you breathe in chlorine gas, you can follow these steps to help get the chlorine out of your system:</p><ul><li>Immediately go somewhere where you can breathe in fresh air.</li><li>Change and wash any clothes that may have been contaminated.</li></ul><blockquote><strong>MEDICAL EMERGENCY<br><br></strong>If your symptoms are severe, call 911 or the National Capital Poison Center (NCPC) at 800-222-1222 and follow their instructions.<br></blockquote><p>Spilling <a href="https://www.healthline.com/health/bleach-on-skin#first-aid" target="_blank">bleach</a> can cause irritation to your skin. You can take the following steps to reduce your chances of developing complications:</p><ul><li>Remove jewelry or clothes that came in contact with bleach and clean them after you wash your skin.</li><li>Rinse your skin with a sponge or an absorbent cloth over a sink.</li><li>Avoid touching other parts of your body such as your face while cleaning.</li><li>Seek immediate medical attention if you spill bleach in your eyes or if you burn your skin.</li></ul><p>Vinegar may also irritate your skin. Even though it's unlikely to cause any serious health complications, it's a good idea to wash vinegar off your skin to avoid any redness or soreness.</p>
Takeaway<p>Mixing bleach and vinegar creates potentially lethal chlorine gas. If you notice a pungent smell after mixing household cleaners, you should immediately leave the area and try to breathe in fresh air.</p><p>If you or somebody you know notice any symptoms of chlorine gas poisoning, it's a good idea to immediately call 911 or the NCPC at 800-222-1222<em>.</em></p>
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By Julia Ries
Around the world, there have been several cases of people recovering from COVID-19 only to later test positive again and appear to have another infection.
The Viral Material in Re-Positive Cases Isn’t Infectious<p>The Korean study examined 285 patients who tested positive again for the new coronavirus after they recovered from COVID-19, which had been confirmed via a negative test result.</p><p>The researchers swabbed the patients and examined the viral material to determine whether it was still actively infectious.</p><p>The team was unable to isolate live viral material, indicating that the positive diagnostic tests were picking up dead virus particles.</p><p>"[This] may speak for the fact that the virus may be dead or not be fit enough to grow — therefore the virus may not be fit enough to infect a new host," said <a href="http://www.providence.org/doctors/profile/1099717-andres-romero" target="_blank">Dr. Andres Romero</a>, an infectious disease specialist at Providence Saint John's Health Center in Santa Monica, California.</p><p>The researchers also tested 790 people who'd been in close contact with the "re-positive" patients. Of the 27 who tested positive, no cases appeared to be caused from exposure to someone who appeared to have a reinfection.</p><p>The report also found that the vast majority of recovered patients (96 percent) had neutralizing antibodies, indicating that they conferred immunity.</p><p>"Whether this is indicative of a completely protective response remains to be proven. If this study holds true, then people who have recovered can get back to work," Zapata said.</p><p>In response to the new findings, South Korea eliminated a policy requiring discharged patients to isolate for 2 weeks.</p>
Conducting and Interpreting PCR Tests<p>The tests widely used to diagnose COVID-19 are called polymerase chain reaction (PCR) tests.</p><p>The tests swab a person's nose or throat and try to pick up the virus's genetic material, or RNA.</p><p>According to <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html" target="_blank">guidance</a> from the U.S. Centers for Disease Control and Prevention (CDC), a positive result on a PCR test doesn't "necessarily mean infectious virus is present or that the patient is contagious."</p><p>Infectious disease experts have suspected that the test kits aren't picking up actively infectious viral material in recovered patients who test positive again, but rather dead remnants of the virus.</p><p>We see this occur with other viruses, too.</p><p>"We know other viruses like parainfluenza, human metapneumovirus, or RSV [respiratory syncytial virus] may linger for months in certain patients, and that does not represent infectious state," Romero said. "Coronavirus may be the same."</p>
We Still Need to Practice Caution<p>While the findings are promising, infectious disease experts say we still need to practice caution.</p><p>More research is needed to validate these findings and determine whether they apply to distinct parts of the population, such as those who are immunocompromised.</p><p>It's common for immunocompromised patients — such as those with cancer — to continue testing positive for a virus for longer, since it takes their immune system more time to clear the virus out of their body.</p><p>"I don't think we can be 100 percent certain of whether each recovered person is no longer contagious. Again, this may differ with distinct population groups," Zapata said.</p><p>Physicians are seeing some hospitalized patients testing positive for a month after they were first swabbed for COVID-19. It's unclear whether these patients still shed infectious virus, according to Zapata.</p><p>Everyone's body mounts a distinct immune response based on their age and overall health. Different individuals will clear the virus out at different speeds, according to Zapata.</p><p>Until we have more data and a preventive vaccine, it's crucial to continue adhering to the <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html" target="_blank">safety precautions</a> laid out by the CDC.</p><p>"The reality is that moving forward, the best approach will be keeping social/physical distancing, wearing a mask, and frequent hand hygiene in order to control the spread of the virus," Romero said.</p>
The Bottom Line<p>Doctors and researchers have been unsure whether people who recover from COVID-19 who test positive again continue to be contagious, or if they could get a second infection.</p><p>New <a href="https://www.cdc.go.kr/board/board.es?mid=a30402000000&bid=0030" target="_blank">research</a> published by the Korea Centers for Disease Control and Prevention has found that recovered COVID-19 patients who test positive again aren't infectious.</p><p>The study also found that most patients who recover have neutralizing antibodies that protect them from getting sick again.</p><p>Though the study is promising, health experts say we need more data to validate the findings and determine whether they apply to all patient populations.</p>
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By Richard Connor
The University of Southern Denmark on Wednesday announced that its researchers have developed the world's first fully automatic robot capable of carrying out throat swabs for COVID-19.
By Jory Brinkerhoff
Summer is field season for ecologists like me, a time when my colleagues, students and I go out into fields and woods in search of ticks to study the patterns and processes that allow disease-causing microbes – primarily bacteria and viruses – to spread among wildlife and humans.
Delaying Medical Treatment Can Be Dangerous<p>As we move from spring into summer, and into the peak period of tick activity in much of the Northern Hemisphere, time spent outdoors will increase, as will risk of tick-transmitted disease.</p><p>In some cases, there are key symptoms of a tick-transmitted disease that can help with diagnosis. For example, early Lyme disease, which is caused by the bite of an infected black-legged tick, sometimes called the deer tick, is commonly associated with an expanding "bull's-eye rash." <a href="https://www.cdc.gov/lyme/signs_symptoms/index.html" target="_blank">Seventy percent to 80% of patients have this symptom</a>.</p><p>However, <a href="https://www.cdc.gov/lyme/signs_symptoms/index.html" target="_blank">other symptoms</a> of Lyme disease – fever, head and body aches and fatigue – are less distinctive and can be easily confused with other illnesses, including COVID-19. This can make it more difficult to diagnose a patient who did not notice a rash or was unaware that they ever had a tick bite. As a result, Lyme disease cases can be <a href="http://doi.org/10.4081/or.2011.e14" target="_blank">misdiagnosed</a>. Nationally, Lyme disease may be undercounted to the point that only <a href="https://www.cdc.gov/lyme/datasurveillance/index.html" target="_blank">one in 10 cases is reported to the CDC</a>.</p>
Lyme Disease Isn’t the Only Tick Problem<p>Lyme disease is most common in the Northeast and North Central U.S., but that does not mean that people in areas without Lyme disease are free from worry about tick-transmitted disease. Ticks throughout North America can spread a <a href="https://www.cdc.gov/ticks/tickbornediseases/index.html" target="_blank">wide range of diseases,</a> many of which also present with flu-like symptoms, leading to the potential for <a href="https://doi.org/10.1016/j.ttbdis.2015.06.005" target="_blank">misdiagnosis</a>, especially when these diseases are not especially common in the general population.</p>
Is COVID-19 Increasing Chances of Tick Bites?<p><a href="https://www.scientificamerican.com/article/how-the-coronavirus-has-changed-animals-landscape-of-fear/" target="_blank">Recent reports</a> from across the nation and around the globe suggest that wildlife have become more bold this spring, wandering into suburbs and cities where human and vehicle traffic are reduced because of COVID-19.</p><p>Whether this phenomenon is being driven by changes in animal behavior or is simply an artifact of humans spending <a href="https://www.popsci.com/story/environment/wildlife-in-cities-covid-shutdown/" target="_blank">more time in their homes and becoming more aware of their surroundings</a> is not clear, but changes in wildlife behavior and habitat use could affect tick-transmitted disease. For example, white-tailed deer are important hosts to multiple human-biting tick species in eastern North America, including black-legged ticks, and more deer around our homes and in our neighborhoods could lead to more ticks that have a chance to bite humans.</p>
Staying Safe<p>Awareness is a key component of preventing and treating tick-borne disease. People should be aware of the activities that could <a href="https://www.cdc.gov/lyme/prev/index.html" target="_blank">expose them to ticks</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/10780095/" target="_blank">physicians should consider the possibility of tick-borne disease</a>, especially given the potential overlap in symptoms with COVID-19.</p><p>As with COVID-19, mitigation efforts can <a href="https://www.cdc.gov/lyme/prev/on_people.html" target="_blank">substantially reduce the risk</a> of tick-borne diseases. Wear long sleeves and long pants and use an <a href="https://www.epa.gov/insect-repellents" target="_blank">EPA-registered repellent</a> when you are in tick habitat, and check yourself thoroughly for ticks when you get home.</p><p>It is important to be aware of ticks when spending time outside, but fear of ticks should not stop people from enjoying nature. </p>
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By Linda Lacina
World Health Organization officials today announced the launch of the WHO Foundation, a legally separate body that will help expand the agency's donor base and allow it to take donations from the general public.
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Henry J. Kaiser Family Foundation
By Nicholas Joyce
The coronavirus has resulted in stress, anxiety and fear – symptoms that might motivate a person to see a therapist. Because of social distancing, however, in-person sessions are less possible. For many, this has raised the prospect of online therapy. For clients in need of warmth and reassurance, could this work? Studies and my experience suggests it does.
Telehealth Versus Traditional Therapy<p><a href="https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf" target="_blank">Private insurance companies</a> like Cigna and Aetna, have come around; they now provide coverage for what they see as a "legitimate" service. And <a href="https://www.prnewswire.com/news-releases/american-wells-2019-consumer-survey-finds-majority-of-consumers-open-to-telehealth-adoption-continues-to-grow-300906438.html" target="_blank">surveys show</a> consumers are receptive to telehealth counseling: no driving to an appointment, no searching for a parking space, no worries about childcare while they're away, no need to switch providers if they move, and no problem if the specialist happens to be far away.</p><p>Online therapy opens doors for clients who wouldn't otherwise seek help, <a href="https://www.worldcat.org/title/empirical-examination-of-the-influence-of-personality-gender-role-conflict-and-self-stigma-on-attitudes-and-intentions-to-seek-online-counseling-in-college-students/oclc/941976505" target="_blank">particularly patients</a> who feel stigmatized by therapy or intimidated by a stranger sitting across the room from them. Often, <a href="https://doi.org/10.1089/1094931041291295" target="_blank">people open up</a> more easily in telehealth sessions. Firsthand accounts have detailed <a href="https://www.romper.com/p/i-tried-online-therapy-for-a-month-this-is-what-happened-13630" target="_blank">positive experiences from consumers</a>.</p>
Overcoming Prejudices About Online Counseling<p>Now COVID-19 is forcing most traditional psychotherapists to adapt their practice to <a href="https://www.psychologytoday.com/intl/blog/expressive-trauma-integration/202003/covid-19-etherapy-in-times-isolation" target="_blank">online counseling</a>. After experiencing the medium, they are <a href="https://www.wecounsel.com/blog/why-every-therapist-in-private-practice-needs-a-telehealth-option/" target="_blank">overcoming their prejudices</a>. Many will convert some or all of their caseloads to telehealth after the pandemic ends. Most of our clients seem to be good with it: responding to a satisfaction survey, 85% of USF students strongly or somewhat agreed their telehealth experience was comparable to an in-person visit.</p><p>All this allows a continuity of care for clients that before was impossible; there is, however, a caveat. Because of the coronavirus, some of my clients at USF who live out-of-state have moved back home. That means, legally, I can no longer serve them. Even though they are still USF students, my license is valid only in Florida.</p><p>For telehealth to work effectively, our national system of licensing and regulation law needs to adapt. Although the federal government temporarily halted HIPAA regulations to promote telehealth during this time, not all states are allowing out-of-state practice. The coronavirus may not be here forever, but spring break and Christmas holidays always will. We need seamless telehealth across state lines.</p>
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By Alexander Freund
In a pilot study at the University of Helsinki, dogs trained as medical diagnostic assistants were taught to recognize the previously unknown odor signature of the COVID-19 disease caused by the novel coronavirus. And they learned with astonishing success: After only a few weeks, the first dogs were able to accurately distinguish urine samples from COVID-19 patients from urine samples of healthy individuals.
Important Findings for Other Teams<p>The very rapid and promising findings from Finland are also important for other research teams, such as those in Great Britain and France, who are training sniffer dogs to detect COVID-19.</p><p>Fellow researchers from the <a href="http://assistenzhunde-zentrum.de/index.php/news/covid-19-hunde" target="_blank">German Assistance Dog Center (TARSQ)</a> have also benefited from the Finnish results.</p><p>"No one could tell us with certainty whether training with the aggressive virus is <a href="https://www.dw.com/en/dutch-house-pets-test-positive-for-coronavirus/a-53460111" target="_blank">dangerous or not for humans and dogs</a>. We wanted to gather more information first before we started training because the German virologists advised us against it — after all, so little is known about the virus so far," explains Luca Barrett from TARSQ.</p>
Where Does the Characteristic Smell Come From?<p>It is still unclear which substances in urine produce the apparently characteristic COVID-19 odor. Since SARS-CoV-2 not only attacks the lungs, but also causes damage to blood vessels, kidneys and other organs, it is assumed that the patients' urine odor also changes. This is something which the dogs, with their highly sensitive olfactory organs, notice immediately.</p><p>Certain diseases appear to have a specific olfactory signature that trained dogs can sniff out with amazing accuracy, Barrett says.</p><p>"According to one study, dogs can detect breast cancer with a 93% probability, for example. And lung cancer with a 97% probability," she says.</p><p>But dogs can also identify skin cancer, colon cancer, ovarian cancer or prostate cancer very reliably, according to Barrett. "The hit rate, which was not so good in the early days of training, has risen enormously in recent years," she says.</p>
Hit Rate Decisive<p>Besides cancer, the <a href="https://www.dw.com/en/german-sniffer-dog-makes-1-million-drug-bust/a-53433307" target="_blank">dogs</a> can also detect Parkinson's disease. Parkinson's sufferers smell different even years before they have the disease. "That's how we came up with the idea of training dogs as an early warning system for Parkinson's," Barrett says.</p><p>Dogs are also trained to detect malaria, but the hit rate is not yet satisfactory, she says. So far, the dogs recognize seven out of 10 infected persons, which is not enough.</p><p>A high hit rate is, of course, also absolutely necessary when training for the aggressive SARS-CoV-2 pathogen, according to Barret. "We hope that the hit rate for the coronavirus is significantly higher in the fully trained dogs; after all, it would be very dangerous if COVID-19 were not detected," she says</p>
Trained Tracking Dogs<p>Dogs' ability to smell is about a million times better than that of humans. Humans have about 5 million olfactory cells, compared with 125 million for dachshunds and 220 million for sheepdogs.</p><p>Dogs also inhale up to 300 times per minute in short breaths, meaning that their olfactory cells are constantly supplied with new odor particles. In addition, dogs' noses differentiate between right and left. This spatial sense of smell allows the animals to follow a trail more easily.</p><p>During the training sessions, the dogs — mostly Labrador retrievers or retrievers in general, but also cocker spaniels or sheepdog breeds — are each trained for one scent. That can be the smell of a drug or an explosive, or, as here, the olfactory signature of a specific disease.This means that one dog cannot recognize several types of cancer.</p><p>The animals are trained with containers holding samples of breath or sweat, for example. As soon as they have identified the smell they are looking for, the dogs hear a click and get a treat. They are reliably trained for the one smell on this reward principle.</p>
Great Potential, Great Skepticism<p>Drug and explosive detection dogs have been used for some time. But trained medical scent detection dogs are also now working in hospitals. For example, they sniff the bodies of patients with suspected skin cancer to try and detect the disease — only with the patients' consent, of course. So these skilled snufflers are helping doctors in diagnosing diseases and detecting them early on.</p><p>However, so far there are only very few medical detection dogs. The dog owners almost always work voluntarily and the trained sniffer dogs live in normal households. There is great skepticism, especially among traditional doctors and health insurance companies, even though the first indications given by the dog have to be followed by further medical tests anyway and a lot of time and costs could be saved by early cancer detection.</p>
Possible Coronavirus Applications<p>If the findings from Finland are confirmed, the sniffer dogs with their extremely sensitive sense of smell could prove to be a great help in the fight against the new coronavirus.</p><p>Luca Barrett from TARSQ can easily picture coronavirus sniffer dogs being used in situations where there is a high risk of infection. For example, people attending football matches and other major events could be checked before they are admitted.</p><p>The dogs could also be employed at airports to scan people entering a country. "When the dogs go down the queue, they can detect if someone is healthy and can enter the country. But if a person smells of COVID-19, the handler could send that person to a coronavirus testing center instead," Barrett says. That is because a second test is still needed to confirm the dog's initial sniff detection.</p><p><span></span>Barrett says dogs could also be used to search for the virus on surfaces. For example, before passengers board an aircraft, a four-legged friend could first check whether the machine is free from SARS-CoV-2. Similar measures are planned for doctors' surgeries, aged care homes or nursing homes that have had to be evacuated because of COVID-19 cases. Before these are used again, a sniffer dog could check whether the environment is "clean."</p>
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