By Kristen Fischer
It's going to be back-to-school time soon, but will children go into the classrooms?
The American Academy of Pediatrics (AAP) thinks so, but only as long as safety measures are in place.
Keeping Schools Safe<p>What will safer schools look like?</p><p>In a <a href="https://jamanetwork.com/journals/jama/fullarticle/2766822" target="_blank">JAMA article</a> published last month, <a href="https://www.jhsph.edu/faculty/directory/profile/1781/joshua-m-sharfstein" target="_blank">Dr. Joshua Sharfstein</a>, a pediatrician and professor at the Johns Hopkins Bloomberg School of Public Health, outlined suggestions — many of which are similar to AAP's.</p><p>Remote learning protocols must stay in place, especially as some schools stagger home and in-building learning. If another shutdown needs to occur, children will rely on distance learning completely, so it must be easy to switch to, he said.</p><p>He suggested giving parents a daily checklist to document their child's health. Kids should be screened quickly on arrival and be given hygiene supplies. Maintenance staff should use appropriate PPE and have regular cleaning schedules. A notification system should be in place if a case is identified, Sharfstein recommended.</p><p><a href="https://www.albany.edu/rockefeller/faculty/erika-martin" target="_blank">Erika Martin</a>, PhD, an associate professor of public administration and policy at University at Albany, said nutrition assistance and health services should be included. She called for tutoring programs with virtual options as well as technology access.</p>
Supporting Staff<p>Teachers and staff will be affected by safeguarding measures, noted <a href="https://directory.sph.umn.edu/bio/sph-a-z/rachel-widome" target="_blank">Rachel Widome</a>, PhD, an associate professor of epidemiology and community health at University of Minnesota.</p><p>"In order for all of the in-school precautions to work well, we'll be asking a lot of teachers and staff," Widome told Healthline. In addition to their usual workload, they'll now be asked to monitor mask-wearing, ensure children are keeping distance, and be aware of any symptoms.</p><p>Along with Sharfstein, Widome called for an increase in financial support. More employees will likely be required so teachers and staff members can keep up with the added demands.</p>
Should Kids Go Back?<p>While these guidelines may help get some schools to reopen, many people don't think children should go back to school over fears they could contract the disease and spread it to other vulnerable family members like grandparents, infant siblings, or their parents.</p><p>In a <a href="https://pediatrics.aappublications.org/content/early/2020/07/08/peds.2020-004879" target="_blank">Pediatrics</a> commentary, <a href="https://www.md.com/doctor/william-raszka-md" target="_blank">Dr. William V. Raszka, Jr.</a>, an infectious disease specialist at The University of Vermont Medical Center, argued that schools should open because school-aged children are far less important drivers of COVID-19 than adults.</p><p>But he says the risk and benefit is not equal among all students ages 5 to 18.</p><p>"Elementary schools are arguably higher priority for face-to-face schooling, since younger children are at lower risk for infection and transmission, and since parental supervision of younger children's distance learning may be particularly challenging," added Sorensen, who penned a <a href="https://jamanetwork.com/channels/health-forum/fullarticle/2767411" target="_blank">June article in JAMA</a> with reopening tips. "That means middle and high schools are more likely to emphasize distance learning."</p><p>Specific student populations, such as special education students and students with disabilities, would also benefit greatly from more time spent in face-to-face environments, Sorensen said.</p>
What Parents Can Do<p>Parents should ask for and receive frequent updates from schools about plans for the fall. They should also be informed about plans if and when COVID infections are identified, Sharfstein said.</p><p>"I'd like to see parents investing now, during the summer, in doing things that can slow and stop the spread of the virus in their communities," Widome said.</p><p>"Now is a good time for kids to practice wearing masks and get used to them as they may be wearing them for longer stretches if school starts up in person," Widome suggested.</p><p>She recommends parents try different mask designs and materials to see what children are more comfortable wearing.</p><p>"If you are using cloth face coverings, it's good to have extras on hand," Widome added.</p><p>Parents should model healthy behavior at home and while out in public — another thing that could affect how well children adapt to reopening practices, Sorensen said.</p><p>"Children may want to know more about face coverings," added <a href="https://www.linkedin.com/in/leescott/" target="_blank">Lee Scott</a>, chairwoman of the Educational Advisory Board at <a href="https://www.goddardschool.com/" target="_blank">The Goddard School</a>. "Dramatic play, such as creating or wearing a face covering, may help some children adjust to this concept." Schools can also show children photos of what faculty members look like in their masks so the students are familiar with that appearance.</p><p>Johns Hopkins University recently released its eSchool+ Initiative, a slew of resources surrounding education during the pandemic. These include a <a href="https://equityschoolplus.jhu.edu/reopening-checklist/" target="_blank">checklist for administrators</a>, report on <a href="https://equityschoolplus.jhu.edu/ethics-of-reopening/" target="_blank">ethical considerations</a>, and a tracker of <a href="https://equityschoolplus.jhu.edu/reopening-policy-tracker/" target="_blank">state and local reopening plans</a>.</p>
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By Joni Sweet
If you get a call from a number you don't recognize, don't hit decline — it might be a contact tracer calling to let you know that someone you've been near has tested positive for the coronavirus.
Interviews With Contact Tracers<p>Contact tracing is a public health strategy that involves identifying everyone who may have been in contact with a person who has the coronavirus. Contact tracers collect information and provide guidance to help contain the transmission of disease.</p><p>It's been used during outbreaks of sexually transmitted infections (STIs), Ebola, measles, and now the coronavirus that causes COVID-19.</p><p>It starts when the local department of health gets a report of a confirmed case of the coronavirus in its community and gives that person a call. The contact tracer usually provides information on how to isolate and when to get treatment, then tries to figure out who else the person may have exposed.</p><p>"We ask who they've been in contact with in the 48 hours prior to symptom onset, or 2 days before the date of their positive test if they don't have symptoms," said <a href="https://case.edu/medicine/healthintegration/people/heidi-gullett" target="_blank">Dr. Heidi Gullett</a>, associate director of the Center for Community Health Integration at the Case Western Reserve University School of Medicine and medical director of the Cuyahoga County Board of Health in Ohio.</p>
“You’ve Been Exposed”<p>After the case interview, contact tracers will get to work calling the folks who may have been exposed to the coronavirus by the person who tested positive.</p><p>"We give them recommendations about quarantining or isolating, getting tested, and what to do if they become sick. If they're not already sick, we still want them to self-quarantine so that they don't spread the disease to anyone else if they were to become sick," said Labus.</p><p>Generally, the contact tracer won't ask for additional contacts unless they happen to call someone who is sick or has a confirmed case of the virus. They will help ensure the contact has the resources they need to isolate themselves, if necessary. The contact tracer may continue to stay in touch with that person over the next 14 days.</p><p>"We follow the percentage of people that were contacts, then converted into being actual cases of the virus. It's an important marker to help us understand what kind of transmission happens in our community and how to control the virus," said Gullett.</p>
Why You Should Participate (and What Happens If You Don’t)<p>A <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30457-6/fulltext" target="_blank">Lancet study</a> from June 16, which looked at data from more than 40,000 people, found that COVID-19 transmission could be reduced by 64 percent through isolating those who have the coronavirus, quarantining their household, and contacting the people they may have exposed.</p><p>The combination strategy was significantly more effective than mass random testing or just isolating the sick person and members of their household.</p><p>However, contact tracing is only as effective as people's willingness to participate, and a small number of people who've contracted the coronavirus or were potentially exposed are reluctant to talk.</p><p>"Contact tracers have all been hung up on, cussed at, yelled at," said Gullet.</p><p>The hesitation to talk to contact tracers often stems from concerns over privacy — a serious issue in healthcare.</p>
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EcoWatch Daily Newsletter
By Andrea Germanos
Oxfam International warned Thursday that up to 12,000 people could die each day by the end of the year as a result of hunger linked to the coronavirus pandemic—a daily death toll surpassing the daily mortality rate from Covid-19 itself.
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The COVID-19 pandemic has revealed both the strengths and limitations of globalization. The crisis has made people aware of how industrialized food production can be, and just how far food can travel to get to the local supermarket. There are many benefits to this system, including low prices for consumers and larger, even global, markets for producers. But there are also costs — to the environment, workers, small farmers and to a region or individual nation's food security.
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By Michael Svoboda
The enduring pandemic will make conventional forms of travel difficult if not impossible this summer. As a result, many will consider virtual alternatives for their vacations, including one of the oldest forms of virtual reality – books.
By Julia Vergin
It is undisputed that vitamin D plays a role everywhere in the body and performs important functions. A severe vitamin D deficiency, which can occur at a level of 12 nanograms per milliliter of blood or less, leads to severe and painful bone deformations known as rickets in infants and young children and osteomalacia in adults. Unfortunately, this is where the scientific consensus ends.
Where Does the Deficiency Begin?<p>Nobody knows exactly how much vitamin D a person actually needs. The question of when a deficiency starts is correspondingly controversial. However, vitamin D is becoming increasingly popular.Not only is the pseudo-scientific literature on the "sun vitamin" experiencing an upswing, but the number of published studies has also increased enormously in recent years. For example, in 2019 <a href="https://academic.oup.com/edrv/article/40/4/1109/5126915" target="_blank">a study found that</a> Vitamin D is responsible for keeping the skeleton functional and is associated with cardiovascular diseases, type 2 diabetes and various types of cancer. <br></p>
An All-Rounder<p>Vitamin D levels in the body rise and fall according to sun exposure. If sufficient UV rays reach the skin, the body is able to produce the vitamin itself. However, the human body only derives an estimated 10 to 20 percent of its daily requirement from food.</p><p>The vitamin D that we synthesize from sunlight or food is not biologically active at first. Before the kidneys can produce the biologically active form of the vitamin, known as calcitriol, and release it into the blood, some metabolic processes must take place beforehand.</p><p>In addition, many organs have receptors to which the precursor of calcitriol binds. Further, this substance is also present in blood.</p><p>From this precursor, the organs then produce calcitriol themselves, which the body then uses for countless other processes in the body. This form of vitamin D thus regulates insulin secretion, inhibits tumor growth, and promotes the formation of red blood cells as well as the survival and activity of macrophages, which are important for the <a href="https://www.mdpi.com/2072-6643/5/7/2502/htm" target="_blank">immune system.</a></p>
Low Vitamin D, Severe COVID-19 Disease?<p>A research study carried out <a href="https://www.sciencedirect.com/science/article/pii/S2352364620300067?via%3Dihub" target="_blank">at the University of Hohenheim</a> has now established a link between vitamin D deficiency, certain previous diseases, and severe cases of COVID-19.</p><p>According to the study, "there is a lot of evidence that several non-communicable diseases (high blood pressure, diabetes, cardiovascular diseases, metabolic syndrome) are associated with low vitamin D plasma levels. These comorbidities, together with the often accompanying vitamin D deficiency, increase the risk of severe COVID-19 events."</p><p>"This statement is completely correct," said Martin Fassnacht, head of endocrinology at the University Hospital of Würzburg. However, he qualifies that it is a pure association, "i.e. a mere observation that these events occur together.</p><p>Dr. Fassnacht is very critical of the hype surrounding vitamin D, but not because he denies the vitamin serves important functions. However, studies on humans have not been able to show that vitamin D has the healing powers many often propagate.</p><p>Fassnacht says, "If you take a closer look, the hopes that the administration of vitamin D has a healing effect have not been confirmed so far."</p>
Association Versus Intervention Studies<p>Many studies on the vitamin are association or observational studies. "By definition, these studies cannot prove the causal relationship, but only point to mere correlations," said Fassnacht. The physician tries to illustrate this with an example:</p><p>"Imagine two groups of 80-year-olds. One group is spry, active and does sports. If you compare them with another group living in nursing homes, the difference in vitamin D levels will be dramatic. Life expectancy would also be extremely different."</p><p>But to try to explain the difference in fitness by vitamin D status alone is far too simplistic. "Vitamin D levels are a good measure of how sick someone is. But not more," says Fassnacht. </p><p>According to Fassnacht, none of the intervention studies carried out to date -- that specifically examined the effect of vitamin D on various diseases -- has been able to confirm the previous association and laboratory studies or the presumed positive effect of vitamin D.</p>
Further Research Is Needed<p>"If a coronavirus infection is suspected, it is therefore absolutely necessary to check the vitamin D status and quickly correct any possible deficit," said the recommendation of the paper published by the University of Hohenheim.</p><p>"Studies are underway to see whether vitamin D helps in COVID-19 infection, but I personally do not believe that this is really the case," says endocrinologist Fassnacht. Nevertheless, he says it is of course useful to carry out these studies.<br></p><p>"I don't want to rule out that there are actually subgroups of people who benefit from an additional vitamin D dose," he says. After all, this has been proven to be the case with a severe deficit.</p><p>In view of the study situation, Fassnacht does not think much of preventive, nationwide vitamin D substitutes. "My belief that the vitamin helps somewhere is very low. But, of course, I can be wrong."</p>
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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.
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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By Tara Lohan
Would you like to take a crack at solving climate change? Or at least creating a road map of how we could do it?
When you build a tool like En-ROADS, who are you hoping uses it?<p>The tools that we build are used by quite a range of people, which is one of the exciting things about them.</p><p>Before En-ROADS we had a tool called C-ROADS, which was used in the context of the United Nations Framework Convention on Climate Change. During the negotiations in Copenhagen it allowed people to add up what each country was offering to do in terms of emissions cuts and calculate what that would mean for the global temperature at the end of the century. That was of interest to the U.S. State Department under President Obama and negotiating parties from other countries.</p><p>As a young bunch of scientists, it was fairly thrilling to hand our results to a colleague who took them to [science advisor] John Holdren, who took them to the president.</p><p>Today we find En-ROADS having quite a lot of traction in the upper levels of companies and governments, but one thing we've learned over the years is that those high-level leaders really can't move further or faster than the civil society is ready to.</p><p>So we invest quite a lot in supporting teachers — university and high school — and advocates. We're in the middle of a second round of webinars training around 1,000 people to use En-ROADS so they can teach others.</p><p>These are people all around the world. One is interested in going to her members of Congress with her laptop and using the simulation to advocate for a better future for her kids.</p>
What does En-ROADS do differently from other computer simulations?<p>One thing we talk about is the democratization of this information. En-ROADS isn't breaking new scientific ground that other computer simulations of climate change don't do. In fact, often we're relying on that cutting-edge research of other groups.</p><p>But we have paid attention to making it run fast and making it freely available online, where most of these other tools aren't designed for those purposes. They're doing scientific research for other scientists. Top leaders can often get the input of those academics if they have a question or a scenario, but it's unlikely that a politically active mom who's trying to influence her member of Congress would have access to those kinds of tools. Whereas if she puts in the time to learn, she can use En-ROADS.</p><p>I think more and more, and especially in the last few years, we come across people who have the impression that [the climate crisis is] pretty much hopeless. "It's too late. We've left it too long." And En-ROADS, for those people, is motivating because it shows that the goal of the Paris Climate Agreement to keep temperature increase well below 2 degrees [Celsius] is still physically possible. There's a huge amount of social and political will needed to do it, but it's within reach.</p>
Your organization is guided by a practice you call “multisolving.” What is that?<p>In the early years of working with models like C-ROADS and En-ROADS, we were really focused on tons of greenhouse gases and how to limit those. And clearly that's the core of the problem. But what we found in Copenhagen was that, despite our group and a few others who were doing this analysis actually being heard, and being on the front page of top newspapers, it didn't lead to more ambitious pledges from countries.</p><p>There was a soul-searching moment for me and for Climate Interactive in realizing that just being good scientists within this narrow bound of counting tons of carbon isn't getting us onto the path we need to be on.</p><p>That got me interested in this question of what else would be different in a world that has gotten off of fossil fuels. This was around 2009-2010. I hired the best researcher I knew, and she went away and came back and handed me this report.</p><p>It said that the benefits of being off fossil fuels, when monetized — when you took all the lives saved, all the healthcare costs saved, all the jobs created — the savings were of the same order of magnitude as the cost.</p><p>I thought she had made a mistake. Because I had worked my whole career trying to convince people that it's going to be <em>hard</em>, it's going to be <em>expensive</em>, but we <em>need</em> to get off fossil fuels. And she was saying that if you just widened your scope and looked not just on the carbon side, but you looked at the lives and health and community well-being, we were going to reap all these benefits.</p><p>I felt like I had been spending my life on a problem that was framed in a way where we would never be able to solve it. But by expanding our view, the things we were missing — basically political will, political power and budgetary power — seemed like maybe they could be aligned.</p><p>After that, for a long time we talked about the "co-benefits," and that that was kind of the word at the time. And many people still use it. We ended up dissatisfied with that word because it sounds like climate change is the main benefit, and then there are these other nice co-benefits.</p><p>That's still putting CO2 at the center of the world.</p><p>To a parent who's been in the emergency room all night with a child with asthma, is protecting the climate 100 years from now the main benefit of closing the neighborhood coal-fired power plant? Or is ending asthma the main benefit and climate is a nice co-benefit?</p><p>So we made up the word "<a href="https://www.climateinteractive.org/programs/multisolving/" target="_blank">multisolving</a>" to talk about how all these problems matter.</p>
What does this look like in action?<p>We learned that by and large our systems are not set up to allow people to take advantage of these synergies. And just to give you one example, if a country is going to go on a low-carbon transportation plan, those are going to be costs that are felt by the ministry of transportation. But the savings are largely going to be felt by the ministry of health. There'll be less hospitalization, fewer premature deaths, less cardiovascular and respiratory illness, less premature birth. But the way current governments are set up, no transportation minister is going to get much political appreciation or an incentive by saving money for the health ministry.</p><p>So for the last few years we've been working more and more on how to bring people together, to build the relationships that are needed to take advantage of these synergies because — until people can shift their systems around in a way where they can act together across these different silos and boundaries and jurisdictions — this will all just stay theoretical.</p><p>One place we have been doing this is in Atlanta with a group called Partnership for Southern Equity. We're creating a community network, the <a href="https://sites.google.com/view/justgrowth/just-growth-circle?authuser=0" target="_blank">Just Growth Circle</a>, that can be mobilized to have influence, decision-by-decision, on the kind of pattern of growth and development that will eventually change a whole city.</p>
That kind of deep-relationship building isn’t something that can be done quickly. How do you balance that kind of work to establish these interconnections with the urgency of the climate crisis?<p>Wendell Berry said, "To be patient in an emergency is a terrible trial." But we're in the kind of emergency that calls for patience. Time is very short and yet to make the kind of changes we need to make requires trust and relationships that can't be rushed and can only be cultivated. All you can do is create the conditions for them.</p><p>If you have urgency — if you need to bring things to scale, if you're looking for transformation and not incremental change — then actually this very slow and patient work of building trust and relationships is the way that you get to a very fast and transformative change.</p>
Has anything shifted in your thinking in the last few months during this global pandemic?<p>There's been a lot of talk about opportunities for transformation within the pandemic, especially about the need for low-carbon solutions. The other side is the social safety net. A lot of what we need to do to help people through the pandemic is also what the smart people behind the Green New Deal have said from the beginning needs to be part of the plan.</p><p>When they talked about universal healthcare, childcare, gender equity programs and the job training side of it, lots of people responded that they were way outside their lane. "What does this have to do with carbon?" But the pandemic is showing us that if you want a society to be able to pivot rapidly, you need a social safety net to support people.</p><p>If you want to pivot to green infrastructure, if you want low carbon infrastructure, you're changing a whole workforce in a generation. The social safety net is the lubrication that allows that to happen with less friction.</p><p>The social safety net we need to build to get through the pandemic could be built to also carry us through the transition to a climate-safe economy. It's not the technical side of this transition, but it is the taking care of each other through the transition. That may sound selfless, but it's also highly practical because the transition isn't going to happen if we can't move a whole society very quickly.</p>
By Leah Campbell
After several months of stay-at-home orders due to the COVID-19 pandemic, many households are beginning to experience family burnout from spending so much time together.
What is Family Burnout?<p>How do you know if you're experiencing family burnout resulting from COVID-19 togetherness?</p><p><a href="https://www.communitypsychiatry.com/providers/dr-pavan-madan-m-d/" target="_blank">Dr. Pavan Madan</a> is a board certified child and adolescent psychiatrist with <a href="https://www.communitypsychiatry.com/" target="_blank">Community Psychiatry</a>, the largest outpatient mental health organization in California. He explained there are three main symptoms to look out for. They are:</p><ul><li>feeling physically or emotionally exhausted</li><li>not being able to handle usual tasks</li><li>feeling annoyed easily</li></ul><p>These are symptoms a large number of people may be feeling right now, with exhaustion <a href="https://patient.info/news-and-features/why-lockdown-is-making-us-feel-exhausted" target="_blank">being reported across the internet</a>. Also, despite the fact that people are home and seemingly have all the time in the world on their hands, this inexplicable fatigue is becoming a common phenomenon.</p><p>In fact, Madan said, "Although no clear data is available, a <a href="http://bpinetwork.com/parental-burnout-crisis-in-corporate-america" target="_blank">2018 survey</a> found that half of all parents experience burnout — and this was prior to the pandemic."</p><p>Given the heightened rates of family togetherness now, it stands to reason those numbers are much higher, especially for single parents.</p>
The Additional Toll Faced by Single Parents<p>For single parents still working, now depleted of their normal childcare assistance, the pandemic may mean more to do and fewer opportunities for self-care than ever before.</p><p><a href="https://journeyswithprairie.com/prairie-conlon-licensed-therapist/" target="_blank">Prairie Conlon</a> is a licensed mental health professional and clinical director of the telehealth company <a href="https://www.certapet.com/" target="_blank">CertaPet</a>.</p><p>She explained, "In a two-parent household, division of tasks allows each parent to have some relief, but single-parent households typically take on all of these tasks themselves, which can absolutely lead to burnout quicker."</p><p>For single parents in a pandemic, there's no partner to help share responsibilities and there are few, if any, opportunities to get away and breathe by oneself. The result can easily lead to family burnout.</p><p>"One of the earliest signs of burnout is having less patience," Conlon said, "whether it's snapping at your kids or making a microwave dinner."</p><p>There are other factors that can contribute to family burnout in the time of COVID-19 as well.</p><p>"How demanding your job is or how the rest of your family is handling quarantine can further exacerbate burnout," Conlon said.</p>
Family Burnout Can Affect Romantic Relationships Too<p>Months together in quarantine can also be a strain on romantic relationships.</p><p>A <a href="https://www.forbes.com/sites/alexandrasternlicht/2020/04/23/couples-in-quarantine-only-18-are-satisfied-with-their-communication-during-coronavirus-pandemic/#178957045807" target="_blank">recent Forbes article</a> reported on a survey that found only 18 percent of respondents were happy with the communication within their relationships since the pandemic began. And in China, an <a href="https://www.bbc.com/future/article/20200601-how-is-covid-19-is-affecting-relationships" target="_blank">unprecedented number of divorce requests</a> were filed as soon as marriage offices began reopening.</p><p>Will we see similar numbers as our states continue reopening here in the United States?</p><p>"When one person in a relationship is experiencing burnout, the other can typically pick up the slack, but when both are, it can be a struggle to connect and feel your best," Conlon said.</p><p>The impact on marriages and romantic relationships is considered part of the <a href="https://www.psychologytoday.com/us/blog/the-intelligent-divorce/202004/how-covid-19-affects-marriage-and-how-adapt" target="_blank">collateral damage</a> of COVID-19. In times of high stress, it may not always be the best thing to be locked at home together, incapable of getting the space and clear head that's often needed to work through marital discord.</p>
It’s Not Just Parents and Adults — Kids Can Experience Family Burnout As Well<p>It's important to remember that amidst all this, adults aren't the only ones experiencing burnout.</p><p>"Burnout in children often presents as anxiety, being irritable, poor academic performance, or staying isolated from peers and not expressing interest in playing," Madan said.</p><p>A recent <a href="https://time.com/5854243/coronavirus-lockdown-impact-children/" target="_blank">survey in Italy</a> found that children are experiencing psychological impacts as a result of lockdown. They're more irritable, having trouble sleeping, and many are regressing developmentally.</p><p>"Compared to younger children, teenagers may be more likely to experience burnout due to higher academic workload, greater need for peer interaction, and more frequent conflicts with parents," Madan said.</p>
How to Reduce the Impact of Burnout in Your Household<p>But just because so many are experiencing burnout doesn't mean it can't be helped.</p><p>"Burnout can be prevented by having a better balance between family time versus me time," Madan said.</p><p>When dealing with kids who may be acting out as a result of lockdown stress, he suggests parents try using encouragement and positive reinforcement over punishment techniques.</p><p>This gentler approach may be best for helping to redirect kids while also honoring the life struggles we're all facing right now.</p><p>"Having a routine for sleep, meals, and study time can help children feel prepared for the next activity and avoid some conflicts," Madan explained.</p><p>How can parents manage their own feelings of burnout?</p><p>"Parents must consider stress management techniques at work and aim towards a better work-life balance," Madan said.</p><p>Conlon agreed, adding that those in two-parent households can help each other by giving one another time off from household obligations and child-rearing duties every once in a while.</p><p>Conlon suggested telling your partner to go out for a walk, or ask for the chance to sit in the tub with a book uninterrupted for the next hour. He explained that mini-breaks such as these can do both parents a world of good.</p><p>"For the kids, try to switch up their activities — take them bike riding, to the pool, or to the park," she said.</p>
Knowing When to Ask for Help<p>It's important to recognize there's a difference between having a slightly shorter fuse and feeling like you're actually on the edge of combusting.</p><p>"When burnout symptoms are moderate to severe, consider getting professional consultation with family therapy, individual therapist, or psychiatrist depending on the situation," Madan said.</p><p>While it may seem as though COVID-19 has made seeking mental health help more difficult, that's simply not the case. In fact, it may currently be easier to get that help than ever before, as many insurance companies have <a href="https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/" target="_blank">removed deductibles and copays</a> for telehealth appointments.</p><p>"Parenting is not easy and burnout is fairly common," Madan explained. "I advise parents to take care of themselves not only for their own well-being, but also to model good behavior for their children to emulate now and for the years to come, even when we are back to 'normal.'"</p><p>Experts emphasize that it's OK to honor your own needs and recognize you may require additional help right now.</p><p>Most mental health practitioners are welcoming telehealth visits, and with antidepression and anti-anxiety prescriptions <a href="https://www.healthline.com/health-news/depression-during-covid-19" target="_blank">both on the rise</a>, you're certainly not alone if you decide you need that additional assistance right now as well.</p><p>The most important thing is that you take care of yourself. After all, your family needs you to be healthy and whole.</p>
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By Brian J. Love and Julie Rieland
The COVID-19 pandemic has disrupted the U.S. recycling industry. Waste sources, quantities and destinations are all in flux, and shutdowns have devastated an industry that was already struggling.
Goodwill's Canton, Mich. site looks overwhelmed on June 16, with an oversupply of donations and little immediate chance for resale. Brian Love / CC BY-ND
Recyclers Under Pressure<p>Since March 2020, when most shelter-in-place orders began, sanitation workers have noted massive increases in municipal garbage and recyclables. For example, in cities like Chicago, workers have seen up to <a href="https://chicago.suntimes.com/coronavirus/2020/4/7/21212543/coronavirus-chicago-garbage-pickup-streets-sanitation-masks" target="_blank">50% more waste</a>.</p><p>According to the <a href="https://swana.org/" target="_blank">Solid Waste Association of North America</a>, U.S. cities saw a <a href="https://swana.org/news/swana-news/article/2020/06/17/swana-submits-statement-on-recycling-challenges-for-u.s.-senate-hearing" target="_blank">20% average increase</a> in municipal solid waste and recycling collection from March into April 2020. Increased trash can be attributed partly to spring cleaning, but most of it is due to people spending greater time at home. Restaurants struggling to survive under COVID-19 restrictions are contributing to the rise in plastic and paper waste with <a href="https://theconversation.com/using-lots-of-plastic-packaging-during-the-coronavirus-crisis-youre-not-alone-135553" target="_blank">takeout packaging</a>.</p><p>Although higher volumes of recyclables are being set on the curb, budget deficits are squeezing recycling programs. Many municipalities are struggling with <a href="https://www.ketv.com/article/omaha-mayor-health-officials-to-provide-covid-19-update-friday-afternoon/32498068#" target="_blank">multimillion-dollar shortfalls</a>. Some communities, such as Rock Springs, Wyoming, and East Peoria, Illinois, <a href="https://resource-recycling.com/recycling/2020/05/27/budget-shortfalls-threaten-local-recycling-programs/" target="_blank">have cut recycling programs</a>.</p><p>And these stresses are testing a business already faced uncertainty.</p>
While bottle deposit stations remain closed, recyclables pile up in basements and garages. David Rieland / CC BY-ND
Turmoil in Scrap Markets<p>The global recycling economy has suffered since 2018 as first China and then other Asian nations <a href="https://theconversation.com/as-more-developing-countries-reject-plastic-waste-exports-wealthy-nations-seek-solutions-at-home-117163" target="_blank">banned imports of low-quality scrap</a> — often meaning improperly cleaned food packaging and poorly sorted recyclable materials. As in any business, the value of raw recyclables is linked to supply and demand. Without demand from nations like China, which formerly took up to 700,000 tons of U.S. scrap annually, recyclers have scrambled to stay in business.</p><p>The pandemic has boosted prices for some materials. One industry leader told us that between February and May 2020, prices doubled for recycled paper and tripled for recycled cardboard. These shifts reflect higher demand for tissue products and shipping packaging under shelter-in-place orders.</p><p>However, he also reported that prices for the most-recycled categories of reclaimed plastics — PET (#1) and PE (#2 and #4) – were at 10-year lows. An influx of cheap oil has driven the raw material cost of oil-derived virgin plastics to their lowest levels in decades, <a href="https://millerrecycling.com/oil-prices-recycling#:%7E:text=Higher%20oil%20prices%20can%20also,robust%20market%20for%20recycled%20plastic." target="_blank">outcompeting recycled feedstocks</a>.</p>
Difficult Economics<p>Ideally, revenues from recycling offset municipalities' costs for collecting and disposing of solid wastes. However, given worker safety concerns, low market prices for scrap materials, a slowed economy and cheaper alternatives for disposal, many communities and businesses across the U.S. have <a href="https://www.wastedive.com/news/recycling-mrfs-prison-labor-suspensions-coronavirus-covid-19/574301/" target="_blank">temporarily suspended</a> collection of recyclables and bottle deposits.</p><p>Meanwhile, as the commercial sector slowed, the distribution of waste generation changed. As people have spent more time producing waste at home, waste collectors implemented <a href="https://www.wastedive.com/news/coronavirus-covid-waste-recycling-safety-collection-mrf/574359/" target="_blank">new procedures</a> to protect their employees from infection.</p><p>Recycling is a very hands-on process that requires workers to manually sort out items from the collection stream that are unsuitable for mechanical processing. Workers and waste collection companies have <a href="https://www.wastedive.com/news/coronavirus-covid-waste-recycling-safety-collection-mrf/574359/" target="_blank">raised many safety questions</a> about recycling during the pandemic.</p><p>Precautions like social distancing and use of personal protective equipment have become commonplace among waste collectors and sorters, though concerns remain. Sorters are increasingly relying on automation, but implementation can be costly and takes time.</p>
Collections on Pause<p>Based on monitoring since 2017 by the trade publication <a href="https://www.wastedive.com/news/curbside-recycling-cancellation-tracker/569250/" target="_blank">Waste Dive</a>, nearly 90 curbside recycling programs had experienced or continue to experience a prolonged suspension over the past several years. About 30 of these suspensions have occurred since January 2020.</p>
Like many bottle deposit programs, Kroger's Ann Arbor, Mich. drop-off center shut down on March 23. Michigan bottle deposits across the state resumed on June 15, 2020 with new safety protocols. Brian Love / CC BY-ND<p>On a broader scale, it's not clear how much more waste Americans are currently producing during shutdowns. Commercial and residential waste aren't directly comparable. For example, a granola bar wrapper thrown away at the office is tallied differently than if discarded at home.</p><p>It is also challenging to quantify the effects of the pandemic while it is still unfolding. Historically, waste output from the commercial and industrial sectors has far outweighed the municipal stream. With many offices and business closed or operating at low levels, total U.S. waste production could actually be at a record low during this time. However, data on commercial and industrial wastes are not readily available.</p><p>At the California-based <a href="https://resource-recycling.com/recycling/2020/04/28/city-data-shows-covid-19-impacts-on-recycling-tonnages/" target="_blank">Peninsula Sanitary Service</a>, which serves the Stanford University community, total tonnage was down 60% in March. The company attributes this drop to reduced commercial waste, particularly from construction. Similarly, the city of Vancouver, British Columbia, noted a <a href="https://www.cbc.ca/news/canada/british-columbia/metro-vancouver-garbage-decrease-covdi-19-1.5544942" target="_blank">10% decrease</a> year over year of waste collection levels for April.</p>
Expected sectors of plastic waste increase due to COVID-19, based on 2018 plastic usage distribution data from PlasticsEurope and Klemes et al., 2020. Brian Love and Julie Rieland / CC BY-ND