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Blowing the Cover off the 'Cleanest Air' Illusion of the Trump Administration

Politics
Smoke pours from the exhaust pipes on a truck on Nov. 5, 2019 in Miami, Florida. According to a 2017 EPA study the largest source of greenhouse gas emissions in the U.S. is from the transportation sector. Joe Raedle / Getty Images

By Julie McNamara

First, a fact: People want clean air. And who can blame them — in the United States more than 100,000 people still die from air pollution each year.


Notably, the Trump administration is right there with them, repeatedly claiming to want clean air — the cleanest air—too:

  • Like President Trump stating: "I want clean air. I want clean water. I want the cleanest air with the cleanest water. The environment is very important to me."
  • Like U.S. Environmental Protection Agency (EPA) Administrator Wheeler declaring: "Our foremost concern must be ensuring clean air for all Americans. That is our goal."
  • Like Secretary of State Pompeo reiterating: "This administration's been very clear we're happy to work on all things that improve safe drinking water, clean air, all those things."

At least, the Trump administration is right there with them rhetorically.

More Like Clean Air Assault

If you look past the dazzling display of the cleanest superlative parade, the narrative takes a turn. In fact, in action, the Trump administration's clean air pursuit looks a whole lot more like clean air assault.

This administration cannot have it both ways.

Despite the rhetoric, the truth of their actions still stands, and they simply cannot obfuscate away the fact that with their policies, our nation's hard-fought clean air progress is ebbing, ebbing away.

Desperately Seeking That Clean-Air Sparkle

So how does the Trump administration actually pursue that clean-air sparkle its words so desperately seek?

It's a simple recipe, really; the no-knead bread of public-health blues. An administration favorite, offered on repeat.

Together, mix:

  • One part pollution
  • One part lies
  • One part cruelty

Pour into area air.

Sprinkle with comparisons to the 1970s, bedazzle with visions of a trillion trees.

And behold, black magic: the very "cleanest" air.

Here, a look at how the Trump administration cooks.

One Part Pollution

Over the past three years, the Trump administration has aggressively, repeatedly, profoundly attacked mainstay public health protections from harmful air pollutants.

It has undermined the processes that inform those standards. It has sidelined the science that improves those standards. It has manipulated math to justify its attacks. It has failed to conduct the assessments that would reveal those disproportionately affected by its actions. It has stifled public engagement. It has tried slashing budgets. It has weakened enforcement. It has lessened oversight.

It has done all these things — and more — again and again and again.

And as a result, it has undermined long-term progress on things like reductions in mercury, in particulate matter, in hazardous air pollutants.

Without question, with this administration, clean air is under attack.

One Part Lies

When the Trump administration undertakes these attacks on public health protections, it does so stunningly boldly — except, that is, when it gets called out.

Then it's straight to the administration's one safe space, "from 1970 to today," where the administration attempts to cloak the devastating impacts of its actions behind the cover of the fact that, compared to the 1970s, compared to the start of the Clean Air Act, compared to the founding days of the EPA, our air is cleaner now than it was back then.

The utterly shameless audacity. Snatching accolades earned by the actions of others, successes advanced by prior Republican and Democratic administrations both, and insinuating they should be awarded to this administration's health-wrecking machine instead.

Our nation's incredible clean air gains have certainly not occurred because of this administration's actions or because of its rollbacks. No, these hard-earned clean-air benefits have not occurred because of them — they've occurred in spite of them.

And now? Still an estimated 100,000 people die prematurely each year, and thanks to this administration, continued progress on clean air is threatened, stalling, even entering reverse.

One Part Cruelty

There is a world in which, after the negative effects of an administration's proposal are made clear, after experts and the general public roar back, there is a world in which an administration changes course.

But not this administration. This administration persists.

It still knee-caps scientific studies supporting stronger health standards, it still erases benefits worth billions of dollars to make regulatory rollbacks pencil out, it still props up coal plants, it still rams through industry input while sidelining experts and the public, it still puts children's health at risk. It still sets attack, after attack, after attack.

It's just that now the administration is continuing its clean air attacks while looking people straight in the face and playing them for a fool.

Our air is cleaner than it's ever been! We'll plant a trillion trees!

Pollution, lies, cruelty.

Blowing Their Cover

Critically, the Trump administration's tragicomic reframing of its outright environmental warfare into, somehow (no-how), environmental gains, only works if their cover sticks.

So far, their cover has not stuck.

Public comments have denounced their attacks. Scientific experts have blasted their moves. And when the Trump administration's actions finally make it to the courts, the administration has lost overwhelmingly.

Yet those wins are small comfort when there's still so much progress left to be made. Clean air access to be broadened, technological innovations to be implemented, emerging science to be incorporated, air pollution burdens to be lifted.

But instead of redoubling a commitment toward progress, we get this: the Trump administration touting the incredible benefits our clean air protections have enabled to date while salting the earth where the very chance for that progress had been sown.

This administration cannot have it both ways.

Julie McNamara is an energy analyst with the Climate & Energy program at the Union of Concerned Scientists.

Reposted with permission from the Union of Concerned Scientists.

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Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Niq Steele / Getty Images

By Sherry H-Y. Chou, Aarti Sarwal and Neha S. Dangayach

The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.

When a neurologist examined him, Tom was diagnosed with Guillain-Barre Syndrome, an autoimmune disease that causes abnormal sensation and weakness due to delays in sending signals through the nerves. Usually reversible, in severe cases it can cause prolonged paralysis involving breathing muscles, require ventilator support and sometimes leave permanent neurological deficits. Early recognition by expert neurologists is key to proper treatment.

We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.

Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.

What Is Guillain-Barre Syndrome?

Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.

Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.

To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.

Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.

The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.

Guillain-Barre Syndrome and Pandemics

As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.

Though Guillain-Barre Syndrome is rare, it is well known to emerge following bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses.

Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.

The first reports of Guillain-Barre Syndrome in COVID-19 pandemic originated from Italy, Spain and China, where the pandemic surged before the U.S. crisis.

Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?

The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.

Understanding the Association Between COVID-19 and Guillain-Barre Syndrome

While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.

It is certainly possible that there are other cases that have not been reported. The Global Consortium Study of Neurological Dysfunctions in COVID-19 is actively underway to find out how often neurological problems like Guillain-Barre Syndrome is seen in hospitalized COVID-19 patients. Also, just because Guillain-Barre Syndrome occurs in a patient diagnosed with COVID-19, that does not imply that it was caused by the virus; this still may be a coincident occurrence. More research is needed to understand how the two events are related.

Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.

Though the reported cases of Guillain-Barre Syndrome so far all have severe symptoms, this is not uncommon in a pandemic situation where the less sick patients may stay home and not present for medical care for fear of being exposed to the virus. This, plus the limited COVID-19 testing capability across the U.S., may skew our current detection of Guillain-Barre Syndrome cases toward the sicker patients who have to go to a hospital. In general, the majority of Guillain-Barre Syndrome patients do recover, given enough time. We do not yet know whether this is true for COVID-19-related cases at this stage of the pandemic. We and colleagues around the world are working around the clock to find answers to these critical questions.

Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.

Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.

Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.

Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Reposted with permission from The Conversation.