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I Asked People Why They Don’t Vote, and This Is What They Told Me

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By Andrew Joseph Pegoda

At least 40 percent to 90 percent of American voters stay home during elections, evidence that low voter turnout for both national and local elections is a serious problem throughout the U.S.


With the 2020 presidential election approaching, directives for people to "get out and vote" will be firing up again.

Some people might be indifferent or simply not care, but many who forgo voting have legitimate reasons.

Over the past decade, through my extensive research on civil rights and oppression, through my observations of social media comments and through my conversations with hundreds of college students, I have concluded that such reasons are both important and, generally, unnoticed.

1. Voter Suppression

Republican-led efforts to diminish participation in voting and voter registration have greatly contributed to the number of nonvoters.

Since 2010, 25 states have adopted measures specifically aimed at making voting more difficult. Such measures include additional voter identification requirements.

Sometimes lawmakers said these were necessary to curb illegal voting, which research shows is an all-but-nonexistent problem.

Some counties and states have also created confusion and uncertainty about how to initially register or re-register after a voter has moved.

In other cases, people might not know where to vote, due to the distribution of deliberately false information.

Since the U.S. Supreme Court ruled in Shelby County v. Holder in 2013 that key aspects of the Voting Rights Act of 1965 were unconstitutional, states have closed more than 1,000 polling locations, half of these in Texas.

2. Personal Choice

Some people decide to forgo voting.

I hear again and again that sometimes people make such choices because they were intimidated by friends, by family members or by people at polling places.

When facing the complexities of races with dozens of candidates and complicated issues, others say they don't feel they know enough to make informed decisions.

People have also told me they worry about feeling personally responsible if they vote for a candidate or position and there are unforeseen consequences, such as cuts to important aid programs. Members of any group, but especially those of underrepresented groups, may long to vote for desirable candidates but not feel that current candidates offer the possibility that anything will really change.

Individuals have shared with me that they have not voted because they do not trust a nation that they feel has lied and perpetuated systemic abuse against minorities, aggravated further by widespread gerrymandering and for presidential elections, by an Electoral College system that doesn't weigh each vote the same.

In France and India, for example, people who dislike all of the candidates can formally "vote" without endorsing any candidate by selecting "none of the above." Not having this option in the U.S. might affect turnout, too.

3. Obstacles to Access

For others, voting may simply be too difficult.

I often hear of people who — even with early voting or absentee options — cannot vote because they lack transportation. They are homeless. They lack child care. They are disabled. They work, go to school and live in different cities.

This is even more applicable for the 7 to 8 million in the U.S. who hold multiple jobs. Laws guarantee time off for voting but aren't enforceable and aren't always workable.

Such people are effectively disenfranchised.

4. Lack of Rights

Only non-incarcerated, mentally competent, registered citizens of age can vote.

Based on 2015 data, the right to vote was not extended to a more than 13 million people with green cards, work visas or refugee status. Given the total population of people 18 and older exceeded 248 million in 2015, one out of every 20 adults living, working and spending money in the U.S. was not eligible to vote.

Using vague and inconsistent language, states have also worked to deny disabled or mentally ill people a political voice. This affects potentially over a million people nationwide.

As discussed in the books The New Jim Crow and in Race, Incarceration and American Values, an additional 6 million Americans cannot vote because of felony convictions, an issue that disproportionately affects black people. In some states, this disenfranchisement remains in effect for life.

The Future

Given the legitimacy of reasons why they don't participate, nonvoters certainly shouldn't be scolded with, "If you don't vote, you can't complain." Or with even harsher words, as one friend on Facebook put it: "If you don't vote, everything wrong in the world is your fault."

People long to be heard and deserve fair representation. Instead of bashing nonvoters, I recommend taking some deep breaths and initiating friendly conversations. Listen and learn. At a time when public trust in government is at historic lows, such conversations might even encourage someone to demand a voice.

Reposted with permission from The Conversation.

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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.

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

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

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

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

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

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

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

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

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

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

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

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

Reposted with permission from The Conversation.


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