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Tag: disease

  • ‘A continual assault.’ How UCLA’s research faculty is grappling with Trump funding freeze

    Their medical research focuses on potentially lifesaving breakthroughs in cancer treatment, and developing tools to more easily diagnose debilitating diseases. Their studies in mathematics could make online systems more robust and secure.

    But as the academic year opens, the work of UCLA’s professors in these and many other fields has been imperiled by the Trump administration’s suspension of $584 million in grant funding, which University of California President James B. Milliken called a “death knell” to its transformative research.

    The freeze came after a July 29 U.S. Department of Justice finding that the university had violated the civil rights of Jewish and Israeli students by providing an inadequate response to alleged antisemitism they faced after the Oct. 7, 2023, Hamas attack.

    The fight over the funding stoppage intensified Friday after the Trump administration demanded that UCLA pay a $1-billion fine, among other concessions, to resolve the accusations — and California Gov. Gavin Newsom said the state will sue, calling the proposal “extortion.”

    Amid heightened tensions in Westwood, thousands of university academics are in limbo. In total, at least 800 grants, mostly from the National Science Foundation and the National Institutes of Health, have been frozen.

    UCLA scholars described days of confusion as they struggle to understand how the loss of grants would affect their work and scramble to uncover new funding sources — or roles that would ensure their continued pay, or that of their colleagues. While professors still have jobs and paychecks to draw on, many others, including graduate students, rely on grant funding for their salaries, tuition and healthcare.

    At least for the moment, though, several academics told The Times that their work had not yet be interrupted. So far, no layoffs have been announced.

    Sydney Campbell, a UCLA cancer researcher whose grant funding has been cut, stands inside the Biomedical Sciences Research building at UCLA.

    (Genaro Molina / Los Angeles Times)

    Sydney Campbell, a pancreatic cancer researcher and postdoctoral scholar at UCLA’s David Geffen School of Medicine, said her work — which aims to understand how diet affects the disease — is continuing for now. She has an independent fellowship that “hopefully will protect the majority of my salary.” But others, she said, don’t have that luxury.

    “It is absolutely going to affect people’s livelihoods. I already know of people … with families who are having to take pay cuts almost immediately,” said Campbell, who works for a lab that has lost two National Institutes of Health grants, including one that funds her research.

    Pancreatic cancer is among the most deadly of cancers, but Campbell’s work could lead to a better understanding of it, paving the way for more robust prophylactic programs — and treatment plans — that may ultimately help tame the scourge.

    “Understanding how diet can impact cancer development could lead to preventive strategies that we can recommend to patients in the future,” said Campbell, a member of the UAW 4811 academic workers union. “Right now we can’t effectively do that because we don’t have the information about the underlying biology. Our studies will help us actually be able to make recommendations based on science.”

    Campbell’s work — and that of many others at UCLA — is potentially groundbreaking. But it could soon be put on hold.

    “We have people who don’t know if they’re going to be able to purchase experimental materials for the rest of the month,” she said.

    Fears of existential crisis

    For some, the cuts have triggered something close to an existential crisis.

    After professor Dino Di Carlo, chair of the UCLA Samueli Bioengineering Department, learned that about 20 grants were suspended there — including four in his lab worth about $1 million — he felt a profound sadness. He said he doesn’t know why his grants were frozen, and there may not be money to pay his six researchers.

    So Di Carlo, who is researching diagnostics for Lyme and other tick-borne diseases, took to LinkedIn, where he penned a post invoking the Franz Kafka novel “The Trial.” The unsettling tale is about a man named Josef K. who wakes up and finds himself under arrest and then on trial — with no understanding of the situation.

    “Like Josef K., the people actually affected — the public, young scientists, patients waiting for better treatments and diagnostic tools — are left asking: What crime did we commit?” wrote Di Carlo. “They are being judged by a system that no longer explains itself.”

    The LinkedIn post quickly attracted dozens of comments and more than 1,000 other responses. Di Carlo, who has been working to find jobs for researchers who depend on paychecks that come from now-suspended grants, said he appreciated the support.

    But, goodwill has its limits. “It doesn’t pay the rent for a student this month,” he said.

    Di Carlo’s research is partly focused on developing an at-home test that would detect Lyme and other tick-borne diseases, which are on the rise. Because no such product is currently approved by the U.S. Food and Drug Administration, he said, people who’ve experienced a tick bite have to wait for lab results to confirm their infection.

    “This delay in diagnosis prevents timely treatment, allowing the disease to progress and potentially lead to long-term health issues,” he said. “A rapid, point-of-care test would allow individuals to receive immediate results, enabling early treatment with antibiotics when the disease is most easily addressed, significantly reducing the risk of chronic symptoms and improving health outcomes.”

    Di Carlo lamented what he called “a continual assault on the scientific community” by the Trump administration, which has canceled billions of dollars in National Institutes of Health funding for universities across the country.

    It “just … hasn’t let up,” Di Carlo said.

    Scrambling for funds

    Some professors who’ve lost grants have spent long hours scrambling to secure new sources of funding.

    Di Carlo said he was in meetings all week to identify which researchers are affected by the cuts, and to try to figure out, “Can we support those students?” He has also sought to determine whether some could be moved to other projects that still have funding, or be given teaching assistant positions, among other options.

    He’s not alone in those efforts. Mathematics professor Terence Tao also has lost a grant worth about $750,000. But Tao said that he was more distressed by the freezing of a $25-million grant for UCLA’s Institute for Pure and Applied Mathematics. The funding loss for the institute, where Tao is director of special projects, is “actually quite existential,” he said, because the grant is “needed to fund operations” there.

    Tao, who is the James and Carol Collins chair in the College of Letters and Sciences, said the pain goes beyond the loss of funds. “The abruptness — and basically the lack of due process in general — just compounds the damage,” said Tao. “We got no notice.”

    A luminary in his field, Tao conducts research that examines, in part, whether a group of numbers are random or structured. His work could lead to advances in cryptography that may eventually make online systems — such as those used for financial transactions — more secure.

    “It is important to do this kind of research — if we don’t, it’s possible that an adversary, for example, could actually discover these weaknesses that we are not looking for at all,” Tao said. “So you do need this extra theoretical confirmation that things that you think are working actually do work as intended, [and you need to] also explore the negative space of what doesn’t work.”

    Tao said he’s been heartened by donations that the mathematics institute has received from private donors in recent days — about $100,000 so far.

    “We are scrambling for short-term funding because we need to just keep the lights on for the next few months,” said Tao.

    Rafael Jaime, president of United Auto Workers Local 4811, which represents 48,000 academic workers within the University of California — including about 8,000 at UCLA — said he was not aware of any workers who haven’t been paid so far, but that the issue could come to a head at the end of August.

    He said that the UC system “should do everything that it can to ensure that workers aren’t left without pay.”

    What comes next?

    A major stressor for academics: the uncertainty.

    Some researchers whose grants were suspended said they have not received much guidance from UCLA on a path forward. Some of that anxiety was vented on Zoom calls last week, including a UCLA-wide call attended by about 3,000 faculty members.

    UCLA administrators said they are exploring stopgap options, including potential emergency “bridge” funding to grantees to pay researchers or keep up labs such as those that use rodents as subjects.

    Some UCLA academics worried about a brain drain. Di Carlo said that undergraduate students he advises have begun asking for his advice on relocating to universities abroad for graduate school.

    “This has been the first time that I’ve seen undergraduate students that have asked about foreign universities for their graduate studies,” he said. “I hear, ‘What about Switzerland? … What about University of Tokyo?’ This assault on science is making the students think that this is not the place for them.”

    But arguably researchers’ most pressing concern is continuing their work.

    Campbell explained that she has personally been affected by pancreatic cancer — she lost someone close to her to it. She and her peers do the research “for the families” who’ve also been touched by the disease.

    “That the work that’s already in progress has the chance of being stopped in some way is really disappointing,” she said. “Not just for me, but for all those patients I could potentially help.”

    Daniel Miller, Jaweed Kaleem

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  • How to Exercise When You Have COPD

    How to Exercise When You Have COPD

    If you’ve been diagnosed with chronic obstructive pulmonary disease, or COPD, you probably have shortness of breath during physical exertion. Regular exercise may seem intimidating, but it’s actually a powerful medicine to improve how you feel when you’re active.

    COPD is a progressive lung condition occurring in several forms, in which structural changes obstruct airflow, making it harder to breathe. It’s often caused by long-term exposure to tobacco smoke, chemical pollutants, and mineral, wood, or metal dusts that irritate the lungs; examples include emphysema and chronic bronchitis. Around 16 million people in the U.S. have COPD, and anxiety about gasping for air leads many to avoid physical activity altogether. But inactivity can drive a downward cycle that worsens breathlessness and the overall condition. 

    With exercise, “people can do more with less shortness of breath,” says Dr. Carolyn Rochester, professor of medicine and director of Yale University’s COPD Program. “It improves participation in daily activities and quality of life.” 

    But not just any approach to exercise will do. It’s important to get started under the supervision of medical professionals. A specific program involving exercise, called pulmonary rehabilitation, is proven to help people with COPD. “I can’t recall a patient who didn’t think pulmonary rehabilitation benefited them a great deal,” says Dr. David Mannino, co-founder and chief medical officer of the COPD Foundation. “Typically, they wish they’d done it years ago.”

    Research shows that pulmonary rehab is highly effective, with large improvements in endurance and quality of life compared to people’s conditions before the program. Rehab also increases survival rates with fewer hospitalizations. You can locate programs through an online directory.

    Why exercise matters

    Exercise offers multiple benefits that improve the ability to engage in everyday activities, such as bathing, dressing, walking to the mailbox, grocery shopping, and playing with grandkids. While a COPD patient’s exercise won’t improve the inner workings of their lungs, it does make breathing and daily activities easier by increasing cardio fitness and strengthening muscles throughout the body, particularly the legs and arms, Rochester says.

    “Especially with aerobic exercise, you get changes in certain cells of the muscles to become more efficient at using oxygen,” says Kerry Stewart, a Johns Hopkins University exercise physiologist who has worked with many COPD patients. Phyliss DiLorenzo, a 66-year-old from Jersey City, N.J., was diagnosed with severe COPD in 2013. The disease interfered with her ability to walk to meetings as a mental health counselor in Manhattan. But an exercise regimen improved her endurance, letting her resume those walks. “I can keep up the pace, knowing I won’t get short of breath,” she says. “I can get up that hill.”  

    Jean Rommes, an 80-year-old Iowan, has one-third of the average person’s lung capacity for her age, but “you can do a lot with that,” she says. “Your body just has to be as efficient as possible. And that’s what exercise really does.” 

    Tailoring your exercise program to your body

    It’s important to speak with a doctor about personalizing exercise for your specific form of COPD. The disease affects people at different fitness levels, and patients with COPD may have additional illnesses like heart disease, osteoporosis, and anemia that should be considered when crafting an exercise plan. 

    If you have moderate to severe COPD, your doctor may refer you to an accredited pulmonary rehab program. Lasting four to 12 weeks, these programs help you manage COPD through exercise, under the guidance of a team of experts. Rehab is covered by Medicare, most Medicaid plans, and many private policies. Yet, studies show that less than 5% of people with COPD who’d benefit from rehab actually receive it—mainly because they never learn about it or have limited access.

    “We’re extremely underutilized,” says Debbie Koehl, manager of pulmonary rehab at Indiana University Health Methodist Hospital. DiLorenzo, the New Jerseyan, didn’t hear about pulmonary rehab until four years after her COPD diagnosis. Before rehab, physical activity was often too demanding. “I was depressed and isolated,” she says.

    Read More: Why You Should Change Your Exercise Routine—and How to Do It

    When rehab starts, specialists will determine your fitness level. For instance, they’ll check your resting heart rate and how far you can walk in six minutes. Initially, rehab seemed like “baby exercises,” DiLorenzo says. With each session, though, “it became more difficult.” The expert team—respiratory therapists, physical therapists, exercise physiologists, occupational nurses, and physicians—monitors your improvement and adjusts your fitness plan based on your progress. 

    “We don’t push you too hard at the beginning,” says Kimberly Wiles, a respiratory therapist with the Allegheny Health Network in Pennsylvania. The goal is incremental improvements. If a patient can only walk for six minutes at 1 mile per hour on a treadmill, she’ll edge them up to seven minutes the next time. 

    Grace Anne Dorney-Koppel, from Maryland, was diagnosed in 2001 with just 26% lung function and given three to five years to live. During her first rehab workouts, “I was exhausted after 15 minutes,” she says. “But I threw myself into the program.” By the time it ended, she could walk the treadmill for 40 minutes—going 3.5 miles per hour at an incline.

    If you have supplemental oxygen, ask your doctor if it should be turned up during exercise. “If you need oxygen at rest, it’s almost certainly needed with exercise,” typically at higher flows, Mannino says.

    The best exercises

    Try to get cardio exercise at least three days per week, and strength training every other day. For the greatest benefits, aim for moderate activity most days or every day if you can.

    “Aerobic training fosters endurance,” Rochester says. This could mean walking on a treadmill or through the neighborhood. Riding a stationary bike occasionally is good for working other muscle groups. “You don’t want to train only one set of muscles,” Koehl explains. It’s beneficial to sustain activity throughout a workout, or you could try intervals, alternating exertion with periods of rest. 

    DiLorenzo does cardio, either on a treadmill or a stationary bike, three to five days per week. Rommes, the Iowan, prefers a NuStep, or a seated elliptical machine. Before starting with exercise, Rommes couldn’t walk from the parking lot to a nearby soccer field to watch her grandkids play. “It became easier and easier,” she says, until she could get there without any trouble.

    Strength training is essential. “With more strength, any work being done becomes easier,” Stewart says. You can exercise muscles with fitness bands or weights. This helps many patients with COPD who become breathless when lifting their arms above their heads, Mannino explains.

    Read More: How to Start Strength Training if You’ve Never Done It Before

    Rommes benefits from strength training. “It’s nice when I’m on an airplane and can put my own bag in the overhead,” she says. Dorney-Koppel was initially challenged to lift her forearms without any resistance, but she progressed to biceps curls with weights. 

    Balance exercises are another priority. “People with COPD often have balance problems as the disease progresses,” Dorney-Koppel says. In 2014, she founded the Dorney-Koppel Foundation to provide pulmonary rehab in places without access. Workouts that improve balance include single-leg stands, chair yoga, and tai chi.

    The COPD Foundation website offers further exercise guidance for those who can’t access in-person rehabilitation. Exercise classes for people with COPD are available online, but they often require payment and range widely in effectiveness, Rochester says. 

    Make it safe

    Before starting a new fitness program, seek expert advice to ensure proper form because “you don’t want to make things worse by causing an injury,” Mannino says. 

    The most common setback patients experience from exercise doesn’t involve the lungs, but rather muscle strains or tears, Mannino says. These injuries can interfere with exercise for weeks. During such inactivity, the lungs get worse. To avoid this predicament, warm up for five to 10 minutes before workouts.

    If you have other illnesses besides COPD, consult with your healthcare provider to learn if you should limit or avoid any specific exercises, Rochester says. Patients with COPD should also be especially careful to avoid exercising outdoors when air quality warnings have been issued, due to their lung sensitivities.

    Push yourself during exercise, but not too hard. COPD experts ask patients to refer to a 10-point scale of effort, fatigue and breathlessness, with 0 meaning the person is at rest. It’s good to exercise mostly at a moderate intensity, about 3 or 4. “We want people to get to 9 or 10 for a short period and then back off,” Mannino says. With excessive exertion, researchers find fewer benefits for COPD patients, and there’s greater risk of falls and related injuries.

    Warning signs of too much intensity include extreme shortness of breath, dizziness, chest pain, palpitations, and joint or muscle pain, Rochester says. “We tell people to listen to their bodies,” Mannino says.  

    Such self-knowledge requires experience. Stewart notes that patients with COPD often underestimate their ability to exercise. “That’s the most common category of people coming into a program,” he explains. Over time, confidence increases as “they prove to themselves that they’re doing okay,” he says. Other patients are overconfident, which could lead to injuries. In a supervised program, each patient learns the right approach for them, Stewart says.

    Breathing and nutrition for exercise

    Certain breathing strategies help people with COPD enjoy physical activity. These strategies, primarily pursed-lip breathing and diaphragmatic breathing, move air through their lungs more efficiently. “They really help to minimize the shortness of breath during exertion,” Rochester says.

    Pursed-lip breathing is especially effective, according to Rochester. Because it takes longer for patients with COPD to exhale for any given breath, compared to people without COPD, their lungs often don’t fully deflate. This is called air trapping, and the leftover air makes it hard to take a full breath. A slower, deeper breathing pattern reduces the amount of trapped air. It’s fostered when patients practice inhaling through the nose while exhaling slowly through pursed lips, as if whistling or playing the harmonica. In fact, the COPD Foundation runs a program called Harmonicas for Health to improve breathing by playing the instrument.

    Through pursed-lip breathing, patients get better at pacing their breaths during exertion. Otherwise, the instinct is to inhale and hold the breath—for example, while climbing stairs. “You want to do the opposite,” Wiles says, breathing slowly in and blowing out through pursed-lips until reaching the top of the stairs. “When in doubt, exhale.”

    Read More: The Most Exciting New Advances in Managing COPD

    With another strategy, diaphragmatic breathing, patients concentrate on distending their abdomen while taking in air. This approach counters a tendency among patients to breathe shallowly, Dorney-Koppel says. 

    Box breathing may help as well. With this technique, people inhale, hold their breath, exhale, and hold breath again for equal intervals, such as three or four seconds, repeating the cycle for several minutes. “A variety of breathing exercises, mostly pursed-lip and diaphragmatic breathing, is very important,” DiLorenzo says. “Many of us have trouble exhaling enough. By working on that, we extend our ability to be active.”

    For nutrition, avoid large meals and high-carb foods before working out, as they can make breathing harder. Diets high in carbs may increase air trapped in the lungs. Once consumed, carbs release gasses like carbon dioxide that cause this problem. “People without COPD have no problem with these gasses, but with COPD it’s more of an issue,” Mannino says. “I avoid carbs before exercise,” DiLorenzo says.

    Achieve exercise goals

    Speak with your doctor about setting realistic goals for exercise. Through exercise, some patients improve so much that they no longer require supplemental oxygen but, “I never guarantee that,” Koehl says. As people improve and set their sights on more activity, sometimes it’s actually helpful to increase supplemental oxygen to support this activity, Koehl notes.

    Other patients seek improvement on important metrics like walking distances. “There’s nothing better than watching a patient go from walking 200 feet to 1,000 feet,” Koehl says. 

    The ultimate goal for COPD patients is to cultivate a lifelong exercise habit that allows them to live their fullest. “By finding exercise, I managed to have the life I had before my diagnosis,” DiLorenzo says. Dorney-Koppel has exercised regularly for 23 years, far surpassing her three- to five-year prognosis. “I’ve been able to travel to give presentations for work,” she says. “It’s a triumph. I have survived.”

    Matt Fuchs

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  • As bird flu outbreaks rise, piles of dead cattle become shocking Central Valley tableau

    As bird flu outbreaks rise, piles of dead cattle become shocking Central Valley tableau

    TIPTON, Calif.  — 

    There’s a sickness hovering over Tulare County‘s dairy industry.

    On a recent 98-degree afternoon, dead cows and calves were piled up along the roadside. Thick swarms of black flies hummed and knocked against the windows of an idling car, while crows and vultures waited nearby — eyeballing the taut and bloated carcasses roasting in the October heat.

    Since the H5N1 bird flu virus was first reported in California in early August, 124 dairy herds and 13 people — all dairy workers — have been infected.

    And according to dairy experts, the spread of the virus has yet to abate.

    Two dead cows lie on the edge of a dairy farm in Tipton, Calif.

    “I’m surprised there are that few reported,” said Anja Raudabaugh, CEO of Western United Dairies, a California dairy trade organization, after being told the latest case number was 105. “This thing is not slowing down.”

    A similar observation was made by Jimmy Andreoli II, spokesman for Baker Commodities, a rendering company with facilities in Southern California, who said his workers are picking up a surge of dead cows throughout the San Joaquin Valley.

    “There’s definitely been an increased number of fallen animals lately, and some of that has got to be attributed to the long, hot summer we’ve had. And some of it, you know, certainly is attributed to the H5N1 virus,” he said, noting that one of his drivers picked up 20 to 30 animals at one farm in one day.

    He said at some farms the cows are intentionally being left on the roadside to reduce contamination — preventing further inter-farm spread. At others, the animals are left on-site — but away from live animals and people.

    An aerial view of a dairy farm.

    Central Valley dairy farms have been reeling from outbreaks of H5N1 bird flu in recent weeks. The mortality rate among infected cows has been higher than anticipated, industry experts say.

    The diseased carcasses are brought to Baker’s rendering site in Kerman, where the bodies are “recycled” and turned into “high protein” animal feed and fertilizer, or rendered into liquids that are then used in fuels, paints, varnishes, lubricants “and all sort of different industrial products.”

    He said the Kerman plant is operating normally with no service disruption, even with the heavy influx of diseased cattle. Although due to the large volume of dead animals and “the extra time required for sanitization procedures,” in some areas, pick-ups have shifted from daily to every-other day schedules.”

    “All of our customers are being serviced effectively,” he said.

    Despite the gruesome scene along the Tipton roadside, John Korslund, a retired U.S. Department of Agriculture veterinarian epidemiologist, said there was probably very little risk to public health in having the animals piled up — even if they were picked at and consumed by buzzards, ravens and flies.

    “At death, virus replication stops and putrefaction and heat begins to neutralize live virus,” he said. “Virus will survive on the carcass surface — not for long at 100 degrees — but temperature and acidification pretty rapidly neutralize it in the carcass, at least influenza viruses.”

    Raudabaugh said although she and the dairy farmers she represents had been reading about the virus for months before it hit, no one was prepared for the devastation and unevenness with which the virus has struck California’s dairy herds.

    She said on some farms, the cows seem virtually unaffected, despite being infected. While on others, the animals are dying in droves. She said she knows of one farm where nearly half the animals died.

    She also said some breeds are harder hit than others. For instance, Holsteins seem to suffer more than Jerseys.

    “The reason is because Holsteins produce more milk. So they have more volume for the virus to enjoy,” she said, noting research showing the virus’ affinity for mammary tissue.

    Asked if the disease was killing them on their hoofs, or if farmers were making tough decisions and euthanizing animals that seemed particularly ill with bacterial pneumonia, mastitis or bloat, she said it was the former.

    A cow sticks out its tongue at a dairy farm.

    Continuing H5N1 outbreaks in California dairy herds and reduced milk productivity among recovered cows is causing increasing concern among dairy operators.

    She said most of the animals that are succumbing to the virus are young — they are going through their second lactational cycles. (She said most dairy cows will have five or six lactational cycles before they are taken out of production and turned into beef or rendered).

    As a result, the farmers are doing what they can to keep these young animals alive “given the extreme rearing and raising and just expenses that go into raising these animals,” she said. “There’s hope that on the other side of the virus, they will come back into production that’s sustainable for the farmer. So it’s definitely a last resort if they are culling them.”

    It is unclear if infected dairy cows will recover full production when they enter a new lactational cycle. Observations suggest that production drops significantly in the current cycle, often to 60% or 70%.

    She said depression is becoming a bigger and bigger problem for dairy farmers who are struggling with high mortality rates in their cattle herds, as well as the financial burden of the disease.

    1

    Brandon Mendonsa, 37, a third generation dairy farmer in Tipton, has lo

    2

    Healthy dairy cattle bask in the morning light on the Mendonsa Farms property in Tipton, CA.

    1. Brandon Mendonsa, 37, a third generation dairy farmer in Tipton, has lost 28 head of dairy cattle to the H5N1 virus which he called covid for cows. There isn’t a cure for the virus which gives the cattle flu like symptoms and has led to a number of cattle deaths. A Holstein dairy cow at auction gets $2200.00 which would put Mendonsa’s losses at one $60,000. 2. Healthy dairy cattle bask in the morning light on the Mendonsa Farms property in Tipton, CA.

    If the cows don’t come back to full production, it could ruin many farmers, she said.

    “There’s real fear,” she said.

    The U.S. Department of Agriculture has a program to pay back farmers for production loss due to the virus. The program covers the three weeks of production lost by a cow when it is removed from the milking herd to recover, as well as the seven days afterward when production is still low.

    But there is currently no program to pay farmers or dairy workers who are affected by the virus, however, which is a concern for infectious disease experts, as well as farmworker advocates who say there is no incentive for dairy workers to report symptoms and isolate for 10 days (the current guidance).

    “The majority of dairy workers in California have no protections. Most of them are immigrants. And I would say at least half of them are undocumented,” said Elizabeth Strater, national vice president and director of strategic campaigns for United Farm Workers.

    “These are folks that don’t have a particular relationship of trust with state and federal government officials.”

    She said dairy work is coveted by immigrants — it’s not seasonal like crop work — and few Americans are hungry for the dangerous and exhausting work the positions require: Two milkings a day (often 15 hours apart) and moving large, unpredictable animals.

    “These workers are on the front lines of infectious outbreak, and if they somehow get tested and are tested positive, then they’re going to be looking at something that is financially a disaster,” she said. “Most people in the United States don’t want to miss two weeks of pay, right? Let alone these people who are already … some of the poorest people, and with the least protections. Without a safety net.”

    She said her organization and others are trying to inform as many workers as possible.

    “We are sharing as much information about how important it is for workers to get their seasonal flu shot this year, even if they don’t always do it,” she said. “But the thing is, that seasonal flu shot does not protect that worker, right? It protects me. It protects you. It protects the rest of the public from a situation in which someone who’s co-infected with two types of influenza exchanges that material” to someone else.

    Recombination of H5N1 with a human flu virus — in which the two viruses mix to potentially become a more contagious or harmful virus — is a major concern for public health officials.

    According to the U.S. Centers for Disease Control and Prevention, the current public health risk of H5N1 is low, but the agency said it was working with states to monitor people with animal exposures.

    The morning sun rises above cows in a pen.

    The morning sun rises above cows in a Tipton, Calif., dairy farm.

    Although the numbers of workers so far reportedly infected with H5N1 remains low, conversations with Tipton residents suggested it’s probably larger than has been reported.

    “A lot of people have it,” said a woman working behind the cash register at Tipton’s Dollar General, one of the few stores in this small, agricultural community right off of Highway 99.

    The woman declined to provide her name, explaining her husband is a dairy worker in the country illegally in Tulare County; she said his job is not protected or secure, and she was fearful of retribution.

    “So far the symptoms seem pretty mild,” she said. “People can keep working.”

    Susanne Rust

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  • How to Travel When You Have COPD

    How to Travel When You Have COPD

    For the 16 million Americans with chronic obstructive pulmonary disease (COPD), travel can be as anxiety-provoking as it is life-affirming. 

    The fatigue, chest tightness, congestion, and difficulty breathing that come with the chronic bronchitis or emphysema behind COPD can make the thought of travel seem overwhelming. There are so many questions: How would I handle a long flight? What do I need to bring? And how would I make my overall itinerary manageable?

    COPD may require a lot more planning, pulmonologists say, but for the majority of patients without the most severe lung disease—even those on oxygen—it’s certainly doable. 

    Here are the considerations doctors and COPD patients say you’ll need to keep in mind before you hit the road and while you’re away.

    Check-in with your doctor

    The first step is making an appointment with your pulmonologist to discuss the conditions at your destination, including altitude, air quality, and weather, as well as what you plan to do there. 

    “Our biggest concern is always the altitude,” says Dr. Roberto Swazo, a pulmonologist with Orlando Health Medical Group. “If you struggle at baseline, you are going to have a harder time at altitude than anywhere else.” 

    Traveling by plane will also mean a lower concentration of oxygen when you reach altitude, which could be challenging for those who struggle with blood oxygen levels.

    If you’re on oxygen already, your doctor can perform a high-altitude simulation test to determine if you’re fit to fly, and how much oxygen you will need to take with you. The procedure involves breathing a mix of oxygen and nitrogen that mimics the reduced oxygen environment of an airplane cabin, while monitoring your blood oxygen saturation and heart rate. If your doctor is unsure if you’ll need a prescription to travel with oxygen to make it through the flight, they can order a test to justify the prescription. 

    From there, you can determine what kind of oxygen concentrator you need for your flight and how many battery packs you require. You’ll have to procure any airline, train, or cruise documentation needed, as well as prescriptions for equipment or meds you need take with you. And plan for when you reach your destination.“We want to make sure you know where the nearest pharmacy is, and that you know where to go in an emergency,” Swazo adds. 

    Read More: The Most Exciting New Advances in Managing COPD

    It’s also important that you make these plans well in advance of your trip, Swazo says, so you have plenty of time to rent any equipment you need and notify your airline, cruise line, or hotel.

    Remember to get an updated COVID-19 booster a month before your flight, and make sure you have your RSV inoculation. If it’s a fall or winter trip, get a flu shot before you go. Your doctor can lay out an action plan for the steps to take in case you don’t feel well, with zones of green, yellow, and red, outlining what to do for each level of symptom severity. In this plan, you’ll take actions and use the medications and therapies specific to each zone, with red being emergency medical treatment.

    What to take with you 

    You’ll need to have your equipment and meds always within reach, including in your carry-on baggage on the plane. For those not prescribed oxygen, that might be as simple as making sure you have your rescue inhaler and all prescription and over-the-counter meds in your bag to control any symptoms. Those with more compromised lung function will need to bring supplemental oxygen along with medications. Swazo says that for his patients who have flare-ups at least a couple of times a year, he also prescribes steroids and antibiotics to take on their trips as a precaution. But be judicious with the drugs.

    “The instructions are clear: Don’t take it unless you need to,” he says. If there is a flare-up, he wants his patients to call him to make sure he can adjust dosing as needed. These medications should be brought in their original container with the prescription label on it, even if you usually use a weekly pill box.

    Keep a list of these medications with you in a travel folder, along with your oxygen prescription, and any letters from your healthcare provider, including your fit-to-fly report, your emergency contacts, and contact information for the airline, train, or cruise line on which you are traveling, advises the COPD Foundation. While this information might be on your smartphone on the MyChart app, you want to have it handy if there’s no cell service or WiFi, or if your battery dies.

    If you’re traveling out of state or out of the country, review your health plan’s coverage and buy additional temporary medical coverage or trip cancellation insurance you think you might need. If you can, consider having a friend, family member, or spouse travel with you—someone who understands your needs and can provide help when required.

    “I automatically know when I’m starting to get sick,” says Lisa Hall, 55, of Minnesota, who struggled with asthma for decades, before being diagnosed with COPD in 2005. “It feels stuffy, I get warm, and I have to sit there and take in deeper breaths and blow out longer.” 

    While she doesn’t travel with oxygen, Hall says her mom knows when she needs help and will say, “‘Lisa, take a deep breath.’ She notices when my breathing is getting shallower.”

    Traveling with oxygen

    Start your trip planning by working with a local oxygen supplier to ensure you not only have enough supplies to bring with you, but will have what you need at your destination. Most oxygen suppliers are part of a network and can make arrangements for you to have oxygen delivered to your hotel or other accommodation. Plan on doing this at least two weeks in advance of your trip. It’s also a good idea to ask for the contact information of the person your local supplier spoke to, so you can call and confirm a day or two before you travel that your equipment will be there when you arrive. 

    Read More: How Climate Change Is Punishing Asthma Sufferers

    If you’re staying in a hotel, make sure they know about any equipment that is to be delivered, and let them know to allow an employee to sign for it, and not to forget to have it brought to your room by the time you check-in.

    “That is not a surprise you want, when you roll into your hotel room at 10 p.m.,” says Dr. Steven Davis, associate professor at the Burnett School of Medicine at Texas Christian University. 

    Planes, trains, automobiles, and boats

    If you are taking to the skies, remember that airlines do not allow oxygen tanks on flights and do not routinely supply oxygen, although they have it for emergencies, Davis adds.

    You’ll need to take a portable oxygen concentrator (POC) that is aviation-approved as well as back-up batteries and an airline form that your health care provider filled out. Make sure you call the airline no later than 72 hours in advance of your flight to notify them of your condition. The general rule for battery life is to make sure you have enough to last from the time you take off until the time you land, plus an additional 50%. You will need more still to accommodate any layovers or delays.  

    The good news is that your medical supplies, such as nebulizers, concentrators, and batteries do not count against your carry-on limit so you can take what you need on board, stashing it either under the seat or in an overhead bin. 

    Tom Krueger, a 70-year-old traveler from Wisconsin who uses oxygen tanks at home to deal with his emphysema, said he was pleased with how well his portable oxygen concentrator worked on his flight, after testing it first on the ground.“It actually worked out better for me than using my tanks on the trip,” he says. 

    Krueger also requests wheelchair assistance to eliminate the long walk to his gate, and ease him through security, so he is not stressed and out of breath before the plane takes off. It also allows him to board first so he can get his luggage stowed and equipment in the right place before other people get on.

    “A lot of this is swallowing that big chunk of pride and recognizing your limitations,” Krueger says. “Don’t be shy to ask for help.” 

    Keep in mind that not every mode of travel is equal. Traina are easier than trains, for example. You can bring oxygen tanks and concentrators on Amtrak, as long as you call to reserve a spot for your equipment. You must have enough oxygen or battery life for your concentrator to go at least four hours without a charge, and the total weight of tanks may not exceed 120 pounds.

    Read More: Severe Asthma Patients on Ways Their Doctors Could Improve Treatment

    Car trips won’t require as much planning, but you will need to have enough tanks to last throughout your trip, and know where you can have empty tanks exchanged for new ones at your destination. Take your stationary concentrator to use at night, and any additional tubing, electrical outlet extenders or other supplies. Also remember to keep your phone charged up for emergencies.

    Cruises are a great way for travelers with COPD to see the world. Most large cruise lines allow passengers to travel with oxygen, as long as your medical documentation is approved and you call special services a month or more before the cruise to get oxygen delivered to the ship.

    Managing expectations 

    Once you’re at your destination, don’t push yourself too hard. Take an Uber or rent a scooter, so you can enjoy yourself without getting short of breath. And don’t feel like you need to keep up with travelers without lung disease. If you’re sightseeing and feel unwell, arrange a time and place to meet and just enjoy the street scene from a local café. 

    Krueger took in the stunning glacier views from the deck of his Alaska cruise and saw the ship’s stage shows, while his wife and her friends did the more taxing excursions. The trip was such a success he and his wife are considering a future trip to Florida in the winter.

    “I think there is a lot of benefit both physically and mentally to travel,” unless your COPD is really severe, Davis says. It’s such a confidence booster, he believes, knowing you can make it to family events, or cross off a bucket-list trip that you’ll always remember. “We do whatever we can to facilitate getting people to where they need to go.”

    Melinda Fulmer

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  • What to Know About MicroRNA, the Nobel-Prizewinning Discovery

    What to Know About MicroRNA, the Nobel-Prizewinning Discovery

    Two scientists have been award the 2024 Nobel Prize in Physiology or Medicine for their discovery of microRNA. Victor Ambros, professor of molecular medicine at the University of Massachusetts Chan Medical School, and Gary Ruvkun, professor of genetics at Harvard Medical School and an investigator at Massachusetts General Hospital, received the prize for revealing how microRNAs turn genes on and off.

    This isn’t the first time RNA has been honored recently. The molecule has been something of a scientific darling of late: last year, Katalin Kariko and Drew Weissman were awarded the Nobel Prize in Physiology or Medicine for their fundamental discovery that made mRNA-based vaccines possible, a development that transformed the COVID-19 pandemic.

    Here’s what the discovery of microRNA means and how it may affect human health.

    What is microRNA, anyway?

    The discovery makes it possible to manipulate which genes are activated or suppressed in cells. Doing so is critical to controlling the production of proteins that in turn regulate nearly all of the body’s functions. It’s one more level of genetic control that is making the next generation of disease treatments possible.

    Read More: FDA Approves the First New Schizophrenia Drug in Decades

    Like many scientific breakthroughs, the discovery was serendipitous. “It was something so unexpected that we ignored it for a while as schmutz,” Ambros said during an Oct. 7 press conference. It started in 1993 when he and Ruvkun worked together as postdoctoral researchers in Massachusetts and published what they thought was an interesting finding in worms that failed to develop properly due to two mutations they identified. The duo each took one of the genes to investigate further, initially focusing on looking for aberrant proteins coded by the mutant genes. Normally, DNA codes that make up genes lead to RNA sequences that cells then turn into proteins. Each cell in the human body, for example, contains the exact same DNA sequences, or blueprint—but depending on which genes are turned on and which are suppressed, they take on different characteristics and functions.

    Ambros and Ruvkun uncovered one of the ways that cells orchestrate this complex signaling: with what are called microRNAs.

    To Ambrose’s surprise, the end product of the mutant gene he explored wasn’t a protein but a tiny snippet of RNA, or microRNA. Ruvkun’s work on the other mutant gene showed that microRNA attached to the RNA made by his mutant gene and acted as a monkey wrench in the protein-making process, essentially blocking its production and leading to the worm’s abnormal development.

    The finding remained an anomaly in the world of worm researchers and was “met with almost deafening silence from the scientific community,” the Nobel Committee noted in its announcement. That is, until Ruvkun discovered another microRNA in 2000: this time one that also appeared in mice, other animals and, importantly, humans.

    The future of microRNA

    About 1,000 microRNAs have been identified in people, and while knowledge about the field is still in its infancy, these small pieces of RNA appear to be involved in a multitude of important processes, from development to basic cellular functions. Some have been implicated in diseases like cancer. Understanding how they work, and how to manipulate them to turn genes on or off, could potentially lead to many new therapies for myriad human diseases. Already, researchers are testing mircoRNA-based strategies in animals and early human studies to treat cancer and infectious diseases.

    “We know from genetic research that cells and tissues do not develop normally without microRNAs. Abnormal regulation by microRNA can contribute to cancer, and mutations in genes coding for microRNAs have been found in humans, causing conditions such as congenital hearing loss, eye and skeletal disorders,” the Nobel committee said. “MicroRNAs are proving to be fundamentally important for how organisms develop and function.”

    Alice Park

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  • Understand aging in pets | Animal Wellness Magazine

    Understand aging in pets | Animal Wellness Magazine

    Understand aging in pets, ensuring your dog or cat’s health and quality of life are enhanced for comfortable and meaningful later years.

    Aging is something every living being goes through, including our dogs and cats as well as ourselves. But what precisely is aging, and what are the different ways it can affect our animals? More importantly, understanding aging in pets can shift how we care for them and make the final stages of life less difficult and painful for both ourselves and our four-legged companions.

     

    Every Animal’s Experience is Unique

    Many of us associate aging with increased illness, weakness and debilitation, but advancing years do not, in and of themselves, lead to specific physical changes in every dog or cat. We’ve all seen animals in their upper teens with bright eyes and a joyful energy that seem to bely the number of birthdays they’ve had. Conversely, of course, many older animals are dealing with failing organs or other disease states. Common concerns in aging animals include difficulties with mobility, chronic pain and illness, personality changes, and cognitive decline. But are these issues really due to how old the dog or cat is?  

     

    Environmental chemicals contribute to “age related” issues

    During my time as a veterinarian, the age of a “senior” dog or cat dropped from over 12 to below eight. This is certainly not due to a sudden epidemic of rapid aging in animals. A combination of nutritional and environmental stressors has led to a situation in which animals show symptoms we have defined as age related, when perhaps they are simply a sign of a reduced ability to manage the current conditions of life.  

    It is no secret that our environment exposes us to many more chemicals than it did 30 years ago. Some of these chemicals include agricultural residues, artificial scents in laundry soaps and body products, or flame retardants in our homes. No one can say for certain what the effects of this stew of chemicals are because each safety study focuses on a single chemical with a short exposure time, rather than a combination of chemicals with an exposure duration of years or a lifetime. Although the popular saying claims “correlation does not equal causation”, the number of chronic disease states continues to grow as more chemicals are introduced into home environments or as residues in diet.

    Point to ponder: Perhaps we can combat aging by simplifying the chemicals used in the home, and choosing diets with ingredients sourced from organic farms, or those that use fewer agricultural chemicals. 

     

    Managing Aging in Pets for Better Quality of Life

    But what about dogs and cats that have already lived a decade or so within the above parameters and are now facing health challenges? Understanding aging in pets can guide us in several ways to ease the aging process and the health problems that often (though not always!) accompany it. 

     

    1. Putting a plan in place 

    When a client comes to me well ahead of the actual deterioration of their dog or cat, I tell them to begin deciding on the right medical approach for their family. This can be driven by circumstances such as finances, religious beliefs, and the willingness of the dog or cat to be treated in the first place. 

    Point to ponder: Having a loose plan in place can help alleviate fear of the future and allows the focus to be redirected to your animal’s present needs.  

     

    2. Growing allopathic and alternative treatment options

    The veterinary profession continues expanding to offer better medical options for the majority of disease states, and these come close to matching those offered by human medicine. They can help maintain an aging dog or cat’s well-being and quality of life much longer than in the past. 

    We have both allopathic and alternative options for pain and disease management, anxiety treatment, and mobility assistance at our disposal. Pharmaceutical, herbal, homeopathic, electromagnetic, vibrational, energetic and structural modalities are also available. Adhering too tightly to any single paradigm does not create the best outcome; using several different approaches often yields more complete results with fewer adverse effects.  

    Because it is virtually impossible to access every option from a single practitioner or hospital, having a team that includes your regular veterinarian, an integrative or holistic vet, boarded specialists, and rehabilitation practitioners creates wonderful outcomes for aging animals. Sometimes an animal parent will work simultaneously with several different modalities, or move from one to the next as their dog or cat’s needs change. 

    Point to ponder: While many treatments need to be done in the hospital or clinic setting, many can be done at home, thereby increasing treatment frequency while reducing overall cost of care.  

    Discussing what you envision for your aging animal’s care, and what options are available, starts with the veterinarian you see for routine physical exams. If they do not have the tools you are looking for, let them know you would like a team approach and ask for local referral options.  

     

    3. Euthanasia decisions for aging pets

    When is enough enough? The answer is a moving target that’s different for every family and every animal. Euthanasia is an important option when the dog or cat is clearly suffering and there are no ways left to alleviate that suffering. 

    As a veterinary practitioner, I was taught we should always reach for humane euthanasia, almost as if a natural death was a terrible thing. However, I have had more than one client inform me they had no intention of euthanizing their dogs or cats, and wanted my assistance keeping the animals comfortable to the natural end of life. I was very judgmental with these first few clients, but after watching them graciously support their animals until they passed on their own, I gained a new appreciation of the particular gift that comes with caring for a dog or cat at the end of life. I was also surprised by how gentle and easy a natural death could be.

    If you make a decision to euthanize your dog or cat, start by discussing it with your regular veterinarian. If they have had a years-long relationship with you and your animal, they will want to be a part of this final stage of the relationship. 

    Point to ponder: Some clinics offer in-home euthanasia, which can reduce the stress of a final car ride for animals that don’t like the car.  

    The senior years of your dog or cat’s life are a time to reflect on the wonderful experience you’ve shared with him. The journey through this end-of-life stage can be challenging, and ultimately painful when he passes – but it’s also full of love as you honor him with your caregiving efforts. Approaching an aging animal’s final phase of life with an open heart and mind can bring grace and comfort to both you and your beloved companion.

     

    Changing your perspective on aging and death

    The last years of a dog or cat’s life present particular concerns and challenges when it comes to healthcare and quality of life. But with an optimistic and appreciative approach, it can also be a time where your relationship with your companion animal deepens as he teaches you about end-of-life care.

    Many people begin the process of grieving for their dogs or cats months to years before they are actually faced with either euthanasia or a natural death. This grief arises from a fear of what is to come, both in the lives of their animals, as well as in their own lives after the dog or cat has passed. I have encountered deep anxiety among my clients and colleagues about how long to support a dog or cat in advanced age, and what specific steps should be taken. I believe this anxiety stems from a fear of losing control over exactly how and when a beloved animal companion will pass. I have even seen clients and colleagues choose euthanasia at a point when the dog or cat was still clearly engaged in life, in order to be able to gain a sense of control over a disease state or condition. 

    But what if we approached the end of life as a joyous culmination of a beautiful relationship? Understanding aging in pets from this perspective can shift how we care for them and make the final stages of life less difficult and painful for both ourselves and our four-legged companions. I feel this perspective helps ease our fears and brings comfort as we honor the wonderful beings that shared their lives with us. 

    Culturally speaking we don’t like to look at death. Our senior relatives are often put elsewhere, such as nursing homes or hospitals, to live out their final months or years. We rationalize it by saying we don’t have the time, or capacity, to properly care for them — and this is absolutely true. But we have also created a society that fears death and does not want to engage with it. 

    In veterinary medicine, we often pride ourselves on being more humane because we have the legal ability to end suffering. Too often, however, I have noticed it’s the animal parent’s suffering that is being treated by the euthanasia  as much as (if not more than) the animal’s. As a veterinarian, I do my best to guide animal parents in both the physical and emotional needs of their aging dogs and cats, but also towards an awareness of the emotional triggers that may be guiding their decision-making.

     


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    Ayse Washington, DVM, CCRP, CVMMP

    Ayse Washington, DVM, CCRP, CVMMP

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  • Former NFL Star Brett Favre Reveals He Has Parkinson’s. Here’s What to Know

    Former NFL Star Brett Favre Reveals He Has Parkinson’s. Here’s What to Know

    Former Green Bay Packers quarterback Brett Favre said that he has been recently diagnosed with Parkinson’s disease.

    The three-time NFL MVP made the revelation during his testimony before a House committee on federal welfare reform. Favre had previously been implicated for his connections to Mississippi’s welfare abuse scandal involving the Temporary Assistance for Needy Families (TANF) program and investments he made in a company that was researching treatments for concussions. The founder of that company pleaded guilty to wire fraud charges and was accused of misappropriating funds received through TANF for personal use. Favre allegedly received TANF money via Mississippi non profit groups for public appearances he did not make, but was not criminally charged. He has paid back some of the money he received, but state auditors say he still owes additional funds to the program.

    “I lost an investment in a company that I believed was developing a breakthrough concussion drug I thought would help others, and I’m sure you’ll understand why it’s too late for me, because I’ve recently been diagnosed with Parkinson’s,” he said in his testimony.

    Here’s what to know about the disease.

    What is Parkinson’s disease?

    Parkinson’s is a brain disorder that results in uncontrolled muscle movements and tremors that can affect everything from the extremities to more core body functions such as swallowing and speaking. It generally occurs with age, but can also result from certain genetic changes that are passed down in families, as well as medications, exposure to toxins, and traumatic injuries to the brain. In an interview on Today in 2018, Favre estimated that he suffered from “hundreds, maybe thousands” of concussions during his decades-long NFL career, in which he once played nearly 300 consecutive games. Favre did not indicate whether his history of concussions was directly related to his condition, or provide any additional details about his diagnosis. But since his retirement from the NFL, he has spoken about his concerns about concussions and the dangers of chronic traumatic encephalopathy among football players, and his own experiences with worsening short term memory.

    Are there treatments?

    Currently, there is no effective treatment that reverses or slows down the progression of Parkinson’s—only medications or surgical interventions that can alleviate some of the motor symptoms by addressing changes in the brain chemical dopamine that contribute to the condition. Patients generally cycle through different medications, which often work for a while, but when the tremors or unpredictable muscle movements return or worsen, doctors can combine or add other medications. For those who no longer respond to available drugs, deep brain stimulation, in which surgeons implant an electrode in the brain to help control tremors, can help. But the implants only address tremors and involuntary muscles movements; they can’t slow other Parkinson’s symptoms, such as cognitive changes or balance issues.

    The future of diagnosis and treatment

    Researchers are working on novel treatment strategies and are developing new ways to detect Parkinson’s earlier. Most of these target alpha synuclein, a protein that accumulates in patients with the disease. Doctors currently rely primarily on clinical symptoms—like tremors, slow movements, or muscle rigidity—to diagnose the condition. But researchers are developing a new test that looks for alpha synuclein in the spinal fluid, which could be a sign of early Parkinson’s.

    Until better treatments become available to address the root cause of Parkinson’s, however, even such tests might not be so useful. “The problem is that at this point, we don’t have any treatment to potentially slow the disease down,” says Dr. Rocco DiPaola, a neurologist at Hackensack Meridian Neuroscience Institute. “But down the road, should those treatments become available, then identifying people who are at risk earlier would be good to know, so we could potentially give them a medication that could either prevent or slow progression of the disease.”

    Alice Park

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  • NY Sees First Death From EEE Virus—How to Protect Yourself

    NY Sees First Death From EEE Virus—How to Protect Yourself

    Concerns about the dangers of mosquito-borne viruses are on the rise after the first New York resident to contract eastern equine encephalitis (EEE) since 2015 died last weekend, New York Gov. Kathy Hochul announced on Monday.

    “Eastern equine encephalitis is different this year. While we normally see these mosquitoes in two to three counties each year, this year they have been in 15 counties so far, and scattered all over New York State,” said State Health Commissioner James McDonald in a press release on Monday. “This life-threatening mosquito-borne disease has no commercially available human vaccine and must be taken seriously. Mosquitoes, once a nuisance, are now a threat.”

    The virus, which is contracted through the bite of an infected mosquito, has been on the rise across the Northeast, prompting Massachusetts coastal towns to shut down parks and playgrounds to better protect residents amid concerns about the deadliness of the disease. Some 30% of people who have a serious case of EEE die, according to the Centers for Disease Control and Prevention (CDC), though that number can be even higher in some years. 

    “The peak time for when these cases are going to be seen is right now, July through September,” says Erin Staples, CDC medical epidemiologist. 

    In 2024, only 10 people were infected with EEE, though the data was last updated on Sept. 17 and does not yet include the New York case.

    What is EEE? 

    Eastern equine encephalitis virus is a rare disease that is transmitted by various species of mosquitoes. Experts say that while cases are few and far between, and most people who contract the diseases are asymptomatic, the most severe cases can prove fatal. 

    “In individuals who do survive eastern equine encephalitis, we often do see folks go on to have virologic deficits longer term. So [it’s] definitely one of our more severe arboviral infections,” says Jennifer White, director of the Vector-Borne Disease Program at the New York State Department of Health. 

    Read More: Why Mosquitoes Are So Dangerous Right Now

    The virus causes inflammation in the brain that can then cause an onset of other symptoms, including fever, headaches, vomiting, weakness, etc., according to Staples. In more serious cases, people can also experience seizures and go into a coma. 

    Because EEE is a virus, there is no treatment for those infected. And unlike other mosquito-borne viruses, eastern equine encephalitis virus can affect people of all age groups. 

    Experts emphasize that it’s even more important to be cautious because the virus has no treatment. “With viral diseases that are transmitted to people, either through the bite of a mosquito or tick, there is not a specific medication, or antiviral,” says Staples. “The doctor may prescribe for more subtle symptoms…[but] with severe illness like eastern equine encephalitis, people will need to be hospitalized, and the healthcare system and doctors will help provide supportive care to try to get them through the acute illness.”

    Why is EEE more common in the Northeast? 

    EEE is found in mosquitos that live in fresh, hard water swamps along the Northeast, but it’s also seen across the Midwest, coastal regions on the East, and the Gulf Coast. 

    New Jersey, Massachusetts, Rhode Island, New Hampshire, New York, Vermont, and Wisconsin have all reported cases of EEE this year. 

    Staples says it’s hard to predict when arboviral diseases are on the upswing because the spread of the disease can depend on multiple factors, including the diseases’ spread to other animals like birds and horses. The highest number of cases ever recorded in one year was 38 in 2019, according to an article published in the National Library of Medicine Journal. 

    “If there’s less water, more water, hurricanes, or other things, that can obviously affect the ecosystem which birds live in. The CDC worked with New Jersey several years ago to look at why things had changed in terms of their EEE, and some of it was human use patterns and changing ecology which influenced where the virus would be located,” says Staples.

    How to protect yourself from EEE 

    The CDC is encouraging people to listen to their local and state officials in order to best protect themselves from EEE. 

    In New York, Hochul called on state agencies to increase access to bug repellent across state parks and facilities, as well as increase public outreach about the disease. Local health departments in the state are also expected to decrease park hours during what they consider peak hours of mosquito activity. White says that officials are especially concerned about EEE this year because there have been reports of the virus in mosquitoes, emus, and horses across 15 counties. “What sort of made this year unprecedented is the geographic range we’re seeing EEE in this year,” says White. “That has everyone’s concern level raised a bit, and we’re also seeing high levels of West Nile virus—we’re seeing more human cases than we have before.”

    The best way to protect yourself is by protecting your skin to avoid getting bitten. “That would mean things like wearing long sleeves, long pants at dawn and at dusk, when mosquitoes tend to be most active,” White says, while also mentioning the importance of wearing bug repellent. Staples adds that people should make sure they use EPA-recommended brands and check that their window screens are intact. Since water attracts mosquitoes, avoiding still water in your backyard is also pivotal. 

    “You just basically want to make your property, and any place with standing water, are inhospitable to mosquitoes,” says Staples. “If you have a bird bath, overturn that before mosquito larva gets a chance to develop into adults.” 

    “We’re not telling individuals not to be outside, but if you’re going to be outside to take steps to prevent you from getting a mosquito borne illness, protect yourself from mosquito bites whenever possible,” she adds. 

    Solcyré Burga

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  • New York State reports 1st human case of EEE in nearly a decade

    New York State reports 1st human case of EEE in nearly a decade

    NEW YORK — New York state reported its first case of eastern equine encephalitis in nearly a decade on Friday.

    The rare mosquito-borne virus was detected in Ulster County, the New York State Department of Health said. The individual is hospitalized, it said.

    The Ulster County Department of Health is currently investigating the case, which marks the first case of EEE confirmed in New York state since 2015, health officials said.

    “Eastern equine encephalitis is a serious and fatal mosquito-borne disease with no vaccine,” New York State Health Commissioner Dr. James McDonald said in a statement. “Even though temperatures are getting cooler, mosquito-borne illnesses are still a risk and New Yorkers must be cautious.”

    The human case comes after a case of EEE was confirmed in a horse in Ulster County in August, the state health department said. Earlier this month, two emus in New York’s Rensselaer County also tested positive for the virus, which does not spread directly from birds to humans, the department said.

    The latest human EEE case in New York brings the national tally to at least 11 so far this year, according to an ABC News tally. The national yearly average is 11, with most cases occurring in eastern or Gulf Coast states.

    Beyond New York, cases have been reported in at least six other states so far this year: Massachusetts, with four; New Hampshire, with two; and, with one each, New Jersey, Rhode Island, Vermont and Wisconsin.

    Between 2003 and 2023, there have been at least 196 EEE cases reported in the U.S., including 176 hospitalizations and 79 deaths.

    The best way to prevent infection from the disease is to protect yourself from mosquito bites, including by using insect repellant, wearing long-sleeved shirts and pants, treating clothing and gear and taking steps to control mosquitoes indoors and outdoors.

    “With the first confirmed human case of eastern equine encephalitis in Ulster County, I urge residents to take the recommended precautions to prevent mosquito bites and the risk of infection,” Ulster County Executive Jen Metzger said in a statement.

    Most people infected with EEE do not develop symptoms. For those who do, symptoms can include fever, headache, vomiting, diarrhea, seizures, behavioral changes and drowsiness, according to the U.S. Centers for Disease Control and Prevention.

    Approximately a third of all people who develop severe cases die, according to the CDC.

    ALSO READ | As mosquito-borne illnesses spread, here’s how to tell them apart

    As mosquito-borne illnesses spread, here’s how to tell West Nile, dengue and EEE apart

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  • Superbugs Could Kill 39 Million People by 2050 Says Study

    Superbugs Could Kill 39 Million People by 2050 Says Study

    A landmark new study published in the Lancet estimates that antimicrobial resistant pathogens, or AMR, will kill more than 39 million people by 2050.

    The study also predicts that 169 million deaths will be associated with drug-resistant infections by that year.

    “These findings highlight that AMR has been a significant global health threat for decades and that this threat is growing,” said Mohsen Naghavi, a professor at the University of Washington’s Institute for Health Metrics and Evaluation and the study’s author.

    Read More: 25% of Antibiotic Prescriptions Are Unnecessary. Here’s Why That’s So Dangerous

    AMR is becoming an especially large problem for the elderly. Adults above the age of 70 have experienced an over 80% increase in deaths attributed to AMR from 1990 to 2021, while deaths among children have decreased by more than 50%. All populations over the age of 25 experienced an increase in deaths attributable to antimicrobial resistance, the study found.

    The Global Research on Antimicrobial Resistance (GRAM) Project carried out the study, which saw over 500 researchers collect and analyze data from 204 counties over a 30 year period, in what is the first global analysis of AMR trends. Based on that data, the researchers forecast that South Asia, Latin America, and the Caribbean will have the highest AMR mortality rates by 2050. 

    AMR occurs when microorganisms that cause disease such as bacteria, viruses, or fungi no longer respond to medicines used to treat them. Overuse and misuse of antimicrobials are the main drivers of AMR, according to the World Health Organization.

    But millions of deaths could be averted via better prevention of infections, improved healthcare access, and new antibiotics, the GRAM study found.

    The study’s results come ahead of a U.N. high-level meeting on AMR, which will convene in New York City on Sept. 24.

    Anna Gordon

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  • Why Mosquitoes Are So Dangerous Right Now

    Why Mosquitoes Are So Dangerous Right Now

    Mosquito-borne diseases seem to be everywhere this year. Towns in Massachusetts are shutting down public parks and other outdoor areas after officials learned that mosquitoes in the region are carrying eastern equine encephalitis, a rare but deadly virus. And Dr. Anthony Fauci, the former top infectious-disease expert in the U.S., recently was hospitalized with West Nile virus that he allegedly acquired from a mosquito buzzing through his backyard.

    Is this a particularly bad year for disease-spreading mosquitoes in the U.S.? And what can we expect in the future?

    Why are mosquitoes are such a big threat

    Mosquitoes carry a number of viruses and parasites that can be harmful to human health, including malaria, dengue, yellow fever, chikungunya, West Nile virus, and eastern equine encephalitis. Different species of mosquitoes are adept at spreading different viruses.

    The species primarily responsible for spreading eastern equine encephalitis, Culiseta melanura, have drawn the most attention lately because of how deadly the disease is. But fewer than six cases have been reported so far this year in the U.S., and that’s pretty on par with what’s reported in New England every year, says Dr. James Shepherd, an infectious disease expert at Yale University School of Medicine. Despite the recent drastic actions of local authorities in closing down public areas, the number of infections so far this year don’t seem to be any greater than other years.

    The more concerning type of mosquito is actually the most common, says Shepherd. Mosquitoes belonging to the Aedes family cause most of the world’s malaria, dengue, yellow fever, West Nile, and Zika. They live primarily in urban, densely populated areas and can replicate in tiny amounts of water—just a capful of water can house hundreds of mosquito eggs. With an estimated 80% of people around the world now living in urban settings, “we are concentrating ourselves in much, much denser communities amongst urban mosquitoes,” Shepherd says.

    When it comes to West Nile Virus, data from the U.S. Centers for Disease Control and Prevention show that 38 states have reported more than 370 cases so far in 2024; last year, more than 2,500 cases were recorded nationwide, nearly double that reported in 2022. Experts note, however, that cases fluctuate depending on mosquito populations and the likelihood of human-mosquito interactions.

    Read More: How to Make Friends as an Adult—at Every Life Stage

    The risk of mosquito-borne infections is likely to increase, however, since mosquitoes are multiplying. “There is data indicating that the larger mosquito populations are, the more likely humans beings are to have an encounter with an infected mosquito,” says Dr. Photini Sinnis, professor and deputy director of the Malaria Research Institute at the Johns Hopkins Bloomberg School of Public Health. “While it’s true that so few mosquitoes are infected, the higher number of mosquitoes makes it more likely that such an encounter will happen.”

    Are there more mosquitoes now than before?

    “Mosquito populations are really climate-driven and habitat-driven,” says Sinnis. Global warming is making it easier for mosquitoes to survive in more parts of the world—and for longer. The warmer planet also helps them to squeeze in more reproductive cycles, and therefore produce more generations of insects, than ever before.

    “With climate change, we see the [habitat] ranges for concerning species like Aedes spreading northward,” says Jonathan Oliver, associate professor in the school of public health at the University of Minnesota. “And all predictions indicate that they are going to spread throughout the Southeast and up the Eastern Seaboard, and fairly high north in the Midwest. As mosquito species become established, people are potentially going to get exposed to a wide range of diseases they carry.”

    Take dengue, Zika, chikungunya, and West Nile Virus, for example. Shepherd says that in the past decade or so, as winters have become warner, the species that carries these diseases (A. albopictus) now breeds year-round in Connecticut. “We are going to see the march of these infections moving into more temperate zones in the U.S.,” he says.

    Milder winters also mean that those surviving mosquitoes can start reproducing earlier, in early spring rather than closer to summer, says Sinnis. “If it’s now only really cold in January and February, then they can start breeding at the beginning of March rather than in April or May,” she says. “Each breeding cycle increases the population by 10-fold. So by the time we get to summer, their populations have increased substantially.”

    Read More: 7 Metrics Everyone Should Know About Their Own Health

    Warmer temperatures also affect how viruses survive and thrive inside the insects. “If it’s warmer for a longer part of the year, then the mosquitoes are active longer,” says Oliver, which affects their biology. “If it’s warmer, the virus reproduces faster inside the mosquito and reduces the window of time between when the mosquito becomes infected and when it becomes infectious.” Studies also show that mosquitoes can become increasingly infectious over the course of a season, which in turn raises the chances that they can bite and sicken people with whatever virus they are carrying, he says.

    Growing urbanization and densely packed cities—with less-than-ideal sewage and sanitation systems—also provide more and fertile environments for mosquitoes to lay eggs and proliferate. Around the world, “urbanization is occurring in a very haphazard fashion,” says Shepherd. In many cases, “it’s not planned and there is no community development, so these cities are ringed by vast shanty towns that are poorly served without water, sewage, and electricity.” These, he says, “are perfect places for infectious diseases to transmit.”

    Another factor is likely fueling the rise of mosquitoes. With increased urbanization comes the destruction of the natural landscape, which contributes to a drop in the biodiversity of species. “The decreased abundance of species is allowing expansion of infectious disease host species and their vectors [like mosquitoes], because they tend to be the most adaptable,” says Shepherd. As abundant insect species are killed off, for example, he says more adaptable ones like Aedes may be filling the void and flourishing.

    How to protect yourself from mosquito-borne diseases

    Try to avoid coming into contact with mosquitoes in the first place, and lower your chances of getting bitten if you do. That means wearing long-sleeved clothing when outdoors and spraying yourself with insect repellent. You can also eliminate mosquito-breeding grounds by getting rid of any standing water around your home, since mosquitoes just need a little bit of water in which to lay their eggs.

    On a broader level, researchers are working on ways to reduce mosquito populations, including traps that attract different mosquito species with specific odors. The traps contain larvicides that destroy any eggs mosquito may lay, thus reducing their populations. But developing the traps requires more detailed knowledge about different species and how to attract them than is currently known, says Sinnis. “What we’d really like to do is to be able to predict when and where mosquito populations might be high,” she says. “But we need to learn more about the habits of specific mosquitoes and where they like to lay their eggs.”

    Some scientists are turning to genetic modification to manipulate mosquito populations. By introducing sterile males into a region, for example, they could drastically reduce or even eliminate future generations of insects. But this is still being tested, as researchers want to make sure that plummeting mosquito populations won’t have more lasting or unintended ecological consequences.

    Another strategy that appears encouraging is infecting mosquitoes with a bacterium that kills the viruses they may carry. This approach has been used in Southeast Asia and Australia to lower the rates of dengue transmission.

    More such approaches are needed in order to fully understand and control mosquitoes and the diseases they carry, say experts. “If we are interested in addressing mosquito-borne diseases before they become really rampant, we need to devote more public health funding to mosquito surveillance,” says Sinnis. With climate change affecting so many species, including mosquitoes, such knowledge is even more critical. “Chances are, [mosquito-borne illnesses] are going to get worse rather than better.”

    Alice Park

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  • What to Know About Mpox in 2024

    What to Know About Mpox in 2024

    For the second time in two years, the World Health Organization (WHO) has declared mpox a public health emergency of international concern. Mpox didn’t disappear in between the two outbreaks, but the WHO’s new announcement signals that it is again becoming a significant concern for global health.

    Right now, the mpox outbreak is concentrated in Africa, where the virus has long been endemic in certain areas. The illness is particularly prevalent in the Democratic Republic of the Congo (DRC), but countries including Burundi, Nigeria, Kenya, Uganda, and the Central African Republic also have cases. Sweden and Thailand have each reported a travel-associated case linked to the outbreak.

    Currently, the WHO says risk to people in other parts of the world is “moderate.” Here’s what to know about mpox in 2024.

    How is this outbreak different from 2022?

    The current outbreak is more complicated than what the world experienced two years ago, says Dr. Krutika Kuppalli, an infectious disease physician who worked on the WHO’s mpox response during the 2022 outbreak. 

    That outbreak was linked to one clade (or strain) of the virus: clade 2b. That clade never went away completely, but many countries were able to contain its spread. Now, cases linked to clade 2b continue to be diagnosed in many places, while countries in Central and Eastern Africa are also reporting cases related to another strain, known as clade 1. Some countries, including the DRC, have also seen cases resulting from a recently identified subvariant of clade 1, labeled clade 1b. “We’re still learning about this new variant,” Kuppalli says.

    Read More: 9 Weird Symptoms Cardiologists Say You Should Never Ignore

    Health authorities including the U.S. Centers for Disease Control and Prevention (CDC) say clade 1 tends to be more severe than clade 2b, and some estimates have placed the new clade 1b’s case fatality rate as high as 6%. But research findings released in August suggests clade 1 has a lower mortality rate than experts initially thought—around 1.7%—when patients receive adequate medical care. A small study published in Nature Medicine in June also found that about 1.4% of patients infected with the new variant died. Kuppalli says emerging reports from the region suggest the rate may be even lower, around 0.7%, which is encouraging.

    How is mpox spreading? 

    When someone has mpox, they often have flu-like symptoms before developing a blister-like rash. They are considered contagious until the rash has fully healed, according to the CDC.

    Mpox is often transmitted through direct skin-to-skin contact with someone who is infected. But it can also spread via exposure to infected animals, contact with a sick person’s bodily fluids, or from a pregnant person to their fetus, the CDC says.

    Read More: AI Could One Day Engineer a Pandemic, Experts Warn

    During the 2022 outbreak, sexual contact among men who have sex with men was a major driver of spread worldwide. Sexual contact is still contributing to a high percentage of cases, according to the WHO. But during the current outbreak in Africa, the virus also seems to be spreading through non-sexual forms of person-to-person contact, the agency says. Children have been disproportionately affected in the DRC—predominantly with the original clade 1 strain, which is known to affect kids, Kuppalli says.

    Reasons for shifting transmission patterns are “probably multifactorial,” she says. Possible reasons include decreased population-wide immunity since people are no longer routinely vaccinated against smallpox (which is similar to mpox), changes to the virus itself, increasing spillover from animals, or the prevalence of compounding health problems—like other infections or malnutrition—that make people more vulnerable. There also seems to be some animal-related transmission occurring in the DRC, according to CDC research.

    Are mpox rates going up in the U.S.?

    As of Aug. 22, the U.S. had not identified any cases linked to clade 1 mpox. But cases related to the strain that caused the 2022 outbreak continue to be diagnosed. “People forgot mpox was still here,” says Dr. Jason Zucker, an infectious disease physician at NewYork-Presbyterian/Columbia University Irving Medical Center. “Even though mpox left the news and we thought about it a lot less, that doesn’t mean it actually went away.”

    More than 1,700 mpox cases have been reported in the U.S. so far this year, according to preliminary CDC data. That’s far lower than during the initial outbreak, when more than 30,000 cases were diagnosed from 2022 into the first half of 2023.

    Even with clade 2b continuing to spread, Zucker says he’s optimistic that cases will not rise anywhere close to as high as they previously did. Mpox’s spread in 2022 was unexpected, leaving laboratories, physicians, and public-health systems scrambling to catch up. Now, Zucker says, people with symptoms are more seamlessly diagnosed, tested, and treated, and vaccines are available for those who need them.

    Should I get vaccinated?

    The CDC’s Advisory Committee on Immunization Practices recommends mpox vaccination only for people with certain risk factors, such as men who have or expect to have multiple male sexual partners. With risk of transmission currently low for the general U.S. public, “there’s no reason right now for anyone who’s not in vulnerable populations to be running out to get a vaccine,” Zucker says.

    Read More: What to Know About the KP.3.1.1 Variant of COVID-19

    Researchers are still determining whether existing mpox vaccines will work against the new clade. There’s not much real-world data available yet, but there’s good reason to think they will, says Alessandro Sette, co-director of the Center for Vaccine Innovation at the La Jolla Institute for Immunology. The currently used shots work against both smallpox and mpox, which suggests they have fairly broad efficacy, Sette says. Pox viruses also tend to mutate less dramatically than viruses like SARS-CoV-2 and influenza, he says.

    To help contain the outbreak, the U.S. has agreed to donate 50,000 mpox vaccine doses to the DRC, along with money to support rollout. Countries including Germany and Japan are also donating shots.

    Kuppalli says it’s also important to scale up surveillance, testing, and high-quality medical treatment on the ground. “The focus really needs to be on where the outbreak is happening right now, which is in Africa,” she says. “In some cases, that [fact] has been lost a little bit.”

    Jamie Ducharme

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  • Rare Mosquito-Borne Disease Causes First Death in N.H.

    Rare Mosquito-Borne Disease Causes First Death in N.H.

    A New Hampshire resident has died of Eastern Equine Encephalitis (EEE) after testing positive for the rare mosquito-borne disease at the hospital, health officials said Tuesday.

     The New Hampshire Department of Health and Human Services revealed that the person who died of EEE was an adult, and was hospitalized due to severe central nervous system disease before they passed away from their illness, according to a press release.

    The man was then identified by his family as 41-year-old Steven Perry. The family told WBZ that Perry did not have any underlying conditions.

    This is the first New Hampshire resident to die of EEE since 2014, and the first infection in the state since that year. In 2014, DHHS identified three human infections, including two fatalities.

    “We believe there is an elevated risk for EEEV (the virus that causes EEE) infections this year in New England given the positive mosquito samples identified,” said New Hampshire State Epidemiologist Dr. Benjamin Chan. “The risk will continue into the fall until there is a hard frost that kills the mosquitos. Everybody should take steps to prevent mosquito bites when they are outdoors.”

    The press release also shared that EEE has been detected in one horse and seven mosquito batches in New Hampshire so far this summer, and it pointed to the multiple recordings of EEE in its neighboring states of Vermont and Massachusetts.

    Per the Center for Disease Control (CDC), EEE is incredibly rare, but it is very  serious. There are typically only a handful of human cases of EEEeastern equine encephalitis in the U.S. each year —the average being 11 cases reported annually, according to the CDC. Still, the CDC cites the mortality rate for EEE as 30%, and those who survive often experience severe neurological harm.

    Symptoms can include fever, headache, vomiting, diarrhea, seizures, behavioral changes, and drowsiness. According to the Massachusetts DPH, inflammation and swelling of the brain, called encephalitis, is the most dangerous and frequent serious complication of EEE. There is currently no vaccine for EEE, but the CDC recommends clinical monitoring and pain management by medical health professionals in order to relieve symptoms.

    Humans and some mammals are what’s known as “dead-end hosts,” meaning they do not spread the virus, even though they get sick, to mosquitoes that bite them.

    According to the Massachusetts Department of Public Health, four towns in Massachusetts have raised the EEE risk level to “critical” and six towns have also raised their EEE risk levels to “high.”

    Read more: What to Know About the Rare But Deadly Mosquito-Borne Virus Concerning U.S. Towns

    The New Hampshire DHHS provided some advice to constituents to prevent mosquito bites, especially as EEE crops up. This includes using “effective mosquito repellents,” wearing long sleeves and pants when outside. especially during peak mosquito hours in the early morning and evening— or, avoiding outdoor activities during those hours altogether.

    They also recommended draining standing water around the home and placing or repairing bug screens.

    Rebecca Schneid

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  • What to Know About the Oropouche Virus, Also Known as Sloth Fever

    What to Know About the Oropouche Virus, Also Known as Sloth Fever

    More than 20 people returning to the U.S. from Cuba have been infected with a virus transmitted by bugs in recent months, federal health officials said Tuesday. They all had Oropouche virus disease, also known as sloth fever.

    None have died, and there is no evidence that it’s spreading in the United States. But officials are warning U.S. doctors to be on the lookout for the infection in travelers coming from Cuba and South America.

    Here’s a look at the illness and what sparked the alert:

    What is Oropouche virus?

    Oropouche is a virus that is native to forested tropical areas. It was first identified in 1955 in a 24-year-old forest worker on the island of Trinidad, and was named for a nearby village and wetlands.

    It has sometimes been called sloth fever because scientists first investigating the virus found it in a three-toed sloth, and believed sloths were important in its spread between insects and animals.

    How does Oropouche virus spread?

    The virus is spread to humans by small biting flies called midges, and by some types of mosquitoes. Humans have become infected while visiting forested areas and are believed to be responsible for helping the virus make its way to towns and cities, but person-to-person transmission hasn’t been documented.

    How many cases have there been?

    Beginning late last year, the virus was identified as the cause of large outbreaks in Amazon regions where it was known to exist, as well as in new areas in South America and the Caribbean. About 8,000 locally acquired cases have been reported in Bolivia, Brazil, Colombia, Cuba, and Peru.

    Some travelers have been diagnosed with it in the U.S. and Europe. The U.S. Centers for Disease Control and Prevention on Tuesday said 21 U.S. cases have been reported so far—20 in Florida and one in New York—all of whom had been in Cuba. European health officials previously said they had found 19 cases, nearly all among travelers.

    What are the symptoms and treatments?

    Symptoms can seem similar to other tropical diseases like dengue, Zika or malaria. Fever, headaches and muscle aches are common, and some infected people also suffer diarrhea, nausea, vomiting or rash.

    Some patients suffer recurring symptoms, and 1 in 20 can suffer more severe symptoms like bleeding, meningitis and encephalitis. It is rarely fatal, though there are recent reports of deaths in two healthy young people in Brazil.

    There are no vaccines to prevent infections and no medicines available to treat the symptoms.

    Are there other concerns?

    In Brazil, officials are investigating reports that infections might be passed on from a pregnant woman to a fetus—a potentially frightening echo of what was seen during Zika outbreaks nearly a decade ago.

    The CDC has recommended that pregnant women avoid non-essential travel to Cuba and suggested all travelers take steps to prevent bug bites, such as using insect repellents and wearing long-sleeved shirts and long pants.

    Mike Stobbe / AP

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  • The Rare But Deadly Mosquito Virus Concerning U.S. Towns

    The Rare But Deadly Mosquito Virus Concerning U.S. Towns

    A coastal town in Massachusetts is shutting its parks, playgrounds, and fields from dusk to dawn due to concerns about the mosquito-borne virus Eastern equine encephalitis (EEE). 

    Plymouth put the early closures in place on Aug. 23, and advised the public to remain cautious and follow the tips found on the Massachusetts Department of Health’s (DPH) website. The news comes after state health officials revealed on Aug. 16 that a man in his 80s had caught EEE after being exposed in Worcester County—reportedly the first human case in Massachusetts since 2020. 

    “As Mass DPH has now elevated Plymouth’s EEE risk status to high, it is important to take extra precautions when outdoors and follow state and local health guidelines to avoid unnecessary risk of exposure to EEE,” said Plymouth’s Commissioner of Health and Human Services, Michelle Bratti in a press release. “The health and safety of our community, residents, and visitors remain our priority.”

    Worcester County in Massachusetts is also concerned about the mosquito-borne virus. On Saturday, Aug. 24, state officials announced that they plan to spray for mosquitoes in sections of Worcester and Plymouth counties due to EEE.

    Here is what you need to know.

    What is Eastern equine encephalitis?

    Per the Massachusetts DPH, EEE is very rare, but incredibly serious. Since the virus—that is spread through the bite of an infected mosquito—was first identified in Massachusetts in 1938, just over 115 cases have occurred. Furthermore, outbreaks of EEE usually occur in Massachusetts every 10-20 years.

    The press release sent out by the town of Plymouth stated that, per the Massachusetts DPH, the “EEE fatality rate in humans varies from 33% to 70%, with most deaths occurring 2–10 days after the onset of symptoms.”

    Symptoms can include fever, headache, vomiting, diarrhea, seizures, behavioral changes, and drowsiness. According to the Massachusetts DPH, inflammation and swelling of the brain, called encephalitis, is the most dangerous and frequent serious complication of EEE.

    EEE can exacerbate quickly and some patients may go into a coma within a week.

    Humans and some mammals are what’s known as “dead-end hosts,” meaning they do not spread the virus, even though they get sick, to mosquitoes that bite them.

    How is Eastern equine encephalitis tested and treated? 

    EEE is diagnosed through symptoms and through testing spinal fluid or blood, which can show if the virus or viral antibodies are present in the body.

    There are currently no vaccines for humans or targeted treatments for EEE. Per the Centers for Disease Control and Prevention (CDC), clinical management of the virus is advised. Patients with EEE require close monitoring by their health care provider, who may prescribe pain control or other treatments to deal with the specific symptoms of EEE.

    Overall, prevention is key. In Plymouth’s Aug. 23 notice, the city recommended certain strategies for citizens to avoid mosquito bites, including draining standing water, wearing long sleeves and pants during peak mosquito hours, and installing screens in your home. They also recommended utilizing bug repellant, specifically a repellent with an EPA-registered ingredient

    Animal owners should reduce potential mosquito breeding sites on their property by eliminating standing water from containers such as buckets, tires, and wading pools—especially after heavy rains.

    What U.S. towns have raised their EEE risk level to “critical” or “high”?

    Four towns in Massachusetts have raised the EEE risk level to “critical”—Douglas, Oxford, Sutton, and Webster.

    According to the Massachusetts Department of Public Health, the towns of Carver, Dudley, Middleborough, Northbridge, and Uxbridge also raised their EEE risk levels to “high,” joining Plymouth.

    Concern is also mounting over the West Nile virus, which is primarily spread by mosquitoes. In July, multiple local health departments warned citizens after officials detected mosquitoes carrying West Nile virus in states across the U.S. As of Aug. 20, the CDC had recorded 216 cases in 33 states in 2024

    On Aug. 24, it was confirmed that Dr. Anthony Fauci, who served as the chief medical advisor to the President from 2021 to 2022, had been hospitalized after being infected with West Nile virus. He is now recovering at home.

    Rebecca Schneid

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  • Dr. Fauci Was Hospitalized With West Nile Virus

    Dr. Fauci Was Hospitalized With West Nile Virus

    Dr. Anthony Fauci, the former top U.S. infectious disease expert, spent time in the hospital after being infected with West Nile virus and is now recovering at home, a spokesperson confirmed Saturday.

    Fauci is expected to make a full recovery, the spokesperson said on condition of anonymity due to security concerns.

    West Nile virus is commonly spread through the bite of an infected mosquito. While most people don’t experience symptoms, about 1 in 5 can develop a fever, headache, body aches, vomiting, diarrhea, or rash, according to the Centers for Disease Control and Prevention. About 1 out of 150 infected people develop a serious, sometimes fatal, illness.

    CBS News’ chief medical correspondent, Dr. Jonathan LaPook, wrote in a social media post that he spoke Saturday with Fauci, who said he was likely infected from a mosquito bite that he got in his backyard.

    “Dr. Fauci was hospitalized about ten days ago after developing fever, chills, and severe fatigue,” the post on X said. It said Fauci spent a week in the hospital.

    As chief White House medical adviser, Fauci was the public face of the U.S. government during the COVID-19 pandemic, a role that made him both a trusted voice to millions and also the target of partisan anger. He left the government in 2022 but was back before Congress in June to testify as part of Republicans’ yearslong investigation into the origins of COVID-19 and the U.S. response to the disease.

    Fauci last summer joined the faculty at Georgetown University as a distinguished university professor.

    There are no vaccines to prevent West Nile, or medicines to treat it. As of Aug. 20, the CDC had recorded 216 cases in 33 states this year. It’s best prevented by avoiding mosquito bites.

    CAROLYN THOMPSON / AP

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  • What to Know About Parvovirus B19

    What to Know About Parvovirus B19

    Parvovirus B19, a respiratory virus that causes a telltale “slapped-cheek” rash, is on the rise in the U.S., according to an Aug. 13 alert from the U.S. Centers for Disease Control and Prevention (CDC).

    There’s no routine surveillance for parvovirus in the U.S., but several indicators suggest the virus is spreading widely right now, the CDC says. Doctors have reported unusual numbers of parvovirus-related complications among two high-risk populations: pregnant people and patients with blood diseases. And as of June, laboratory data hinted that about 10% of the U.S. population—and 40% of kids ages 5 to 9—had antibodies in their blood suggesting they were recently infected, the CDC’s alert says.

    Here’s what to know about parvovirus B19 as the virus circulates.

    What is parvovirus B19?

    Parvovirus is a common respiratory illness, with “mini-outbreaks” occurring roughly every three to four years, according to the National Library of Medicine (NLM). In developed countries like the U.S., the vast majority of people get it at some point during their lives, often during childhood. Up to 10% of kids get parvovirus by the time they’re 5, the NLM says, and about half of people have had it by age 20.

    Parvovirus B19 is a virus that solely affects humans; it’s different from the parvovirus that affects pets. Like other respiratory diseases, it spreads person-to-person, commonly through the respiratory droplets expelled when a sick person sneezes or coughs, the CDC says.

    Read More: I Was Exposed to COVID-19. How Long Will It Take for Symptoms to Start?

    Most of the time, the CDC says, cases are mild or even asymptomatic. When people do develop symptoms, they commonly start with fever, headache, cough, and a sore throat. As the illness progresses, people may develop additional symptoms. The most distinctive later-phase symptom is a red facial rash—also known as a “slapped-cheek” rash—that more commonly affects children than adults. Some may also develop a rash covering the torso, limbs, and buttocks.

    Patients with parvovirus may also develop joint pain as their illness progress. Sometimes, according to the CDC, joint pain is the only symptom adults experience, and it may last for weeks or even months following infection.

    Is parvovirus B19 serious?

    People who are otherwise healthy usually recover from parvovirus on their own and require no treatment. But complications are possible for certain groups.

    Read More: The 1 Heart-Health Habit You Should Start When You’re Young

    People with blood disorders or compromised immune systems may experience potentially serious anemia—a drop in red blood cells—if they catch parvovirus, according to the Mayo Clinic. And pregnant people who catch the virus may pass it to their fetus, potentially causing anemia in the fetus and raising the risk of miscarriage or stillbirth. People who fit into these categories should see a doctor if they think they have parvovirus.

    What should I do during the parvovirus B19 outbreak?

    There is no vaccine that can prevent parvovirus’ spread, so the best way to avoid infection is to wash your hands frequently, clean communal surfaces like doorknobs regularly, and avoid direct contact with someone who is sick with the virus. People are most contagious during the early phases of the illness, the CDC says. Someone is unlikely to be contagious by the time they develop a rash or joint pain.

    During the current outbreak, the CDC says, people who work in high-risk settings—such as schools and daycares—or who are at high risk of complications may consider wearing a mask for additional protection.

    Jamie Ducharme

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  • The Link Between a Mother’s Lupus and a Child’s Autism

    The Link Between a Mother’s Lupus and a Child’s Autism

    At the turn of the 21st century, the prevalence of autism spectrum disorder among American children was roughly 1 in 150. That’s according to data collected by the Autism and Developmental Disabilities Monitoring Network of the U.S. Centers for Disease Control and Prevention. A decade later, in 2010, the prevalence had risen to 1 in 68 children. By 2020, it had climbed again—to 1 in 36 children. “The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically in recent decades, supporting the claim of an autism epidemic,” wrote the authors of a 2020 study in the journal Brain Sciences.

    The precise cause and extent of that epidemic are contested. Some researchers have observed that the diagnostic criteria for ASD have evolved during that time—stretching and broadening to include a wider array of conditions. And so part of the rise in diagnoses, they argue, is likely attributable to dilating conceptions and a deeper understanding of autism. Still, the increasing prevalence of ASD diagnoses has spurred greater scientific interest in the underlying causes of the disorder. That work has revealed a possible connection between ASD and autoimmune conditions, including systemic lupus erythematosus (SLE).

    “For quite a while, there’s been a link between maternal autoimmune diseases and risk for having a child with autism,” says Paul Ashwood, a professor of medical microbiology and immunology at the University of California, Davis and the MIND Institute, which focuses on autism and other neurodevelopmental conditions. He mentions work based on nationwide data collected over a period of many years from mothers and their offspring in Denmark. That research found that prenatal exposure to a number of different maternal autoimmune diseases, including both lupus and rheumatoid arthritis, was associated with an increased risk for an eventual autism diagnosis.

    Since then, more research has firmed up the apparent association, and also found evidence of a broader connection between a pregnant woman’s immune system and the risk of an offspring with autism. “What we’ve been looking at a lot more recently is how anything that generates a maternal immune response could be linked to autism risk,” Ashwood says.

    Read More: The Most Exciting New Advancements in Managing and Treating Lupus

    Antibodies and the developing brain

    In response to a threat, such as a virus or other pathogen, the immune system produces protein antibodies that are intended to neutralize or eliminate the danger. But among people with autoimmune conditions such as systemic lupus erythematosus, the immune system produces antibodies that attack the body’s own healthy proteins or tissues. These are called autoantibodies.

    In a 2015 study in the journal Arthritis and Rheumatology, a group of Canadian researchers found that children born to women with systemic lupus erythematosus were nearly twice as likely to develop autism as children of women who did not have SLE. Furthermore, the children of mothers with SLE tended to be diagnosed with autism at a younger age than those of mothers without SLE. 

    “In-utero exposures to maternal antibodies and cytokines [proteins that regulate the growth of immune system cells] are important risk factors for ASD,” the authors of that study wrote. Women with SLE “display high levels of autoantibodies and cytokines,” which have been shown in animal models to alter fetal brain development and induce behavioral anomalies in offspring, they added.

    “Maternal antibodies, including autoantibodies, start crossing the placenta barrier around day 100 of gestation, and we know that this can affect the developing fetus,” says Judy Van de Water, professor of medicine and associate director of biological sciences at the University of California, Davis and the MIND Institute. “One of the things we’re looking at is how these autoantibodies or other aspects of the mother’s immune response could affect neurodevelopment.”

    Some research has already found that maternal autoantibodies related to SLE may lead to the development of heart conditions and also blood and liver abnormalities in a developing fetus. Van de Water and her colleagues are examining whether and how other autoantibodies may similarly affect fetal brain development. “Several of the proteins that these autoantibodies target are really highly expressed in the developing brain, and not the mature brain,” she says. This may create unique exposure risks for a developing fetus.

    Read More: How Changing Your Diet Could Have a Major Impact on Managing Lupus Symptoms

    The immune-autism link

    Apart from lupus, several other maternal autoimmune disorders, including rheumatoid arthritis, have been tied to an increased risk for having children with autism. The same is true of immune-related conditions such as asthma and allergies. Van de Water and other researchers are now taking a broad look at how a pregnant woman’s immune system activity may affect the fetal brain. “Anything that impacts maternal immune homeostasis or the balance of the immune response in the mother could impact neurodevelopment in the child,” she says. “So we’re looking at different immune systems responses—what the response is, how intense the response is, the makeup of inflammatory markers—and their relationships to autism.” 

    An autoimmune condition like lupus is one source of a heightened maternal immune response, but Van de Water says that, under the right conditions, just about anything that triggers an immune reaction could potentially affect neurodevelopment in ways that contribute to autism. “We’re looking at a lot of different maternal immune activations or perturbations—whether from an existing condition or illness, or something that happens during pregnancy,” she says. 

    In particular, experts highlight the role that inflammatory cytokines may play in autism risk. “The way to think about cytokines in the fetal environment is that they can potentially act in a dose response manner—just as too much is bad, then too little is also bad, but there is this goldilocks level that you need to have for appropriate growth,” Ashwood says. “If there’s some kind of immune condition or inflammatory response that leads to the constant production and release of these cytokines, those could cross the placental barrier and affect fetal development.” 

    In the brain, for example, the presence of cytokines “could affect neuron growth, neuron proliferation, the connection of neurons to other neurons, synapse formation, neuronal migration, and all sorts of processes that are necessary to build an interconnected network as the brain grows,” he explains. “Having those systems slightly off-kilter can potentially affect the trajectory of neurodevelopment.”

    Lupus and other autoimmune disorders are one potential source of cytokine imbalance. But Van de Water says that obesity is another inflammation-related condition—and a far more common one than lupus—that could produce the sort of immune activity that contributes to autism. “Obesity has a major inflammatory component attached to it,” she says. “We just published a paper looking at this, and it turns out that the biggest maternal risk factor for autism was not any autoimmune disease, but asthma and allergies coupled with obesity. You put these two together with obesity and he risk was significantly greater.”

    Another potential connection between a mother’s immune activity and her offspring’s autism risk is the microbiome—the community of bacteria that inhabit the gut. Some research has found that the metabolites produced by a mother’s gut bacteria can affect the neurodevelopment of the fetus. Furthermore, there’s evidence that infections, metabolic stress (such as obesity), and other immune-related events can lead to maternal microbiome imbalances that, potentially, could raise her offspring’s risk for autism. 

    On top of this, there’s evidence that people with autism share some distinct microbiome characteristics, and that gut-related symptoms—diarrhea, constipation, and abdominal pain in particular—are common comorbidities among people with autism. “There’s a lot of interest right now in the microbiome —how it’s formed, the way it nourishes the body, and how it shapes the activity of the immune system,” Ashwood says. There’s also been much recent interest in the so-called “gut-brain connection,” and science has established that the gut’s microbiota influence brain connectivity and functioning.

    It’s not certain yet, but it’s possible that maternal autoimmune disorders and other immune-related perturbations could directly or indirectly affect the microbiome of the fetus in ways that contribute to the development of autism.

    Read More: What to Know About Complementary Treatments for Lupus

    A multifaceted disease

    While there are several plausible mechanisms that could tie autoimmune disorders to autism, experts say this is likely only one small part of the autism equation. “It’s worth remembering that autoimmunity in the general populace is pretty low,” Ashwood says. Also, research on the link between maternal lupus and autism has found that while the risks are elevated, women with the autoimmune condition were still at low overall risk for having a child with autism.

    Apart from maternal immune conditions, there’s growing evidence of the role that genetics play in a person’s risk for autism. “More than 100 genes are known to confer risk, and 1,000 or more may ultimately be identified,” wrote David Amaral, a distinguished professor at the University of California, Davis and the MIND Institute, in a 2017 paper on the causes of autism. He goes on to explain that, most likely, a mix of genetic and environmental factors contribute to the development of autism. “It seems clear at this point,” he writes, “that when all is said and done, we will find that autism has multiple causes that occur in diverse combinations.”

    Van de Water likewise emphasizes this point. Autism spectrum disorder is a diverse and multifaceted condition, and its underlying causes are likely equally complex. Lupus and other immune-related conditions may be a piece of the puzzle, but they’re just one of many. “Anyone who tells you they know the cause of autism doesn’t know autism very well. There are many layers to it,” Van de Water says. “There seems to be a relationship between the mother’s immune activity and autism, but we don’t have all the answers yet.” 

    Markham Heid

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  • The Plague Never Went Away: What to Know

    The Plague Never Went Away: What to Know

    The plague sounds like something out of a history book. But the disease—nicknamed the “Black Death” or “Great Pestilence”—that killed more than 25 million people, about a third of Europe, in medieval times is very much still with us today.

    Colorado officials confirmed Tuesday a human case of the plague was detected in Pueblo County. It comes after another human case in Oregon in February.

    Caused by the bacterium Yersinia pestis, which is often transmitted by fleas and passed through small animals like rodents or cats, the plague has been responsible for more than 200 million deaths throughout history, dating as far back as 3,800 years ago, according to an article published in the American Journal of Medicine. While the bulk of its casualties came during three major pandemics—in the 6th century in and around Constantinople, in 14th century Europe, and in 19th century Asia—outbreaks have persisted to modern day.

    The U.S. Centers for Disease Control and Prevention says an average of seven cases are reported in the country each year, mostly in the western and southwestern states. Globally, there are about 1,000–3,000 cases per year, with the three most endemic countries being the Democratic Republic of Congo, Madagascar, and Peru, according to the World Health Organization.

    There are two main forms of plague infection: bubonic, which is caused by a flea bite or blood contact with another infected animal or material and is characterized by swollen lymph nodes or “buboes”; and pneumonic, a severe lung infection caused by inhaling droplets, such as the coughs of infected humans or cats. Over 80% of plague cases in the U.S. have been the bubonic form, according to the CDC, though the pneumonic form is more dangerous.

    There is currently no vaccine available in the U.S. that can prevent plague infection, though there are steps you can take, including wearing insect repellent and applying flea control products to pets, to reduce the risk of infection. Today, however, most plague cases don’t result in death because of advances in treatment, including with commonly available antibiotics—though untreated cases can be fatal. The overall risk of death for all types of plague in the U.S., according to Mayo Clinic, is around 11%.

    The most important factor for survival is that medical attention begins promptly. Symptoms to watch out for include swollen lymph nodes, sudden fever, head and body aches, weakness, vomiting and nausea, shortness of breath, chest pain, and cough, particularly with bloody mucus.

    Chad de Guzman

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  • How Is Parkinson’s Disease Diagnosed?

    How Is Parkinson’s Disease Diagnosed?

    Speculation about President Joe Biden’s health is rife after the president’s poor debate performance, marked by a stiff gait and soft voice, and muddled answers. Also fueling conjecture is reporting in the New York Times and elsewhere that, according to visitor logs, a neurologist who specializes in movement disorders like Parkinson’s disease has come to the White House eight times in the past eight months. 

    The White House pushed back, releasing a letter from Dr. Kevin O’Connor, physician to the president, explaining that the specialist, Dr. Kevin Cannard, was at the residence in support of active duty service members assigned to White House operations, some of whom may have neurological issues related to their service. Cannard has only examined Biden during his annual physicals, according to the White House. The president, according to O’Connor’s letter and its account of details of Biden’s physical released in February, does not have symptoms consistent with “any cerebellar or other central neurological disorder, such as stroke, multiple sclerosis, Parkinson’s or ascending lateral sclerosis.”

    Parkinson’s is not always straightforward to spot. Here, experts (who are not involved in Biden’s care) explain what people should know about how the disease typically presents and how it’s diagnosed.

    The varied signs and symptoms of Parkinson’s disease 

    Dr. Michael Okun, director of the Fixel Institute for Neurological Diseases at the University of Florida and medical adviser to the Parkinson’s Foundation, says that Parkinson’s disease might be better called Parkinson’s diseases—plural—because the condition has many different causes and expressions.

    “There are multiple causes for Parkinson’s and a lot of them have similar symptoms, but we tend to clump them together, because humans like to clump things—it’s easier to deal with,” he says.

    For one thing, Okun explains, about 15% to 20% of Parkinson’s cases are associated with a genetic abnormality, and in those cases, patients are likelier to develop symptoms earlier—at age 50, or even 45 or 40. In cases that aren’t genetic, neurologists look at possible environmental causes. “We’ve been interested in pesticides, chemicals, and other things in the environment that might be triggering symptoms,” he says.

    Whatever the causes, the brains of Parkinson’s patients generally start to show a deficit in three neurotransmitters: serotonin, dopamine, and acetylcholine. Those neurological changes don’t, at first, lead to the motor symptoms that are commonly associated with the disease. Rather, people may experience a loss of the sense of smell, constipation, and sleep disturbances known as REM sleep behavior disorder. In these cases, dreams may become so vivid that people act them out. “Let’s say you’re fighting off the bad guys,” Okun says. “You might be punching in your sleep, and that’s not a good thing for your bed partner.”

    Read More: What’s the Least Amount of Sleep You Need?

    Later symptoms start to involve emotional functions. Parkinson’s patients are at higher risk than other people of experiencing depression, anxiety, and apathy, and when anxiety in particular occurs for the first time later in life, a Parkinson’s screening might be warranted. “People who have new-onset anxiety over the age of 50 are at twice the risk of having Parkinson’s disease,” says Okun.

    More common are the motor and cognitive deficits that most define the disease. People with Parkinson’s may become distracted or disorganized or find it difficult to plan or accomplish tasks. About 80% of people with the disease have a resting tremor in the hands—though that means that one out of five don’t have this signature symptom. Posture can suffer as well, and stiffness in the wrists and arms may be evident. Steps may become shuffling, and there can be an overall slowness, called bradykinesia. 

    “When you have people tap their fingers or open or close their hands, there’s a certain slowness the neurologist is looking for,” says Okun. Speech can be affected too. “Sometimes people repeat syllables in the middle of speech,” Okun says. “The voice can become softer and softer and sometimes trail off.”

    Other symptoms affect the face, with blinking becoming less frequent and facial muscles growing stiff or still—a condition called masked face. 

    How Parkinson’s is diagnosed

    In the early stages of Parkinson’s, an internist, family physician, or neurologist is often the first to make a diagnosis, according to the Parkinson’s Foundation. The most common symptoms that lead to a diagnosis are a resting tremor; stiffness or rigidity in the arms, legs, or trunk; or trouble with balance and falls. Magnetic resonance imaging (MRI) or a dopamine transport scan of the brain—in which a radioactive tracer that attaches itself to dopamine receptors is injected into the blood—can also help confirm the diagnosis. No doctor of any kind, of course, can diagnose Parkinson’s in someone without seeing and evaluating the person. When it comes to the president or any other public official or celebrity, Okun abides by the so-called Goldwater Rule—adopted by the American Psychiatric Association after hundreds of psychiatrists presumed, without an exam, to diagnose mental illness in Republican presidential nominee Barry Goldwater in 1964. 

    “I was one of the physicians who cared for Muhammed Ali,” says Okun, “and we didn’t publish details of his medical record until we had permission of the family.”

    Read More: The Vaccines You’ll Need This Fall and Winter

    Still, Okun urges family members and others to follow the “see something, say something” guideline. “If you see somebody who’s not blinking, if you see someone who has decreased facial expression, if you see someone who is rigid or still in the arms or shuffling or falling, get those folks to the right doctors,” he says. “In Parkinson’s disease you need a whole team.”

    Treatment options

    There is no cure for Parkinson’s disease, but people with the condition are by no means without recourse. A dozen or so medications and medication cocktails exist, including levodopa, a dopamine replacement drug that helps ease physical symptoms. Also increasingly used are selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), which increase the availability of both neurotransmitters in the brain. 

    “There are other drugs that go straight to the dopamine receptors and sort of tickle the receptors,” says Okun. “These are called dopamine agonists.” Increasingly popular is also deep-brain stimulation, in which a fine probe is threaded into the brain and adjusts its firing, similar to the way a pacemaker affects the heart.

    Jeffrey Kluger

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