Tag: Infectious disease

What If There’s a Secret Benefit to Getting Asian Glow?

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At every party, no matter the occasion, my drink of choice is soda water with lime. I have never, not once, been drunk—or even finished a full serving of alcohol. The single time I came close to doing so (thanks to half a serving of mulled wine), my heart rate soared, the room spun, and my face turned stop-sign red … all before I collapsed in front of a college professor at an academic event.

The blame for my alcohol aversion falls fully on my genetics: Like an estimated 500 million other people, most of them of East Asian descent, I carry a genetic mutation called ALDH2*2 that causes me to produce broken versions of an enzyme called aldehyde dehydrogenase 2, preventing my body from properly breaking down the toxic components of alcohol. And so, whenever I drink, all sorts of poisons known as aldehydes build up in my body—a predicament that my face announces to everyone around me.

By one line of evolutionary logic, I and the other sufferers of so-called alcohol flush (also known as Asian glow) shouldn’t exist. Alcohol isn’t the only source of aldehydes in the body. Our own cells also naturally produce the compounds, and they can wreak all sorts of havoc on our DNA and proteins if they aren’t promptly cleared. So even at baseline, flushers are toting around extra toxins, leaving them at higher risk for a host of health issues, including esophageal cancer and heart disease. And yet, somehow, our cohort of people, with its intense genetic baggage, has grown to half a billion people in potentially as little as 2,000 years.

The reason might hew to a different line of evolutionary logic—one driven not by the dangers of aldehydes to us but by the dangers of aldehydes to some of our smallest enemies, according to Heran Darwin, a microbiologist at New York University. As Darwin and her colleagues reported at a conference last week, people with the ALDH2*2 mutation might be especially good at fighting off certain pathogens—among them the bug that causes tuberculosis, or TB, one of the greatest infectious killers in recent history.

The research, currently under review for publication at the journal Science, hasn’t yet been fully vetted by other scientists. And truly nailing TB, or any other pathogen, as the evolutionary catalyst for the rise of ALDH2*2 will likely be tough. But if infectious disease can even partly explain the staggering size of the flushing cohort—as several experts told me is likely the case—the mystery of one of the most common mutations in the human population will be one step closer to being solved.

Read: Tuberculosis got to South America through … seals?

Scientists have long been aware of aldehydes’ nasty effects on DNA and proteins; the compounds are carcinogens that literally “damage the fabric of life,” says Ketan J. Patel, a molecular biologist at the University of Oxford who studies the ALDH2*2 mutation and is reviewing the new research for publication in Science. For years, though, many researchers dismissed the chemicals as the annoying refuse of the body’s daily chores. Our bodies produce them as part of run-of-the-mill metabolism; the compounds also build up during infection or inflammation, as byproducts of some of the noxious chemicals we churn out. But then aldehydes are generally swept away by our molecular cleanup systems like so much microscopic trash.

Darwin and her colleagues are now convinced that the chemicals deserve more credit. Dosed into laboratory cultures, aldehydes can kill TB within days. In previous research, Darwin’s team also found that aldehydes—including ones produced by the bacteria themselves—can make TB ultra sensitive to nitric oxide, a defensive compound that humans produce during infections, as well as copper, a metal that destroys many microbes on contact. (For what it’s worth, the aldehydes found in our bodies after we consume alcohol don’t seem to much bother TB, Darwin told me. Drinking has actually been linked to worse outcomes with the disease.)

The team is still tabulating the many ways in which aldehydes are exerting their antimicrobial effects. But Darwin suspects that the bugs that are vulnerable to the chemicals are dying “a death by a thousand cuts,” she told me at the conference. Which makes aldehydes more than worthless waste. Maybe our ancestors’ bodies wised up to the molecules’ universally destructive powers—and began to purposefully deploy them in their defensive arsenal. “It’s the immune system capitalizing on the toxicity,” says Joshua Woodward, a microbiologist at the University of Washington who has been studying the antibacterial effects of aldehydes.

Specific cells show hints that they’ve caught on to aldehydes’ potency. Sarah Stanley, a microbiologist and an immunologist at UC Berkeley, who has been co-leading the research with Darwin, has found that when immune cells receive certain chemical signals signifying infection, they’ll ramp up some of the metabolic pathways that produce aldehydes. Those same signals, the researchers recently found, can also prompt immune cells to tamp down their levels of aldehyde dehydrogenase 2—the very aldehyde-detoxifying enzyme that the mutant gene in people like me fails to make.

If holstering that enzyme is a way for cells to up their supply of toxins and brace for inevitable attack, that could be good news for ALDH2*2 carriers, who already struggle to make enough of it. When, in an extreme imitation of human flushers, the researchers purged the ALDH2 gene from a strain of mice, then infected them with TB, they found that the rodents accumulated fewer bacteria in their lungs.

The buildup of aldehydes in the mutant mice wasn’t enough to, say, render them totally immune to TB. But even a small defensive bump can make for a massive advantage when combating such a deadly disease, Russell Vance, an immunologist at UC Berkeley who’s been collaborating with Darwin and Stanley on the project, told me. Darwin is now curious as to whether TB’s distaste for aldehyde could be leveraged during infections, she told me—by, for instance, supplementing antibiotic regimens with a side of Antabuse, a medication that blocks aldehyde dehydrogenase, mimicking the effects of ALDH2*2.

Tying those results to the existence of ALDH2*2 in half a billion people is a larger leap, several experts told me. There are clues of a relationship: Darwin and Stanley’s team found, for instance, that in a cohort from Vietnam and Singapore, people carrying the mutation were less likely to have active cases of TB—echoing patterns documented by at least one other study from Korea. But Daniela Brites, an evolutionary geneticist at the Swiss Tropical and Public Health Institute, told me that the connection still feels a little shaky. Other studies that have searched for genetic predispositions to TB, or resistance to it, she pointed out, haven’t hit on ALDH2*2—a sign that any link might be weak.

The team’s general idea could still pan out. “They are definitely on the right track,” Patel told me. Throughout most of human history, infectious diseases have been among the most dramatic influences over who lives and who dies—a pressure so immense that it’s left obvious scars on the human genome. A mutation that can cause sickle cell anemia has become very common in parts of the African continent because it helps guard people against malaria.

Read: A history of humanity in which humans are secondary

The story with ALDH2*2 is probably similar, Patel said. He’s confident that some infectious agent—perhaps several of them—has played a major role in keeping the mutation around. TB, with its devastating track record, could be among the candidates, but it wouldn’t have to be. A few years ago, work from Woodward’s lab showed that aldehydes can also do a number on the bacterial pathogens Staphylococcus aureus and Francisella novicida. (Darwin and Stanley’s team have now shown that mice lacking ALDH2 also fare better against the closely related Francisella tularensis.) Che-Hong Chen, a geneticist at Stanford who’s been studying ALDH2*2 for years, suspects that the culprit might not be a bacterium at all. He favors the idea that it’s, once again, malaria, acting on a different part of our genome, in a different region of the world.

Other tiny perks of ALDH2*2 may have helped the mutation proliferate. As Chen points out, it’s a pretty big disincentive to drink—and people who abstain (which, of course, isn’t all of us) do spare themselves a lot of potential liver problems. Which is another way in which the consequences of my genetic anomaly might not be so bad, even if at first flush it seems more trouble than it’s worth.

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Katherine J. Wu

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October 25, 2023
A Vaccine for Birth Control?

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For half a century, Gursaran Pran Talwar has been developing what he hopes will be the next big thing in birth control. A nonagenarian who was once the director of India’s National Institute of Immunology, Talwar envisions bringing to market a new form of contraception that could block pregnancy without the usual trade-offs—an intervention that’s long-acting but reversible; cheap, discreet, and easy to administer; less invasive than an intrauterine device and more convenient than a daily pill. It would skip messy, sometimes dangerous side effects, such as weight gain, mood swings, and rare but risky blood clots and strokes. It would embody the sort of “set it and forget it” model that’s become a gold standard for health—and, in his words, be “accepted by the world over.”

Talwar’s invention is now in early-stage clinical trials. If all goes well, it could become humanity’s first contraceptive vaccine—one that would prevent pregnancies in a way distinct from any birth control ever cleared for human use. Whether they’re packaged as pills, patches, implants, or shots, most common medical contraceptives work by flooding the body with hormones to put a pause on ovulation. Talwar’s vaccine would do something different: It leaves the menstrual cycle unaltered, instead leveraging the powers of the immune system to keep unwanted pregnancies at bay.

But temporarily vaccinating against pregnancy is both brilliant in concept and devilishly difficult in execution, both scientifically and socially. Making a contraceptive vaccine effectively means “trying to immunize an animal against itself,” says Julie Levy, a feline-infectious-disease expert at the University of Florida who has worked on immunocontraceptives in animals. Which runs counter to the prime directive of immune systems, evolved over countless millennia to distinguish the foreign from the familiar and to leave the body’s most vital tissues alone. Solve that problem, and researchers will still be left with another: persuading people to take a fertility-hampering shot in an era of widespread vaccine hesitancy—while the specter of contraception’s problematic past still looms.

For many decades, the most stubborn barriers in contraception have been not about science, but about access and acceptance. Talwar remembers those issues crystallizing sharply for him in the 1970s, he told me, when he encountered several groups of women in the holy city of Varanasi, who told him they were struggling to feed their large families. Yet the women’s husbands weren’t eager to use condoms and they themselves weren’t satisfied with the pills and IUDs available at the time, which sometimes interfered with normal menstruation and ovulation, and triggered headaches and mood swings. “I wanted to make something free of all these problems,” Talwar told me.

Read: The different stakes of male and female birth control

Within a few years, he had cooked up a solution: a vaccine against hCG, a hormone exclusive to pregnancy that’s necessary for fertilized eggs to implant. Taught to neutralize hCG, Talwar reasoned, the immune system could stop a pregnancy from ever truly starting, without attacking other tissues. His hunch so far appears to have panned out. By the mid-1990s, his team had shown in small, early-stage clinical trials that most women receiving the shots could produce enough antibodies to prevent pregnancy for several months, in some cases more than a year. Of the 119 women in the trial whose antibody levels reached what Talwar deems a protective threshold, only one became pregnant over a period of almost two years. Several participants also went on to conceive after opting out of boosters, a sign that the shot’s effects were reversible.

Almost immediately, though, drawbacks appeared. Immune responses are infamously variable across individuals—a major reason that the effectiveness of many shots designed against pathogens tops out around 60 to 80 percent. About a fifth of the women who received the hCG vaccine didn’t produce enough antibodies to meet the protective threshold. Those stats would still be enough to slow the transmission of, say, a deadly respiratory virus. But the expectations for a contraceptive “have to be different,” says Neel Shah, the chief medical officer of Maven Clinic, a virtual clinic for women’s and family health. The top IUDs on the market prevent more than 99 percent of pregnancies, require one appointment to insert, and last for up to a decade.

For now, the hCG vaccine is more cumbersome than that. In its current iteration—a revamp of the successful ’90s recipe—it requires an initial series of at least three doses, spaced out over several weeks. It’s still unclear how people would figure out when, and how often, to boost without regular antibody tests. The answer will likely differ from person to person; that uncertainty alone could make these shots a tough sell, says Diana Blithe, a contraception expert at the National Institutes of Health. And although halting hormonal contraceptives can reset fertility back to baseline within days or weeks, some people with especially enthusiastic immune responses could end up waiting far longer for the hCG vaccine’s effects to wear off, says Aaron Hsueh, a reproductive biologist at Stanford. For that reason and more, Hsueh has said for years that he’s “not enthusiastic” about Talwar’s experimental shot.

There is some reason to think these issues aren’t insurmountable. Immunocontraceptives have been used for decades by wildlife scientists to prevent pregnancies in all sorts of mammals—among them deer, horses, elephants, pigs, and seals—as a more humane alternative to culling. And in that context, at least, researchers have found a way to circumvent the need for frequent boosts. Certain animals can be dosed with nanoparticles that slowly release the vaccine’s ingredients over months and years, repeatedly tickling the immune system without any additional jabs, says Derek Rosenfield, a veterinarian and wildlife biologist at the University of São Paulo. Work in wild creatures, though, has also shown how hard it is to persuade the body to target its own hormones. To get their shots to work, veterinarians have needed to include powerful adjuvants, or vaccine ingredients meant to rile up the immune system—“some of the most potent ones ever developed,” Levy told me. Which exacts a tax for the shots’ potency: In some animals, such as cats, the vaccines can cause worrying side effects, including injection-site reactions.

In humans, where safety standards must be stricter and effectiveness better, Talwar’s hCG vaccine has encountered some issues with tolerability, too. The shots so far do seem to be skirting the side effects of pills and IUDs. But some of the women in his team’s ongoing trials are developing painless but prominent nodules—a likely sign that the new recipe’s adjuvants are riling up the immune system a tad too much. To deliver on a discreet, low-maintenance contraceptive—something with, as Talwar puts it, “zero side effects”—they’ll need to tinker with dosing or ingredients.

Gaps in the contraceptive market do need to be filled. Technology has come a long way since Talwar first spoke with the women in Varanasi, but “we need more options,” says Debanjana Choudhuri, the director of programs and partnerships at India’s Foundation for Reproductive Health Services. Nearly half the world’s pregnancies are unplanned, and access to existing contraception is inconsistent, inequitable, and still stymied by stigma and misinformation; even in places where availability isn’t an issue, some people hesitate over the trade-offs. A temporary contraception, packaged into a super-safe vaccine, could offer convenience and privacy, with potential appeal for young urbanites, who have already been enthusiastic about injectable contraceptives and might not mind getting boosts, Choudhuri told me. Most important, adding a vaccine to the repertoire gives people “another choice.”

But for all its unique perks, a contraceptive vaccine could also come with social drawbacks. The history of contraception is riddled with abuses, often concentrated among poor populations, people struggling with mental-health issues, and communities of color. Vaccines’ primary purpose for centuries has been to fight infectious disease, and “pregnancy is not a disease,” Sanghamitra Singh, the policy-and-programs lead at the Population Foundation of India, told me. Implying—even unintentionally—that the condition is a problem to be eradicated could stigmatize the shot.

Deploying the vaccine primarily in under-resourced populations could also raise the specter of the eradication of fertility in society’s most vulnerable subsects. Lisa Campo-Engelstein, a reproductive bioethicist at the University of Texas Medical Branch, worries that even the vaccine’s ease of administration—an ostensible benefit—could be viewed as a downside: Administering a shot without a patient’s full understanding or consent is easier than coercively inserting an IUD or forcing a daily pill. And in this pandemic era, a contraceptive vaccine will likely be met with pushback from people already disinclined toward shots—especially amid false accusations that other immunizations compromise fertility. On top of all that, a shot that goes after hCG can prevent only implantation, not fertilization, a guaranteed sticking point for people who believe that life begins at conception, and may argue that the vaccine triggers abortion.

In part, the timing is just bad luck. Shortly after his original clinical trial results were published, in the ’90s, Talwar, already late into his 60s, was asked to retire from the National Institute of Immunology, he told me, and had to leave his vaccine behind. After he managed to revive his efforts with the help of independent funders, Indian regulators took nearly a decade to green-light a new recipe for clinical trials—just in time for the coronavirus pandemic to begin. Régine Sitruk-Ware, a reproductive endocrinologist at the Population Council’s Center for Biomedical Research, in New York, remembers the initial buzz around the human hCG vaccine when Talwar’s clinical-trial results were published. But in the absence of more progress, she and other researchers have moved on, she told me. Many now have their sights set on long-acting reversible male birth control, several new forms of which are now close to being publicly available, and could offer safe complements to female methods and make family planning more equitable.

Read: Block that sperm!

Still, Talwar, who will turn 97 in October, hasn’t lost hope; to him, the nodules represent one of the last major hurdles, and should be resolved soon. As his 100th birthday ticks closer, he’s even thinking of how he can expand his approach—repurposing the hCG shot, for instance, into immunotherapy against certain cancers that aberrantly produce the hormone. “I am healthy and hearty,” he told me. “I just hope and pray,” he said, that his invention might clear its final hurdles “before I call it a day.”

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Katherine J. Wu

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May 2, 2023
74 Things That Blew Our Minds in 2022
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The writers on The Atlantic’s Science, Technology, and Health desks have learned a lot this year. Our coverage of the ongoing coronavirus pandemic has continued, but this year, more so than in 2020 and 2021, we’ve also had the chance to report on topics that have filled us with awe and delight. Though the past 12 months have not been free of concerns about infectious disease, climate change, and even nuclear war, we’ve embraced more fascination and curiosity in our coverage this year, and we wanted to share and reflect on some of the most compelling tidbits we’ve stumbled across. We hope you find these facts as mind-blowing as we did.
Days on the moon are hot enough to boil water, and nights are unfathomably cold, but at least one spot on the lunar surface stays a pleasant 63 degrees Fahrenheit.

Actually, snakes do have clitorises.

Scientists don’t know where the virus in the smallpox vaccine came from.

Sour or curdled milk is often perfectly safe to consume.

The bone of a mastodon named Fred preserved memories from its life 13,200 years ago.

The most common phrase on Facebook in several French-speaking countries is “Have a nice day!”

Most people with diabetes should not receive insulin as a first-, second-, or even third-line treatment.

There might not be a theoretical limit to the height from which a cat can fall and survive.

Beyond a certain temperature—as low as 95 degrees, by some estimates—fans do more harm than good.

About 10 percent of the bills introduced in Congress in the past two years have been titled with reverse-engineered acronyms, including the ZOMBIE Act.

The notes your doctor writes about you probably don’t look the same now as they did a year and a half ago.

It takes at least seven years to train the muscles and tendons in your elbow that will make you a great arm wrestler, according to the arm wrestler Jack Arias, who was in the 1987 arm-wrestling movie Over the Top with Sylvester Stallone.

American Express started making metal cards in 2004 because of an urban legend about its most exclusive card being titanium.

The first-of-its-kind electric Hummer weighs as much as an ambulance and accelerates like a Formula 1 race car.

Woodpeckers have small brains, which is why they can smash their heads against trees unharmed.

A toaster-size device inside a rover on Mars can convert Martian air, made almost entirely of carbon dioxide, into breathable oxygen.

Parrot theft is weirdly common.

Lactose-intolerant people have been throwing back dairy for thousands and thousands of years.

The provision in the Affordable Care Act that requires health insurance to cover contraception does not require coverage for vasectomies.

Pawpaws tend to stay green throughout their life cycle, so in order to tell if they’re ripe, you have to individually caress every fruit on a tree.

The metal that makes up a nickel has long been worth more than the coin itself.

The Presidential Fitness Test was developed because the federal government worried that postwar children were too soft to defeat communism when they grew up.

The iPhone is the only major Apple product that doesn’t support charging with the now-ubiquitous USB-C cable.

The oldest clam ever lived to 507.

The word sure was once pronounced more like syoor.

Some of YouTube’s earliest hits got popular thanks to “coolhunters,” a group of editors who individually picked videos for the site’s homepage.

In 1918, California conscripted children into a week-long war on squirrels.

Some baby cameras feature artificial intelligence that will recognize when your baby’s face is covered or when the baby has coughed.

Extreme heat and specific pressure conditions on WASP-96b, an exoplanet about 1,150 light-years from Earth, mean that rock can condense in the air like water does on Earth, producing clouds made of sand.

In 2021, a full quarter of single-family homes sold in America went to buyers with no intention of living in them, such as house flippers, landlords, Airbnb hosts, and other investors.

Apple has released 38 distinct models of the iPhone since 2007.

Slurpees and Icees are the exact same “frozen carbonated beverage,” sold under different trademarks.

The agricultural revolution is a myth.

Hypoallergenic dogs are also a myth.

Reindeers’ eyes change color—from blue to gold, and then back to blue again—twice a year to cope with the Arctic’s strange light schedule.

If current trends hold, half of the world’s population could be nearsighted by 2050.

A 2006 effort to automatically take down internet pornography by detecting repetitive noises ended up catching a lot of tennis videos.

Some minerals in rechargeable batteries can be recycled indefinitely.

Julius Caesar reportedly announced his conquest of Gaul via pigeon.

The Japanese makers of Hi-Chew candy were persuaded to push into the mainstream American market because of the candy’s enduring popularity among missionaries from the Church of Jesus Christ of Latter-day Saints who had returned home after time in East Asia.

Secondhand-smoke inhalation causes more than 41,000 deaths annually in the U.S., more than some flu seasons.

The Microsoft Excel World Championship: (1) exists, (2) streams on ESPN3, and (3) is legitimately exciting.

Saturn’s trademark rings will disappear in about 300 million years.

But, on the bright side, Neptune has rings too.

China’s zero-COVID policy may be largely responsible for gas prices falling from a March peak to below $4 a gallon in August.

Polar bears in Southeast Greenland are homebodies.

The world’s best chess player, Magnus Carlsen, has, by one calculation, a 98 percent chance of losing and a 2 percent chance of drawing against the world’s best chess-playing computer program; victory is basically impossible.

Earlier this year, Moonbirds NFTs—basically colorful little pixelated owls—generated $489 million in trading volume in their first two weeks of existence.

In 1975, the average grocery store stocked 65 kinds of fruits and veggies. By 1998, that number had reached 345.

Octopuses all over the sea starve for years on end while brooding.

Government spending on climate change over the next decade could end up more than double what Democratic senators predicted for the Inflation Reduction Act.

Robusta coffee—whose taste has been likened to “rotten compost … with a hint of sulfur”—can actually be delicious.

Journals can be big business: One collector sold a diary from a 1912 Machu Picchu visitor and another by an 1868 Missouri River traveler for about $9,000 each.

There is such a thing as a reformed parasite.

In Wordle, just one correct letter in the right spot and one in the wrong spot can eliminate 96 percent of possible solutions.

A major obstacle to meeting the United States’ clean-energy goals is that we have to double the rate at which we build the giant cables that transmit power between regions.

Little kids who grew up amid intense COVID restrictions might have different microbiomes than those born several years earlier—and whether that’s good or bad is unclear.

Militaries are developing swarms of starling-size drones that will be able to fly and attack together with the use of artificial intelligence.

Psychedelics seem to quiet a network in our brain that is most active when we focus on ourselves.

The cryptocurrency exchange FTX, once valued at $32 billion before a spectacular collapse, used QuickBooks for accounting.

A product needs to be just 10 percent cocoa to be called “chocolate” by the FDA.

Gophers … might … farm?

While asleep, teeth-grinders can clench down with up to 250 pounds of force.

In 2021, 95 of the United States’ 100 most-watched telecasts were sporting events.

You can pay hundreds of dollars an hour for cow-hug therapy.

Male widow spiders will somersault into a female’s mouth to be cannibalized while they’re mating.

Ninety percent of people report having at least one memory in which they can see themselves as if watching a character in a movie.

Offices are designed to be inefficient.

Climate-minded architectural firms in Senegal are pushing the country to reclaim mud construction.

Rats can learn to play hide-and-seek, and they have fun doing it.

A cat kidney transplant costs $15,000.

The Apollo 11 moon lander will sit on the moon for millions of years because there’s no wind or water to erode it away.

Your smart thermostat mostly exists to help the utility company, not your wallet.

The cocaine-eating bear that died in 1985 and inspired the upcoming film Cocaine Bear is stuffed, mounted, and on display at a mall in Lexington, Kentucky.
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The Atlantic Science Desk

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December 30, 2022
Climate Change Is Harming Physical and Mental Health
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Dec. 16, 2022 — Laken Brooks, a 27-year-old PhD student at the University of Florida, has dealt with the skin condition psoriasis since she was a preteen. It’s always been a painful and difficult condition to manage, but over the past several years, Brooks has struggled even more. She suspects her psoriasis is worse thanks to climate change.

“Each year, the summer seems to last a bit longer,” Brooks says. “When I first moved to Florida (5 years ago), I noticed that sunburn and sweat made my skin feel even itchier than normal. I tried to alleviate some of the symptoms by wearing hats and head scarves, and I expected that I would acclimate to the new climate. But it’s difficult to acclimate when each year, the temperatures continue going up and my skin can never really get accustomed to the Florida climate.”

Brooks is onto something — climate change is having increasingly bigger impacts on health. The seventh annual The Lancet Countdown on Health and Climate Change, released this fall, confirms that. The report, authored by nearly 100 experts from over 50 academic institutions and agencies, tracks the impact of climate change on global health. The 2022 version revealed that every year, in every region of the globe, climate change is undermining health.

The Lancet report this year identified four major harms from climate change: air quality, heat-related illness, infectious disease, and mental health.

Renee Salas, MD, of the Center for Climate, Health, and the Global Environment at Harvard’s T.H. Chan School of Public Health, is one of the report’s authors. She’s regularly sees how climate change is harming her patients’ health — especially those who cannot afford to mitigate its impacts.

“We had a patient present to the emergency room last summer with a core temperature of 106,” she explains. “He met the criteria for heat stroke. He and his wife lived in an upper story apartment with no access to A/C.”

Salas sees it as part of her responsibility to her patients to make the connections between climate change and health effects. Heat, in particular, is a palpable way for people to understand that connection, she says.
The impacts go beyond heat, however. “I have concerns about all of them,” says Salas. “And how climate change impacts a person will be impacted by how they live and the resources they have.”
Climate’s Impact on Mental Health

While heat might be the most obvious of harms people recognize from climate change, the mental health piece of the equation is likely the least. Susan Clayton, PhD, is a professor of psychology and environmental studies at the College of Wooster in Ohio. She’s been studying the link between the two for several years and has written three papers on the subject, the first in 2014.

“We’re reaching a point where people express that they’re anxious about climate change, but they don’t recognize that as a mental health threat,” she says.

In her work on the subject, Clayton has identified four categories where climate change impacts mental health:

Increasingly severe weather events: As more people experience devastating weather events, more people are also experiencing PTSD, clinical anxiety, depression, and substance abuse.

Slower changes: It doesn’t take a category 5 hurricane to dole out mental health harm. As temperatures rise higher than normal for longer periods of time, so too do the rates of suicide and psychiatric hospitalizations.

Involuntary displacement: Many people love and are rooted to where they live. As coastal flooding, wildfires, and other weather events displace them, they suffer deteriorating mental health.

Awareness of climate change: As everyone bears witness to climate change and become increasingly aware of its impacts, collective anxiety levels rise. For most people this is manageable, but it’s still harmful.
While talking about climate change and how it harms mental health can sometimes increase feelings of anxiety and other conditions, it’s an essential conversation to have, says Clayton. “When you’re overwhelmed and disempowered, it can be too much to cope with,” she explains. “But it can also encourage you to attend to the issue.”

Mitigation in the Meantime

As the data continues to pour out and demonstrate the link between climate change and health, it remains difficult for people to understand. For Salas, this can often be frustrating.
“I often have to walk upstream to understand what’s causing patients’ issues in the first place,” she says. “That’s why I do the work I do — I cannot just treat patients in the ER and call it good. That’s like putting a band aid on a bullet wound.”

Recognizing and pointing out that those in the line of fire are often those with fewer resources to change how climate is impacting their health is a starting point.

“We recognize that policy and higher-level decisions have drive these situations,” Salas says. “So I try to find the risks, educate patients, and then give them recommendations to protect themselves.”

This might look like suggesting a patient add an air filtration system in their home, or ensuring they have a back-up plan for using a nebulizer if the electricity is knocked out. The biggest message to get across, says Salas, is that health is harmed by what is happening “upstream.” “We need political and social will to change,” she says. “We’re beginning to see this — the health community is rising up and recognizing it as fundamental to the mission of medicine.”

For people like Brooks, who are not able to relocate now, the temporary fix is trying to minimize how climate change exacerbates existing conditions. “I have been able to mitigate some flare-ups by taking cool showers,” she says. “I don’t plan to live in Florida forever, but right now I don’t have the resources to transplant my life and move somewhere else.”

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December 16, 2022
The Future of Monkeypox

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The World Health Organization has recommended a new name for monkeypox, asking countries to forget the original term in favor of a new one, “mpox,” that scientists hope will help destigmatize the disease. But in the United States, the request seems to be arriving late. The outbreak here has already been in slow retreat for months—and has already left many Americans’ minds.

About 15 cases are now being recorded among Americans each day, less than 4 percent of the tally when the surge was at its worst. After a sluggish and bungled early rollout, tests and treatments for the virus are more available; more than a million doses of the two-shot Jynneos smallpox vaccine have found their way into arms. San Francisco and New York—two of the nation’s first cities to declare mpox a public-health emergency this past summer—have since allowed those orders to expire; so have the states of New York and Illinois. “I think this is the endgame,” says Caitlin Rivers, an infectious-disease epidemiologist at the Johns Hopkins Center for Health Security.

But “endgame” doesn’t mean “over”—and mpox will be with us for the foreseeable future. The U.S. outbreak is only now showing us its long and ugly tail: 15 daily cases is not zero daily cases; even as the number of new infections declines, inequities are growing. Black and Latino people make up a majority of new mpox cases and are contracting the disease at three to five times the rate of white Americans, but they have received proportionately fewer vaccines. “Now it’s truly the folks who are the most marginalized that we’re seeing,” says Ofole Mgbako, a physician and population-health researcher at New York University. “Which is also why, of course, it’s fallen out of the news.” If the virus sticks around (as it very likely could), and if the disparities persist (as they almost certainly will), then mpox could end up saddling thousands of vulnerable Americans each year with yet another debilitating, stigmatized, and neglected disease.

Read: America should have been able to handle monkeypox

At this point, there’s not even any guarantee that this case downturn will persist. “I’m not convinced that we’re out of the woods,” says Sara Bares, an infectious-disease physician at the University of Nebraska Medical Center, in Omaha. Immunity, acquired through infection or vaccines, is now concentrated among those at highest risk, says Jay Varma, a physician and epidemiologist at Weill Cornell Medicine. But researchers still don’t know how well those defenses can stave off another infection, or how long they might last—gaps in knowledge that may be tough to fill, now that incidence is so low. And although months of advocacy and outreach from the LGBTQ community have cut down on risky sexual activities, many cautionary trends will eventually reset to their pre-outbreak norm. “We know extensively from other sexually transmissible infections that behavior change is not usually the most sustained response,” says Boghuma Kabisen Titanji, an infectious-disease physician at Emory University.

At the same time, this year’s mpox outbreaks are stranger and more unwieldy than those that came before. A ballooning body of evidence suggests that people can become infectious before they develop symptoms, contrary to prior understanding; some physicians are concerned that patients, especially those who are immunocompromised, might remain infectious after the brunt of visible illness resolves, says Philip Ponce, an infectious-disease physician at the University of Texas Health Science Center at San Antonio and the medical director of San Antonio’s Kind Clinic. (Some 40 percent of Americans who have been diagnosed with mpox are living with HIV.) Researchers still don’t have a good grip on which bodily fluids and types of contact may be riskiest over the trajectory of a sickness. Cases are still being missed by primary-care providers who remain unfamiliar with the ins and outs of diagnosis and testing, especially in people with darker skin. And although this epidemic has, for the most part, continued to affect men who have sex with men, women and nonbinary people are getting sick as well, to an underappreciated degree.

Read: What should worry most Americans about our monkeypox response

Intel on the only mpox-fighting antiviral on the shelf, a smallpox drug called tecovirimat, also remains concerningly scant, even as experts worry that the virus could develop resistance. The treatment has been given a conditional greenlight for use in people who are currently, or at risk of becoming, severely sick. Anecdotally, it seems to work wonders, shaving days or weeks off the painful, debilitating course of symptoms that can send infected people into long-term isolation. But experts still lack rigorous data in humans to confirm just how well it works, Bares, who’s among the scientists involved in a nationwide study of the antiviral, told me. And although clinical trials for tecovirimat are under way, she added, in the U.S., they’re “struggling to enroll patients” now that infections have plummeted to such a sustained low. It’s a numerical problem as well as a sociocultural one. “The urgency with which people answer questions declines as case counts go down,” Varma told me.

Recent CDC reports show that a growing proportion of new infections aren’t being reported with a known sexual-contact history, stymieing efforts at contact tracing. That might in part be a product of the outbreak’s gradual migration from liberal, well-off urban centers, hit early on in the epidemic, to more communities in the South and Southwest. “In small towns, the risk of disclosure is high,” Bares told me. In seeking care or vaccination, “you’re outing yourself.” When mpox cases in Nebraska took an unexpected nosedive earlier this fall, “a colleague and I asked one another, ‘Do you think patients are afraid to come in?’” Those concerns can be especially high in certain communities of color, Ponce told me. San Antonio’s Latino population, for instance, “tends to be much more conservative; there’s much more stigma associated with one being LGBT at all, let alone being LGBT and trying to access biomedical interventions.”

Hidden infections can become fast-spreading ones. Monitoring an infectious disease is far easier when the people most at risk have insurance coverage and access to savvy clinicians, and when they are inclined to trust public-health institutions. “That’s predominantly white people,” says Ace Robinson, the CEO of the Pierce County AIDS Foundation, in Washington. Now that the mpox outbreak is moving out of that population into less privileged ones, Robinson fears “a massive undercount” of cases.

Americans who are catching the virus during the outbreak’s denouement are paying a price. The means to fight mpox are likely to dwindle, even as the virus entrenches itself in the population most in need of those tools. One concern remains the country’s vaccination strategy, which underwent a mid-outbreak shift: To address limited shot supply, the FDA authorized a new dosing method with limited evidence behind it—a decision that primarily affected people near the back of the inoculation line. The method is safe but tricky to administer, and it can have tough side effects: Some of Titanji’s patients have experienced swelling near their injection site that lasted for weeks after their first dose, and now “they just don’t want to get another shot.”

The continued shift of mpox into minority populations, Robinson told me, is also further sapping public attention: “As long as this is centered in BIPOC communities, there’s going to be less of a push.” Public interest in this crisis was modest even at its highest point, says Steven Klemow, an infectious-disease physician at Methodist Dallas Medical Center and the medical director of Dallas’s Kind Clinic. Now experts are watching that cycle of neglect reinforce itself as the outbreak continues to affect and compress into marginalized communities, including those that have for decades borne a disproportionate share of the burden of sexually associated infections such as syphilis, gonorrhea, and HIV. “These are not the groups that necessarily get people jumping on their feet,” Titanji told me.

Some of the people most at risk are moving on as well, Robinson told me. In his community in Washington, he was disappointed to see high rates of vaccine refusal at two recent outreach events serving the region’s Black and American Indian populations. “They had no knowledge of the virus,” he told me. Titanji has seen similar trends in her community in Georgia. “There’s some sense of complacency, like, ‘It’s no longer an issue, so why do I need to get vaccinated?’” she said.

Read: America is zooming through the pandemic panic-neglect cycle

The tide seems unlikely to shift. Even tens of thousands of cases deep into the American outbreak, sexual-health clinics—which have been on the front lines of the mpox response—remain short on funds and staff. Although the influx of cases has slowed, Ponce and Klemow are still treating multiple mpox patients a week while trying to keep up the services they typically offer—at a time when STI rates are on a years-long rise. “We’re really assuming that this is going to become another sexually associated disease that is going to be a part of our wheelhouse that we’ll have to manage for the indefinite future,” Klemow told me. “We’ve had to pull resources away from our other services that we provide.” The problem could yet worsen if the national emergency declared in August is allowed to expire, which would likely curb the availability of antivirals and vaccines.

Rivers still holds out hope for eliminating mpox in the U.S. But getting from low to zero isn’t as easy as it might seem. This current stretch of decline could unspool for years, even decades, especially if the virus finds a new animal host. “We’ve seen this story play out so many times before,” Varma told me. Efforts to eliminate syphilis from the U.S. in the late ’90s and early 2000s, for instance, gained traction for a while—then petered out during what could have been their final stretch. It’s the classic boom-bust cycle to which the country is so prone: As case rates fall, so does interest in pushing them further down.

Our memories of public-health crises never seem to linger for long. At the start of this mpox outbreak, Titanji told me, there was an opportunity to shore up our systems and buffer ourselves against future epidemics, both imported and homegrown. The country squandered it and failed to send aid abroad. If another surge of mpox cases arrives, as it very likely could, she said, “we will again be going back to the drawing board.”

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Katherine J. Wu

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November 28, 2022
Celebration of life to be held for Leslie Jordan in Chattanooga

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The City of Chattanooga announced plans to hold a celebration of life for the late actor Leslie Jordan who died in a car crash in Los Angeles two weeks ago.

Jordan was born and raised in the Scenic City. His friends, family and fans will have the chance to mourn together.

Jordan’s family requested that the proceeds from the event be given to Cempa Community Care.

The organization serves underserved communities through primary care and infectious disease care.

The event will be held on Sunday, Nov. 20, at 5 p.m. at the Memorial Auditorium in Chattanooga.

It will be all about Leslie Jordan from performances, to comedy, shared memories from family and close friends, special guest appearances, and a special announcement is also expected to be made.

“Thanks to the city elevating the event and honestly who he was a person and the way he blew up on social media during COVID and the light he brought to so many, I think it will be sold out. I am hopeful for that because he deserves that. He deserves that recognition and honor of all of us to come together across any line that we have and celebrate him,” Miles Huff said.

Miles Huff is the Director of Community Engagement for Cempa Community Cares.

He said it is an honor that Jordan’s family wanted the proceeds to go to Cempa to help continue their mission.

“When we found out about Leslie’s death, our entire team mourned that loss. We reached out proactively to his manager at the time and offered to help and we found out that family requested that we be a part of the event to receive funds and recognition because of his legacy. It is very humbling and a testament to who he was as a person and the friend he was to our organization,” Huff said.

Huff expressed that Jordan was a longtime friend and advocate for Cempa Community Care as they have always assisted those affected by HIV.

“We first partnered with him in 2006 with an event that sold out at the Tivoli Theater and several more events in person prior to COVID. Also, in a variety of ways whenever he had a platform that involved Chattanooga, he also mentioned Cempa Community Care and has always been kind to use,” Huff said.

Here’s the link to tickets.

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November 9, 2022
In a first, doctors treat fatal genetic disease before birth

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A toddler is thriving after doctors in the U.S. and Canada used a novel technique to treat her before she was born for a rare genetic disease that caused the deaths of two of her sisters.

Ayla Bashir, a 16-month-old from Ottawa, Ontario, is the first child treated as fetus for Pompe disease, an inherited and often fatal disorder in which the body fails to make some or all of a crucial protein.

Today, she’s an active, happy girl who has met her developmental milestones, according to her father, Zahid Bashir and mother, Sobia Qureshi.

“She’s just a regular little 1½-year-old who keeps us on our toes,” Bashir said. The couple previously lost two daughters, Zara, 2½, and Sara, 8 months, to the disease. A third pregnancy was terminated because of the disorder.

In a case study published Wednesday in the New England Journal of Medicine, doctors describe an international collaboration during the COVID-19 pandemic that led to the treatment that may have saved Ayla’s life – and expanded the field of potential fetal therapies. The outlook for Ayla is promising but uncertain.

“It holds a glimmer of hope for being able to treat them in utero instead of waiting until damage is already well-established,” said Dr. Karen Fung-Kee-Fung, a maternal-fetal medicine specialist at The Ottawa Hospital who gave the treatment and delivered Ayla.

Fung-Kee-Fung was following a new treatment plan developed by Dr. Tippi MacKenzie, a pediatric surgeon and co-director of the Center for Maternal-Fetal Precision Medicine at the University of California, San Francisco, who shared her research after the pandemic prevented Ayla’s mother from traveling for care.

“We were all motivated to make this happen for this family,” MacKenzie said.

Doctors have treated fetuses before birth for three decades, often with surgeries to repair birth defects such as spina bifida. And they’ve given blood transfusions to fetuses through the umbilical cord, but not medicines. In this case, the crucial enzymes were delivered through a needle inserted through the mother’s abdomen and guided into a vein in the umbilical cord. Ayla received six biweekly infusions that started at about 24 weeks of gestation.

“The innovation here wasn’t the drug and it wasn’t accessing the fetal circulation,” said Dr. Pranesh Chakraborty, a metabolic geneticist at Childrens Hospital of Eastern Ontario, who has cared for Ayla’s family for years. “The innovation was treating earlier and treating while still in utero.”

The unusual partnership also involved experts at Duke University in Durham, N.C., which has led research on Pompe disease, and University of Washington in Seattle.

Babies with Pompe disease are often treated soon after birth with replacement enzymes to slow devastating effects of the condition, which affects fewer than 1 in 100,000 newborns. It is caused by mutations in a gene that makes an enzyme that breaks down glycogen, or stored sugar, in cells. When that enzyme is reduced or eliminated, glycogen builds up dangerously throughout the body.

In addition, the most severely affected babies, including Ayla, have an immune condition in which their bodies block the infused enzymes, eventually stopping the therapy from working. The hope is that Ayla’s early treatment will reduce the severity of that immune response.

Babies with Pompe disease have trouble feeding, muscle weakness, floppiness and, often, grossly enlarged hearts. Untreated, most die from heart or breathing problems in the first year of life.

In late 2020, Bashir and Qureshi had learned they were expecting Ayla and that prenatal tests showed she, too, had Pompe disease.

“It was very, very scary,” recalled Qureshi. In addition to the girls who died, the couple have a son, Hamza, 13, and a daughter, Maha, 5, who are not affected.

Both parents carry a recessive gene for Pompe disease, which means there’s a 1 in 4 chance that a baby will inherit the condition. Bashir said their decision to proceed with additional pregnancies was guided by their Muslim faith.

“We believe that what will come our way is part of what’s meant or destined for us,” he said. They have no plans for more children, they said.

Chakraborty had learned of MacKenzie’s early stage trial to test the enzyme therapy and thought early treatment might be a solution for the family.

The treatment could be “potentially very significant,” said Dr. Brendan Lanpher, a medical geneticist at the Mayo Clinic in Rochester, Minn., who was not involved in the research.

“This is a progressive disease that builds up over time, so every day a fetus or baby has it, they’re accumulating more of the material that affects muscle cells.”

Still, it’s too early to know whether the protocol will become accepted treatment, said Dr. Christina Lam, interim medical director of biochemical genetics at the University of Washington and Seattle Children’s Hospital in Seattle.

“It’s going to take some time to really be able to establish the evidence to definitively show that the outcomes are better,” she said.

Ayla receives drugs to suppress her immune system and weekly enzyme infusions that take five to six hours — a growing challenge for a wiggly toddler, her mother said. Unless a new treatment emerges, Ayla can expect to continue the infusions for life. She is developing normally — for now. Her parents say every milestone, such as when she started to crawl, is especially precious.

“It’s surreal. It amazes us every time,” Qureshi said. “We’re so blessed. We’ve been very, very blessed.”

———

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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November 9, 2022
In a first, doctors treat fatal genetic disease before birth

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A toddler is thriving after doctors in the U.S. and Canada used a novel technique to treat her before she was born for a rare genetic disease that caused the deaths of two of her sisters.

Ayla Bashir, a 16-month-old from Ottawa, Ontario, is the first child treated as fetus for Pompe disease, an inherited and often fatal disorder in which the body fails to make some or all of a crucial protein.

Today, she’s an active, happy girl who has met her developmental milestones, according to her father, Zahid Bashir and mother, Sobia Qureshi.

“She’s just a regular little one-and-a-half year old who keeps us on our toes,” Bashir said. The couple previously lost two daughters, Zara, 2 ½, and Sara, 8 months, to the disease. A third pregnancy was terminated because of the disorder.

In a case study published Wednesday in the New England Journal of Medicine, doctors describe an international collaboration during the COVID-19 pandemic that led to the treatment that may have saved Ayla’s life – and expanded the field of potential fetal therapies. The outlook for Ayla is promising but uncertain.

“It holds a glimmer of hope for being able to treat them in utero instead of waiting until damage is already well-established,” said Dr. Karen Fung-Kee-Fung, a maternal-fetal medicine specialist at The Ottawa Hospital who gave the treatment and delivered Ayla.

Fung-Kee-Fung was following a new treatment plan developed by Dr. Tippi MacKenzie, a pediatric surgeon and co-director of the Center for Maternal-Fetal Precision Medicine at the University of California, San Francisco, who shared her research after the pandemic prevented Ayla’s mother from traveling for care.

“We were all motivated to make this happen for this family,” MacKenzie said.

Doctors have treated fetuses before birth for three decades, often with surgeries to repair birth defects such as spina bifida. And they’ve given blood transfusions to fetuses through the umbilical cord, but not medicines. In this case, the crucial enzymes were delivered through a needle inserted through the mother’s abdomen and guided into a vein in the umbilical cord. Ayla received six biweekly infusions that started at about 24 weeks of gestation.

“The innovation here wasn’t the drug and it wasn’t accessing the fetal circulation,” said Dr. Pranesh Chakraborty, a metabolic geneticist at Childrens Hospital of Eastern Ontario, who has cared for Ayla’s family for years. “The innovation was treating earlier and treating while still in utero.”

The unusual partnership also involved experts at Duke University in Durham, N.C., which has led research on Pompe disease, and University of Washington in Seattle.

Babies with Pompe disease are often treated soon after birth with replacement enzymes to slow devastating effects of the condition, which affects fewer than 1 in 100,000 newborns. It is caused by mutations in a gene that makes an enzyme that breaks down glycogen, or stored sugar, in cells. When that enzyme is reduced or eliminated, glycogen builds up dangerously throughout the body.

In addition, the most severely affected babies, including Ayla, have an immune condition in which their bodies block the infused enzymes, eventually stopping the therapy from working. The hope is that Ayla’s early treatment will reduce the severity of that immune response.

Babies with Pompe disease have trouble feeding, muscle weakness, floppiness and, often, grossly enlarged hearts. Untreated, most die from heart or breathing problems in the first year of life.

In late 2020, Bashir and Qureshi had learned they were expecting Ayla and that prenatal tests showed she, too, had Pompe disease.

“It was very, very scary,” recalled Qureshi. In addition to the girls who died, the couple have a son, Hamza, 13, and a daughter, Maha, 5, who are not affected.

Both parents carry a recessive gene for Pompe disease, which means there’s a 1 in 4 chance that a baby will inherit the condition. Bashir said their decision to proceed with additional pregnancies was guided by their Muslim faith.

“We believe that what will come our way is part of what’s meant or destined for us,” he said. They have no plans for more children, they said.

Chakraborty had learned of MacKenzie’s early stage trial to test the enzyme therapy and thought early treatment might be a solution for the family.

The treatment could be “potentially very significant,” said Dr. Brendan Lanpher, a medical geneticist at the Mayo Clinic in Rochester, Minn., who was not involved in the research.

“This is a progressive disease that builds up over time, so every day a fetus or baby has it, they’re accumulating more of the material that affects muscle cells.”

Still, it’s too early to know whether the protocol will become accepted treatment, said Dr. Christina Lam, interim medical director of biochemical genetics at the University of Washington and Seattle Children’s Hospital in Seattle.

“It’s going to take some time to really be able to establish the evidence to definitively show that the outcomes are better,” she said.

Ayla receives drugs to suppress her immune system and weekly enzyme infusions that take five to six hours — a growing challenge for a wiggly toddler, her mother said. Unless a new treatment emerges, Ayla can expect to continue the infusions for life. She is developing normally — for now. Her parents say every milestone, such as when she started to crawl, is especially precious.

“It’s surreal. It amazes us every time,” Qureshi said. “We’re so blessed. We’ve been very, very blessed.”

———

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

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November 9, 2022