H5N1

The first local cases of Zika virus in Europe

A letter in The Lancet: The first local cases of Zika virus in Europe. Excerpt:

In October, 2019, the first mosquito-transmitted, locally acquired cases of Zika virus were reported in Europe. This outbreak event has implications far beyond the three people affected and represents a new phase in the global Zika threat. 

When Zika virus first emerged in the Pacific in 2007, then spread to the Americas and the Caribbean in 2015–17, the global community treated Zika virus as an epidemic disease. The Zika virus was expected to spread to Asia, but when surveillance began, not only were outbreaks in Asia found to be due to indigenous strains of Zika virus, but the virus was found to have been circulating silently for decades. The source of this latest European outbreak is unknown at present, but the world is clearly moving into an era of more unpredictable circulation of the Zika virus. 

The arrival of Zika virus in Europe is part of a wider pattern of accelerating arboviral risk on the continent (figure). The arrival also confirms the mosquito species Aedes albopictus as capable of supporting Zika virus transmission. This expands considerably the number of countries and territories where this unpredictable disease can occur to 177, putting 4·6 billion people potentially at risk.

Although the European Centre for Disease Prevention and Control describes the individual risk of infection in many of these areas as very low, advice for pregnant women living in or visiting these areas is wanting. These introductions also challenge the view that Zika is a tropical disease best dealt with by reactive outbreak response and containment. Zika is an increasingly cosmopolitan and more unpredictable threat than ever before. The Zika virus and other arboviruses continue their global expansion.

The arrival of Zika virus in Europe should signal a re-evaluation of the broader field of arboviral diseases. In an increasingly globalised world, Europeans need to care as much about outbreaks in Manila, Manaus, or Majuro as they do about outbreaks in Marseille. Investments in arbovirus research and surveillance systems worldwide are needed to monitor the new and emerging threats posed by this increasingly high-profile group of viruses. The global emergence of dengue virus, chikungunya virus, and Zika virus should be a wake-up call to shift the strategy from emergency response to increased vigilance and prevention measures. We should not have to wait for the next global arbovirus to arrive on the shores of Europe or the USA before we act on this.

Schools closed in New Delhi as air quality dips for third day

Via The Globe and Mail, an Associated Press report: Schools closed in New Delhi as air quality dips for third day. Excerpt:

Schools in India’s capital were shut on Thursday and remain closed on Friday after a thick haze of noxious air enveloped the city for a third consecutive day, and angry residents blamed authorities for holding an annual children’s race. 

Buildings and monuments were largely obscured by smog and an official health advisory urged people to avoid all physical activity outdoors.  

The air quality index exceeded 460, nine times the level recommended by the World Health Organization, according to the state-run Central Pollution Control Board. In some places, the index crossed the 500 level. 

Still, hundreds of children took part Thursday in the annual Run for Children race organized by a non-profit group called Prayas. 

Residents took to social media and blamed authorities for allowing the run after pictures were shared of children without protective masks.  

The event was organized to mark the birthday of India’s first prime minister, Jawaharlal Nehru, which is celebrated as Children’s Day in India. 

“It was a symbolic event and children didn’t run beyond 200 metres,” organizer Amod Kanth said. 

Mr. Kanth said the organization had permission from the authorities and he was not directed to cancel the event. 

Many decried the rising pollution levels and said the government is not doing enough.  

New Delhi is one of the world’s most polluted cities, and winters have become a time of annual health woes when the city is covered in a toxic haze that obscures the sky and blocks sunlight.

Doctors in the city of 20 million people say many of their patients are complaining of ailments related to the filthy air. 

Air pollution in northern India, including New Delhi, peaks from smoke from agricultural fires in neighbouring Haryana and Punjab states, which mixes with the city’s vehicle emissions and construction dust.  

Authorities have resorted to emergency measures such as banning construction, reducing traffic and prohibiting the use of diesel generators. But the steps have had little effect because state governments have failed to co-operate in tackling pollution.

As of 9:00 p.m. Friday, local time, Delhi's AQI stations report numbers ranging from the high 200s (Very Unhealthy) to 639 (Hazardous). 

The 2019 report of The Lancet Countdown on health and climate change

Via The Lancet: The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate.Excerpt from the executive summary:

A child born today will experience a world that is more than four degrees warmer than the pre-industrial average, with climate change impacting human health from infancy and adolescence to adulthood and old age. Across the world, children are among the worst affected by climate change. 

Downward trends in global yield potential for all major crops tracked since 1960 threaten food production and food security, with infants often the worst affected by the potentially permanent effects of undernutrition (indicator 1.5.1). Children are among the most susceptible to diarrhoeal disease and experience the most severe effects of dengue fever. 

Trends in climate suitability for disease transmission are particularly concerning, with 9 of the 10 most suitable years for the transmission of dengue fever on record occurring since 2000 (indicator 1.4.1). Similarly, since an early 1980s baseline, the number of days suitable for Vibrio (a pathogen responsible for part of the burden of diarrhoeal disease) has doubled, and global suitability for coastal Vibrio cholerae has increased by 9·9% (indicator 1.4.1). 

Through adolescence and beyond, air pollution—principally driven by fossil fuels, and exacerbated by climate change—damages the heart, lungs, and every other vital organ. These effects accumulate over time, and into adulthood, with global deaths attributable to ambient fine particulate matter (PM2·5) remaining at 2·9 million in 2016 (indicator 3.3.2) and total global air pollution deaths reaching 7 million. 

Later in life, families and livelihoods are put at risk from increases in the frequency and severity of extreme weather conditions, with women among the most vulnerable across a range of social and cultural contexts. Globally, 77% of countries experienced an increase in daily population exposure to wildfires from 2001–14 to 2015–18 (indicator 1.2.1). India and China sustained the largest increases, with an increase of over 21 million exposures in India and 17 million exposures in China over this time period. 

In low-income countries, almost all economic losses from extreme weather events are uninsured, placing a particularly high burden on individuals and households (indicator 4.1). Temperature rise and heatwaves are increasingly limiting the labour capacity of various populations. In 2018, 133·6 billion potential work hours were lost globally, 45 billion more than the 2000 baseline, and southern areas of the USA lost 15–20% of potential daylight work hours during the hottest month of 2018 (indicator 1.1.4). 

Populations aged 65 years and older are particularly vulnerable to the health effects of climate change, and especially to extremes of heat. From 1990 to 2018, populations in every region have become more vulnerable to heat and heatwaves, with Europe and the Eastern Mediterranean remaining the most vulnerable (indicator 1.1.1). In 2018, these vulnerable populations experienced 220 million heatwave exposures globally, breaking the previous record of 209 million set in 2015 (indicator 1.1.3). 

Already faced with the challenge of an ageing population, Japan had 32 million heatwave exposures affecting people aged 65 years and older in 2018, the equivalent of almost every person in this age group experiencing a heatwave. Finally, although difficult to quantify, the downstream risks of climate change, such as migration, poverty exacerbation, violent conflict, and mental illness, affect people of all ages and all nationalities. 

A business as usual trajectory will result in a fundamentally altered world, with the indicators described providing a glimpse of the implications of this pathway. The life of every child born today will be profoundly affected by climate change. Without accelerated intervention, this new era will come to define the health of people at every stage of their lives.

NSW and Queensland fires: Sydney to face catastrophic fire danger for first time

Via The Guardian: NSW and Queensland fires: Sydney to face catastrophic fire danger for first time. Excerpt:

The greater Sydney region will face catastrophic fire danger on Tuesday for the first time since the rating was introduced and fire authorities say conditions in other parts of New South Wales could also be set to worsen. 

The warning was issued as more than 80 fires continued to burn in the north of the state late on Sunday. 

Three people have died in the fires and at least 150 properties have been destroyed. The number of properties lost in the emergency is expected to grow as fire grounds become accessible to crews assessing the damage. 

On Sunday afternoon, two emergency warnings were issued for fires burning on the north-east and mid-north coast of NSW.  

A fire at Bills Crossing, north of Taree, had already burned through almost 12,000 hectares, with the Rural Fire Service warning people in the Johns River area to seek shelter as the blaze approached. 

The other warning was issued for an out-of-control fire in the Mt Nardi national park, where people were advised that leaving early was their safest option.  

While some weather conditions were expected to ease late on Sunday and into Monday, both the Rural Fire Service and the Bureau of Meteorology warned that dangerous conditions were forecast for Tuesday. 

The Rural Fire Service issued a catastrophic fire danger warning for the greater Sydney and greater Hunter regions – including the Blue Mountains and the central coast – on Tuesday due to high temperatures, strong winds and dry conditions. 

Extreme fire danger is forecast in the Illawarra/Shoalhaven region, the north coast, the central ranges, the northern slopes and the north-western regions.  

The far north coast, New England, the far south coast, the southern ranges, and the lower central west plains are expecting severe fire danger.

'Nobody gets out without damage': What fighting fire does to the body

Via The Guardian, a report as relevant to Australia and Canada as the US: 'Nobody gets out without damage': what fighting fire does to the body.

Over the past decade, scientists have been working to better understand how firefighters’ exposure to smoke and chemical vapors affects their long-term health. In California, the researchers’ work has taken on a new urgency as increasingly ferocious fires burn through wilderness and development alike, unleashing unprecedented amounts of gases and particulate upon those battling the blazes. 

“We know that firefighters have pretty intense exposures under those conditions,” said Rachel Morello-Frosch, an environmental scientist at the University of California, Berkeley. An analysis she released in July found that firefighters who fought the October 2017 Tubbs fire, which raged for more than three weeks through nearly 37,000 acres in California’s wine country and killed 22, came home with heightened levels of mercury and other toxic chemicals in their blood. 

Blood samples from 149 firefighters deployed to Tubbs showed higher rates of mercury compared not only with members of the general public, but also with other firefighters who weren’t deployed. 

“This was just an initial, pilot study,” Morello-Frosch said. Still, it seemed to validate what many firefighters already suspected: those working in regions referred to as wildland-urban interface, where residential areas blend into wilderness, face elevated health risks. 

Risks of firefighting are changing  

Wildland firefighters are often exposed to smoke for longer periods of time, working 40-, 50- or 60-hour shifts, even camping and sleeping amid the fumes. “They’re doing backbreaking work,” said Morello-Frosch, digging lines, trimming trees and hiking for miles.  

They tend to wear relatively lightweight gear so they can stay nimble. Whereas the responders running into burning buildings wear heavy-duty masks that feed them clean air, wildland firefighters might use a handkerchief.  

And a simple handkerchief might do, if all that was burning was vegetation. “But the dynamics of wildfire have changed,” said Matt Alba, a fire captain who led his San Francisco-based strike team to the Camp fire last year.

As communities have built and expanded into the wild areas, “it’s not just plants and leaves burning, it’s homes and structures too,” Alba said. 

Paradise didn’t smell like wildfire smoke, he recalled. “There was this awful taste to it. We just knew it was wrong.” His crew fought through stinging eyes and headaches.  

Most of the houses in Paradise were prefabricated, and when they burned so did a noxious mix of plastics, metals, household cleaning chemicals and who knows what else. 

“There were charred piles of just open cans, and lots of burned out cars,” he said – some with bodies in them. “It was apocalyptic.” 

Afterward, he said, “we got all new boots, because ours were just covered in a lot of toxic content.”  

Scientists still don’t know what exactly that “content” contains – and how toxic it may be. “That’s always the 50-million-dollar question,” said Morello-Frosch. Fumes from anything and everything that burns have the potential to cause harm, but so do PFAS – a controversial class of chemicals used in firefighters’ turnout gear – and so does the neon-pink fire retardant that responders blanket over blazes, she said.

A new twenty-first century science for effective epidemic response

Thanks to Mary Marshall for sending the link to this Nature article: A new twenty-first century science for effective epidemic response. The abstract:

With rapidly changing ecology, urbanization, climate change, increased travel and fragile public health systems, epidemics will become more frequent, more complex and harder to prevent and contain. 

Here we argue that our concept of epidemics must evolve from crisis response during discrete outbreaks to an integrated cycle of preparation, response and recovery. This is an opportunity to combine knowledge and skills from all over the world—especially at-risk and affected communities. Many disciplines need to be integrated, including not only epidemiology but also social sciences, research and development, diplomacy, logistics and crisis management. 

This requires a new approach to training tomorrow’s leaders in epidemic prevention and response.

Delhi smog continues at 'hazardous' levels

Here's the Mandir Marg, Delhi, Delhi Air Pollution: Real-time Air Quality Index, update at 5:00 a.m. Monday Delhi time. Note the number of stations reporting readings in the 700s and 800s, before the working day has really started. 

This is a public health disaster happening in a megacity of almost 30 million people, and happening also in other North Indian cities. 

Please Lord Indra, stop blaming stubble burning: BJP leader on rising pollution

Via the Deccan Chronicle: Please Lord Indra, stop blaming stubble burning: BJP leader on rising pollution.

Lucknow: A BJP leader in Uttar Pradesh on Sunday advised the government to perform yajnas to please rain god Lord Indra as many parts of northern India have been battling high pollution levels due to stubble burning and bursting of crackers on Diwali.  

Sunil Bharala, the chairman of the state Labour Welfare Council, said stubble burning is an "age-old practice".   

A Supreme Court mandated panel on Friday declared a public health emergency in the Delhi-National Capital Region and banned construction activity till November 5 as pollution levels have entered the "severe plus" category. 

According to official figures, the pollution levels in Lucknow in Uttar Pradesh and Patna in Bihar were worse than in Delhi on Saturday. 

He said, "The government should perform yajnas to please Lord Indra. He will set everything right". Barla said sprinkling water by helicopters will not end pollution, rather "we must seek divine intervention". 

To back his argument, Bharala said, "It was around 1991-92, when there were no rains in Meerut and nearby areas, a community yajna of 40-50 villages was held and as soon as it was over, rains started". 

He said holding farmers responsible for the spike in pollution levels was "unfortunate". "Stubble burning has always been done, since those items burnt are waste material. It is a natural system practised by farmers. The attack on farmers over this is very unfortunate," he said. 

Responding to those who were questioning the scientificity of his statement, Bharala said, "It is their thought and way of thinking. They do not follow the Hindu dharam and its culture. They do not believe in scientific ways nor do they believe in yajnas." 

Thirteen cities of the country had an average Air Quality Index (AQI) above 400, which falls in "severe" category, with seven of them in Uttar Pradesh, five in Haryana and one in Bihar, according to the Central Pollution Control Board's (CPCB) Saturday 4-pm bulletin. 

According to the bulletin, the average AQI in Delhi was 399. During the same period, Fatehabad recorded the worst average AQI at 493, while it was 428 in Patna and 422 in Lucknow.  

In Uttar Pradesh, Ghaziabad had the worst average AQI of 453, followed by Bulandshahr (446), Hapur (444), Greater Noida (438), Baghpat (435), Noida (432), Lucknow (422), Kanpur (379), Meerut (371) and Varanasi (328), the CPCB data showed.

US: Public health consequences of wildfire-induced blackouts

Via the Fort Bragg Advocate-News in northern California, an October 31 report: PSPS roils coast; community steps up. Excerpt:

Steve Orsi and Dave Latoof, fire chiefs from Fort Bragg and Mendocino, both reported an increase in calls for practical concerns and information (does the fire department deliver water to your house? – no, it does not). But both reported people getting along, generally not setting things on fire and being reasonably well-prepared. 

That was not the case across the board. The Mendocino Coast District Hospital Emergency Room was deluged by people with a variety of needs, according to Will Lee, medical staff services director (also mayor of Fort Bragg).  

City government’s email system and internet service, provided by Comcast, went out and remained out Wednesday morning. This reduced City Manager Tabatha Miller to sending updates on the situation by text, and severely limited communication for all city employees during a crisis event. 

City council member Lindy Peters was at City Hall Monday, and said he (and council member Bernie Norvell) had spent part of Sunday at the police station, where a steady stream of people, many of them refugees from Sonoma County, came in with all manner of questions and problems.  

Medical needs 

Oxygen bottles were a major issue, Lee said. State law requires everyone needing oxygen to have six- to eight-bottle backup supply, Lee said. It turned out quite a few people didn’t have that backup, couldn’t get more or fill bottles without electricity, and came to the ER for help.  

Lee said one of the companies that supplies oxygen bottles was responsive to the crisis. The other was not, he said, and that is a situation that needs to be corrected. 

Lack of a generator to adequately power the North Coast Family Health Center’s Urgent Care Center also put an extra load on the emergency room Monday, but a generator supplied Tuesday eased the load. 

Another strain on local medical services were refugees from the Kincade Fire in Sonoma County, which has driven well over 100,000 people from their homes. With air quality bad and motel rooms scarce farther south, many fire refugees came to the Mendocino Coast even without power and very limited shelter. 

A number, Lee said, had respiratory issues from having to deal with intense smoke. Others had anxiety-related complaints, others had full-on medical emergencies. While the hospital ran on backup generators (which, contrary to rumor, Lee said, have all functioned fine throughout), the medical staff dealt with a significant increase in traffic.  

Lee said the blackout itself triggered some anxiety-related issues among local people, from chest pains to mental health crises, and they all ended at the Emergency Room.

New threats put wildfire fighters’ health on the line

Via The New York Times: New Threats Put Wildfire Fighters’ Health on the Line. This will be a serious issue for the rest of the century. Excerpt:

SANTA ROSA, Calif. — As fires spread across Northern California last year, Capt. Matt Alba and Strike Team 2253A found themselves wading through a smoldering jungle of plastic and metal in search of bodies.  

As they worked through charred auto shops and trailers, Mr. Alba kept thinking about the poisons they were kicking up, and that they did not have a single mask or hazmat suit among them. 

Wildfire fighting had changed. 

For generations, firefighters fought mostly in desolate forests, where most of the dangers were fatigue and falling trees. But a confluence of modern factors — namely America’s rapid suburban expansion into the wilderness, combined with the growing ferocity of wildfires — is posing a host of new health threats to the men and women who fight these blazes. 

While burning wood poses some threat to lungs, man-made products and the gases and particles they produce when burned are far more dangerous.  

In the last three years, California has seen a record number of devastating fires, and thousands of firefighters have been exposed to chemicals they had not previously encountered in such high volumes.

Unlike urban firefighters dealing with structural blazes, these wildfire responders do not wear heavy gear that filters air or provides clean air because the gear is unwieldy and too limited to allow the kind of multi-hour, high-exertion efforts demanded on the front lines of these large outdoor infernos.  

But some think more needs to be done to keep wildland firefighters safe.  

Mr. Alba, who has been with the San Francisco Fire Department for 18 years, spent 11 days working in Paradise, Calif., last year, in a smog so thick it burned his lungs. As he picked his way through the wreckage, he said, his crew began to fall sick: severe headaches, brutal coughs. 

“I was just thinking about 9/11,” he said of the many firefighters who fell ill after the 2001 terrorist attacks. “I asked myself: Is history repeating itself here?”