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March 8, 2023

Medical tourism to Mexico is on the rise, but it can come with risks | CNN

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CNN
—

One of the four Americans who were kidnapped in Mexico last week was traveling for medical tourism, a friend said. A growing number of US residents are traveling internationally to seek more affordable medical care, more timely care or access to certain treatments or procedures that are unapproved or unavailable in the United States.

Latavia “Tay” Washington McGee, 33, drove to Mexico with Shaeed Woodard, Zindell Brown and Eric Williams for cosmetic surgery that was scheduled to take place Friday, according to a close friend of Washington McGee’s who did not want to be identified.

The four Americans were found Tuesday near the border city of Matamoros, officials said. Washington McGee and Williams were found alive, and Woodard and Brown were found dead, a US official familiar with the investigation told CNN. Investigators are still piecing together what happened after they were abducted.

Medical tourism takes people all over the world, including to Mexico, India and Eastern Europe. Violence against medical tourists is generally thought to be rare, but the US Centers for Disease Control and Prevention warns about other risks such as quality of care, infection control and communication challenges with medical staff.

“It’s on the daily, without a doubt. There are people going daily to get this kind of stuff done,” said Dr. Nolan Perez, a gastroenterologist in Brownsville, Texas, which is across the border from Matamoros. “Whether it’s primary care provider visits or dental procedures or something more significant, like elective or weight loss surgery, there’s no doubt that people are doing that because of low cost and easier access.”

One study published in the American Journal of Medicine estimated that fewer than 800,000 Americans traveled to other countries for medical care in 2007, but by 2017, more than 1 million did.

More current estimates suggest that those numbers have continued to grow.

“People travel because there may be a long waiting time, wait lists or other reasons why they can’t get treatment as quickly as they would like it. So they explore their options outside the United States to see what’s available,” said Elizabeth Ziemba, president of Medical Tourism Training, which provides training and accreditation to international health travel organizations.

Also, “price is a big issue in the United States. We know that the US health care system is incredibly expensive,” she added. “Even for people with insurance, there may be high deductibles or out-of-pocket costs that are not covered by insurance, so that people will look based on price for what’s available in other destinations.”

The most common procedures that prompt medical tourism trips include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplants and cancer treatment, according to the CDC.

“With Mexico and Costa Rica, it’s overwhelmingly dental and cosmetic surgery. However, certain countries are known for specialties. For example, in Singapore, stem cell and oncology is huge. In India, South India and Chennai Apollo hospitals does incredible work with hip and knee surgeries,” said Josef Woodman, founder of Patients Beyond Borders, an international health care consulting company.

“In Eastern Europe, a lot of people from the UK – but also people from the United States – travel to Hungary, Croatia and Turkey for everything from dental to light cosmetic surgery,” he said.

Mexico is the second most popular destination for medical tourism globally, with an estimated 1.4 million to 3 million people coming into the country to take advantage of inexpensive treatment in 2020, according to Patients Beyond Borders.

Matamoros – where officials said the four kidnapped Americans were found – is “not considered a primary medical travel destination,” Woodman said, “largely because there are no internationally accredited medical centers/specialty clinics there or in the immediate region.”

Mexico City, Cancun and Tijuana are more frequented and reliable destinations in the country, Woodman said.

On average, Americans can save 40% to 60% across the most common major procedures received by medical tourists in Mexico, according to an analysis of 2020 health ministry data conducted by Patients Beyond Borders.

Woodman said that violence against medical tourists was extremely rare, but he added that “price shopping” – searching for the cheapest location for a procedure – is a “blueprint for trouble,” namely substandard medical care.

Medical tourism can be dangerous, depending on the destination and the person’s condition.

“There are the complexities of traveling if you have a medically complex situation. There are fit-to-fly rules. And your health care providers should take into consideration the impact of traveling if you have orthopedic injuries or issues,” Ziemba said.

“The quality of care may be an unknown,” she said. “It may be that the quality of care is not up to the standards that you would like. So there’s a bit of an unknown there, and then the last thing I would say is, if something goes wrong, what’s going to happen?”

Perez said he commonly manages complications from medical tourism in his practice.

“There are a lot of bad outcomes. There are a lot of infections and a lot of botched procedures gone wrong, and patients have to come back to the United States and then have a revision of the surgery,” he said. “So it’s really unfortunate.”

Yet Ziemba added that there can be benefits to medical tourism, including that someone could receive a service that they need faster overseas than locally.

“And price: If you simply can’t afford the out-of-pocket costs of health care in the United States, and assuming the risks involved, it may make much more sense for you financially to travel outside the United States,” she said.

Medical tourism is not just for people traveling around the world. Many living along the US-Mexico border, where access to health care can be scarce, cross into Mexico for care.

The Rio Grande Valley, at the southernmost point of Texas, is considered to be a medically underserved area. The region has some of the nation’s highest rates of comorbidities, including obesity and diabetes, and one of the lowest physician-to-patient ratios.

There is a “dire need” for health care professionals along the border, Perez said.

“There are not as many doctors given our big and our growing population down here. So the demands on primary care doctors and specialists are very high because there are not enough of us for this population,” he said. “So that’s one reason why people end up going to Mexico to visit with physicians, because of easier access.”

People interested in medical tourism can take some steps to help minimize their risk, the CDC says.

Those planning to travel to another country for medical care should see their health care provider or a travel medicine provider at least four to six weeks before the trip and get international travel health insurance that covers medical evacuation back to the United States.

The CDC advises taking copies of your medical records with you and checking the qualifications of the providers who will be overseeing your medical care. Also, make sure you can get any follow-up care you may need.

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February 24, 2023

Saving water can help us deal with the climate crisis. Here’s how to reduce your use | CNN

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Editor’s Note: Sign up for CNN’s Life, But Greener newsletter. Our limited newsletter series guides you on how to minimize your personal role in the climate crisis — and reduce your eco-anxiety.

CNN
—

The reliability of our faucets providing water every time we turn them on can make water seem like a magical, never-ending resource.

But abusing the availability of this finite resource can contribute to water scarcity and harm our capacity to deal with the impact of the climate crisis.

“Four billion people today already live in places that are affected by water scarcity at least part of the year,” said Rick Hogeboom, executive director of the Water Footprint Network, an international knowledge center based in the Netherlands. “Climate change will have a worsening influence on the demand-supply balance,” he said.

“If all people were to conserve water in some way, that would help ease some of the immediate impacts seen from the climate crisis,” said Shanika Whitehurst, associate director of sustainability for Consumer Reports’ research and testing. Consumer Reports is a nonprofit that helps consumers evaluate goods and services.

“Unfortunately, there has been a great toll taken on our surface and groundwater sources, so conservation efforts would more than likely have to be employed long term for there to be a more substantial effect.”

Yes, businesses and governments should play a part in water conservation by, respectively, producing goods “water efficiently” and allocating water in a sustainable, equitable way, Hogeboom said.

But “addressing the multifaceted water crises is a shared responsibility. No one actor can solve it, nor is there a silver bullet,” he added. “We need all actors to play their part.”

Contrary to what you might think, the water used directly in and around the home makes up a minor portion of the total water footprint of a consumer, Hogeboom said.

“The bulk — typically at least 95% — is indirect water use, water use that is hidden in the products we buy, the clothes we wear and the food we eat,” Hogeboom said. “Cotton, for instance, is a very thirsty crop.”

Of the 300-plus gallons of water the average American family uses every day at home, however, roughly 70% of this use occurs indoors, according to the US Environmental Protection Agency — making the home another important place to start cutting your use.

Here are some ways to reduce your water footprint as you move from room to room and outdoors.

Since the kitchen involves dishwashing, cooking and one of the biggest water guzzlers — your diet — it’s a good place to start.

An old kitchen faucet can release 1 to 3 gallons of water per minute when running at full blast, according to Consumer Reports. Instead of rinsing dishes before putting them in the dishwasher, scrape food into your trash or compost bin. Make sure your dishwasher is fully loaded so you only do as many wash cycles as necessary and make the most use of the water.

With some activities you can save water by not only using less but also upgrading the appliances that deliver the water. Dishwashers certified by Energy Star, the government-backed symbol for energy efficiency, are about 15% more water-efficient than standard models, according to Consumer Reports.

If you do wash dishes by hand, plug up the sink or use a wash basin so you can use a limited amount of water instead of letting the tap run.

If you plan on eating frozen foods, thaw them in the fridge overnight instead of running water over them. For drinking, keep a pitcher of water in the fridge instead of running the faucet until the water’s cool — and if you need to do that to get hot water, collect the cold water and use it to water plants.

Cook foods in as little water as possible, which can also retain flavor, according to the University of Toronto Scarborough’s department of physical and environmental sciences.

When it comes to saving water via what you eat, generally animal products are more water-intensive than plant-based alternatives, Hogeboom said.

“Go vegetarian or even better vegan,” he added. “If you insist on meat, replace red meat by pig or chicken, which has a lower water footprint than beef.”

It takes more than 1,800 gallons of water to produce 1 pound of beef, Consumer Reports’ Whitehurst said.

The bathroom is the largest consumer of indoor water, as the toilet alone can use 27% of household water, according to the EPA. You can cut use here by following this adage: “If it’s yellow, let it mellow. If it’s brown, flush it down.”

“Limiting the amount of toilet flushes — as long as it is urine — is not problematic for hygiene,” Whitehurst said. “However, you do have to watch the amount of toilet paper to avoid clogging your pipes. If there is solid waste or feces, then flush the toilet immediately to avoid unsanitary conditions.”

Older toilets use between 3.5 and 7 gallons of water per flush, but WaterSense-labeled toilets use up to 60% less. WaterSense is a partnership program sponsored by the EPA.

“There’s probably more to gain by having dual flush systems so you don’t waste gallons for small flushes,” Hogeboom said.

By turning off the sink tap when you brush your teeth, shave or wash your face, you can save more than 200 gallons of water monthly, according to the EPA.

Cut water use further by limiting showers to five minutes and eliminating baths. Shower with your partner when you can. Save even more water by turning it off when you’re shampooing, shaving or lathering up, Consumer Reports suggests.

Replacing old sink faucets or showerheads with WaterSense models can save hundreds of gallons of water per year.

Laundry rooms account for nearly a fourth of household water use, according to the EPA. Traditional washing machines can use 50 gallons of water or more per load, but newer energy- and water-conserving machines use less than 27 gallons per load.

You can also cut back by doing full loads (but not overstuffing) and choosing the appropriate water level and soil settings. Doing the latter two can help high-efficiency machines use only the water that’s needed. If you have a high-efficiency machine, use HE detergent or measure out regular detergent, which is more sudsy and, if too much is used, can cause the machine to use more water, according to Consumer Reports.

Nationally, outdoor water use accounts for 30% of household use, according to the EPA. This percentage can be much higher in drier parts of the country and in more water-intensive landscapes, particularly in the West.

If you prefer to have a landscape, reduce your outdoor use by planting only plants appropriate for your climate or ones that are low-water and drought-resistant.

“If maintained properly, climate-appropriate landscaping can use less than one-half the water of a traditional landscape,” the EPA says.

The biggest water consumers outside are automatic irrigation systems, according to the EPA. To use only what’s necessary, adjust irrigation controllers at least once per month to account for weather changes. WaterSense irrigation controllers monitor weather and landscape conditions to water plants only when needed.

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February 10, 2023

Common kinds of air pollution led to changes in teens’ blood pressure, study says | CNN

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CNN
—

Scientists know that air pollution can make it difficult to breathe and may ultimately cause serious health problems like cancer, but a new study shows that it might also have a negative impact on teens’ blood pressure.

Exposure to higher levels of nitrogen dioxide was associated with lower blood pressure in teens, according to the study, published Wednesday in the journal PLOS One. Exposure to particulate matter 2.5, also known as particle pollution, was associated with higher blood pressure.

The researchers say the impact is “considerable.”

Other studies have found a connection between blood pressure changes and pollution, but much of that work focuses on adults. Some research has also found negative associations with pollution exposure and younger children, but little has focused on teens.

Generally, low blood pressure can cause immediate problems like confusion, tiredness, blurred vision and dizziness. High blood pressure in adolescence can lead to a lifetime of health problems including a higher risk of stroke or heart attack. It’s a leading risk factor for premature death worldwide.

The study did not look at whether the teens had symptoms or health effects from the change in blood pressure.

The scientists saw this association between pollution and blood pressure in data from the Determinants of Adolescent Social Well-Being and Health study, which tracks the health of a large and ethnically diverse group of children in London over time.

The researchers took data from more than 3,200 teens and compared their records to their exposures to pollution based on annual pollution levels where they lived.

Nitrogen dioxide pollution is most commonly associated with traffic-related combustion byproducts. Nitrogen may help plants grow, but it can impair a person’s ability to breathe and may cause damage to the human respiratory tract. In this study, the nitrogen was thought to be coming predominantly from diesel traffic.

The particle pollution in the study is so tiny – 1/20th of a width of a human hair – that it can travel past the body’s usual defenses. Instead of being carried out when a person exhales, it can get stuck in the lungs or go into the bloodstream. The particles cause irritation and inflammation and may lead to a whole host of health problems.

Particle pollution can come from forest fires, wood stoves, power plants and coal fires. It can also come from traffic and construction sites.

In this study, the link between pollution exposure and changes in blood pressure was stronger in girls than in boys. The researchers can’t determine why there is a gender difference, but they found that 30% of the female participants got the least amount of exercise among the group and noted that that can have an effect on blood pressure.

“It is thus imperative that air pollution is improved in London to maximise the health benefits of physical exercise in young people,” the study says.

Although the study also can’t pinpoint why teens’ blood pressure changed with pollution exposure, others have found that exposure to air pollution may affect the central nervous system, causing inflammation and damage to the body’s cells. Additionally, exposure to particle pollution can disrupt a person’s circadian rhythms, which could affect blood pressure. Particle pollution exposure may also reduce the kidneys’ ability to excrete sodium during the day, leading to a higher nighttime blood pressure level, the study says.

When it came to nitrogen dioxide pollution, the researchers had previously done a crossover study that involved the blood pressure of 12 healthy teen participants who were exposed to nitrogen oxide from a domestic gas cooker with lit burners. Their blood pressure fell compared with participants exposed to only room air.

In the new study, the associations between pollution and blood pressure were consistent. Body size, socieoecomonic status and ethnicity didn’t change the results.

However, it looks only at teens in London, and only 8% of them were people of color. Those children were exposed to higher levels of pollution than White children, the study found.

Levels of pollution in London are also well above what World Health Organization guidelines suggest is safe for humans. However, the same could be said for most any area in the world. In 2019, 99% of the world’s population lived in places that did not meet WHO’s recommended air quality levels.

Earlier work has shown that pollution can damage a young person’s health and may put them at a higher risk for chronic diseases like heart problems later in life. Studies in adults found that exposure to air pollution can affect blood pressure even within hours of exposure.

Pollution caused 1 in 6 deaths worldwide in 2019 alone, another study found.

Some experts suggest that one way to reduce a teen’s risk of pollution-related health problems is to invest in portable air cleaners with HEPA filters that are highly effective at reducing indoor air pollution. However, the filters can’t remove all of the problem, and experts say communitywide solutions through public policy are what’s needed.

Dr. Panagis Galiatsatos, an assistant professor in pulmonary and critical care medicine at Johns Hopkins Medicine, said research like this is important to generate a hypothesis about what these pollutants are doing to people. Galiatsatos, a volunteer medical spokesperson with the American Lung Association, was not involved with the new study.

“A lot of these air pollutions tend to cluster in economically disadvantaged neighborhoods, so it’s one of the big reasons we want to always keep a close eye on this, as it disproportionately impacts certain populations more than others,” he said.

Blood pressure is an important marker to track for health because it is a surrogate to understand the more complex processes that might be happening in the body.

“My big takeaway is that these toxins clearly seem to have some physiological impact on the cardiovascular system, and any manipulation should be taken into the context of a concern,” Galiatsatos said.

Study co-author Dr. Seeromanie Harding, a professor of social epidemiology at King’s College London, said she hopes it will lead to more research on the topic.

“Given that more than 1 million under 18s live in [London] neighborhoods where air pollution is higher than the recommended health standards,” she said in a news release, “there is an urgent need for more of these studies to gain an in-depth understanding of the threats and opportunities to young people’s development.”

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February 7, 2023

Climate change is contributing to the rise of superbugs, new UN report says | CNN

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CNN
—

Climate change and antimicrobial resistance are two of the greatest threats to global health, according to a new report from the United Nations Environment Programme.

The report, titled “Bracing for Superbugs,” highlights the role of climate change and other environmental factors contributing to the rise of antimicrobial resistance. It was announced Tuesday at the Sixth Meeting of the Global Leaders Group on Antimicrobial Resistance in Barbados.

Antimicrobial resistance or AMR happens when germs such as bacteria, viruses and fungi develop the ability to defeat the medications designed to kill them.

“The development and spread of AMR means that antimicrobials used to prevent and treat infections in humans, animals and plants might turn ineffective, with modern medicine no longer able to treat even mild infections,” the UN Environment Programme said in a news release.

Roughly 5 million deaths worldwide were associated with antimicrobial resistance in 2019, and the annual toll is expected to increase to 10 million by 2050 if steps aren’t taken to stop the spread of antimicrobial resistance, according to the report.

In the US, there are nearly 3 million antimicrobial-resistant infections each year, and more than 35,000 people die as a result, the US Centers for Disease Control and Prevention says.

Antimicrobials are commonly used in cleaning products, plant pesticides and medications to kill and prevent the spread of germs among people, animals and crops.

Drug resistance can develop naturally, but experts say the overuse of antimicrobials in people, animals and food production has accelerated the process. The microorganisms that survive these chemicals are stronger and more powerful, and they can spread their drug-resistant genes to germs that have never been exposed to antimicrobials.

The focus so far has largely been on excessive antimicrobial use, but experts say there is growing evidence that environmental factors play a significant role in the development, transmission and spread of antimicrobial resistance.

“Climate change, pollution, changes in our weather patterns, more rainfall, more closely packed, dense cities and urban areas – all of this facilitates the spread of antibiotic resistance. And I am certain that this is only going to go up with time unless we take relatively drastic measures to curb this,” said Dr. Scott Roberts, an infectious diseases specialist at Yale School of Medicine, who was not involved with the new UN report.

The climate crisis worsens antimicrobial resistance in several ways. Research has shown that increased temperatures increase both the rate of bacterial growth and the rate of the spread of antibiotic-resistant genes between microorganisms.

“As we get a more extreme climate, especially as it warms, the gradients that drive the evolution of resistance will actually accelerate. So, by curbing temperature rises and reducing the extremity of events, we can actually then fundamentally curb the probability of evolving new resistance,” Dr. David Graham, a professor of ecosystems engineering at Newcastle University and one of the UN report’s authors, said at a news conference ahead of the report’s release.

Experts also say severe flooding as a result of climate change can lead to conditions of overcrowding, poor sanitation and increased pollution, which are known to increase infection rates and antimicrobial resistance as human waste, heavy metals and other pollutants in water create favorable conditions for bugs to develop resistance.

“The same drivers that cause environmental degradation are worsening the antimicrobial resistance problem. The impacts of antimicrobial resistance could destroy our health and food systems,” Inger Andersen, the UN Environment Programme’s executive director, said at the news conference.

Environmental pressures are creating bugs that thrive in the human body, which experts say is unusual for some species.

“There’s one hypothesis from a prominent mycologist who suggests that the reason the body’s temperature is 98.6 is because that is the temperature where fungi can’t grow that well. And so, now we’re seeing Candida auris and some of the other new microbes that have come up that really grow quite well – even at temperatures of 98.6 in the human body. And so I think climate change, really selecting for these organisms to adapt to a warmer climate, is going to increase the odds that there’s infection in humans,” Roberts said.

Such opportunistic infections jeopardize medical advancements like joint replacements, organ transplants and chemotherapy – procedures in which patients have a significant risk of infection and require effective antibiotics.

Drug-resistant infections can make treatment difficult or even impossible. Roberts says that resorting to “last-ditch treatments” is “never a good scenario from the patient level because there are reasons we don’t use them up front,” such as organ toxicity and failure.

“When somebody does present with a drug-resistant bacteria or fungus and we really need to rely on one of these last-line antibiotics, it’s usually a challenge to treat from the outset. And so the patients really don’t do as well as a result,” he said. “In rare circumstances, we run out of options entirely, and in that case, there’s really nothing we can do. Fortunately, those cases remain quite rare, but I am certain that with this growing antibiotic resistance problem, we’ll see these increasing frequency over time.”

Experts say that both climate change and antimicrobial resistance have been worsened by and can be improved by human actions. One critical step is to limit antibiotic overuse and misuse.

“Antibiotics and antifungals do not work on viruses, such as colds and the flu. These drugs save lives. But, anytime they are used, they can lead to side effects and antimicrobial resistance,” the UN report’s authors wrote.

The authors also emphasize that the health of people, animals, plants and the environment are closely linked and interdependent, and they call on governments to identify policies to limit antibiotic use in agriculture and reduce environmental pollution.

Finally, experts say, steps to reduce climate change are steps to limit antimicrobial resistance.

“Whatever we can do on an individual level to kind of reduce the impact of climate change, really, that’s kind of only worsening this problem, as well as pollution and urbanization and in dense, crowded areas. Although I know from the individual level that’s a hard thing to change,” Roberts said.

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February 6, 2023

Alcohol and dementia: Study finds benefits in minimal drinking, but it’s complicated | CNN

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CNN
—

Keeping alcohol consumption to one or two drinks a day lessened the odds of developing dementia, according to a study of nearly 4 million South Koreans.

However, drinking more than two drinks a day increased that risk, according to the study published Monday in the journal JAMA Network Open.

“We found that maintaining mild to moderate alcohol consumption as well as reducing alcohol consumption from a heavy to moderate level were associated with a decreased risk of dementia,” said first author Dr. Keun Hye Jeon, an assistant professor at CHA Gumi Medical Center, CHA University in Gumi, South Korea, in an email.

But don’t rush to the liquor store, experts say.

“This study was well done and is extremely robust with 4 million subjects, but we should be cautious not to over interpret the findings,” said Alzheimer’s researcher Dr. Richard Isaacson, a preventive neurologist at the Institute for Neurodegenerative Diseases of Florida. He was not involved in the new study.

Alcohol use can be a risk factor for breast and other cancers, and consuming too much can contribute to digestive problems, heart and liver disease, hypertension, stroke, and a weak immune system over time, according to the US Centers for Disease Control and Prevention.

There are red flags for Alzheimer’s as well. For example, if a person has one or two copies of the APOE4 gene variant, which raises your risk of developing the mind-wasting disease, drinking is not a good choice, Isaacson said.

“Alcohol has been shown to be harmful for brain outcomes in people with that risk gene — and about 25% of the US population carries one copy of APOE4,” he said.

The new study examined the medical records of people covered by the Korean National Health Insurance Service (NHIS), which provides a free health exam twice a year to insured South Koreans who are 40 and older. In addition to doing various tests, examiners asked about each person’s drinking, smoking and exercise habits.

The study looked at the data collected in 2009 and 2011 and categorized people by their self-reported drinking levels. If a person said they drank less than 15 grams (approximately 0.5 ounces) of alcohol a day, they were considered “mild” drinkers.

In the United States, a standard drink contains 14 grams of alcohol, which is roughly the same as 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

If study participants told doctors they drank 15 to 29.9 grams a day — the equivalent of two standards drinks in the US — the researchers categorized them as “moderate” drinkers. And if people said they drank over 30 grams, or three or more drinks a day, researchers considered them “heavy” drinkers.

Researchers also looked at whether people sustained or changed the amount they drank between 2009 and 2011, Jeon said.

“By measuring alcohol consumption at two time points, we were able to study the relationship between reducing, ceasing, maintaining and increasing alcohol consumption and incident dementia,” he said.

The team then compared that data to medical records in 2018 — seven or eight years later — to see if anyone studied had been diagnosed with dementia.

After adjusting for age, sex, smoking, exercise level and other demographic factors, researchers found people who said they drank at a mild level over time — about a drink a day — were 21% less likely to develop dementia than people who never drank.

People who said they continued to drink at moderate level, or about two drinks a day, were 17% less likely to develop dementia, the study found.

“One has to be cautious when interpreting studies using medical records. They can be fraught with challenges in how diseases are coded and studied,” Isaacson said. “Any anytime you ask people to recall their behaviors, such as drinking, it leaves room for memory errors.”

The positive pattern did not continue as drinking increased. People who drank heavily — three or more drinks a day — were 8% more likely to be diagnosed with dementia, the study found.

If heavy drinkers reduced their drinking over time to a moderate level, their risk of being diagnosed with Alzheimer’s fell by 12%, and the risk of all-cause dementia fell by 8%.

However, people aren’t very good at judging how much alcohol they are drinking, Isaacson said.

“People don’t really monitor their pours of wine, for example,” Isaacson said. “They may think they are drinking a standard-sized glass of wine, but it’s really a glass and a half every time. Drink two of those pours and they’ve had three glasses of wine. That’s no longer mild or moderate consumption.”

In addition, too many people who think they are moderate drinkers do all of their drinking on weekends. Binge drinking is on the rise worldwide, even among adults, studies show.

“If someone downs five drinks on Saturday and Sunday that’s 10 drinks a week so that would qualify as a moderate alcohol intake,” Isaacson said. “To me, that is not that is not the same as having a glass of wine five days a week with a meal, which slows consumption.”

The new study also found that starting to drink at a mild level was associated with a decreased risk of all-cause dementia and Alzheimer’s, “which, to our knowledge, has never been reported in previous studies,” the authors wrote.

However, “none of the existing health guidelines recommends starting alcohol drinking,” Jeon said, adding that since the study was observational, no cause and effect can be determined.

“Our findings regarding a initiation of mild alcohol consumption cannot be directly translated into clinical recommendations, thereby warranting additional studies to confirm these associations further,” Jeon said.

A study published in March 2022 found that just one pint of beer or glass of wine a day can shrink the overall volume of the brain, with the damage increasing as the number of daily drinks rises.

On average, people between 40 and 69 who drank a pint of beer or 6-ounce glass of wine per day for a month had brains that appeared two years older than those who only drank half of a beer, according to that previous study.

“I’ve never personally suggested someone to start drinking moderate amounts of alcohol if they were abstinent,” Isaacson said. “But there’s really not a one-size-fits-all approach towards counseling a patient on alcohol consumption.”

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February 2, 2023

Mpox is almost gone in the US, leaving lessons and mysteries in its wake | CNN

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CNN
—

The US public health emergency declaration for mpox, formerly known as monkeypox, ends Tuesday.

The outbreak, which once seemed to be spiraling out of control, has quietly wound down. The virus isn’t completely gone, but for more than a month, the average number of daily new cases reported to the US Centers for Disease Control and Prevention has hovered in the single digits, plummeting from an August peak of about 450 cases a day.

Still, the US led the world in cases during the 2022-23 outbreak. More than 30,000 people in the US have been diagnosed with mpox, including 23 who died.

Cases are also down across Europe, the Western Pacific and Asia but still rising in some South American countries, according to the latest data from the World Health Organization.

It wasn’t always a given that we’d get here. When mpox went global in 2022, doctors had too few doses of a new and unproven vaccine, an untested treatment, a dearth of diagnostic testing and a difficult line to walk in their messaging, which needed to be geared to an at-risk population that has been stigmatized and ignored in public health crises before.

Experts say the outbreak has taught the world a lot about this infection, which had only occasionally been seen outside Africa.

But even with so much learned, there are lingering mysteries too – like where this virus comes from and why it suddenly began to spread from the Central and West African countries where it’s usually found to more than 100 other nations.

Before May 2022, when clusters of people with unusual rashes began appearing in clinics in the UK and Europe, the country reporting the most cases of mpox was the Democratic Republic of Congo, or DRC.

There, cases have been steadily building since the 1970s, according to a study in the CDC’s Morbidity and Mortality Weekly Report.

In the DRC, people in rural villages depend on wild animals for meat. Many mpox infections there are thought to be the result of contact with an animal to which the virus has adapted; this animal host is not known but is assumed to be a rodent.

For years, experts who studied African outbreaks observed a phenomenon known as stuttering chains of transmission: “infections that managed to transmit themselves or be transmitted from person to person to a limited degree, a certain number of links in that chain of transmission, and then suddenly just aren’t able to sustain themselves in humans,” said Stephen Morse, an epidemiologist at Columbia University’s Mailman School of Public Health.

Informally, scientists kept track, and Morse says that for years, the record for links in a mpox chain was about four.

“Traditionally, it always burned itself out,” he said.

Then the chains started getting longer.

In 2017, Nigeria – which hadn’t had a confirmed case of mpox in more than four decades – suddenly saw a resurgence of the virus, with more than 200 cases reported that year.

“People have speculated maybe it was a change in the virus that allowed it to be made better-adapted to humans,” Morse said.

From 2018 through 2021, eight cases of mpox were reported outside Africa. All were in men ages 30 to 50, and all had traveled from Nigeria. Three reported that the rashes had started in their groin area. One went on to infect a health care provider. Another infected two family members.

This Nigerian outbreak helped experts realize that mpox could efficiently spread between people.

It also hinted that the infection could be sexually transmitted, but investigators couldn’t confirm this route of spread, possibly because of the stigma involved in sharing information about sexual contact.

In early May 2022, health officials in the UK began reporting confirmed cases of mpox. One of the people had recently traveled to Nigeria, but others had not, indicating that it was spreading in the community.

Later, other countries would report cases that had started even earlier, in April.

Investigators concluded that mpox had been silently spreading before they caught up to it.

In early summer, as US case numbers began to grow, the public health response bore some uncomfortable similarities to the early days of Covid-19. People with suspicious rashes complained that it was too hard to get tested because a limited supply was being rationed. Because the virus had so rarely appeared outside certain countries in Africa, most doctors weren’t sure how to recognize mpox or how to test for it and didn’t understand all its routes of spread.

A new vaccine was available, and the government had placed orders for it, but most of those doses weren’t in the United States. Beyond that, its efficacy against mpox had been studied only in animals, so no one knew whether it would actually work in humans.

There was an experimental treatment, Tpoxx, but it too was unproven, and doctors could get it only after filling out reams of paperwork required by the government for compassionate use.

Some just gave up.

“Tpoxx was hard to get,” said Dr. Jeffrey Klausner, a clinical professor of public health at the University of Southern California’s Keck School of Medicine.

“I was scrambling to find places that could prescribe it because my own institution just became a bureaucratic nightmare. So I basically would be referring people for treatment outside my own institution to be able to get monkeypox treatment,” he said.

Finally, in August, the federal government declared a public health emergency. This allowed federal agencies to access pots of money set aside for emergencies. It also allows the government to shift funds from one purpose to another to help cover costs of the response – and it helped raise awareness among doctors that mpox was something to watch for.

The government also set up a task force led by Robert Fenton, a logistics expert from the Federal Emergency Management Agency, and Dr. Demetre Daskalakis, director of the CDC’s Division of HIV and AIDS Research.

Daskalakis is openly gay and sex-positive, right down to his Instagram account, which mixes suit-and-tie shots from White House briefings with photos revealing his many tattoos.

“Dr. Daskalakis … really walks on water in most of the gay community, and then [Fenton is] a logistics expert, and I think that combination of leadership was the right answer,” Klausner said.

Early on, after the CDC identified men who have sex with men as being at highest risk of infection, officials warned of close physical contact, the kind that often happens with sexual activity. They also noted that people could be infected through contact with contaminated surfaces like sheets or towels.

But they stopped short of calling it a sexually transmitted infection, a move that some saw as calculated.

“In this outbreak, in this time and context to Europe, United States and Australia, was definitely sexually transmitted,” said Klausner, who points out that many men got rashes on their genitals and that infectious virus was cultured in semen.

Klausner believes vague descriptions about how the virus spread were intentional, in order to garner resources needed for the response.

“People felt that if they called it an STD from the get-go, it was going to create stigma, and because of the stigma of the type of sex that was occurring – oral sex, anal sex, anal sex between same-sex male partners – there may not have been the same kind of federal response,” Klausner said. “So it was actually a political calculation to garner the resources necessary to have a substantial response to be vague about how it spread.”

This ambiguity created room for misinformation and confusion, said Tony Hoang, executive director of Equality California, a nonprofit advocacy group for LGBTQ civil rights.

“I think there was a balancing dance of not wanting to create stigma, in terms of who is actually the highest rates of transmission without being forthright,” Hoang said.

Hoang’s group launched its own public information campaign, combining information from the CDC on HIV and mpox. The messaging stressed that sex was the risky behavior and made sure to explain that light brushes or touches weren’t likely to pass the infection, he said.

Klausner thinks the CDC could have done better on messaging.

“By giving vague, nonspecific information and making comments like ‘everyone’s potentially at risk’ or ‘there’s possible spread through sharing a bed, clothing or close dancing’ … that kind of dilutes the message, and people who engage in risk behavior that does put them at risk get confused, and they say ‘well, maybe this isn’t really a route of spread,’ ” he said.

In July and August, when the US was reporting hundreds of new mpox cases each day, health officials were worried that the virus might be here to stay.

“There were concerns that there would be ongoing transmission and that ongoing transmission would become endemic in the United States like other STIs: gonorrhea, chlamydia, syphilis. We have not seen that occur,” said Dr. Jonathan Mermin, director of the CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention.

“We are now seeing three to four cases a day in the United States, and it continues to decline. And we see the possibility of getting to zero as real,” he said.

At the peak of the outbreak, officials scrambled to vaccinate the population at highest risk – men who have sex with men – in the hopes of limiting both severity of infections and transmission. But no one was sure whether this strategy would work.

The Jynneos vaccine was approved by the US Food and Drug Administration in 2019 to prevent monkeypox and smallpox in people at high risk of those infections.

At that time, the plan was to bank it in the Strategic National Stockpile as a countermeasure in case smallpox was weaponized. The approval for mpox, a virus closely related to smallpox, was tacked on because the US had seen a limited outbreak of these infections in 2003, tied to the importation of exotic rodents as pets.

Jynneos had passed safety tests in humans. In lab studies, it protected primates and mice from mpox infections. But researchers only learn how effective vaccines are during infectious disease outbreaks, and Jynneos has never been put through its paces during an outbreak.

“We were left, when this started, with that great unknown: Does this vaccine work? And is it safe in large numbers?” Mermin said.

Beyond those uncertainties, there wasn’t enough to go around, and infectious disease experts feared that a shortage of the vaccine might thwart any effort to stop the outbreak.

So public health officials announced a change in strategy: Instead of injecting a full dose under the skin, or subcutaneously, they would inject just one-fifth of that dose between the skin’s upper layers, or intradermally.

An early study in the trials of the vaccine had suggested that intradermal dosing could be effective, but it was a risk. Again, no one was sure this dose-sparing strategy would work.

Ultimately, all of these gambles appear to have paid off.

Early studies of vaccine effectiveness show that the Jynneos vaccine protected men from mpox infections. According to CDC data, people who were unvaccinated were almost 10 times as likely to be diagnosed with the infection as those who got the recommended two doses.

Men who had two doses were about 69% less likely, and men with a single dose were about 37% less likely, to have an mpox infection that needed medical attention compared with those who were unvaccinated, according to the CDC.

Mermin says studies have since showed that the vaccine worked well no matter if was given into the skin or under the skin – another win.

Still, the vaccine is almost certainly not the entire reason cases have plunged, simply because not enough people have gotten it. The CDC estimates that 2 million people in the United States are eligible for mpox vaccination. Mermin says that about 700,000 have had a first dose – about 36% of the eligible population.

So it’s unlikely that vaccination was the only reason for the steep decline in cases. CDC modeling suggests that behavior change may have played a substantial role, too.

In an online survey of men who have sex with men conducted in August, half of participants indicated that they had reduced their number of partners and one-time sexual encounters, behaviors that could cut the growth of new infections by 20% to 30%.

If that’s the case, some experts worry that the US could see monkeypox flare up again as the weather warms.

“The party season was during the summer, during the height of the outbreak, and we’re in the dead of winter. So there’s a possibility that behavior change may not able to be sustained,” said Gregg Gonsalves, an epidemiologist at the Yale School of Public Health.

Although we’re clearly in a much better position than we were last summer, he says, public health officials shouldn’t make this a “mission accomplished” moment.

“Now, put your foot on the accelerator. Let’s get the rest of these cases,” Gonsalves said.

Mermin says that’s exactly what the CDC intends to do. It isn’t finished with the response but intends to switch to “a ground game.”

“So much of our work in the next few months will be setting up structures so that getting vaccinated is easy,” he said.

Nearly 40% of mpox cases in the United States were diagnosed in people who also had HIV, Mermin said. So the CDC is going to make sure Jynneos vaccines are available as a routine part of care at HIV clinics and STI clinics that offer pre-exposure prophylaxis, or PrEP, for HIV.

Mermin said officials are also going to continue to go to LGBTQ festivals and events to offer on-site vaccinations.

Additionally, they’re going to study people who’ve been vaccinated and infected to see whether they remain immune – something else that’s still a big unknown.

Experts say that’s just one of many questions that need a closer look. Another is just how long the virus had been spreading outside Africa before the world noticed.

“We’re starting to see some data that suggests that asymptomatic infection and transmission is possible, and that certainly will change how we how we think about this virus and and risk,” said Anne Rimoin, an epidemiologist at the Fielding School of Public Health at UCLA.

When researchers at a sexual health clinic in Belgium rescreened more than 200 nasal and oral swabs they had taken in May 2022 to test for the STIs chlamydia and gonorrhea, they found positive mpox cases that had gone undiagnosed. Three of the people reported no symptoms, while another reported a painful rash, which was misdiagnosed as herpes. Their study was published in the journal Nature Medicine.

“Mild and asymptomatic infections may have indeed delayed the detection of the outbreak,” study author Christophe Van Dijck of the Laboratory of Medical Microbiology at the University of Antwerp in Belgium said in an email to CNN.

While researchers tackle those pursuits, advocacy groups say they aren’t ready to relax.

Hoang says Equality California is pushing the CDC to address continuing racial disparities in mpox vaccination and treatment, particularly in rural areas.

He’s not worried that gay men will drop their guard now that the emergency has expired..

“We’ve learned that we have to take health into our own hands, and I do think that we will remain vigilant as a community for this outbreak and future outbreaks,” Hoang said.

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January 26, 2023

Recently identified inflammatory disease VEXAS syndrome may be more common than thought, study suggests | CNN

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CNN
—

David Adams spent half a decade fighting an illness he couldn’t name. He was in and out of the hospital several times per year. His inflamed joints made his hands feel like they had been squeezed into gloves – and he could no longer play his beloved classical and jazz guitars.

He had constant fevers and fatigue. He even developed pain and swelling in his genitalia, which was his first sign that something was really wrong.

“At the turn of the year 2016, I started with some really painful effects in the male anatomy,” said Adams, now 70. “After that, again, a lot of fatigue – my primary care physician at that point had blood tests done, and my white blood cell count was very, very low.”

Next, Adams, who lives in Alexandria, Virginia, saw a hematologist, a pulmonologist, a urologist, a rheumatologist and then a dermatologist. Some of them thought he might have cancer.

Adams’ symptoms continued, with even more fatigue, pneumonia and a large rash below his waist. He tried at least a dozen medications, saw about two dozen doctors, and nothing helped.

In 2019, worsening symptoms forced him to retire early from his decades-long career in clinical data systems. But he remained in the dark about what was causing the problems.

Finally, in 2020, scientists at the National Institutes of Health discovered and named a rare genetic disorder: VEXAS syndrome, which wreaks havoc on the body through inflammation and blood problems.

Adams had an appointment with his rheumatologist at the time, and when he walked into the office, he saw that his physician “was giddy like a little kid.”

In his doctor’s hands was a copy of a paper in the New England Journal of Medicine detailing the discovery of VEXAS syndrome.

Adams had his answer.

“For the first time, there was a one-to-one correlation of symptoms,” he said. “It was quite a shock.”

An estimated 1 in about 13,500 people in the United States may have VEXAS syndrome, a new study suggests, which means the mysterious and sometimes deadly inflammatory disorder may be more common than previously thought.

In comparison, the genetic disorder spinal muscular atrophy affects about 1 in 10,000 people and Huntington’s disease occurs in about 1 in every 10,000 to 20,000 people.

Since its discovery, occasional VEXAS cases have been reported in medical research, but the study reveals new estimates of its prevalence.

The research, published Tuesday in the journal JAMA, suggests that about 1 in 13,591 people in the US have mutations in the UBA1 gene, which develop later in life and cause VEXAS syndrome.

“This study is demonstrating that there’s likely tens of thousands of patients in the US that have this disease, and the vast majority of them are probably not being recognized because physicians aren’t really considering this as a diagnosis more broadly,” said Dr. David Beck, an assistant professor in the Department of Medicine at NYU Langone Health and a lead author of the study.

VEXAS syndrome is not inherited, so people who have it don’t pass the disease to their children. But the UBA1 gene is on the X chromosome, so the syndrome is an X-linked disease. It predominantly affects men, who carry only one X chromosome. Women have two X chromosomes, so if they have a mutation in a gene on one X chromosome but not the other, they are generally unaffected.

“It’s present in 1 in 4,000 men over the age of 50. So we think it’s a disease that should be thought about in terms of testing for individuals that have the symptoms,” said Beck, who also led the federal research team that identified the shared UBA1 mutation among VEXAS patients in 2020.

“The benefit of VEXAS syndrome is that we have a test. We have a genetic test that can help directly provide the diagnosis,” he said. “It’s just a question of patients who meet the criteria – who are older individuals with systemic inflammation, low blood counts, who really aren’t responding to anything but steroids – then advocating to their doctors to get genetic testing to get a diagnosis.”

Adams, who became a patient of Beck’s, said that finally getting a diagnosis – and understanding the cause of his symptoms – was life-changing.

“It really was incredibly freeing to have the diagnosis,” he said.

“You can’t fight your enemy unless your enemy has a name,” he added. “We finally had something where we could point to and say, ‘OK, we understand what’s going on. This is VEXAS.’ “

For the new study, Beck and his colleagues at the NIH, New York University, Geisinger Research and other institutions analyzed data on 163,096 patients in a health system in central and northeastern Pennsylvania, from January 1996 to January 2022, including electronic health records and blood samples.

Eleven of the patients had a disease-causing UBA1 variant, and a 12th person had a “highly suspicious” variant.

Only three of the 12 are still alive. A five-year survival rate of 63% has been previously reported with VEXAS.

Among the 11 patients in the new study who had pathogenic variants in UBA1, only two were women. Seven had arthritis as a symptom, and four had been diagnosed with rheumatologic diseases, such as psoriasis of the skin or sarcoidosis, which causes swollen lumps in the body. All had anemia or low blood cell counts.

“None had been previously clinically diagnosed with VEXAS syndrome,” Beck said.

The finding “is emphasizing how it’s important to be able to pick these patients out, give them the diagnosis and start the aggressive therapies or aggressive treatments to keep their inflammation in check,” he said.

VEXAS – an acronym for five clinical characteristics of the disease – has no standardized treatment or cure, but Beck said symptoms can be managed with medications like the steroid prednisone or other immunosuppressants.

“But the toxicities of prednisone over years is challenging. There are other anti-inflammatory medications that we use, but they’re only partially effective at the moment,” he said. “One treatment for individuals that we’ve seen that’s very effective is bone marrow transplantation. That comes with its own risks, but that’s just underscoring the severe nature of the disease.”

Although the new study helps provide estimates of the prevalence and symptoms of VEXAS syndrome, the data is not representative of the entire United States, and Beck said that more research needs to be done on a larger, more diverse group of people.

Some men might be hesitant to seek medical care for VEXAS symptoms, but Adams said that doing so could save their life.

“Eventually, it’s going to get so bad that you’ll end up like my first hospitalization, where you’re on death’s door,” Adams said. “You don’t want to be in that situation.”

Adams has been taking prednisone to ease his symptoms, and it’s helped. But because steroid use can have side effects such as cataracts and weight gain, he has been working with his doctors to find other therapies so he can reduce his intake of the medication.

Beck and his colleagues are studying targeted therapies for VEXAS syndrome, as well as conducting stem cell bone marrow transplant trials at the NIH.

“There are many different facets of the disease,” Dr. Bhavisha Patel, a hematologist and researcher in the National Heart, Lung and Blood Institute’s Hematopoiesis and Bone Marrow Failure Laboratory, said in an NIH news release last month.

“I believe that is what is challenging when we think about treatment, because it’s so heterogeneous,” said Patel, who was not involved in the new study.

“Both at NIH and worldwide, the groups that have dedicated themselves to VEXAS are looking for medical therapies to offer to other patients who don’t qualify for a bone marrow transplant,” she said. “We continue to collaborate on many projects in order to categorize this disease further and ultimately come up with the best treatment options.”

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January 16, 2023

Study shows convalescent plasma works for immune-compromised Covid-19 patients, but it can be hard to find | CNN

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CNN
—

Convalescent plasma – a once-celebrated treatment for Covid-19 that has largely fallen out of favor – does work well for people who are immune-compromised, according to a study published Thursday.

The report in the journal JAMA Network Open analyzed the results of nine studies and found that immune-compromised Covid-19 patients were 37% less likely to die if they got convalescent plasma, an antibody-rich blood product from people who’d recovered from the virus.

Although it’s legal to use convalescent plasma to treat Covid patients who are immune-compromised, as inpatients or outpatients, government guidelines are neutral about whether the treatment works, so some hospitals offer it but others do not.

“Our concern is that many patients who need [convalescent plasma] are not getting it,” said Dr. Arturo Casadevall, an infectious disease expert at Johns Hopkins University and a co-author of the new study. “This is really important because these people can be treated, and they could have better outcomes with this material if we can just get the word out.”

He said it’s to everyone’s advantage to treat immune-compromised patients quickly.

Immune-compromised people sometimes have “smoldering Covid” for months because they lack the antibodies to fight it off, which gives the virus plenty of opportunities to mutate in the person’s body.

“These immune-compromised patients are essentially variant factories,” said Dr. Michael Joyner, an anesthesiologist at the Mayo Clinic and another study co-author. “And you do not want a bunch of people running around out there making weird variants.”

There are about 7 million immune-compromised people in the US, and treating them if they contract Covid-19 has proved challenging.

Many of them can’t take the antiviral drug Paxlovid because it interferes with other medicines they take.

Monoclonal antibodies, once popular for prevention and treatment for this group, aren’t used anymore because coronavirus variants have changed over time. One of the advantages of convalescent plasma is that as long as it’s been donated recently, there’s a high likelihood it will have antibodies to currently circulating variants, according to advocates for the treatment.

But the National Institutes of Health’s Covid-19 treatment guidelines say there’s not enough evidence to recommend either for or against the use of convalescent plasma in people with compromised immune systems.

Three times last year – in May, August and December – Casadevall, Joyner and dozens of other doctors from Harvard, Stanford, Mayo, Columbia and other academic medical centers wrote emails to scientists at the National Institutes of Health, sending them research materials and urging them to revise the guidelines. They say they have not received a response.

Joyner said he’s “frustrated” with the NIH’s “bureaucratic rope-a-dope,” calling the agency’s guidelines a “wet blanket” that discourages doctors from trying convalescent plasma on these people.

Some patient advocates say they’re angry.

“This lack of response to the researchers is infuriating,” said Janet Handal, co-founder of the Transplant Recipient and Immunocompromised Patient Advocacy Group.

Several large randomized clinical trials on the general population, including one in India and one in the UK, have found that convalescent plasma did not reduce Covid-19 deaths or prevent severe illness, and the treatment is no longer authorized in the US for people who have healthy immune systems.

The nine studies analyzed in the new report are much smaller and looked only at immune-compromised patients.

Dr. Peter Horby, a professor at the University of Oxford and the co-principal investigator of the large UK study, said that a large randomized clinical trial should be done on immune-compromised patients before clinical practice guidelines for this group are changed.

He said that support for convalescent plasma to treat Covid-19 has been based on “an emotional feeling that something had to be done.”

“We’ve seen time and again that people’s beliefs and emotions about what works can be wildly wrong, and so the best thing to do is to evaluate these things properly in trials,” he said.

At the beginning of the pandemic, there was great enthusiasm for convalescent plasma as Covid-19 survivors sought to save lives, donating antibodies against the virus to people who were sometimes at death’s door.

In August 2020, the US Food and Drug Administration granted emergency use authorization for the treatment, but some questioned whether it was politically motivated and whether the data really showed that it worked.

Then, the large clinical trials suggested convalescent plasma didn’t work.

“We didn’t see a benefit,” said Horby, director of Oxford’s Pandemic Sciences Institute.

But there was one exception.

Horby said his study did find “some evidence of some benefit” in Covid-19 patients who had not developed antibodies against the virus. This would most likely include immune-compromised patients because their faulty immune systems don’t always generate antibodies the way they should, even after infection.

When this group of patients received convalescent plasma, Horby said, they had a slightly shortened hospital stay and a slightly lower risk of ending up on a ventilator compared with similar patients who did not receive convalescent plasma.

Joyner and Casadevall, the Mayo and Hopkins doctors, point to that finding – and a similar one in a large trial in Australia, Canada, the UK and the US, as well as results of smaller studies – as an indication that convalescent plasma is worth trying in immune-compromised patients.

Immune-compromised patients who catch Covid-19 can get convalescent plasma relatively easily if they’re patients at Hopkins, Mayo or several other medical centers.

But many other people might have a difficult time accessing it.

It took Bernadette Kay of Manhattan Beach, California, months to get it, and she had to be “relentless” and call in the help of several “angels” in New York, Maryland, Minnesota and California to finally make it work.

Kay, 64, who has a compromised immune system because of a drug she takes for rheumatoid arthritis, got Covid-19 in July. She took two monoclonal antibodies, as well as remdesivir and Paxlovid – twice. But she still tested positive on and off for months and had fatigue, congestion and headaches.

“I felt like half a person,” she said. “I was not an able-bodied person. I was disabled because of lack of energy. It feels dark – a heavy feeling in your forehead and your face.”

Kay said she saw several doctors and none of them suggested convalescent plasma. That’s where her first angel came in: her daughter, who had signed her up for the Transplant Recipient and Immunocompromised Patient Advocacy Group.

That group, as well as the CLL Society, an advocacy organization for cancer patients, have been helping immune-compromised people when they get infected with Covid-19, connecting them with experts and offering guidance on how to arrange to have the plasma ordered.

Kay says Handal, the co-founder of the immune-compromised patients’ group, was her second angel, because she pointed her to angels No. 3 and 4: Joyner, the Mayo doctor, and Dr. Shmuel Shoham, an infectious disease expert at Hopkins.

Joyner and Shoham pointed Kay to her fifth angel: Chaim Lebovits, a businessman, leader in the New York’s Hasidic Jewish community and co-founder of the Covid Plasma Initiative.

Lebovits reached out to a hospital and blood bank near Kay that could procure the plasma once a doctor ordered it. Kay then reached out to six local doctors, most of them infectious disease experts, inquiring about convalescent plasma, but she didn’t make any progress.

“I think they thought it was quack medicine,” she said.

By this time, it was November, four months after she initially tested positive for Covid. She sought out a seventh doctor, sending him information from plasma experts, including a slide presentation by Joyner and Casdevall. She said that doctor, after conferring with someone at the blood bank that Libovits had suggested, agreed to order the plasma.

That’s where her sixth angel came in: Robert Simpson, vice president for hospital services at the San Diego Blood Bank, who arranged to have the blood flown in from Stanford University Medical Center.

“Robert watched the flight on Flight Tracker and had a courier waiting to bring it to the hospital,” Kay said, adding that she calls her angels collectively her “circle of love.”

Two to three weeks after her infusion, she began to feel better. She tested negative on January 4 and has continued to feel well and test negative since then.

“My energy level is back to normal. I don’t feel like half a person,” she said.

She said she’ll never know for sure exactly what spurred her recovery, but “I think it was plasma that made the difference, because in six months, nothing else made a difference.”

Kay, who works in health care, said most other people wouldn’t have known how to navigate the system like she did or might have given up in frustration.

“With the help of Janet [Handal] and her team of scientists, I’ve been able to get where I am today,” she said. “But it was not easy. This was driven by my bullheaded advocacy, because that’s who I am. I think I’m a total anomaly. No one has the persistence that I have.”

Joyner said that while he and his colleagues wait for a response from their emails to the NIH, they’ve formed the National Covid-19 Convalescent Plasma Project, and they have a phone meeting every Thursday night to discuss their progress.

“We’ve encountered many roadblocks,” said Dr. Liise-anne Pirofski, chief of the Division of Infectious Diseases at the Albert Einstein College of Medicine. “It’s just not viewed as part of the Covid-19 treatment armamentarium, and it should be.”

Pirofski, Joyner and Casadevall say they receive no financial benefit from convalescent plasma. They think one reason convalescent plasma isn’t more widely used is that there isn’t a pharmaceutical company spending money to advocate for it.

Handal, who runs the Facebook group for people who are immune-compromised, said that after she sent several emails to the NIH, agency scientists wrote back, inviting her and other leaders of her group to a meeting next week.

She plans to tell them that they need to review their Covid-19 plasma guidelines and fund more research on the coronavirus and the immune-compromised, as they have few treatment options and so often isolate at home with their families to avoid the virus.

“It is unconscionable that the NIH has let stand for months its guideline on Covid convalescent plasma, which says there is not enough information to make a recommendation, while we who are immune-compromised see our treatments dwindle,” she said. “The NIH needs to speak to the clinician researchers who are experts, prioritize the immune-compromised and fund the research needed to keep us safe.”

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January 6, 2023

Why Cristiano Ronaldo’s move to Saudi Arabia means so much for the Gulf monarchy’s sporting ambitions | CNN

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Editor’s Note: A version of this story appears in today’s Meanwhile in the Middle East newsletter, CNN’s three-times-a-week look inside the region’s biggest stories. Sign up here.

Abu Dhabi, UAE
CNN
—

It’s a partnership that’s been hailed as “history in the making.”

One of the world’s most famous soccer stars landed in the Saudi capital Riyadh on Tuesday, where Cristiano Ronaldo was received in an extravagant ceremony, with excited children sporting his new club’s yellow and blue jerseys.

Oil-rich Saudi Arabia’s success in luring the five-time Ballon d’Or winner on a two-year contract with the kingdom’s Al Nassr FC is the Gulf monarchy’s latest step in realizing its sporting ambitions – seemingly at any cost.

According to Saudi state-owned media, Ronaldo will earn an estimated $200 million a year with Al Nassr, making him the world’s highest-paid soccer player.

Shortly after the 37-year-old’s signing with Al Nassr, the club’s Instagram page gained over 5.3 million new followers. Its official website was inaccessible after exceeding its bandwidth limit due to the sudden surge in traffic, and the hashtag #HalaRonaldo – Hello, Ronaldo in Arabic – was trending for days across the Middle East on Twitter.

Analysts say that his recruitment in Saudi Arabia is part of a wider effort by the kingdom to diversify its sources of revenue and become a serious player in the international sporting scene.

It is also seen as a move by the kingdom to shore up its image after it was tarnished by the 2018 dismemberment and killing of Washington Post columnist Jamal Khashoggi at the hands of Saudi agents, and a devastating war it started in Yemen in 2015.

Critics have decried the kingdom for “sportswashing,” an attempt to burnish one’s reputation through sport.

“I think Saudi Arabia has recognized a couple of years ago that to be a powerful nation internationally, you cannot just rely on hard power,” Danyel Reiche, a visiting research fellow and associate professor at Georgetown University Qatar, told CNN.

“You also need to invest in soft power, and the case of Qatar shows that this can work pretty well,” he said, adding that Saudi Arabia is following in the Qatari approach with sport, but with a delay of around 25 years.

Neighboring Qatar has also faced immense criticism since it won the bid to hosting last year’s FIFA World Cup in 2010.

Despite the smaller Gulf state facing similar accusations of “sportswashing,” the tournament has largely been viewed as a success, not least in exposing the world to a different view of the Middle East, thanks in part to Morocco’s success in reaching the semifinals and Saudi Arabia beating eventual World Cup champion Argentina in their opening group game.

Gulf nations engage in fierce competition to become the region’s premier entertainment and sporting hubs. The UAE, Saudi Arabia, Qatar and Bahrain, in close proximity to each other, each have their own Formula One racing event. But their competition hasn’t been confined to the region. Qatar, Saudi Arabia and the UAE have also bought trophy European soccer teams.

Riyadh is playing catchup with neighbors who have long realized the importance of investing in sports, said Simon Chadwick, professor of sport and geopolitical economy at SKEMA Business School in Lille, France, especially as its main source of income – oil – is being gradually shunned.

“This is part of an ongoing attempt to create more resilient economies that are more broadly based upon industries other than those that are derived from oil and gas,” Chadwick told CNN.

Ronaldo’s new club Al Nassr is backed by Qiddiya Investment Company (QIC), a subsidiary of the kingdom’s wealth fund, the Public Investment Fund (PIF), which has played a pivotal role in Saudi Arabia’s diversification plans.

“It is also a sign of interconnectedness, of globalization and of opening up to the rest of the world,” said Georgetown University’s Reiche.

The move is part of “several recent high profile moves in the sports world, including hosting the Andy Ruiz Jr. and Anthony Joshua world heavywight boxing championship bout in 2019, and launching the LIV Golf championship,” said Omar Al-Ubaydli, director of research at the Bahrain-based Derasat think tank. “It is a significant piece of a large puzzle that represents their economic restructuring.”

The kingdom has been on a path to not only diversify its economy, but also shift its image amid a barrage of criticism over its human rights record and treatment of women. Saudi Arabia is today hosting everything from desert raves to teaming up with renowned soccer players. Argentina’s Lionel Messi last year signed a lucrative promotional deal with the kingdom.

Hailed as the world’s greatest player, 35-year-old Messi ended this year’s World Cup tournament in Qatar with his team’s win over France, making his ambassadorship of even greater value to the kingdom.

The acquisition of such key global figures will also help combat the monarchy’s decades-long reputation of being “secretive” and “ultra-conservative,” James Dorsey, a senior fellow at the S. Rajaratnam School of International Studies in Singapore and an expert on soccer in the Middle East, told CNN’s Eleni Giokos on Wednesday.

Al-Ubaydli said that the kingdom wants to use high profile international sports “as a vehicle for advertising to the world its openness.”

Saudi Arabia bought the English Premier league club Newcastle United in 2021 through a three-party consortium, with PIF being the largest stakeholder. The move proved controversial, as Amnesty International and other human rights defenders worried it would overshadow the kingdom’s human rights violations.

Ronaldo’s work with Saudi Arabia is already being criticized by rights groups who are urging the soccer player to “draw attention to human rights issues” in Saudi Arabia.

“Saudi Arabia has an image problem,” especially since Khashoggi’s killing, says Reiche. But the kingdom’s recent investments in sports and entertainment are “not about sportswashing but about developing the country, social change and opening up to the world.”

Saudi Arabia is reportedly weighing a 2030 World Cup bid with Egypt and Greece, but the kingdom’s tourism ministry noted in November that it has not yet submitted an official bid. Chadwick believes that Ronaldo’s deal with Al Nassr, however, may help boost the kingdom’s bid should it choose it pursue it.

Another way Saudi Arabia may benefit from Ronaldo’s acquisition is that it will be able to improve commercial performance, says Chadwick, especially if this collaboration attracts further international talent.

“It is important to see Ronaldo not just as a geopolitical instrument,” said Chadwick, “There is still a commercial component to him and to the purpose he is expected to serve in Saudi Arabia.”

What Ronaldo’s move to Saudi Arabia shows is that the kingdom aspires “to be seen as being the best” and that it wants to be perceived as a “contender and a legitimate member of the international football community,” said Chadwick.

UAE FM meets Syria’s Assad in Damascus in further sign of thawing ties

Syrian President Bashar al-Assad received the United Arab Emirates Foreign Minister Sheikh Abdullah bin Zayed in Damascus on Wednesday in the latest sign of thawing relations between Assad and the Gulf state. The meeting addressed developments in Syria and the wider Middle East, according to UAE state news agency WAM.

Background: It was Abdullah bin Zayed’s first visit since a November 2021 meeting with Assad that led to the resumption of relations. Months later, in March 2022, Assad visited the UAE, his first visit to an Arab state since the start of Syria’s civil war.
Why it matters: A number of Assad’s former foes have been trying to mend fences with his regime. Last week, talks between the Syrian and Turkish defense ministers were held in Moscow in the highest-level encounter reported between the estranged sides since the war in Syria began. The regional rapprochement is yet to improve the lives of average Syrians. Syria is still under Western sanctions.

Turkish President Erdogan says he could meet with Assad

Turkish President Recep Tayyip Erdogan said in a speech on Thursday that he could meet the Syrian leader “to establish peace.”

Background: Erdogan’s comments came after the Moscow talks between the two nations’ defense ministers and intelligence chiefs. “Following this meeting… we will bring our foreign ministers together. And after that, as leaders, we will come together,” Erdogan said on Thursday.
Why it matters: The meeting would mark a dramatic shift in Turkey’s decade-long stance on Syria, where Ankara was the prime supporter of political and armed factions fighting to topple Assad. The Turkish military maintains a presence across the Syrian border and within northern Syria, where it backs Syrian opposition forces. Erdogan has also pledged to launch yet another incursion into northern Syria, aiming at creating a 30-km (20-mile) deep “safe zone” that would be emptied of Kurdish fighters.

Iran shuts down French cultural center over Charlie Hebdo’s Khamenei cartoons

Iran announced on Thursday it had ended the activities of a Tehran-based French research institute, in reaction to cartoons mocking Ayatollah Ali Khamenei and fellow Shia Muslim clerics published by French satirical magazine Charlie Hebdo this week.

Background: Iran summoned the French ambassador to Tehran on Wednesday to protest cartoons published by satirical magazine Charlie Hebdo. More than 30 cartoons poking fun at Iran’s supreme leader were published by the magazine on Wednesday, in a show of support for the Iranian people who have been protesting the Islamic Republic’s government and its policies.
Why it matters: French-Iranian relations have deteriorated significantly since protests broke out in Iran late last year. Paris has publicly supported the protests and spoken out against Iran’s response to them. French Foreign Minister Catherine Colonna criticized Iran’s freedom of press and judicial independence on Thursday, saying “press freedom exists, contrary to what is going on in Iran and… it is exercised under the supervision of a judge in an independent judiciary – and there too it’s something that Iran knows little of.”

The prized legacy of iconic Egyptian singer Umm Kulthum re-emerged this year when Rolling Stone magazine featured her in its “200 Greatest Singers of All Time.”

Ranking 61st, Umm Kulthum was the only Arab artist to make it to the list, with the magazine saying that she “has no real equivalent among singers in the West.”

Born in a small village northeast of the Egyptian capital Cairo, Umm Kulthum rose to unmatched fame as she came to represent “the soul of the pan-Arab world,” the music magazine said.

“Her potent contralto, which could blur gender in its lower register, conveyed breathtaking emotional range in complex songs that, across theme and wildly-ornamented variations, could easily last an hour, as she worked crowds like a fiery preacher,” it wrote.

Nicknamed “the lady of Arab singing,” her music featured both classical Arabic poetry as well as colloquial songs still adored by younger generations. Her most famous pieces include “Inta Uumri” (you are my life), “Alf Leila Weileila” (a thousand and one nights), “Amal Hayati” (hope of my life) and “Daret al-Ayyam” (the days have come around). Some of her songs have been remixed to modern beats that have made their way to Middle Eastern nightclubs.

The singer remains an unmatched voice across the Arab World and her music can still be heard in many traditional coffee shops in Old Cairo’s neighborhoods and other parts of the Arab world.

Umm Kulthum’s death in 1975 brought millions of mourners to the streets of Cairo.

By Nadeen Ebrahim

Women athletes aim their air rifles while competing in a local shooting championship in Yemen's Houthi rebel-held capital Sanaa on January 3.

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December 10, 2022

LeBron James and Billie Jean King lead tributes to American journalist Grant Wahl | CNN

Post By zittrexstore Sports 2022 FIFA World Cup, billie jean king, brand safety-nsf death, brand safety-nsf sensitive, business, business and industry sectors, Companies, continents and regions, Death and dying, deaths and fatalities, domestic alerts, domestic-business, domestic-international news, domestic-us news, economy and trade, fifa, fifa world cup, football (soccer), iab-bereavement, iab-business and finance, iab-computing, iab-family and relationships, iab-industries, iab-internet, iab-media industry, iab-soccer, iab-social networking, iab-sports, iab-technology & computing, iab-tennis, international alerts, international-business, international-us news, internet and www, journalism and news media, lebron james, media industry, Middle East, middle east and north africa, North America, Qatar, soccer events, social media, society, sports and recreation, sports events, sports figures, sports organizations and teams, Technology, tennis, the americas, twitter, United States, united states soccer federation No Comments

CNN
—

The death of prominent journalist Grant Wahl at the World Cup in Qatar has led to an outpouring of shock and grief across the sports world, with NBA star LeBron James and tennis great Billie Jean King leading the tributes to the American.

Prominent American journalist Grant Wahl has died in Qatar after collapsing while covering the World Cup, sparking an outpouring of shock and grief across the sports world. He was 49.

King said Wahl’s death was “heartbreaking.”

“A talented journalist, Grant was an advocate for the LGBTQ community & a prominent voice for women’s soccer,” King tweeted Saturday. “He used his platform to elevate those whose stories needed telling. Prayers for his family.”

On Friday in Philadelphia, basketball star James said he had been “very fond of Grant.” While Wahl was at Sports Illustrated, he did a cover story on James when James was in high school.

“I’ve always kind of watched from a distance even when I moved up in ranks and became a professional, and he went to a different sport,” said James, speaking at a postgame press conference. “Any time his name would come up I’ll always think back to me as a teenager and having Grant in our building … It’s a tragic loss.”

Tyler Adams, the captain of the US men’s national soccer team, which was knocked out of the World Cup by the Netherlands in the last 16, sent his “deepest sympathy” to Wahl’s wife, Celine Gounder, and to those who knew him.

“As players we have a tremendous amount of respect for the work of journalists, & Grant’s was a giant voice in soccer that has tragically fallen silent,” Adams wrote on Twitter.

Qatar’s World Cup organizers said on Saturday that Wahl “fell ill” in the press area, where he received “immediate medical treatment on site.”

He was then transferred to Hamad General Hospital, said a spokesperson for the Supreme Court Committee for Delivery and Legacy, the body responsible for planning the tournament.

Wahl was treated in the stadium “for about 20-25 minutes” before he was moved to the hospital, Keir Radnedge, a columnist at World Soccer Magazine, told CNN Saturday.

“This was towards the end of extra time in the match. Suddenly, colleagues up to my left started shouting for medical assistance. Obviously, someone had collapsed. Because the chairs are freestanding, people were able to move the chairs, so it’s possible to create a little bit of space around him,” Radnedge said.

He added that the medical team were there “pretty quickly and were able to, as best they could, give treatment.”

White House Press Secretary Karine Jean-Pierre reacted to Wahl’s death on Saturday, adding that senior State Department officials were in touch with Qatari officials and Grant’s family.

“Grant Wahl was an inspiration to many. Our thoughts are with his wife Dr. Céline Gounder and all those who loved him. State Department officials are in touch with Grant’s family and with senior officials in the government of Qatar to ensure his family gets the support they need,” Jean-Pierre wrote on Twitter.

“Only some days ago, Grant was recognized by FIFA and AIPS (the International Sports Press Association) for his contribution to reporting on eight consecutive FIFA World Cups,” said FIFA President Gianni Infantino in a statement.

Infantino and FIFA media director Bryan Swanson were at the hospital on Saturday to offer any kind of support needed for the family, friends, and the journalists who were also his housemates in Qatar.

The co-editors in chief of Sports Illustrated, the publication where Wahl spent the majority of his career, said in a joint statement they were “shocked and devastated at the news of Grant’s passing.”

“We were proud to call him a colleague and friend for two decades – no writer in the history of (Sports Illustrated) has been more passionate about the sport he loved and the stories he wanted to tell,” said the statement.

It added that Wahl had first joined the publication in November 1996. He had volunteered to cover the sport as a junior reporter – back before it reached the heights of global popularity it now enjoys – eventually becoming “one of the most respected soccer authorities in the world,” it said.

The statement said that Wahl also worked with other media outlets including Fox Sports. After leaving Sports Illustrated in 2020, he began publishing his podcast and newsletter.

Other current and former US soccer players, including Ali Krieger and Tony Meola, shared their condolences, as did sporting bodies such as Major League Soccer and the National Women’s Soccer League.

Wittyngham, Wahl’s podcast co-host, told CNN on Saturday the news of his death had been hard to fathom.

“For Americans, Grant Wahl is the first person you read covering soccer. He was kind of the only person for a while … Grant was the first person who really paid genuine attention to this sport in a meaningful way,” Wittyngham said.

Several journalists shared stories of reporting alongside Wahl, and having encountered him at multiple World Cups over the years.

“Before he became the best covering soccer he did hoops and was so kind to me,” wrote famed broadcaster Dick Vitale.

Timmy T. Davis, the US Ambassador to Qatar, tweeted that Wahl was “a well known and greatly respected reporter who focused on the beautiful game.”

“The entire US Soccer family is heartbroken to learn that we have lost Grant Wahl,” US Soccer said in a statement on its official Twitter account.

“Grant made soccer his life’s work, and we are devastated that he and his brilliant writing will no longer be with us.”

US Soccer praised Wahl’s passion and “belief in the power of the game to advance human rights,” and shared its condolences with Wahl’s wife, Celine Gounder, and his loved ones.

Gounder also posted the US Soccer statement on Twitter.

“I am so thankful for the support of my husband Grant Wahl’s soccer family and of so many friends who’ve reached out tonight. I’m in complete shock,” wrote Gounder, a former CNN contributor who served on the Biden-Harris transition Covid-19 advisory board.

US State Department spokesperson Ned Price said the department was in “close communication” with Wahl’s family. The World Cup organizers also said they were in touch with the US embassy “to ensure the process of repatriating the body is in accordance with the family’s wishes.”

Wahl wearing a rainbow-colored t-shirt while working at Qatar 2022.

Wahl had covered soccer for more than two decades, including 11 World Cups — six men’s, five women’s – and authored several books on the sport, according to his website.

He had just celebrated his birthday earlier this week with “a great group of media friends at the World Cup,” according to a post on his official Twitter account, which added: “Very thankful for everyone.”

In an episode of the podcast Futbol with Grant Wahl, published days before his death on December 6, he had complained of feeling unwell.

“It had gotten pretty bad in terms of like the tightness in my chest, tightness, pressure. Feeling pretty hairy, bad,” Wahl told co-host Chris Wittyngham in the episode. He added that he sought help at the medical clinic at the World Cup media center, believing he had bronchitis.

He was given cough syrup and ibuprofen, and felt better shortly afterward, he said.

Wahl also said he experienced an “involuntary capitulation by my body and mind” after the US-Netherlands game on December 3.

“This isn’t my first rodeo. I’ve done eight of these on the men’s side,” he said at the time. “And so like, I’ve gotten sick to some extent at every tournament, and it’s just about trying to find a way to like get your work done.”

He further described the incident in a recent newsletter published on December 5, writing that his body had “broke down” after he had little sleep, high stress and a heavy workload. He’d had a cold for 10 days, which “turned into something more severe,” he wrote, adding that he felt better after receiving antibiotics and catching up on sleep.

Wahl had made headlines in November by reporting that he was detained and briefly refused entry to a World Cup match because he was wearing a rainbow t-shirt in support of LGBTQ rights.

He said security staff had told him to change his shirt because “it’s not allowed,” and had taken his phone. Wahl said he was released 25 minutes after being detained and received apologies from a FIFA representative and a senior member of the security team at the stadium.

Afterward, Wahl told CNN he “probably will” wear the shirt again.

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