The U.S. Centers for Disease Control and Prevention (CDC) Thursday issued a draft of revised guidelines for prescribing opioid painkillers, urging doctors to be flexible and individualize their use of the drugs to the needs of the patient.  
The CDC’s current guidelines were issued in 2016, largely in response to the over-prescribing of opioids in the United States from 2007 to 2012. The agency reports in 2012, 259 million prescriptions were written for the highly addictive painkillers, enough for every person in the country to have their own bottle.

The result was one of the worst drug-abuse epidemics in the U.S., with addiction and deaths related to the drugs skyrocketing. The CDC reports that from 1999 to 2014, more than 165,000 people in the United States died from overdoses related to opioid pain medication.  

But CDC officials said that while 2016 guidelines helped end the over-prescribing of the drugs, they also may have pushed doctors too far in the other direction.  

Co-author of the new guidelines, acting director of the National Center for Injury Prevention and Control, Christopher Jones, said some doctors were too quick to cut off patients taking prescription painkillers and too strict in keeping the drugs from patients who might benefit.

The 229-page draft of the updated guidelines removes some of the suggested limits the original guidelines placed on administering opioids and proposes individualized patient care. It also offers more options for treating the kind of short-term, acute pain that follows surgeries or injuries.

The CDC published the draft of the new guidelines in the U.S. Federal Register, where the public can view and comment on them for the next 60 days. The CDC will consider comments before finalizing the updated guidance.

CDC guidelines are voluntary, though they are widely followed by U.S. healthcare providers.

Some information in this report came from The Associated Press.
…

France will build at least six new nuclear reactors in the decades to come, President Emmanuel Macron said on Thursday, placing nuclear power at the heart of his country’s drive for carbon neutrality by 2050.

Macron said the new plants would be built and operated by state-controlled energy provider EDF and that tens of billions of euros in public financing would be mobilized to finance the projects and safeguard EDF’s finances.

“What our country needs, and the conditions are there, is the rebirth of France’s nuclear industry,” Macron said, unveiling his new nuclear strategy in the eastern industrial town of Belfort.

Promising to accelerate the development of solar and offshore wind power in France, Macron also announced he wanted to extend the lifespan of older nuclear plants to 50 years or more from 40 years currently, provided it was safe.

The announcement comes at a difficult time for debt-laden EDF, which is facing delays and budget over-runs on new nuclear plants in France and Britain, and corrosion problems in some of its aging reactors.

The nuclear blueprint cements France’s commitment to nuclear power, a mainstay of the country’s postwar industrial prowess but whose future was uncertain after Macron and his predecessor had promised to reduce its weight in the country’s energy mix.

Macron’s thinking has been reshaped by the European Union’s ambitious goals for carbon neutrality within three decades, which put renewed focus on energy forms that emit fewer, or zero, greenhouse gases than fossil fuels, including nuclear.

Surging energy prices and concerns about Europe’s reliance on imported Russian gas have also persuaded French officials of the region’s need for more energy independence.

EDF estimates the cost of six new EPR reactors at about 50 billion euros, depending on financing conditions.

The first new reactor, an evolution of the European Pressurized Reactor (EPR), would come online by 2035, Macron said. Studies for a further eight reactors beyond the initial half-dozen new plants would be launched, he added.

France will also increase its solar power capacity tenfold by 2050 to more than 100 gigawatts (GW) and target building 50 offshore wind farms with a combined capacity of at least 40 GW. Capacity from land-based wind turbines, which face strong public resistance, would only be doubled by 2050, he said.

Energy U-turn

Macron’s decision to extend the lifespan of existing plants marked a U-turn on an earlier pledge to close more than a dozen of EDF’s 56 reactors by 2035.

Nuclear safety still divides Europe after Japan’s Fukushima disaster. France lobbied hard for nuclear to be labeled as sustainable under new European Commission rules on green financing.

If the new EU taxonomy rules are approved, it should reduce the cost of financing nuclear energy projects.

Macron said the state would assume its responsibilities in securing EDF’s finances, indicating that the government may inject fresh capital into the 84% state-owned firm.

The State will assume its responsibilities in securing EDF’s finances and its short- and medium-term financing capacity,” Macron said.

EDF’s EPR reactors have suffered a troubled history. EPR projects at Flamanville in France and Hinkley Point in Britain are running years behind schedule and billions over budget, while EPR reactors in China and Finland have been hit by technical issues.

Separately EDF this week revised lower its output forecast for its nuclear fleet to 295-315 TWh compared to 361 TWh last year, in part due to extended reactor shutdowns due to corrosion problems in several reactors. If the level drops below 300 TWh, it would be at its lowest since 1990.

Compounding EDF’s difficulties, Macron, who faces a re-election battle in two months and is striving to head off public anger over rising energy bills, has ordered the utility to sell more cheap power to rivals – a move that will knock about 8 billion euros off EDF’s 2022 core earnings.

EDF’s share price is down 18% so far in 2022.

EDF confirmed on Thursday it would buy a France-based nuclear turbine unit from General Electric as the utility looks to bundle nuclear activities deemed to be strategic.
…

Cameroonian health authorities say at least 1,300 cholera cases have been detected, with nearly three dozen people dying as a result of the outbreak within the past two weeks. Cameroon’s Public Health Ministry says water shortages and poor hygiene have spread the bacterial disease throughout half the country.

Cameroon says the lives of thousands of its citizens are at risk. Manaouda Malachie, the state minister of public health, said five of the country’s 10 regions have been affected by an ongoing cholera outbreak in a press release published Wednesday. 

The statement says Bakassi, a southwestern peninsula near the Nigerian border, Cameroon’s commercial hub and coastal city Douala, and Cameroon’s capital, Yaounde, are the worst hit by the outbreak. Other locations affected are Buea,Tiko and Mutengene, southwestern commercial towns, as well as Maroua and Garoua on the northern border with Nigeria.

Kelvin Fosong, a community health worker, said he was sent from Buea to Mutengene this week to help civilians affected by the outbreak.

“Since the outbreak, we have engaged ourselves into community sensitization, most especially in the quarters where deaths were reported. We have been there visiting homes, disinfecting toilets, public taps and water points. We teach them (civilians) how to take care of their environment with the help of some doctors (health workers),” Fosong said, speaking from Mutengene.

Cameroon’s public health minister said 32 of the 1,300 people affected by the outbreak have died within two weeks, and added that the figures may be higher. The government reports that about 70% of the country’s 26 million people visit African traditional healers and go to hospitals only when their health conditions get worse. The government says it is difficult to gather statistics from African traditional healers in the country’s towns and villages.

Linda Esso, director of epidemics and pandemics at Cameroon’s Public Health Ministry, said after the first cases were reported, the government started telling people to go to the nearest hospitals if they experience watery diarrhea, vomiting or dehydration. She said civilians should follow basic hygiene practices such as washing their hands with soap, and using and cleaning latrines after defecation.

Esso warned against eating uncooked raw food and unwashed fruits or drinking water that has not been boiled. She said keeping latrines dirty increases the risk of cholera.

Mathias Ngund, the most senior government health official in Buea, an English-speaking southwestern town where 30 cholera cases have been reported with three deaths, said the lack of clean drinking water is exacerbating the spread of cholera in Buea. He said he has informed the government that the provision of water is an emergency need.

“We went to all the houses of suspected cases, we disinfected them and also we have had coordination meetings with the administrative authorities to respond to the outbreak,” Ngund said.

The central government in Yaounde said it will provide clean drinking water to arid towns and villages in Cameroon but did not say when. Authorities are encouraging civilians to boil water from wells and streams before drinking it.

Cameroon said a cholera outbreak in November claimed 13 lives, with several hundred people infected, as it prepared to host the African Football Cup of Nations, or AFCON. Cameroon hosted AFCON from January 9 to February 6. The government had promised to stop its spread before the continental football event that brought several thousand football fans, players and match officials tio the country.
…

A new study says 1 in 10 Australian health care workers has had thoughts of suicide or self-harm during the pandemic.

The authors of the Australian Frontline Health Workers survey believe it is the world’s largest study of suicidal thoughts among health care workers. It canvassed the opinions of 8,000 staff, in a range of positions and professions, including support staff, cleaners, doctors and nurses.

The survey finds 10% of respondents have had thoughts of self-harm or suicide during the pandemic, but fewer than half had sought help from a mental health professional.

Even before the emergence of COVID-19, Australian health workers had higher rates of suicide than those in other occupations.

The study’s authors said that emotional exhaustion and burnout were common among many respondents. What is unclear is the impact stress, which could cause more medical errors, has had on the quality of patient care.

Georgina Lonergan, a nuclear medicine technologist in Victoria state, told the Australian Broadcasting Corp. that her job was extremely stressful.

“There is an undercurrent of anxiety, I think, for everyone working in health care,” she said. “I have definitely had an undercurrent of anxiety increasing over the last couple of years. Some days you just really do not want to come. There has been a couple of days where I have been close to tears on the way in just from anxiety and just being tired of it all.”

The survey was published Wednesday in the Australian and New Zealand Journal of Psychiatry.

Much of Australia continues to battle a wave of omicron variant infections. Government data has shown that more than 3,500 people are in the hospital with the virus.

Since the pandemic began, Australia has detected 2.4 million coronavirus cases; 4,366 people have died, according to the Health Department. 

 

 
…

The COVID pandemic exposed stark vaccine inequities between high- and low-income nations and underscored Africa’s dependence on outside countries for jabs. However, a new initiative in Senegal hopes to reduce that inequity Annika Hammerschlag reports from Dakar, Senegal.
Camera: Annika Hammerschlag
…

Health care workers in Somalia suffer from high rates of anxiety, depression and stress because of their work with COVID-19 cases, a new study finds.

The study was presented at a health research conference in the Somali town of Garowe last week. Initial findings recorded a high prevalence of anxiety in the workforce at 69.3%, 46.5% for depression and 15.2% for stress.

The study used the Depression, Anxiety and Stress Scales (DASS), widely used in scientific circles to measure the three emotional states. Researchers interviewed 186 health care workers in three hospitals in Mogadishu between May and August 2021.

Dr. Abdirazak Yusuf Ahmed, the study’s lead author and director of the De Martino Hospital, the main COVID-19 medical facility in Mogadishu, said several factors played a role in the prevalence of these traumatic experiences in the health care workforce.

“The first one is that this disease is associated with deaths,” Ahmed said. “They (workers) were afraid they could take the virus to their homes and pass on to their loved ones.”

He also mentioned low motivation among the COVID-19 workers.

Doctors working in Somalia are not surprised that the multiplier effects from COVID-19 contributed to the workers’ ill health.

Since March 16, 2020, when the first case was detected, Somalia has recorded 1,340 COVID-19 deaths and 26,203 positive cases, at a fatality rate of 5.1%. But independent studies and press reports argued that COVID-19 deaths in Somalia have been enormously undercounted. Somalia has administered more than 1.6 million COVID-19 vaccine doses so far, with only 5.6% of the population fully vaccinated.

The discovery of personal health challenges among frontline workers comes at a time when the country lacks enough health care workforce to provide services.

Last week’s conference, which was attended by federal and regional health officials, local doctors and international health workers, including representatives from the World Health Organization, recognized the severity of the lack of enough health care workers.

A statement issued at the end of the conference stated that the low workforce density in the country stands at 5.4 doctors, nurses, and midwives per 10,000 population. WHO recommends a ratio of 44.5 per 10,000.

The statement further said that according to WHO’s health workforce guidelines, there is a gap of 55,000 skilled health professionals in the country.

It said the gap affects all components of the health system, ranging from service delivery, health workforce, health information systems, access to essential medicines, financing and leadership, policy and governance.

This shortage is attributed to the migration of health workers from Somalia because of war and crisis, according to Dr. Mamunur Rahman Malik, WHO’s Somalia representative.

“This shortage means that the country doesn’t have adequate health workers who are required to run and manage primary health centers or hospitals,” he said. “So, services are below optimal or of poor quality as the services are provided by lay health workers.”

Good news for child mortality

The conference predicted progress in reducing child mortality and maternal mortality in Somalia in coming years.

With investment and implementation of basic health services, the maternal mortality ratio is expected to decline to 332 deaths per 100,000 live births by the year 2030, signifying a 50% reduction from the present level, the statement said.

Similarly, the mortality rates for neonatal, infant and children younger than 5 are expected to decline from 122, 77 and 38 per 1,000 live births in 2020 to 63, 42 and 20 deaths per 1,000 live births, respectively, by the year 2030.

Child mortality in Somalia is believed to be the highest in the world, according to a report published by Amnesty International in August 2021, with an estimated 15% of people having access to medical care in rural areas.

This report originated in VOA Somali service’s “Investigative Dossier” program.
…

As if we didn’t have enough to worry about: Some scientists are warning about the inevitable catastrophic effects on modern life from a super-sized solar storm.

These outbursts from the sun, which eject energy in the form of magnetic fields and billions of tons of plasma gas known as “flares,” are unpredictable and difficult to anticipate.

The Earth suffers a devastating direct hit every century or two, according to recent analysis of scientific data and historic accounts. In the past, these were mainly celestial events with spectacular aurora light shows but scant impact on humanity. Modern technology, however, is vulnerable to the shocks from extreme solar storms.

“It’s not as rare as an asteroid or a comet hitting the Earth, but it’s something that really needs to be dealt with by policymakers,” said Daniel Baker, distinguished professor of planetary and space physics at the University of Colorado. “Certainly, in the longer term, it’s not a question of if but when.”

Astrophysicists estimate the likelihood of a solar storm capable of causing catastrophe to be as high as 12% in a decade.

“It’s just a matter of time,” according to professor Raimund Muscheler, chair of quaternary sciences in the geology department of Lund University in Sweden. “One has to be aware of it and one has to calculate the risks and be prepared as much as possible.”

A new study of ancient ice samples conducted by the Swedish scientist concludes that a previously unknown, huge solar storm about 9,200 years ago would have crippled communications if it had hit Earth in modern times.

“A failure in one kind of sector can propagate through the system and affect a lot of other things, and I think that’s probably the thing that worries me most about storms is that they can be widespread and can have consequences in all kinds of systems that that we might not otherwise think about,” Baker said.

A relatively minor solar storm, that caused a disturbance in the Earth’s magnetic field, is blamed for the loss of as many as 40 of the 49 Starlink internet-access satellites launched February 3 from the Kennedy Space Center in Florida.

Phases of disturbance

When the sun shoots out energy, it affects Earth in phases. The first occurs here eight minutes after the solar event 150 million kilometers away, the time it takes light to travel from the sun.

The initial trouble occurs on the daylight side of the planet from the early arriving X-rays, which dramatically disrupt the ionosphere — where the Earth’s atmosphere meets space — and radio communications. They also create additional drag on some satellites, degrading their orbits, which is what happened to the Starlink satellites.

In subsequent minutes and hours, highly charged particles unleash a radioactive storm, posing a danger to astronauts in orbit.

The third phase, known as the coronal mass ejection — gas and magnetic field explosions on the surface of the sun — disturbs the planet’s magnetosphere, lighting up the sky and inducing electrical currents on the surface, which can overload power grids and speed corrosion of pipelines.

“The geomagnetic storm can actually cause transformers to burn through if they are not adequately protected,” said Muscheler of Lund University.

The power industry in North America has taken steps in recent years to harden its infrastructure to protect from the dangerous surges. U.S. government agencies have a program to deploy emergency transformers to replace those that would fail.

“Although the U.S. government has estimated the cost of a severe space weather event to be in the billions, this worst-case scenario is typically not considered by most policy planners,” said Sangeetha Abdu Jyothi, assistant professor in the computer science department at the University of California, Irvine. “In short, the risk is well-known, but not always considered during design and planning in most cases.”

Long-distance fiber-optic and submarine telecommunications cables at higher latitudes, where the Earth is more exposed, can also suffer serious damage.

“The U.S. is highly susceptible to disconnection from Europe,” Jyothi wrote in a recent research paper. “Europe is in a vulnerable location but is more resilient due to the presence of a larger number of shorter cables. Asia has relatively high resilience with Singapore acting as a hub with connections to several countries.”

The sun frequently hurls big flares at Earth, but most are not large enough to wreak havoc or don’t strike the planet directly. But, as SpaceX experienced this week, even some of the less severe flares can neutralize satellites.

“The timing is unfortunate for SpaceX,” said Bill Murtagh, program coordinator for the Space Weather Prediction Center of the National Oceanic and Atmospheric Administration. He added that the 1,500 SpaceX satellites already in orbit were not affected.

Any major solar storm poses a threat to Global Positioning System satellites, which provide accurate time signals and precise navigation, technology critical in modern life from agriculture to aviation.

A big storm can also trigger ozone depletion, meaning there are possible effects on the terrestrial climate, according to atmospheric scientists.

Previous disruptions

The societal reactions to the solar outbursts of past centuries now seem quaint, although they were sensational events at the time.

When an intense geomagnetic storm hit the Earth in September 1859, known as the Carrington Event, telegraph systems across North America and Europe failed and some operators reported receiving electrical shocks.

A solar storm in March 1989 caused power failures in Quebec, Canada.

The Halloween Storms of 2003 affected more than half of the orbiting satellites, and disrupted aviation for more than a day because planes could not be accurately tracked. Electrical service was also knocked out in parts of Europe for several hours, and transformers in South Africa were permanently damaged.

Since the Carrington Event, state-of-the-art communication has gone from the telegraph to the internet.

“Are we ready for a Carrington class event? No, we still have work to do,” Murtagh of NOAA told VOA.

“While the frequency of climate disasters is increasing gradually, we will be caught by surprise by an extreme solar event that causes significant disruptions. Most people alive today have never experienced an extreme space weather event that has a global impact during our lifetime,” Jyothi of University of California-Irvine told VOA.

She also warned that solar superstorms could cause large-scale internet outages covering the entire globe and lasting several months.

The geomagnetic storms tend to happen more frequently when there are more sunspots (each such freckle on the sun being about the size of Earth). The sun is heading into a new cycle, meaning there is an increasing likelihood of disruptive events as this cycle ramps up to its predicted peak in July 2025.

“We’re going to see more sunspots, more solar flares, more eruptions and consequently more effects on technology here on Earth,” Murtagh said.

Intensity levels

One bit of good news: Solar scientists predict this cycle will be less intense than the most active cycles of past centuries.

Society in the 21st century, however, seems unprepared for the consequences of cascading inter-connected technological failings likely to be caused by future major storms.

“The sun is the giver of life, but it can be cruel too — especially on the technology we rely on for so much of what we do today,” Murtagh said.

Congress passed a bill in 2020 directing the National Science Foundation, NASA and the Defense Department to continue supporting basic research related to space weather.

Some other governments seem less focused on the issue.

Baker recalls a letter he received from a concerned woman in France who contacted officials there for advice on how to prepare for a major geo-magnetic storm.

“We suggest you buy a chocolate cake, eat it and wait for the end of the world,” she was told, according to Baker.
…

The director of the U.S. Centers for Disease Control and Prevention said Wednesday that even though she was encouraged by dropping COVID-19 hospitalizations and case rates, the pandemic was still not at the point at which the agency could recommend dropping nationwide indoor mask requirements.

During a White House COVID-19 response team briefing, CDC Director Rochelle Walensky told reporters the team was very encouraged by current trends that have shown overall cases dropping more than 44% in the past week and hospitalizations down nearly 25%.

But Walensky said that while hospitalizations were down, U.S. deaths from COVID-19 rose by 3% in the past week, and that both indicators were too high to change the CDC guidance on indoor masking in areas of high transmission. 

“We aren’t there yet,” she said. 

More state and local governments are announcing plans to begin lifting their mask requirements. Wednesday, New York state became the latest, with Governor Kathy Hochul saying infection rates had declined to a level at which it was safe to rescind the broad masking order. 

Hochul said masks would still be required in schools, health care facilities, certain types of shelters and public transit. Private businesses will be free to set their own masking rules for staff and patrons. 

Walensky said that many states like New York were lifting their mandates in phases, and that she recognized the need for local governments to be flexible. But she said the CDC was basing its guidance on nationwide surveillance and data, with hospitals, in particular, being a barometer.  

White House Coronavirus Response Coordinator Jeff Zients said that, in terms of the pandemic, January was a difficult month, but data showed the nation was moving toward a time when COIVD-19 would no longer disrupt our daily lives.  

He said 210 million people had been fully vaccinated, and, in the last three weeks, nationwide, daily cases were down 65% and hospitalizations were down 40%.
…

SpaceX says a geomagnetic storm brought down 40 satellites launched last Thursday as part of its Starlink satellite internet service.

In a release posted to the company’s website, the private space company said the satellites were among 49 Starlink satellites launched from the Kennedy Space Center, and that they were deployed to their intended orbit 210 kilometers above Earth.  

The company explained it deploys its satellites into lower orbits so that, in the event they do not pass initial system checkouts, it can quickly and safely bring them out of orbit by atmospheric drag.  

But SpaceX says the satellites were significantly impacted by a geomagnetic storm on Friday. The National Oceanic and Atmospheric Administration’s ((NOAA)) Space Weather Prediction Center had posted a watch late last week for minor to moderate geomagnetic storm activity.

The company said the storms cause the atmosphere to warm and increase its density at altitudes where the satellites are deployed. SpaceX reports GPS readings on the satellites suggests the storm increased atmospheric drag 50 percent higher than normal.  

The SpaceX ground control team set the satellites into a “safe-mode,” changing their flight attitude to minimize drag to effectively “take cover from the storm.”

The company says its preliminary analysis shows the increased drag at the low altitudes prevented the satellites from leaving safe mode and they failed to return to their intended orbits. It said 40 will reenter or already have reentered Earth’s atmosphere.  

The company says the satellites pose no collision risk with other ones and are designed to disintegrate upon re-entering the atmosphere with no orbital debris expected to hit the ground.   

SpaceX has launched nearly 2,000 satellites as part of a network to provide high-speed internet service to users anywhere in the world. Service in the northern United States and Canada is expected to start later this year.
…

World Health Organization officials say insecurity and bureaucratic difficulties continue to prevent medical supplies and other crucial relief from reaching millions of beleaguered civilians in conflict-ridden northern Ethiopia.

An estimated 9.4 million people in northern Ethiopia’s Tigray, Amhara, and Afar regions are in desperate need of humanitarian assistance. Millions are suffering from severe food shortages, acute malnutrition is rising, disease and chronic illnesses are going untreated.

The World Health Organization reports dozens of mobile health and nutrition teams are operating across the three regions. However, treating those in need remains challenging. It says essential medical equipment and medical supplies, vaccines and basic medicines are not reaching the people in need.

WHO spokesman Christian Lindmeier says the situation is particularly critical in Tigray. He says the number of people needing health assistance has risen from 2.3 million during the first half of December to an estimated 3.9 million.

However, he says there is, what he calls, light on the horizon. He notes a shipment of medical supplies reached Mekelle, the capital of Tigray at the end of January. And, he adds the Ethiopian government has announced it would facilitate daily relief flights to augment the transportation of crucial goods by land.

“WHO is preparing to airlift critically needed medicines, medical supplies and equipment to Tigray,” he said. “The first shipment of this is expected to be dispatched this Friday,11 February when 10 metric tons of the total 33 metric tons of supplies will be airlifted. Most clearances for this have been secured and the remaining permits will be processed over the next few days.”

Nevertheless, he says humanitarian agencies are being forced to downsize their operations because they are running out of supplies, fuel, and cash. He warns these operations may have to shut down in the coming weeks if the situation does not improve.

He says an integrated measles campaign at the end of January highlights some of the difficulties aid agencies run into. The campaign, he says targeted nearly 800,000 children under age five using vaccines provided by the Ethiopia Ministry of Health.

“During this phase, 145,000 children of the targeted population were reached because the campaign faced challenges, including cash, lack of fuel, and cold chain capacity,” he said.

Lindmeier says WHO continues to negotiate with the authorities for access to the regions. Despite ongoing difficulties, he says some things are moving and that is a good development.

 
…

An international collaboration led by researchers in Canada and Brazil is applying innovative funding and testing methods to determine whether existing medications can provide cheaper and more effective treatments for COVID-19 and is encouraged by its initial results.

Calling it the “TOGETHER Trial,” researchers predominantly in Brazil and Canada refer to their method as “adaptive platform clinical trial,” which permits several potential treatments to be tested simultaneously, reducing costs and the number of people who need to be tested.

The researchers have also speeded up the search for effective COVID treatments by relying on financing and support from private foundations, universities and the private sector, rather than the time-consuming process of seeking government funding.

One such trial conducted in Brazil beginning in June 2020 found fluvoxamine, a common anti-depressant, helped reduce hospitalization and death of COVID-19 patients by 32%.

Ed Mills, a clinical epidemiologist who teaches at Ontario’s McMaster University, is helping to coordinate the project from offices in Vancouver, Canada. He explained the “adaptive platform” model in which more than one drug is tested at the same time.

“Typically, in a clinical trial, you expect to see a drug versus placebo,” Mills told VOA. “Well, in our circumstance, we’re doing five drugs versus placebo, six drugs versus placebo.”

While uncovering promising data on fluvoxamine, discovering what does not work has been equally important. Mills said the group’s trials showed that hydroxychloroquine, lopinavir, metformin, doxazosin and ivermectin do not help prevent hospitalization from COVID-19.

Two of those drugs, hydroxychloroquine and ivermectin, gained notoriety in the United States as some COVID-19 patients have insisted on taking them despite warnings by U.S. health officials that the drugs are ineffective at best for treating a coronavirus infection.

Amid a global wave of infections driven by the omicron variant, the project is recruiting about 100 participants a day, with trials now underway in South Africa, Pakistan and Brazil. About 5,000 people have participated to date in the trials, which currently involve about 2,500 people.

Mills said the researchers are studying several other existing drugs, and combinations of those drugs, to gauge their effectiveness.

“One would be a drug called peginterferon lambda, which is a single subcutaneous injection, single-dose drug to treat COVID. I’m extremely optimistic about that. We’re also now evaluating combination strategies,” he said.

“So, we know that fluvoxamine works. We also know that budesonide works — an inhaled steroid. What would happen if you put them together? So, I think that’s going to be a really great, cheap intervention that can be applied,” he said. Both drugs are widely available and — in some countries — economical.

Mills said he expects further results within the next few weeks.

Dr. Brian Conway, the medical director of the Vancouver Infectious Diseases Centre, sees the work being conducted by the TOGETHER Trial as a model for some future medical research.

New medications require rigorous and time-consuming clinical trials before they can be approved for use, he noted. But progress can be quicker “if a medicine’s been around for a while, it’s been licensed, it’s available for sale, and you’re trying to decide if there’s a new indication for it.”

Conway, who is not involved with the TOGETHER Trial, was also impressed with the researchers’ methodology.

“I think that going forward, they’re quick. They are rigorous. They generate the kind of information that we need to help guide clinical practice,” he said. “These adaptive platforms are, to my mind, a very appropriate way of figuring out if they work against something for which they have not yet been tested or approved.”

Conway also sees the program as a good way to counter unsubstantiated rumors about unproven medications.

“And it avoids us from getting into a situation where someone says, ‘I gave this treatment to eight or 10 people and it saved their lives. So you should do this, too,’” he said.

“That’s not how we should do science. That’s not how we should practice medicine, especially in the era of COVID,” he said. “And it helps us be rigorous, responsive, and as helpful to our patients as we can be.”

Among the takeaways from the studies, according to Mills, is that the “Global South” — developing countries in the Southern Hemisphere — has a lot to teach the so-called “Global North,” or more developed nations.

“Although we are the ones that tend to come up with the rules on epidemiology, they’re the ones that apply those rules on epidemiology and have practical experience,” he said.

“If you think about a country like Rwanda, for example, where I’ve spent a long time, they deal with Ebola monitoring all the time, they deal with malaria, deal with HIV all the time. They’re very, very experienced at infectious diseases,” Mills said.

This is not the first time Vancouver has played a role in advancing epidemiology. MRNA vaccines developed by Pfizer and Moderna rely on lipid nanoparticles to enter human cells. That technology was first researched at the University of British Columbia in the late 1970s.
…

The U.S. needs a nimble, multipronged strategy and Cabinet-level leadership to counter its festering overdose epidemic, a bipartisan congressional commission advises.

With vastly powerful synthetic drugs like fentanyl driving record overdose deaths, the scourge of opioids awaits after the COVID-19 pandemic finally recedes, a shift that public health experts expect in the months ahead.

“This is one of our most pressing national security, law enforcement and public health challenges, and we must do more as a nation and a government to protect our most precious resource — American lives,” the Commission on Combating Synthetic Opioid Trafficking said in a 70-page report released Tuesday to Congress, President Joe Biden and the American people.

The report envisions a dynamic strategy. It would rely on law enforcement and diplomacy to shut down sources of chemicals used to make synthetic opioids. It would offer treatment and support for people who become addicted, creating pathways that can lead back to productive lives. And it would invest in research to better understand addiction’s grip on the human brain and to develop treatments for opioid use disorder.

The global coronavirus pandemic has overshadowed the American opioid epidemic for the last two years, but recent news that overdose deaths surpassed 100,000 in one year caught the public’s attention. Politically, federal legislation to address the opioid crisis won support across the partisan divide during both the Obama and Trump administrations.

Rep. David Trone, D-Md., a co-chair of the panel that produced the report, said he believes that support is still there, and that the issue appeals to Biden’s pragmatic side. “The president has been crystal clear,” Trone said. “These are two major issues in America: addiction and mental health.”

The U.S. government’s record is also clear. It has been waging a losing “war on drugs” for decades.

The stakes are much higher now with the widespread availability of fentanyl, a synthetic painkiller 80 to 100 times more powerful than morphine. It can be baked into illicit pills made to look like prescription painkillers or anti-anxiety medicines. The chemical raw materials are produced mainly in China. Criminal networks in Mexico control the production and shipment to the U.S.

Federal anti-drug strategy traditionally emphasized law enforcement and long prison sentences. But that came to be seen as tainted by racial bias and counter-productive because drug use is treatable. The value of treatment has recently has gained recognition with anti-addiction medicines in wide use alongside older strategies like support groups.

The report endorsed both law enforcement and treatment, working in sync with one another.

“Through its work, the commission came to recognize the impossibility of reducing the availability of illegal synthetic opioids through efforts focused on supply alone,” the report said.

“Real progress can come only by pairing illicit synthetic opioid supply disruption with decreasing the domestic U.S. demand for these drugs,” it added.

The report recommends what it calls five “pillars” for government action:

Elevating the White House Office of National Drug Control Policy to act as the nerve center for far-flung federal efforts, and restoring Cabinet rank to its director.
Disrupting the supply of drugs through better coordinated law enforcement actions.
Reducing the demand for illicit drugs through treatment and by efforts to mitigate the harm to people addicted. Treatment programs should follow science-based "best practices."
Using diplomacy to enlist help from other governments in cutting off the supply of chemicals that criminal networks use to manufacture fentanyl.
Developing surveillance and data analysis tools to spot new trends in illicit drug use before they morph into major problems for society.

Trone said it’s going to take cooperation from both political parties. “We have to take this toxic atmosphere in Washington and move past it,” he said. “Because 100,000 people, that’s husbands, sisters, mothers, fathers. As a country, we are better than that.”
…

Paris — Plastic has infiltrated all parts of the ocean and is now found “in the smallest plankton up to the largest whale” wildlife group WWF said on Tuesday, calling for urgent efforts to create an international treaty on plastics.

Tiny fragments of plastic have reached even the most remote and seemingly pristine regions of the planet: it peppers Arctic sea ice and has been found inside fish in the deepest recesses of the ocean, the Mariana Trench.

There is no international agreement in place to address the problem, although delegates meeting in Nairobi for a United Nations environment meeting this month are expected to launch talks on a worldwide plastics treaty.

WWF sought to bolster the case for action in its latest report, which synthesizes more than 2,000 separate scientific studies on the impacts of plastic pollution on the oceans, biodiversity and marine ecosystems.

The report acknowledged that there is currently insufficient evidence to estimate the potential repercussions on humans.

But it found that the fossil-fuel derived substance “has reached every part of the ocean, from the sea surface to the deep ocean floor, from the poles to coastlines of the most remote islands and is detectable in the smallest plankton up to the largest whale.”

According to some estimates, between 19 and 23 million tons of plastic waste is washed into the world’s waterways every year, the WWF report said.

This is largely from single-use plastics, which still constitute more than 60% of marine pollution, although more and more countries are acting to ban their use.

“In many places (we are) reaching some kind of saturation point for marine ecosystems, where we’re approaching levels that pose a significant threat,” said Eirik Lindebjerg, Global Plastics Policy Manager at WWF.

In some places there is a risk of “ecosystem collapse,” he said.

Many people have seen images of seabirds choking on plastic straws or turtles wrapped in discarded fishing nets, but he said the danger is across the entire marine food web.

It “will affect not only the whale and the seal and the turtle, but huge fish stocks and the animals that depend on those,” he added.

In one 2021 study, 386 fish species were found to have ingested plastic, out of 555 tested.

Separate research, looking at the major commercially fished species, found up to 30% of cod in a sample caught in the North Sea had microplastics in their stomach.

Once in the water, the plastic begins to degrade, becoming smaller and smaller until it is a “nano plastic,” invisible to the naked eye.

So even if all plastic pollution stopped completely, the volume of microplastics in the oceans could still double by 2050.

But plastic production continues to rise, potentially doubling by 2040, according to projections cited by WWF, with ocean plastic pollution expected to triple during the same period.

Lindebjerg compares the situation to the climate crisis — and the concept of a “carbon budget,” that caps the maximum amount of CO2 that can be released into the atmosphere before a global warming cap is exceeded.

“There is actually a limit to how much plastic pollution our marine ecosystems can absorb,” he said.

Those limits have already been reached for microplastics in several parts of the world, according to WWF, particularly in the Mediterranean, the Yellow and East China Seas (between China, Taiwan and the Korean Peninsula) and in the Arctic sea ice.

“We need to treat it as a fixed system that doesn’t absorb plastic, and that’s why we need to go towards zero emissions, zero pollution as fast as possible,” said Lindebjerg.

WWF is calling for talks aimed at drawing up an international agreement on plastics at the U.N. environment meeting, from February 28 to March 2 in Nairobi.

It wants any treaty to lead to global standards of production and real “recyclability.”

Trying to clean up the oceans is “extremely difficult and extremely expensive,” Lindebjerg said, adding that it was better on all metrics not to pollute in the first place.
…

Millions of people around the world enjoy a daily cup of coffee; however, their daily caffeine fix could be under threat because climate change is killing coffee plants, putting farmers’ livelihoods at risk.

Inside the vast, steamy greenhouses at the Royal Botanic Gardens at Kew in the leafy suburbs of west London, Aaron Davis leads the research into coffee.

“Arabica coffee, our preferred coffee, provides us with about 60% of the coffee that we drink globally. It’s a delicious coffee, it’s the one we love to drink. The other species is robusta coffee, which provides us with the other 40% of the coffee we drink – but that mainly goes into instant coffees and espresso mixes,” Davis explains.

The cultivation of arabica and robusta coffee beans accounts for millions of livelihoods across Africa, South America and Asia.

“These coffees have served us very well for many centuries, but under climate change they’re facing problems,” Davis says.

“Arabica is a cool tropical plant; it doesn’t like high temperatures. Robusta is a plant that likes even moist conditions; it likes high rainfall. And under climate change, rainfall patters are being modified, and it’s also experiencing problems. In some cases, yields are dramatically reduced because of increased temperatures or reduced rainfall. But in some cases, as we’ve seen in Ethiopia, you might get a complete harvest failure and death of the trees.”

The solution could be growing deep in the forests of West Africa. There are around 130 species of coffee plant – but not all taste good. In Sierra Leone, scientists from Kew helped to identify one candidate, stenophylla, growing in the wild.

“This is extremely heat tolerant. And is an interesting species because it matches arabica in terms of its superb taste,” Davis says.

Two other coffee species also show promise for commercial cultivation in a changing climate: liberica and eugenioides, which “has low yields and very small beans, but it has an amazing taste,” according to Davis.

Some believe the taste is far superior. At the 2021 World Barista Championship in Milan, Australia’s Hugh Kelly won third prize with his eugenioides espresso. Kelly recalled the first time he tasted it at a remote farm in Colombia. “It was a coffee like I’ve never tasted before; as I tasted it, it was unbelievably sweet … I knew that sweetness and gentle acidity were the bones for an incredible espresso,” Kelly told judges in Milan.

Researchers hope Kelly’s success could be the breakthrough moment for these relatively unknown beans.

The team at the Botanic Gardens is working with farmers in Africa on cultivating the new coffees commercially. Catherine Kiwuka of the Ugandan National Agricultural Research Organization, who oversees some of the projects, says challenges still lie ahead.

“What requirements do they need? How do we boost its productivity? Instead of it being dominated by only two species, we have the opportunity to tap into the value of other coffee species.”

It’s hoped that substantial volumes of liberica coffee will be exported from Uganda to Europe this year. Researchers hope it will provide a sustainable income for farmers – and an exciting new taste for coffee drinkers.
…