For two decades, scientists have been comparing every person’s full set of DNA they study to a template that relies mostly on genetic material from one man affectionately known as “the guy from Buffalo.”

But they’ve long known that this template for comparison, or “reference genome,” has serious limits because it doesn’t reflect the spectrum of human diversity.

“We need a really good understanding of the variations, the differences between human beings,” said genomics expert Benedict Paten of the University of California, Santa Cruz. “We’re missing out.”

Now, scientists are building a much more diverse reference that they call a “pangenome,” which so far includes the genetic material of 47 people from various places around the world. It’s the subject of four studies published Wednesday in the journals Nature and Nature Biotechnology. Scientists say it’s already teaching them new things about health and disease and should help patients down the road.

Paten said the new reference should help scientists understand more about what’s normal and what’s not. “It is only by understanding what common variation looks like that we’ll be able to say, ‘Oh, this big structural variation that affects this gene? Don’t worry about it,'” he said.

A human genome is the set of instructions to build and sustain a human being, and experts define a pangenome as a collection of whole genome sequences from many people that is designed to represent the genetic diversity of the human species. The pangenome is not a composite but a collection; scientists depict it as a rainbow of stacked genomes, compared with one line representing the older, single reference genome.

The Human Pangenome Project builds upon the first sequencing of a complete human genome, which was nearly completed more than two decades ago and finally finished last year. Paten, a pangenome study author and project leader, said 70% of that first reference genome came from an African American man with mixed African and European ancestry who answered an ad for volunteers in a Buffalo newspaper in 1997. About 30% came from a mix of around 20 people.

The pangenome contains material from 24 people of African ancestry, 16 from the Americas and the Caribbean, six from Asia and one from Europe.

Although any two people’s genomes are more than 99% identical, Paten said “it’s those differences that are the things that genetics and genomics is concerned with studying and understanding.”

It may take a while for patients to see concrete benefits from the research. But scientists said new insights should eventually make genetic testing more accurate, improve drug discovery and bolster personalized medicine, which uses someone’s unique genetic profile to guide decisions for preventing, diagnosing and treating disease.

“The Pangenome Project gives a more accurate representation of the genome of people from around the world,” and should help doctors better diagnose genetic conditions, said clinical genetics expert Dr. Wendy Chung at Columbia University, who was not involved in the research.

If someone has a variation in a certain gene, it could be compared to the rainbow of references.

Study author Evan Eichler of the University of Washington said researchers will also learn more about genes already linked to problems, such as one tied to cardiovascular disease in African Americans.

“Now that we can actually sequence that gene in its entirety and we can understand the variation in that gene, we can start to go back to unexplained cases of patients with coronary heart disease” and look at them in light of the new knowledge, he said.

University of Minnesota plant genetics expert Candice Hirsch, who wasn’t involved in the research but has closely followed the effort, said she expects many discoveries to flow from it. Until now, “we really have only been able to scratch the surface of understanding the genetics that underlies disease,” she said.

The consortium leading the research is part of the Human Genome Reference Program, which is funded by an arm of the U.S. National Institutes of Health.

The team is in the process of adding to the collection of reference genomes, with the goal of having sequences from 350 people by the middle of next year. Scientists are also hoping to work more with international partners, including those focusing on Indigenous populations.

“We’re in it for the long game,” Paten said.
…

An unmarried Chinese woman on Tuesday began her final appeal of a hospital’s denial of access to freeze her eggs five years ago in a landmark case of female reproductive rights in the country. 

Teresa Xu’s case has drawn broad coverage in China, including by some state media outlets, since she first brought her case to court in 2019. She lost her legal challenge last year at another Beijing court, which ruled the hospital did not violate her rights in its decision. 

The upcoming judgment will have strong implications for the lives of many unmarried women in China and the country’s demographic changes, especially after the world’s second-largest economy recorded its first population decline in decades. 

In China, the law does not explicitly ban unmarried people from services such as fertility treatments and simply states that a “husband and wife” can have up to three children. But hospitals and other institutions, in practice, implement the regulations in a way that requires people to present a marriage license. 

Xu, who wanted to preserve her eggs so she could have the option to bear children later, is one of those facing difficulties in accessing fertility treatment. 

In 2018, Xu, then 30 years old, had gone to a public hospital in Beijing to ask about freezing her eggs. But after an initial check-up, she was told she could not proceed without a marriage certificate. 

According to the judgment she received last year, the hospital argued that egg freezing poses certain health risks. It said that egg-freezing services were only available to women who could not get pregnant in the natural way, and not for healthy patients. 

But it also stated that delaying pregnancy could bring risks to the mother during pregnancy and “psychological and societal problems” if there is a large age gap between parents and their child. 

After Tuesday’s hearing, Xu told reporters that the denial constituted a violation of her right to bodily autonomy, and she chose to fight on because this matter is very important to single women. 

“I also have grown up a lot as the case evolves, I don’t want to give up easily,” she said. 

It is unclear when the court will hand down the judgment, she said. 
…

A report by leading United Nations agencies says global progress in reducing maternal and newborn deaths has stalled for nearly a decade largely due to underinvestment in providing the health care.

The report shows more than 4.5 million women and babies die every year in pregnancy, childbirth or the first weeks after birth — equivalent to one death every seven seconds — “mostly from preventable or treatable causes if proper care was available.”

Allisyn Moran, unit head for maternal health at the World Health Organization, said all the deaths have similar risk factors and causes.

While the trends pre-date the coronavirus pandemic, she said “COVID-19-related service disruptions and funding diversions, rising poverty and worsening humanitarian crises are intensifying pressures on already overstretched maternity and newborn health services.”

Since 2018, the report finds, more than three-quarters of all conflict-affected and sub-Saharan African countries report funding for maternal and newborn health has declined and that only one in 10 of more than 100 countries surveyed reported they had the money needed to implement their current plans.

Speaking in Cape Town, South Africa, the site of a major global conference on maternal health, Moran said that a lack of investment in primary health care risked lowering survival prospects.

“For instance, while prematurity is now the leading cause of all under-5 deaths globally, less than a third of countries report having sufficient newborn care units to treat small and sick babies,” she said. “Two-thirds of emergency childbirth facilities in sub-Saharan Africa lack essential resources like medicines and supplies, water, electricity or staffing for 24-hour care.”

Steven Lauwerier, UNICEF director of health, agreed with that assessment. Since the COVID-19 pandemic, he said “babies, children, and women who were already exposed to threats to their well-being, especially those living in fragile countries and emergencies, are facing the heaviest consequences of decreased spending and efforts on providing quality and accessible healthcare.”

The report, “Improving Maternal and Newborn Health and Survival and Reducing Stillbirth,” found that in sub-Saharan Africa and central and southern Asia, the regions with the greatest number of newborn and maternal deaths, fewer than 60 percent of women receive even four of the WHO’s recommended eight prenatal checks.

“The death of any woman or young girl during pregnancy or childbirth is a serious violation of their human rights,” said Julitta Onabanjo, director of the technical division at the U.N. Population Fund.  “It also reflects the urgent need to scale-up access to quality sexual and reproductive health services as part of universal health coverage and primary health care, especially in communities where maternal mortality rates have stagnated or even risen during recent years.”

The authors of the report agree that women and babies must have quality, affordable health care before, during and after childbirth, as well as access to family planning services to increase survival rates.

They add that “more skilled and motivated health workers, especially midwives, are needed, alongside essential medicine and supplies, safe water, and reliable electricity.”

The stated aim of health leaders from over 30 countries attending the week-long conference is to develop plans that accelerate progress where it is most needed.

Anshu Banerjee, the WHO director of maternal, newborn, child and adolescent health and aging, is in no doubt as to where that is. “Pregnant women and newborns continue to die at unacceptably high rates worldwide,” he said, “and the COVID-19 pandemic has created further setbacks to providing them with the healthcare they need.”

“If we wish to see different results, we must do things differently,” he said. “More and smarter investments in primary health care are needed now so that every woman and baby — no matter where they live — has the best chance of health and survival.”
…

Providing simple and cheap healthcare measures to pregnant women — such as offering aspirin — could prevent more than a million babies from being stillborn or dying as newborns in developing countries every year, new research said on Tuesday.   

An international team of researchers also estimated that one quarter of the world’s babies are born either premature or underweight, adding that almost no progress is being made in this area.    

The researchers called for governments and organizations to ramp up the care women and babies receive during pregnancy and birth in 81 low- and middle-income countries.   

SEE ALSO: A related video by VOA’s Timothy Obiezu

Eight proven and easily implementable measures could prevent more than 565,000 stillbirths in these countries, according to a series of papers published in the Lancet journal.    

The measures included providing micronutrient, protein and energy supplements, low-dose aspirin, the hormone progesterone, education on the harms of smoking, and treatments for malaria, syphilis and bacteria in urine.   

If steroids were made available to pregnant women and doctors did not immediately clamp the umbilical cord, the deaths of more than 475,000 newborn babies could also be prevented, the research found.    

Implementing these changes would cost an estimated $1.1 billion, the researchers said.   

This is “a fraction of what other health programs receive”, said Per Ashorn, a lead study author and professor at Finland’s Tampere University.    

‘Shockingly’ common 

Another study author, Joy Lawn of the London School for Hygiene and Tropical Medicine, told AFP that the researchers used a new definition for babies born premature or underweight.   

She said the traditional way to determine a baby had a low birthweight — if it was born weighing under 2.5 kilograms — was “a bit randomly selected” by a Finnish doctor in 1919.   

 This “very blunt measure” has remained the benchmark for more than a century, despite plentiful evidence that “those babies are not all the same”, Lawn said.   

The researchers analyzed a database that included 160 million live births from 2000 to 2020 to work out how often babies are born “too soon and too small”, she said.   

“Quite shockingly, we found that this is much more common once you start to think about it in a more nuanced way.”   

The researchers estimated that 35.3 million — or one in four — of the babies born worldwide in 2020 were either premature or too small, classifying them under the new term “small vulnerable newborns.”   

While most of the babies were born in southern Asia and sub-Saharan Africa, Lawn emphasized that every country was affected.    

One reason progress has flatlined is that these problems tend “to be something that happens to families and women with less of a voice”, Lawn said.   

For example, pregnant African American women in the United States received a lower level of care than other groups, she added. 
…

Mexican officials and the conservation group Sea Shepherd said Monday that experts would set out in two ships in a bid to locate the few remaining vaquita marina, the world’s most endangered marine mammal. 

Mexico’s environment secretary said experts from the United States, Canada and Mexico will use binoculars, sighting devices and acoustic monitors to try to pinpoint the location of the tiny elusive porpoises. The species cannot be captured, held or bred in captivity. 

The trip will start Wednesday and run to May 26 in the Gulf of California, also known as the Sea of Cortez, the only place the vaquita lives. The group will travel in a Sea Shepherd vessel and a Mexican boat and try to sight vaquitas. As few as eight of the creatures are believed to remain. 

SEE ALSO: A related video by VOA’s Annika Hammerschlag

Illegal gillnet fishing traps and kills the vaquita. Fishermen set the nets to catch totoaba, a fish whose swim bladder is considered a delicacy in China and can fetch thousands of dollars per pound (0.45 kilograms). 

Sea Shepherd has been working in the Gulf alongside the Mexican navy to discourage illegal fishing in the one area where vaquitas were last seen. The area is known as the “zero tolerance” zone, and fishing is supposedly not allowed there. However, illegal fishing boats are regularly seen there, and so Mexico has been unable to completely stop them. 

Pritam Singh, Sea Shepherd’s chairman, said that a combination of patrols and the Mexican navy’s sinking of concrete blocks with hooks to snare illegal nets has reduced the number of hours that fishing boats spend in the restricted zone by 79% in 2022, compared with the previous year. 

Singh said that “the last 18 months have been incredibly impactful and encouraging,” while noting that “the road ahead for saving this species is long.” 

SEE ALSO: A related video by VOA’s Henry Wilkins

The last such sighting expedition in 2021 yielded probable sightings of between five and 13 vaquitas, a decline from the previous survey in 2019. The porpoises are so small and so elusive, and are usually seen from so far away, that it is hard for observers to be certain that they saw a vaquita, count how many they saw or determine whether they saw the same animal twice. 

Illegal fishing itself has impeded population calculations in the past. 

According to a report published in 2022, both the 2019 and 2021 surveys “were hindered by the presence of many illegal fishing boats with gillnets in the water. Some areas could not be surveyed at all on some days due to the density of illegal fishing.” 

The government’s protection efforts have been uneven, at best, and often face violent opposition from local fishermen. 

President Andrés Manuel López Obrador’s administration has largely declined to spend money to compensate fishermen for staying out of the vaquita refuge and not using gillnets, or to monitor the fishing boats or the areas they launch from. 
…

Funding for a global initiative aimed at creating more environmentally friendly and climate-resilient farming has grown to $13 billion, co-leaders the United States and the United Arab Emirates said Monday.

That money means the Agriculture Innovation Mission (AIM) for Climate, launched in 2021, now exceeds its $10 billion target for the COP28 climate talks, to be hosted by the UAE in November and December.

“Climate change continues to impact longstanding agricultural practices in every country and a strong global commitment is necessary to face the challenges of climate change head-on,” U.S. Secretary of Agriculture Tom Vilsack said in a statement.

Vilsack and his Emirati counterpart Mariam bint Mohammed Almheiri, the UAE Minister of Climate Change and Environment, are co-hosting an AIM for Climate Summit in Washington this week.

“I think the beauty of this is that of the $13 billion, $10 billion comes from the government and three billion is coming from the private sector,” said Almheiri.

Between a quarter and a third of global greenhouse emissions come from food systems, from factors like deforestation to make way for agricultural land, methane emissions from livestock, the energy costs associated with supply chains and energy used by consumers to store and prepare food.

At the same time, the changing climate is threatening food security across the world, as global warming increases the frequency of punishing heat waves, droughts and extreme weather events.

Projects underway include developing newer, greener fertilizers that use less fossil fuels to create, and returning to so-called “regenerative agriculture” practices that restore soil biodiversity, thus improving both yield and carbon sequestration while reducing the need for fertilization.

Artificial intelligence-enhanced tools meanwhile are being developed to take data from sources including satellites and ground sensors to then accurately estimate how carbon-rich any given plot of land is, which could help farmers boost soil health or enable the creation of a viable carbon offset market.

Also on the group’s agenda are efforts to adopt more efficient farming techniques and to switch to growing crops that require less water in some climate-impacted areas.

“Black farmers, Indigenous farmers, low-income farmers, they need access to this innovation as well,” former U.S. Vice President Al Gore and climate activist told the summit’s opening meeting.

U.S. climate envoy John Kerry, as well as ministers from Britain, the European Commission, Australia, Kenya, Mexico and Panama are all set to address the conference.
…

For the first time, the U.S. government will pay for a large study measuring whether overdoses can be prevented by so-called safe injection sites, places where people can use heroin and other illegal drugs and be revived if they take too much.

The grant provides more than $5 million over four years to New York University and Brown University to study two sites in New York City and one opening next year in Providence, Rhode Island.

Researchers hope to enroll 1,000 adult drug users to study the effectiveness of the sites to prevent overdoses, to estimate their costs and to gauge potential savings for the health care and criminal justice systems.

The universities announced the grant Monday. The money will not be used to operate the sites, the universities said.

With U.S. drug overdose deaths reaching nearly 107,000 in 2021, supporters contend safe injection sites, also called overdose preventions centers, can save lives and connect people with addiction treatment, mental health services and medical care.

Opponents worry the sites encourage drug use and that they will lead to the deterioration of surrounding neighborhoods.

“There is a lot of discussion about overdose prevention centers, but ultimately, we need data to see if they are working or not, and what impact they may have on the community,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which awarded the grant.

Sites operate in 14 countries, including Canada, Australia and France, according to the Drug Policy Alliance, a group working for decriminalization and safe drug use policies.

In the U.S., New York City opened the first publicly recognized safe injection site in 2021, and Rhode Island became the first state to authorize them that year.

States including Colorado, Nevada and New Mexico have considered allowing them. The governors of California and Vermont vetoed bills allowing safe injection sites last year, and Pennsylvania’s Senate last week voted for a ban on them.

The grant marks another move by the Biden administration toward what is known as harm reduction, a strategy focused on preventing death and illness in drug users while helping them get care, as opposed to punishment.

The White House’s drug control strategy is the first to emphasize harm reduction, and the Justice Department has signaled it will allow safe injection sites.

In December, the National Institutes of Health established a harm reduction research network to study programs providing services and supplies, including naloxone, a drug that can reverse overdoses, and materials to test drugs for fentanyl, a powerful opioid driving record numbers of overdoses. The new study on safe injection sites will be part of that project.
…

Most Democrats and Republicans agree that the federal government should better regulate the biggest technology companies, particularly social media platforms. But there is little consensus on how it should be done. 

Concerns have skyrocketed about China’s ownership of TikTok, and parents have grown increasingly worried about what their children are seeing online. Lawmakers have introduced a slew of bipartisan bills, boosting hopes of compromise. But any effort to regulate the mammoth industry would face major obstacles as technology companies have fought interference. 

Noting that many young people are struggling, President Joe Biden said in his February State of the Union address that “it’s time” to pass bipartisan legislation to impose stricter limits on the collection of personal data and ban targeted advertising to children. 

“We must finally hold social media companies accountable for the experiment they are running on our children for profit,” Biden said.

A look at some of the areas of potential regulation: 

Children’s safety

Several House and Senate bills would try to make social media, and the internet in general, safer for children who will inevitably be online. Lawmakers cite numerous examples of teenagers who have taken their own lives after cyberbullying or have died engaging in dangerous behavior encouraged on social media. 

In the Senate, at least two bills are focused on children’s online safety. Legislation by Senators Richard Blumenthal, a Connecticut Democrat, and Marsha Blackburn, a Tennessee Republican, approved by the chamber’s Commerce Committee last year would require social media companies to be more transparent about their operations and enable child safety settings by default. Minors would have the option to disable addictive product features and algorithms that push certain content. 

The idea, the senators say, is that platforms should be “safe by design.” The legislation, which Blumenthal and Blackburn reintroduced last week, would also obligate social media companies to prevent certain dangers to minors — including promotion of suicide, disordered eating, substance abuse, sexual exploitation and other illegal behaviors. 

A second bill introduced last month by four senators — Democratic Senators Brian Schatz of Hawaii and Chris Murphy of Connecticut and Republican Senators Tom Cotton of Arkansas and Katie Britt of Alabama — would take a more aggressive approach, prohibiting children under 13 from using social media platforms and requiring parental consent for teenagers. It would also prohibit companies from recommending content through algorithms for users under 18.

Critics of the bills, including some civil rights groups and advocacy groups aligned with tech companies, say the proposals could threaten teens’ online privacy and prevent them from accessing content that could help them, such as resources for those considering suicide or grappling with their sexual and gender identity. 

“Lawmakers should focus on educating and empowering families to control their online experience,” said Carl Szabo of NetChoice, a group aligned with Meta, TikTok, Google and Amazon, among other companies. 

Data privacy 

Biden’s State of the Union remarks appeared to be a nod toward legislation by Senators Ed Markey, a Massachusetts Democrat, and Bill Cassidy, a Louisiana Republican, that would expand child privacy protections online, prohibiting companies from collecting personal data from younger teenagers and banning targeted advertising to children and teens. The bill, also reintroduced last week, would create an “eraser button” allowing parents and kids to eliminate personal data, when possible. 

A broader House effort would attempt to give adults as well as children more control over their data with what lawmakers call a “national privacy standard.” Legislation that passed the House Energy and Commerce Committee last year would try to minimize data collected and make it illegal to target ads to children, usurping state laws that have tried to put privacy restrictions in place. But the bill, which would have also given consumers more rights to sue over privacy violations, never reached the House floor. 

Prospects for the House legislation are unclear now that Republicans have the majority.

 

TikTok, China 

Lawmakers introduced a raft of bills to either ban TikTok or make it easier to ban it after a combative March House hearing in which lawmakers from both parties grilled TikTok CEO Shou Zi Chew over his company’s ties to China’s communist government, data security and harmful content on the app. 

Chew attempted to assure lawmakers that the hugely popular video-sharing app prioritizes user safety and should not be banned because of its Chinese connections. But the testimony gave new momentum to the efforts. 

Soon after the hearing, Missouri Senator Josh Hawley, a Republican, tried to force a Senate vote on legislation that would ban TikTok from operating in the United States. But he was blocked by a fellow Republican, Kentucky Senator Rand Paul, who said that a ban would violate the Constitution and anger the millions of voters who use the app. 

Another bill sponsored by Republican Senator Marco Rubio of Florida would, like Hawley’s bill, ban U.S. economic transactions with TikTok, but it would also create a new framework for the executive branch to block any foreign apps deemed hostile. His bill is co-sponsored by Representatives Raja Krishnamoorthi, an Illinois Democrat, and Mike Gallagher, a Wisconsin Republican. 

There is broad Senate support for bipartisan legislation sponsored by Senate Intelligence Committee Chairman Mark Warner, a Virginia Democrat, and South Dakota Senatpr John Thune, the No. 2 Senate Republican, that does not specifically call out TikTok but would give the Commerce Department power to review and potentially restrict foreign threats to technology platforms. 

The White House has signaled it would back that bill, but its prospects are uncertain. 

Artificial intelligence 

A newer question for Congress is whether lawmakers should move to regulate artificial intelligence as rapidly developing and potentially revolutionary products like AI chatbot ChatGPT begin to enter the marketplace and can in many ways mimic human behavior. 

Senate Democratic leader Chuck Schumer of New York has made the emerging technology a priority, arguing that the United States needs to stay ahead of China and other countries that are eyeing regulations on AI products. He has been working with AI experts and has released a general framework of what regulation could look like, including increased disclosure of the people and data involved in developing the technology, more transparency and explanation for how the bots arrive at responses.

The White House has been focused on the issue as well, with a recent announcement of a $140 million investment to establish seven new AI research institutes. Vice President Kamala Harris met Thursday with the heads of Google, Microsoft and other companies developing AI products.
…

The U.S. Centers for Disease Control and Prevention says America’s leading cause of overdose deaths is synthetic opioids, mostly fentanyl, which can be up to 50 times stronger than heroin. U.S. law enforcement says illicit fentanyl is cheaply made from chemicals mostly coming from China, trafficked through Mexico, and then smuggled into the United States. VOA’s Natasha Mozgovaya looks at fentanyl in Washington state in a series that today explores how stigmas about fentanyl abuse complicate treatment for addicts.
…

The U.S. Centers for Disease Control and Prevention says America’s leading cause of overdose deaths is synthetic opioids, mostly fentanyl, which can be up to 50 times stronger than heroin. U.S. law enforcement says illicit fentanyl is cheaply made from chemicals mostly coming from China, trafficked through Mexico, and then smuggled into the United States, says U.S. law enforcement. VOA’s Natasha Mozgovaya looks at fentanyl in a series from the state of Washington that concludes by showing how breaking free from addiction can be a lifelong journey.
…

“Being in hospitals during the early days of COVID-19 was terrifying, like I was going to war. But as far as I’m concerned, those days are done, Danielle King, a nurse working in Luling, Louisiana, told VOA.

“I think it’s pretty obvious that the pandemic was over a year ago,” she added. “The government’s lagging behind that reality, so maybe they’ll finally catch up.”

The U.S. government will take a big step in that direction Thursday as Washington officially declares an end to the coronavirus pandemic by allowing the COVID-19 Public Health Emergency (PHE) to expire.

The emergency was first instituted more than three years ago to provide funding and resources that would keep Americans safe during the then-growing global pandemic.

While many health care officials agree the time is right to end the national emergency and let state and local governments allocate resources to the COVID-19 response, some worry the move will harm Americans — particularly the impoverished — who will be less likely to afford vaccinations and risk being dropped from government programs such as Medicaid.

“It’s regrettable, but we have no certainty on what impact the PHE’s end will have on the public,” said Amy Pisani, CEO of Vaccinate Your Family, a national nonprofit organization.

“Public health advocates haven’t had a seat at the table to discuss how the end of the PHE declaration will look,” she said. “We know, for example, that COVID-19 vaccinations have been essential in keeping us safe, but how will uninsured adults access and afford the vaccines when the PHE is done? How long will free vaccines be available? Will it vary from region to region? We have no idea. All we know is it’s going to affect a lot of people.”

‘No longer a threat’

The PHE was first declared in January 2020 by former Health and Human Services Secretary Alex Azar.

Since entering office in 2021, President Joe Biden has repeatedly extended the emergency. Many public health officials, including Dr. Jeffrey Elder, associate chief medical officer for emergency management at LCMC Health in New Orleans, Louisiana, believe the emergency allowed the government to take sweeping steps to support the country’s economic, health and welfare systems throughout the crisis.

“The PHE supported and funded nationwide coronavirus testing, the research and distribution of vaccinations and treatments, telehealth services, disaster responses, hospital-at-home services, nurse aide training for nursing homes and so much more,” Elder told VOA.

“And it gave our patients the comfort of knowing they couldn’t be kicked off their Medicaid insurance coverage during the emergency,” he added. “It was invaluable.”

Most public health officials, however, acknowledge the coronavirus no longer presents the crisis it once did, and the PHE may no longer be necessary.

“While we continue to see illness and deaths from COVID-19, it is no longer the threat it once was, thanks to testing, vaccines and treatment,” said Dr. Susan Kansagra, director of the North Carolina Department of Health and Human Services Division of Public Health.

She believes COVID-19 will soon be treated as routinely as other respiratory illnesses the country regularly faces.

Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said this is a good thing.

“To call this an emergency is to elevate it above other viruses that are causing basically the same number of hospitalizations and deaths,” he said.

“I think there’s a danger to that, and I see that danger with some of my friends,” Offit said. “When their 8-year-old is sick they say, ‘Oh, I hope it’s not COVID,’ and then they test them. If they test negative, they just send them to school or to their grandparents or wherever they are going, as if it’s OK to pass on whatever disease they do have. Maybe putting coronavirus on the level of these other diseases will encourage us to take their spread all a little more seriously, as well.”

‘Wide-ranging chaos’

Coronavirus cases and deaths continue to drop, but thousands of Americans are still affected by the disease. According to the Centers for Disease Control and Prevention, 1,773 people died of COVID-19 during the week ending April 5.

Some fear that with so many people still being impacted, suddenly ending the declaration could create a new set of problems.

“An abrupt end to the emergency declarations would create wide-ranging chaos and uncertainty throughout the health care system — for states, for hospitals and doctors’ offices, and most importantly, for tens of millions of Americans,” the Office of Management and Budget wrote in a Statement of Administration Policy earlier this year.

Dr. Joe McLaughlin, Alaska state epidemiologist, believes ending the PHE can reduce government spending and help the country return to a more traditional health care model. But he warns of downsides.

“We’re going to see fewer health care provider flexibilities, a reduction in access to over-the-counter tests and a decrease in some social safety net benefits. This is definitely going to affect people,” he said.

Of particular concern to health care providers is that states will no longer be forbidden from dropping enrollees from Medicaid, a federal health care program for the poor and disadvantaged, as they were during the PHE. In the months following the emergency’s conclusion, the Kaiser Family Foundation estimates that between 5.3 million and 14.2 million of America’s most vulnerable will lose their Medicaid coverage.

Additionally, it is expected that COVID-19 tests and vaccinations will no longer be offered free of charge. Once the government stops buying vaccines, the cost is expected to skyrocket. Pfizer announced it could charge as much as $130 per dose.

Challenge and opportunity

“I think it’s the right time to end it,” New Orleans nurse Brandon Legnion said of the PHE.

“I don’t think I’ve seen or heard of a single COVID-positive admission at our hospital in the last six months,” he told VOA. “The demand for PPE [personal protective equipment] and vaccines are way down, so maybe it’s time to treat coronavirus patients with the same well-researched protocols we use for other airborne transmitted diseases like tuberculosis or varicella [chickenpox].”

Ending the PHE will restructure the federal government’s COVID-19 response as an endemic, rather than a pandemic, managed through government agencies’ normal authorities. In addition to tapering coronavirus relief funds, the development of vaccines and treatments will be shifted away from federal government control.

State health department officials say the transition will be a challenge, but they are ready.

“We’ve been preparing for the possibility of the end of the federal public health emergency for some time now, and we released our state’s plan in a roadmap last year,” said AnneMarie Harper, communications director at the Colorado Department of Public Health and Environment.

“It’s a sustainable, continued response to COVID-19 that features partnerships between public and private entities that ensure all Coloradans are being taken care of, including those without insurance,” she said.

In Maryland, similar work has been done to prepare for what has become a critical transition in the country’s health care system.

Chase Cook, acting director of communications at the Maryland Department of Health, said ending the PHE makes sense because it aligns with a decrease in COVID-19 hospitalization and severity, as well as an increasing integration of coronavirus-related services into existing public health infrastructure.

“The end of the public health emergency can be seen as a challenge,” Cook told VOA, “but it’s also an opportunity … to continue responding to the effects of the pandemic on public health, to strengthen relationships within the health care system, to maintain public-private partnerships, to grow the public health workforce, and to build on renewed efforts to decrease health disparities in Maryland. It’s an opportunity, and we’re ready.” 
…

Mohammed Azhar holds his baby niece next to a storm drain full of plastic and stinking black sludge, testament to India’s failure to treat nearly two-thirds of its urban sewage.

“We stay inside our homes. We fall sick if we go out,” the 21-year-old told AFP in the Delhi neighborhood of Seelampur, where open gutters packed with plastic and sickly greyish water flow alongside the narrow lanes.

“It stinks. It attracts mosquitoes. We catch diseases and the kids keep falling sick,” he added. “There is no one to clean the filth.”

India at the end of April was projected to have overtaken China as the world’s most populous country, according to the United Nations, with almost 1.43 billion people.

Its urban population is predicted to explode in the coming decades, with over 270 million more people forecast to live in its cities by 2040.

But of the 72 billion liters of sewage currently generated in urban centers every day, 45 billion liters — enough to fill 18,000 Olympic-sized swimming pools — aren’t treated, according to government figures for 2020-21.

India’s sewerage system does not connect to about two-thirds of its urban homes, according to the National Fecal Sludge and Septage Management Alliance (NFSSM).

Many of the sewage treatment plants in operation don’t comply with standards, including 26 out of Delhi’s 35 facilities, according to media reports.

Coupled with huge volumes of industrial effluent, the sewage is causing disease, polluting India’s waterways, killing wildlife and seeping into groundwater.

Ecologically dead

Although India has made major progress in reducing child mortality, diarrhea — caused mostly by contaminated water and food — remains a leading killer.

More than 55,000 children under five died of diarrhea across India in 2019, according to a study published last year in the scientific journal BMC Public Health.

The Yamuna in Delhi is one of the world’s filthiest rivers and is considered ecologically dead in places, although people still wash clothes and take ritual baths in it.

It often billows with white foam, and facilities processing drinking water from the river for Delhi’s 20 million people regularly shut down because of dangerous ammonia levels.

Despite some bright spots, as well as efforts to plant more trees alongside rivers, the situation elsewhere is often no better in big cities including Mumbai and Chennai.

In Bengaluru, massive Bellandur Lake has on occasion caught fire when methane, generated by bacteria feasting on sewage in the oxygen-depleted water, ignited.

Water crisis

Mridula Ramesh, author of a book about India’s water woes who lives in a “nearly” net-zero-waste home, said properly treating sewage into useable water would help solve the crisis.

According to the World Bank, India is one of the most “water-stressed” countries in the world, with plummeting water tables and increasingly erratic monsoon rains.

Chennai nearly ran out of water briefly in 2019, and other cities may see similar calamities in the coming years due to excessive groundwater pumping and rainfall volatility.

“India is headed for a water crisis. Sewage can so easily be co-opted to fight that and help us to a very large extent solve the problem in our cities,” Ramesh told AFP.

This could be achieved with decentralized treatment plants partially funded by the private sector or non-governmental organizations, with some of the fully treated sewage reused or released into local lakes.

“India’s water is so seasonal. Many cities in India get 50 rain days… but sewage is available every day because you go to the bathroom every day… It’s such a powerful weapon,” she said.

For Khalil Ahmad, standing by the revolting open drain in Seelampur as flies buzz around, a solution can’t come soon enough.

“Children keep falling sick… If they don’t get treatment and medicine, the children will die,” he told AFP. 
…