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Impact of COVID-related state of emergency declarations on asthma exacerbations in children

An investigation into the impact of the 2020 state of emergency declarations on exacerbated bronchial asthma (*1) in children has been conducted in Kobe City, Hyogo Prefecture, Japan. The research group included Project Assistant Professor YAMAGUCHI Hiros

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An investigation into the impact of the 2020 state of emergency declarations on exacerbated bronchial asthma (*1) in children has been conducted in Kobe City, Hyogo Prefecture, Japan. The research group included Project Assistant Professor YAMAGUCHI Hiroshi and Professor NOZU Kandai of the Department of Pediatrics at Kobe University’s Graduate School of Medicine, and the Kobe Children’s Primary Emergency Medical Center Director ISHIDA Akihito.

Credit: Modified version of Yamaguchi et al., Int. J. Environ. Res. Public Health 2021, 18, 11407.

An investigation into the impact of the 2020 state of emergency declarations on exacerbated bronchial asthma (*1) in children has been conducted in Kobe City, Hyogo Prefecture, Japan. The research group included Project Assistant Professor YAMAGUCHI Hiroshi and Professor NOZU Kandai of the Department of Pediatrics at Kobe University’s Graduate School of Medicine, and the Kobe Children’s Primary Emergency Medical Center Director ISHIDA Akihito.

The survey covered patient visits to the Kobe Children’s Primary Emergency Medical Center for the period from 2011 to 2020. First of all, the researchers identified yearly spring and fall peaks in the number of asthma patients in the annual data up to 2019. In addition, they also found a significant correlation between children’s asthma attacks and atmospheric temperature increases. Furthermore, they revealed that asthma attacks occurred more easily in children aged 5 and under the higher the level of atmospheric sulfur dioxide (SO2). The average temperature for 2020 was similar to the previous year, however under the state of emergency in spring, the number of patients with bronchial asthma declined as SO2 levels decreased. After the state of emergency was lifted, the regular peak in patient numbers was seen in fall. It can be supposed that this is due to the relationship between the occurrence of asthma attacks and exposure to SO2, as well asthe increase in viral infections resulting from the recommencement of social activities and in-person interactions.

These research results were published online in the ‘International Journal of Environmental Research and Public Health’ on October 29, 2021.

Main Points

  • The researchers conducted a survey on the number of patients who visited Kobe Children’s Primary Emergency Medical Center with bronchial asthma from 2011 to 2020.
  • Clear peaks were observed in spring and fall in the data up until 2019. In addition, there was a significant correlation between the number of children with bronchial asthma across all age groups and the increase in average atmospheric temperature. Furthermore, in children aged 5 and under, there was a significant correlation with increased levels of atmospheric sulfur dioxide (SO2).
  • Due to the state of emergency declarations, there was markedly less atmospheric pollution in Kobe City during 2020 compared to other years, and SO2 levels also significantly declined.
  • No peak was observed in the data for spring 2020, when a state of emergency was in place. However, the regular yearly peak was found in the data for fall 2020, when the state of emergency had been lifted. It is assumed that the spring results were due to the reduced SO2 emissions and the state of emergency measures, which meant that children were exposed to less environmental pollutants and infections. Measures such as social distancing reduced face-to-face interactions, and practices such as handwashing and mask-wearing contributed towards making children’s environments more hygienic. 

Research Background

Studies in numerous countries have reported various environmental factors involved in bronchial asthma, including infections (such as rhinovirus, RS virus and influenza), meteorological factors (such as temperature, pressure and humidity), allergens (eg. pollen, yellow sand) and atmospheric pollutants (such as SO2, nitrogen oxide (NO2) and PM2.5). However, the effects of environmental factors on bronchial asthma in children living in Kobe City was unclear, as no study had been conducted into the seasonal and yearly changes in the numbers of patients. In addition, it was also not known what impact the 2020 state of emergency declarations in response to the novel coronavirus pandemic had on the number of pediatric inpatients with bronchial asthma in Kobe City.

Research Findings
A total of 278, 465 patients under the age of 16 visited the Kobe Children’s Primary Emergency Medical Center in the 2011-2020 period, of which 7,476 were diagnosed with bronchial asthma. This believed to be the largest number of patients with bronchial asthma in a single-institution study.

First of all, the researchers investigated trends in patient numbers between 2011 and 2020. From the results, they discovered that for the 2011-2019 period there were clear peaks in the spring and fall of every year. In contrast to this, no peak was observed during the state of emergency in spring 2020, however a similar peak in the number of patients compared to previous years was observed in the data for October 2020 when the state of emergency had been lifted (Figure 1). Next, the researchers looked at what kind of environmental factors in Kobe City were related to pediatric bronchial asthma for the 2011-2019 period in order to determine the factors that caused the 2020 change in the number of patients. The subsequent results revealed a significant correlation between the total number of pediatric patients with respiratory difficulties and the increase in average atmospheric temperature. Furthermore, in children aged 5 and under, there was a significant correlation with increased concentrations of SO2. However, no significant correlations were found with other factors relating to climate, pollutants, the number of patients with respiratory infections (e.g. influenza, RS virus), typhoons, yellow sand nor pollen levels.

Due to the state of emergency declarations, 2020 levels of atmospheric pollution in Kobe City were markedly lower than in other years, with a significant decrease in SO2 levels (Figure 2). It is believed that the peak in bronchial asthma admissions was not observed in spring 2020 due to the decrease in SO2 and other impacts of the state of emergency, such as reduced person-to-person contact due to social distancing, and handwashing and mask-wearing measures that created a more hygienic environment. It is thought that the peak in cases returned in fall 2020 due to infection transmission resulting from increased contact between children, and the increase in environmental pollution due to the recommencement of social activities, which also increased exposure risks.

Further Developments
It is said that bronchial asthma attacks often occur on cold days and before or after a typhoon. However, this research study has shown that in Kobe City, bronchial asthma is more easily triggered on high temperature days, and is also exacerbated by SO2 emissions, particularly during the back-to-school periods. Preventative measures such as taking care not to be outside for long periods during high temperature days, and avoiding places with high levels of car and factory emissions could help, particularly during spring and fall when there is a high number of asthma attacks.

In addition, a relationship was also found between the number of asthma patients and the increase in person-to-person contact and social activities after the state of emergency was lifted. Therefore, measures that create a hygienic environment (such as mask-wearing, handwashing and gargling) are also important for children who have a history of respiratory issues.

Glossary
1. Bronchial Asthma: 
Bronchial asthma is an illness characterized by repetitive instances of breathing difficulties due to the narrowing of the airways. In serious cases the patient may become unable to breathe, resulting in death.
2. Sulfur Dioxide (SO2): This is produced by burning coal and oil. Industrial emissions of SO2, such as those from factories, are known to cause acid rain. In addition, SO2 emissions were also responsible for the Yokkaichi asthma cases that occurred in the city of Yokkaichi (Mie Prefecture, Japan) from the 1960s to the early 1970s. It is a known cause of respiratory illnesses.

Journal Information
Title:

“Impact of the state of emergency during the COVID-19 pandemic in 2020 on asthma exacerbations among children in Kobe city, Japan”
DOI: 10.3390/ijerph182111407

Authors:
Hiroshi Yamaguchi *, Kandai Nozu, Shinya Ishiko, Hiroaki Nagase, Takeshi Ninchoji, China Nagano, Hiroki Takeda, Ai Unzaki, Kazuto Ishibashi, Ichiro Morioka, Kazumoto Iijima, Akihito Ishida
*Corresponding Author

Journal:
International Journal of Environmental Research and Public Health


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A dog has caught monkeypox from one of its owners, highlighting risk of the virus infecting pets and wild animals

The monkeypox virus can easily spread between humans and animals. A veterinary virologist explains how the virus could go from people to wild animals in…

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A dog in Paris has become the first case of a pet contracting monkeypox from its owners. Cavan Images via Getty Images

A dog in Paris has caught monkeypox from one of its owners, both of whom were infected with the virus, according to a scientific paper published on Aug. 10, 2022. This is the first case of a dog contracting the monkeypox virus through direct contact with skin lesions on a human.

I am a veterinary pathologist and virologist who has been working with poxviruses for over 20 years. I study how these viruses evade the immune system and am working on modifying poxviruses to prevent infection as well as treat other diseases, including cancer.

With monkeypox spreading in humans throughout the world, my colleagues and I have begun to worry about the increased risk of monkeypox spreading from humans to animals. If monkeypox spreads to wildlife species in the U.S. and Europe, the virus could become endemic in these places – where it has historically been absent – resulting in more frequent outbreaks. The report of the infected dog shows that there is a decent chance these fears could become a reality.

A microscope image of a bunch blue circles in a brown-colored cell.
The monkeypox virus – the blue circles in this image of an infected cell – is a poxvirus similar to smallpox and cowpox and can easily infect many different species. NIAID/Wikimedia Commons, CC BY

A species-jumping virus

Monkeypox is a poxvirus in the same family as variola – the virus that causes smallpox – and cowpox viruses and likely evolved in animals before jumping to humans. Monkeypox causes painful lesions in both humans and animals and, in rare cases, can be deadly. Researchers have found the monkeypox virus in several species of wild rodents, squirrels and primates in Africa, where the virus is endemic. Monkeypox does not need to mutate or evolve at all to be able to infect many different species. It can easily spread from animals to people and back again.

Though there is a fair bit of research on monkeypox, a lot more work has been done on cowpox, a similar zoonotic poxvirus that is endemic in Europe. Over the years, there have been several reports of cowpox infection spreading from animals to humans in Europe.

From people to animals

Until recently, most monkeypox infections occurred in specific areas of Africa where some wildlife species act as reservoirs for the virus. These outbreaks are usually contained quickly through isolation of infected individuals and vaccinating people around the infected individual. The current situation is very different though.

With nearly 40,000 cases globally as of Aug. 17, 2022 – and more than 12,500 cases in the U.S. alone – monkeypox is now widespread within the human population. The risk of any one person transmitting the virus to an animal – particularly a wild one – is small, but the more people are infected, the greater the chances. It’s a numbers game.

There are a number of ways viruses can transfer from animals to people – called spillover – and from people back to animals – called spillback. Since monkeypox is most easily spread through direct skin-to-skin contact, it is a bit more difficult to transmit between species than COVID-19, but certainly possible.

The case of the dog in Paris provides a clear example of how cuddling or being close to a pet can spread the virus. Previous studies on poxviruses like monkeypox have shown that they can stay active in fecal matter. This means that there is a risk of wild animals, likely rodents, catching it from human waste.

A grey rat.
There are a number of species that host monkeypox in Africa – like this gambian rat. Monkeypox can spread from humans to many other animals, including dogs and likely cats and other species of rodents. Louisvarley/Wikimedia Commons, CC BY-SA

The monkeypox virus is also present in saliva. While more research needs to be done, it is potentially possible that an infected person could discard food that would then be eaten by a rodent.

The chances of any one of these events happening is extremely low. But I and other virologists worry that with more people becoming infected, there is a greater risk that rodents or other animals will come into contact with urine, feces or saliva that is contaminated with the virus.

Finally, there is the risk of people giving monkeypox to a pet, which then passes it on to other animals. One case study in Germany described an outbreak of cowpox that was caused when someone took an infected cat to a veterinary clinic and four other cats were subsequently infected. It is feasible that an infected household pet could spread the virus to wild animals somehow.

How to help

One of the key reasons that the World Health Organization was able to eradicate smallpox is that it only infects people, so there were no animal reservoirs that could re-introduce the virus to human populations.

Monkeypox is zoonotic and already has several animal reservoirs, though these are currently limited to Africa. But if monkeypox escapes into wild animal populations in the U.S., Europe or other locations, there will be always be potential for animals to spread it back to humans. With this in mind, there are a number of things people can do to reduce the risks with regard to animals.

As with any infectious disease, be informed about the signs and symptoms of monkeypox and how it is transmitted. If you suspect you have the virus, contact a doctor and isolate from other people.

As a veterinarian, I strongly encourage anyone with monkeypox to protect your pets. The case in Paris shows that dogs can get infected from contact with their owners, and it is likely that many other species, including cats, are susceptible, too. If you have monkeypox, try to have other people take care of your animals for as long as lesions are present. And if you think your pet has a monkeypox infection, be sure to contact a veterinarian so they can test the lesion and provide care when needed.

Even though monkeypox has been declared a public health emergency, it is unlikely to directly affect most people. Taking precautionary steps can protect you and your pets and will hopefully prevent monkeypox from getting into wildlife in the U.S., too.

Amy Macneill does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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UBC researchers discover ‘weak spot’ across major COVID-19 variants

Researchers at the University of British Columbia have discovered a key vulnerability across all major variants of the SARS-CoV-2 virus, including the…

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Researchers at the University of British Columbia have discovered a key vulnerability across all major variants of the SARS-CoV-2 virus, including the recently emerged BA.1 and BA.2 Omicron subvariants.

Credit: Dr. Sriram Subramaniam, UBC

Researchers at the University of British Columbia have discovered a key vulnerability across all major variants of the SARS-CoV-2 virus, including the recently emerged BA.1 and BA.2 Omicron subvariants.

The weakness can be targeted by neutralizing antibodies, potentially paving the way for treatments that would be universally effective across variants.

The findings, published today in Nature Communications, use cryo-electron microscopy (cryo-EM) to reveal the atomic-level structure of the vulnerable spot on the virus’ spike protein, known as an epitope. The paper further describes an antibody fragment called VH Ab6 that is able to attach to this site and neutralize each major variant. 

“This is a highly adaptable virus that has evolved to evade most existing antibody treatments, as well as much of the immunity conferred by vaccines and natural infection,” says Dr. Sriram Subramaniam (he/him), a professor at UBC’s faculty of medicine and the study’s senior author. “This study reveals a weak spot that is largely unchanged across variants and can be neutralized by an antibody fragment. It sets the stage for the design of pan-variant treatments that could potentially help a lot of vulnerable people.”

Identifying COVID-19 master keys

Antibodies are naturally produced by our bodies to fight infection, but can also be made in a laboratory and administered to patients as a treatment. While several antibody treatments have been developed for COVID-19, their effectiveness has waned in the face of highly-mutated variants like Omicron.

“Antibodies attach to a virus in a very specific manner, like a key going into a lock. But when the virus mutates, the key no longer fits,” says Dr. Subramaniam. “We’ve been looking for master keys — antibodies that continue to neutralize the virus even after extensive mutations.”

The ‘master key’ identified in this new paper is the antibody fragment VH Ab6, which was shown to be effective against the Alpha, Beta, Gamma, Delta, Kappa, Epsilon and Omicron variants. The fragment neutralizes SARS-CoV-2 by attaching to the epitope on the spike protein and blocking the virus from entering human cells.

The discovery is the latest from a longstanding and productive collaboration between Dr. Subramaniam’s team at UBC and colleagues at the University of Pittsburgh, led by Drs. Mitko Dimitrov and Wei Li. The team in Pittsburgh has been screening large antibody libraries and testing their effectiveness against COVID-19, while the UBC team has been using cryo-EM to study the molecular structure and characteristics of the spike protein.

Focusing in on COVID-19’s weak points

The UBC team is world-renowned for its expertise in using cryo-EM to visualize protein-protein and protein-antibody interactions at an atomic resolution. In another paper published earlier this year in Science, they were the first to report the structure of the contact zone between the Omicron spike protein and the human cell receptor ACE2, providing a molecular explanation for Omicron’s enhanced viral fitness.

By mapping the molecular structure of each spike protein, the team has been searching for areas of vulnerability that could inform new treatments.

“The epitope we describe in this paper is mostly removed from the hot spots for mutations, which is why it’s capabilities are preserved across variants,” says Dr. Subramaniam. “Now that we’ve described the structure of this site in detail, it unlocks a whole new realm of treatment possibilities.”

Dr. Subramaniam says this key vulnerability can now be exploited by drug makers, and because the site is relatively mutation-free, the resulting treatments could be effective against existing—and even future—variants.

“We now have a very clear picture of this vulnerable spot on the virus. We know every interaction the spike protein makes with the antibody at this site. We can work backwards from this, using intelligent design, to develop a slew of antibody treatments,” says Dr. Subramaniam. “Having broadly effective, variant-resistant treatments would be a game changer in the ongoing fight against COVID-19.”


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German Official Trashes Cost Of Living Protesters As “Enemies Of The State”

German Official Trashes Cost Of Living Protesters As "Enemies Of The State"

Authored by Paul Joseph Watson via Summit News,

A top German…

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German Official Trashes Cost Of Living Protesters As "Enemies Of The State"

Authored by Paul Joseph Watson via Summit News,

A top German official has trashed people who may be planning to protest against energy blackouts as “enemies of the state” and “extremists” who want to overthrow the government.

The interior minister of the German state of North Rhine-Westphalia (NRW), Herbert Reul (CDU), says that anti-mandatory vaxx and anti-lockdown demonstrators have found a new cause – the energy crisis.

In an interview with German news outlet NT, Reul revealed that German security services were keeping an eye on “extremists” who plan to infiltrate the protests and stage violence, with the unrest being planned via the Telegram messenger app, which German authorities have previously tried to ban.

“You can already tell from those who are out there,” said Reul. “The protesters no longer talk about coronavirus or vaccination. But they are now misusing people’s worries and fears in other fields. (…) It’s almost something like new enemies of the state that are establishing themselves.”

Despite the very real threat of potential blackouts, power grid failures and gas shortages, Reul claimed such issues were feeding “conspiracy theory narratives.”

However, it’s no “conspiracy theory” that Germans across the country have been panic buying stoves, firewood and electric heaters as the government tells them thermostats will be limited to 19C in public buildings and that sports arenas and exhibition halls will be used as ‘warm up spaces’ this winter to help freezing citizens who are unable to afford skyrocketing energy bills.

As Remix News reports, blaming right-wing conspiracy theorists for a crisis caused by Germany’s sanctions on Russia and is suicidal dependence on green energy is pretty rich.

“Reul, like the country’s federal interior minister, Nancy Faeser, is attempting to tie right-wing ideology and protests against Covid-19 policies to any potential protests in the winter.”

“While some on the right, such as the Alternative for Germany (AfD), have stressed that the government’s sanctions against Russia are the primary factor driving the current energy crisis, they have not advocated an “overthrow” of the government. Instead, they have stressed the need to restart the Nord Stream 2 pipeline, end energy sanctions against Russia, and push for a peaceful solution to end the war.”

Indeed, energy shortages and the cost of living crisis are issues that are of major concern to everyone, no matter where they are on the political spectrum.

To claim that people worried about heating their homes and putting food on the table this winter are all “enemies of the state” is an utter outrage.

As we highlighted last week, the president of the Thuringian Office for the Protection of the Constitution, Stephan Kramer, said energy crisis riots would make anti-lockdown unrest look like a “children’s birthday party.”

“Mass protests and riots are just as conceivable as concrete acts of violence against things and people, as well as classic terrorism to overthrow it,” Kramer told ZDF.

*  *  *

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Tyler Durden Thu, 08/18/2022 - 03:30

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