Study finds evidence of fecal aerosol COVID-19 transmission

An outbreak of COVID-19 in an apartment building in China may have been caused by fecal aerosol transmission through bathrooms connected by drainage pipes, according to research published in the Annals of Internal Medicine.

“To prevent such transmission, bioaerosols can be controlled at the source by avoiding any potential gas leaks from the drainage system to indoor spaces,” Min Kang, MSc, of the Guangdong Provincial Center for Disease Control and Prevention in China, and colleagues wrote.

Kang and colleagues conducted an epidemiologic survey and a quantitative reverse transcriptase polymerase chain reaction analysis on throat swabs obtained from study participants to evaluate the temporal and spatial distributions of infected families living in a high-rise apartment building in Guangzhou, China. They also sought to identify environmental variables that may confirm the role of fecal aerosols in these transmissions.

The researchers collected the dates of symptom onset in nine residents from three families in vertically aligned apartments who were infected from January 26 to February 13. They also collected data on travel and exposure history, demographic information and any symptoms experienced by infected residents. Additionally, they examined floor plans, site plans, drainage system information, weather data and CCTV records from elevators in the building.

Later, Kang and colleagues performed airflow and dispersion tests using a tracer gas to mimic SARS-CoV-2 droplets in gas in the drainage systems.

They found that one of the three families with infected persons had traveled to the COVID-19 epicenter in Wuhan, while the other two families did not have a history of travel and developed symptoms later than the first family. The families did not know each other, and CCTV records showed that they did not use the elevator at the same time when they were potentially infectious.

None of the other 217 residents and staff who participated tested positive for COVID-19, according to the researchers.

All but one SARS-CoV-2-positive environmental samples were taken from master bathrooms in the apartments, suggesting that exposure likely occurred there. All three apartments with residents who had COVID-19 were connected through drainage stacks and vents.

Kang and colleagues did not identify evidence of transmission in the elevator or in other locations in the building.

After releasing the tracer gas into the drainage stack through a pipe in a toilet, the researchers determined that bioaerosols could travel to other apartments through the drainage pipes.

Kang and colleagues concluded that the identified infections and locations where SARS-CoV-2-positive samples were taken were consistent with vertical spread of aerosols with the virus through vents. They added that the fecal aerosols containing the virus were likely produced in the vertical stack connecting the apartments when a toilet was flushed after being used by an infected patient.

In an editorial accompanying the study, Michael Gormley, PhD, CEng, director of the Institute for Sustainable Building Design at Heriot-Watt University in the United Kingdom, said, “Kang and colleagues describe a situation in which infectious aerosols may have been formed as the result of turbulent flows within a wastewater plumbing system containing virus-laden feces.”

Gormley said the research adds “to the growing body of evidence that wastewater plumbing systems, particularly those in high-rise buildings, deserve closer investigation, both immediately in the context of SARS-CoV-2 and in the long term, because they may be a reservoir for other harmful pathogens.”

Kang M, et al. Ann Intern Med. 2020;doi:10.7326/M20-0928.
Gormley M. Ann Intern Med. 2020;doi: 10.7326/M20-6134.

Watch a toy boat float upside down in levitating liquid

Shaking a liquid fast enough allows it to levitate, and a toy boat can float on top of the levitating fluid – or upside down beneath it.

When a viscous fluid like silicone oil is shaken up and down around 100 times a second, resulting pressure waves can cause air bubbles in the fluid to pulsate, wobble and sink. If the bubbles are big enough, this can lead to a layer of air beneath the fluid, making a sort of strange floating pond.

When Emmanuel Fort at the Langevin Institute in Paris and his colleagues poured beads into one of these floating ponds, they found that rather than falling straight through the liquid and the air below it to the bottom of the vibrating container, some beads seemed to “float” at the bottom of the liquid.

“We were playing with the experiment,” says Fort. “We had this liquid layer and some beads, and we were surprised to see the beads floating on the lower interface. At first, it was not meant to be applied to anything practical, we were just amazed by the system and how counter-intuitive it was.”

They found that the shaking of the container stabilises the bottom of the liquid, vibrating any droplets that might start to form back into the bulk of the puddle. This also creates a stable point for floating objects at the bottom of the liquid: the researchers floated small toy boats on both the top and the bottom.

Their container levitated about half a litre of silicone oil or glycerol, but a bigger shaker could in theory make just about any amount of liquid levitate, says Fort. “There is no size limit as long as the liquid is viscous enough, so if you wanted to swim on the bottom of a levitating liquid layer you would be swimming through something more viscous like honey, which would be entertaining to watch,” he says.

More practically, he says that this method of levitating liquid and floating objects beneath it could be used for processes that involve sorting and transporting solid objects in fluids, like some kinds of mining or waste-water treatment.

Journal reference: Nature, DOI: 10.1038/s41586-020-2643-8

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Does washing clothes kill all the germs?


Laundry serves far nobler purposes than stamping out body odor. It also protects you from getting sick. (Brace yourself, because this is going to get gross in a hurry.)

Imagine that someone who lives in your house is ill. A single gram of his fecal matter contains millions of viruses, and exposure to just a hundred of those viruses can make you sick, says Kelly Reynolds, a germ researcher and associate professor of environmental health at the University of Arizona.

Regardless of how assiduously he wipes, the average person has about a tenth of a gram of fecal residue in his underwear, says Chuck Gerba, a professor of microbiology at Arizona. If you’re washing that sick person’s underwear with your own, chances are very good that his sickness-causing organisms are going to make their way onto your clothing.

“We’ve found that one germy item in the washer will spread to 90% of the other items,” Reynolds says. And no, it doesn’t matter how hot you set the water temperature on your machine. “When it comes to molds that cause skin or respiratory infections, or organisms that cause colds, flu and stomach flu, most of them will survive the wash cycle,” she says.

It’s the dryer—not the washing machine—that lays waste to harmful microorganisms. “High heat drying for at least 28 minutes is the most effective way to kill viruses,” Reynolds says. The “high heat” setting is key. Energy efficient, low-heat settings may not get the job done, she says.

You’re not even safe if you wash your sick housemate’s clothing separately from your own, since his germs will hang out in the washer even after the clothing is gone. Run a wash cycle with bleach or another type of disinfectant to clean it of sickness-cause organisms, Reynolds says.

The good news is that if no one in your household is sick, you can relax a bit about killing the germs in your load. “It’s when someone is ill that you really want to up your game,” Reynolds says. If your housemate catches something, have him or her wear clothing and sleep on sheets that you can wash and dry using high heat.

And yes—it’s ok to spare your expensive, line-dry only gym gear from the dryer. Your big worry there is probably foul odors, not viral pathogens. If you’re diligent about washing your hands (and wiping down the machines at the gym before you climb aboard) you shouldn’t have much to worry about, Reynolds says. Just be sure to wash your duds soon after you finish exercising. “The longer those clothes remain damp with sweat, the more mold and bacteria are going to proliferate,” she says.

If your first instinct after reading this is to double down on detergent, don’t. A washing machine’s cycles are designed to break up and wash away only so much cleaning agent, says Jolie Kerr, an author, cleaning expert and host of the podcast Ask a Clean Person. If you have a heavy hand with the pump or scoop, the excess detergent can build up on your clothing and lock in bacteria and odors, she says. (Fabric softener, too, can coat your clothing in a residue that traps smells, she adds.)

If you can’t dry your stuff on high heat—or at all—hang it up outdoors or in direct sunlight. The sun’s ultraviolet light has disinfecting properties, Reynolds says.

Finally, be mindful of transferring your clothes from the washer to the dryer. “Unless you’ve used bleach or some other disinfectant, those items are not sanitized,” Reynolds says, so be sure to wash your hands after handling them.

Thanks to Mr. C for bringing this to the It’s Interesting commmunity.

2 College Students Dreamed Up an A.L.S. Treatment. The Results Are In.

Amylyx co-founders Joshua Cohen, left, and Justin Klee in their company’s new Cambridge offices.

Mike Teal, who lives in Tallahassee, began developing symptoms of A.L.S. in 2016. He takes an experimental drug called AMX0035 which aims to slow the progression of the disease.

Seven years ago, Joshua Cohen, then a junior at Brown University majoring in biomedical engineering, was captivated by the question of why people develop brain disorders. “How does a neuron die?” he wondered.

After poring over scientific studies, he sketched out his ideas for a way to treat them. “I was sitting in my dorm room and I had kind of written out the research on these crazy-looking diagrams,” he recalled.

A study published on Wednesday in the New England Journal of Medicine reported that the experimental treatment he and another Brown student, Justin Klee, conceived might hold promise for slowing progression of amyotrophic lateral sclerosis, the ruthless disease that robs people of their ability to move, speak, eat and ultimately breathe.

More than 50 clinical trials over 25 years have failed to find effective treatments for A.L.S., also called Lou Gehrig’s disease, which often causes death within two to five years. But now, scientific advances and an influx of funding are driving clinical trials for many potential therapies, generating hope and intense discussion among patients, doctors and researchers.

The new study reported that a two-drug combination slowed progression of A.L.S. paralysis by about six weeks over about six months, approximately 25 percent more than a placebo. On average, patients on a placebo declined in 18 weeks to a level that patients receiving the treatment didn’t reach until 24 weeks, said the principal investigator, Dr. Sabrina Paganoni, a neuromuscular medicine specialist at Massachusetts General Hospital’s Healey & AMG Center for A.L.S.

“It’s such a terrible disease and as you can imagine, for the folks who have it or the family members, it’s just desperation that something’s going to work,” said Dr. Walter Koroshetz, director of the National Institute of Neurological Disorders and Stroke, who wasn’t involved in the new study. “Any kind of slowing of progression for a patient with A.L.S. might be valuable even though it’s not a big effect.”

He and other experts were careful not to overstate the results and noted that the drug wasn’t shown to improve patients’ condition or halt decline. The study evaluated safety and efficacy in a Phase 2 trial with 137 participants, not as large and long as many Phase 3 trials often required for regulatory approval. Experts and the authors themselves said further trials were necessary.

Still, doctors and advocates said the relentlessness of the illness and the availability of only two approved A.L.S. medications, neither significantly effective, gives urgency to finding additional treatments. The A.L.S. Association, an advocacy group, said that since the study found the drug to be safe and patients can die waiting for other trials, it should be made available to people with the disease as soon as possible.

“That can mean the difference between being able to feed yourself versus being fed or not needing a wheelchair versus needing a wheelchair, and if we can delay that level of disability, that’s a big deal for our community,” said Neil Thakur, chief mission officer of the association, which helped finance the study.

The association will urge the Food and Drug Administration to grant approval as soon as the company applies for it, and then require rigorous follow-up studies. The group will also urge the company, Amylyx, a Massachusetts start-up the students founded, to seek the agency’s permission to provide the drug for compassionate use while it is still being evaluated.

A.L.S., the most common motor neuron disorder, diagnosed in about 6,000 people worldwide each year, has drawn greater attention of late, bolstered by prominent people with the disease, like Stephen Hawking, the astrophysicist who died in 2018; Steve Gleason, a former professional football player; and Ady Barkan, a health care activist who used a computer-generated voice at this year’s Democratic National Convention because he can no longer speak.

There is now legislation in Congress to accelerate A.L.S. therapy access and a $25 million federal research program. The Ice Bucket Challenge, a 2014 fund-raising juggernaut featuring celebrities and others dumping icy water on their heads, generated about $220 million. More than 20 treatments are being tested, including stem cells, immunotherapy and genetic therapies for the 10 percent of cases caused by known mutations. Results from other trials are expected soon.

“This is a really exciting time,” said Dr. Robert Miller, director of clinical research at Forbes Norris MDA/A.L.S. Research Center at California Pacific Medical Center, who is involved in several trials, but not the new study.

Most of the study’s participants were already taking one or both of the approved A.L.S. medications: riluzole, which can extend survival by several months, and edaravone, which can slow progression by about 33 percent. It’s possible the new drug, AMX0035, provided additional benefit. Dr. Merit Cudkowicz, the Healey Center’s director and the study’s senior author, said she envisioned the new drug combination would be taken alongside existing medications.

The study is the first clinical trial supported by Ice Bucket Challenge money to publish results, said the A.L.S. Association. Amylyx financed the bulk of the study and agreed to use a percentage of income from sales of the drug to repay 150 percent of the association’s grant to fund more research.

Mr. Cohen’s idea in 2013 was that a combination of taurursodiol, a supplement, and sodium phenylbutyrate, a medication for a pediatric urea disorder, could safeguard neurons by preventing dysfunction of two structures in cells, mitochondria and the endoplasmic reticulum.

He quickly involved Mr. Klee, a senior neuroscience major who was a fraternity brother and fellow player on the university’s club tennis team. Over cheap sparkling wine, “we both said ‘let’s start a company,’” Mr. Klee said. “We had no idea what we were doing.”

They heard skepticism from several experts they consulted until they met with Rudolph Tanzi, a prominent Alzheimer’s expert who had belonged to their fraternity.

Dr. Tanzi told them to test whether the drug combination protected rat neurons from a bleach-like chemical that kills them. With $8,000 from a university grant, their parents (two of whom are physicians) and savings, they hired a professional lab, which found that their combination salvaged 90 percent of neurons, Dr. Tanzi said.

“’That’s impossible,’” he said he told them, urging more tests, which showed 95 percent of neurons were saved.

“Guys, you got something here,” Dr. Tanzi told them. He became an Amylyx co-founder and leads its scientific advisory board.

The combination was christened AMX0035 because 3 and 5 are the favorite numbers of Mr. Cohen’s fiancée. During YMCA basketball sessions with Dr. Tanzi, they discussed trying it for Alzheimer’s. But investors weren’t interested.

Dr. Tanzi introduced the young men to Dr. Cudkowicz, who had once studied sodium phenylbutyrate and convinced them to test it for A.L.S. It’s now also in an Alzheimer’s trial.

The A.L.S. study, called Centaur, conducted across the country by leading A.L.S. researchers, involved patients who developed symptoms within 18 months before the trial and were affected in at least three body regions, generally signs of fast-progressing disease. Two-thirds received AMX0035, a bitter-tasting powder they mixed with water to drink or ingest through a feeding tube twice daily.

The primary goal was slowing decline on a 48-point A.L.S. scale rating 12 physical abilities, including walking, speech, swallowing, dressing, handwriting and breathing. Over 24 weeks, patients on placebo declined 2.32 points more than those taking the drug combination. Fine motor skills benefited most.

“The data that we see here indicates there may be some beneficial effect but it doesn’t look like what you’d call a home run,” Dr. Koroshetz said.

Some patients experienced gastrointestinal side effects like nausea and diarrhea, but after three weeks those effects largely subsided, and overall, the drug was safe, researchers said.

In most secondary measures, including muscle strength, respiratory ability and whether patients were hospitalized, AMX0035 appeared better than placebo, although it wasn’t statistically significant. Another measure, a biomarker of neurodegeneration, didn’t seem significantly affected. A few patients died in both groups, but experts said identifying the impact on mortality would require evaluation over a longer period.

“This is very encouraging,” said Dr. Neil Shneider, director of the Eleanor and Lou Gehrig A.L.S. Center at Columbia University, who was not involved. “The question is, is the effect on function sustained beyond the six-month trial period and does it have an effect on survival?”

Researchers said they would soon publish longer-term data because most participants opted to take the drug combination after the trial, and some have now taken it for over two years.

Experts were torn about whether F.D.A. approval should be granted, since Phase 3 results are often required.

“From my heart, I’d say we are so desperate for meaningful treatment for A.L.S. that something that looks as promising as this might well be approved,” Dr. Miller said. “From my head, I’d say it could be chance. We’ve seen that before where Phase 2 looked really good.”

Dr. Shneider noted that some patients have already been obtaining one or both components from Europe or Asia and taking it themselves. “There’ll be a lot of interest from patients and families to get out this drug,” he said.

But experts also said that making the drug available soon might make it difficult to recruit patients for subsequent trials. And insurers may not cover drugs approved based on Phase 2 results, Dr. Koroshetz said. Some patients have had difficulty getting insurance coverage for edaravone, which costs about $148,000 a year and was approved after a Phase 3 trial of the same size and duration as Centaur. Amylyx officials declined to provide a price estimate for their treatment.

In interviews, two trial participants said they believed AMX0035 was beneficial. Given the unpredictable trajectory of the disease, they said any specific effects were hard to describe. Neither knows if they received the drug or placebo during the trial, but they’ve received the treatment since.

Mike Teal, 52, of Tallahassee, Fla., began having symptoms in 2016 and has taken the drug since at least the spring of 2018, when his trial ended. Soon after, he also started edaravone.

He currently has limited speech, needs a feeding tube, often uses a wheelchair and requires a breathing machine every few hours. Last year, he had to stop working at the gift and accessories store he owns with his wife, Lauren.

He said he’s had no negative side effects and believes the drug may have eased cramps in his neck, abdomen and legs.

“I’m confident it has slowed my progression,” he wrote in an email. “But it’s difficult to measure.”

Jeff Derby, 61, a retired forest products company manager in Cloverdale, British Columbia, said that when he was diagnosed in July 2018, doctors described his disease as relatively slow-progressing. He thinks his decline has become more gradual in the 18 months he’s been taking the drug since his trial ended. Mr. Derby, who also takes the two approved medications, said weakness in his left hand isn’t worsening as quickly.

“I think AMX0035 will ultimately be part of a treatment cocktail like there is for other diseases where you’ll take three, four or five different things, and as a group, they will help slow the progression to the point where you can live a somewhat normal life,” he said.

Long-term usage of antidepressant medications may protect from dementia

Long-term treatment with certain antidepressants appeared associated with reduced dementia incidence, according to results of a case-control study published in Journal of Clinical Psychiatry.

“Depression could represent one of these potentially modifiable risk factors for all-cause dementia,” Claudia Bartels, PhD, of the department of psychiatry and psychotherapy at University Medical Center Goettingen in Germany, and colleagues wrote. “Numerous studies have concordantly demonstrated a strong association between depression and an increased risk [for] subsequent dementia. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depressive symptoms in [Alzheimer’s disease] dementia.

“Preclinical research in recent years has suggested that SSRIs reduce amyloid plaque burden in transgenic mouse models of [Alzheimer’s disease] and in cognitively healthy humans, attenuate amyloid-[beta]1-42–induced tau hyperphosphorylation in cell culture and improve cognition in mice.”

However, the effects of SSRIs on cognition in Alzheimer’s disease dementia were linked mostly to negative results in randomized clinical trials; research is sparse regarding which antidepressants may influence risk for developing dementia; and evidence is particularly rare for treatment duration effects on this risk. Thus, Bartels and colleagues sought to determine the effects of antidepressant drug classes and individual compounds with various treatment durations on the risk for developing dementia. The researchers analyzed data of 62,317 individuals with an incident dementia diagnosis who were included in the German Disease Analyzer database, and they compared outcomes to those of controls matched by age, sex and physician. They conducted logistic regression analyses, which were adjusted for health insurance status and comorbid diseases linked to dementia or antidepressant use, to evaluate the association between dementia incidence and treatment with four major classes of antidepressant drug, as well as 14 of the most commonly prescribed individual antidepressants.

Results showed an association between treatment for 2 years or longer with any antidepressant and a lower risk for dementia vs. short-term treatment among 17 of 18 comparison. Particularly for long-term treatment, herbal and tricyclic antidepressants were linked to a decrease in incidence of dementia. Long-term treatment with escitalopram (OR = 0.66; 95% CI, 0.5-0.89) and Hypericum perforatum (OR = 0.6; 95% CI, 0.51-0.7) were associated with the lowest risks for dementia on an individual antidepressant basis.

“Clinical trials — although well acknowledged as the gold standard procedure — have debunked numerous promising compounds and become increasingly challenging with longer treatment durations,” Bartels and colleagues wrote. “Thus, and in awareness of the controversy of this suggestion, analyzing data from registries in a naturalistic setting may be an attractive and feasible alternative. If individual datasets could be combined in a multinational effort, even more powerful analyses of merged big databases could be performed and an additive contribution with naturalistic data could be made.”

A new blood test may predict the onset of psychotic disorders years in advance, during childhood

By Rich Haridy

An international team of researchers has used machine learning to produce a novel blood test that can predict a young person’s risk of developing a psychotic disorder, such as schizophrenia, years before the condition develops.

Only around a quarter of young people who display mild, transitory psychotic symptoms at an early age ultimately go on to develop a serious psychotic disorder. Schizophrenia, for example, is generally not clinically diagnosed until a person reaches their twenties. However, the condition is known to present a number of signs and symptoms than can precede the full-blown psychotic episodes often needed for clinical diagnosis.

This early pre-clinical phase of a psychotic disorder is often referred to as the prodromal stage. In the case of schizophrenia, prodromal symptoms appear in nearly three quarters of patients up to five years before the first episode of psychosis occurs.

David Cotter, a molecular psychiatrist from the Royal College of Surgeons in Ireland and senior author on the new study, suggests early detection of those most at risk of developing psychotic disorders is vital for administering preventative treatments.

“Ideally, we would like to prevent psychotic disorders, but that requires being able to accurately identify who is most at risk,” says Cotter.

The new study first looked at blood samples from a number of 12-year-olds classified as at a clinically high-risk of psychosis. Over recent years several tools have been developed to identify adolescent subjects at the highest risk of developing psychosis.

The 12-year-old subjects were followed until around the age of 18, so the researchers were able to differentiate blood samples between those who went on to suffer a psychotic episode and those who didn’t. Using machine learning, the researchers homed in on a unique pattern of proteins that distinguished those who ultimately went on to develop a psychotic disorder.

Ten particular proteins were identified as most predictive, and the test was subsequently validated in a separate dataset. Using the most accurate protein pattern, the researchers were able to correctly determine which high-risk subjects would go on to develop a psychotic disorder by the age of 18 with a 93-percent accuracy.

The test was less accurate in predicting those high-risk 12-year-olds that did not go on to develop a psychosis by the age of 18. However, considering only between 16 and 35 percent of young people considered at clinical high risk ultimately transition to a full psychotic disorder, even this low level of accuracy could be useful in stratifying those younger patients more likely to develop psychosis.

“Our research has shown that, with help from machine learning, analysis of protein levels in blood samples can predict who is at truly at risk and could possibly benefit from preventive treatments,” says Cotter. “We now need to study these markers in other people at high risk of psychosis to confirm these findings.”

Another compelling insight offered by this new study is the finding that many of these protein markers predicting psychosis are linked with inflammatory processes. There is a small, but burgeoning, body of study finding links between psychosis and autoimmune conditions, suggesting systemic inflammation can influence a number of psychiatric illnesses.

The new research was published in the journal JAMA Psychiatry.

Elon Musk’s Euralink soon to reveal a working brain-computer chip for “human-AI symbiosis”

By Anthony Cuthbertson

Elon Musk has said he will demonstrate a functional brain-computer interface this week during a live presentation from his mysterious Neuralink startup.

The billionaire entrepreneur, who also heads SpaceX and Tesla, founded Neuralink in 2016 with the ultimate aim of merging artificial intelligence with the human brain.

Until now, there has only been one public event showing off the startup’s technology, during which Musk revealed a “sewing machine-like” device capable of stitching threads into a person’s head.

The procedure to implant the chip will eventually be similar in speed and efficiency to Lasik laser eye surgery, according to Musk, and will be performed by a robot.

The robot and the working brain chip will be unveiled during a live webcast at 3pm PT (11pm BST) on Friday, Musk tweeted on Tuesday night.

In response to a question on Twitter, he said that the comparison with laser eye surgery was still some way off. “Still far from Lasik, but could get pretty close in a few years,” he tweeted.

He also said that Friday’s demonstration would show “neurons firing in real-time… the matrix in the matrix.”

The device has already been tested on animals and human trials were originally planned for 2020, though it is not yet clear whether they have started.

A robot designed by Neuralink would insert the ‘threads’ into the brain using a needle

A fully implantable neural interface connects to the brain through tiny threads

Neuralink says learning to use the device is ‘like learning to touch type or play the piano’

Neuralink says learning to use the device is ‘like learning to touch type or play the piano’

In the build up to Friday’s event, Musk has drip fed details about Neuralink’s technology and the capabilities it could deliver to people using it.

In a series of tweets last month, he said the chip “could extend the range of hearing beyond normal frequencies and amplitudes,” as well as allow wearers to stream music directly to their brain.

Other potential applications include regulating hormone levels and delivering “enhanced abilities” like greater reasoning and anxiety relief.

Earlier this month, scientists unconnected to Neuralink unveiled a new bio-synthetic material that they claim could be used to help integrate electronics with the human body.

The breakthrough could help achieve Musk’s ambition of augmenting human intelligence and abilities, which he claims is necessary allow humanity to compete with advanced artificial intelligence.

He claims that humans risk being overtaken by AI within the next five years, and that AI could eventually view us in the same way we currently view house pets.

“I don’t love the idea of being a house cat, but what’s the solution?” he said in 2016, just months before he founded Neuralink. “I think one of the solutions that seems maybe the best is to add an AI layer.”

Air Pollution Exposure Comparable to High-Fat Diet, Could Lead to Cardiometabolic Diseases Like Diabetes

In a first-of-its-kind study, researchers have found that air pollution can play a role in the development of cardiometabolic diseases such as diabetes. Moreover, the study also shows that living in a polluted region was comparable to eating a high-fat diet.

A team of researchers from the Case Western Reserve University and John Hopkins Bloomberg School of Public Health in the US, led by Indian-origin scientist Dr Sanjay Rajagopalan, made the discovery. The study shows that air pollution was a ‘risk factor for a risk factor’ that formed the underlying cause of fatal problems like heart attack and stroke.

“In this study, we created an environment that mimicked a polluted day in New Delhi or Beijing,” Dr Rajagopalan said. “We concentrated fine particles of air pollution called PM2.5. Concentrated particles like this develop from human impact on the environment, such as automobile exhaust, power generation and other fossil fuels.”

The fine pollution particles have been strongly linked to risk factors for several diseases like lung cancer, heart failure, Alzheimer’s and other chronic diseases. Air pollution is the deadliest environmental hazard in the current times, with an estimated death toll of more than 90 lakh per year. The evidence for the cardiovascular effects of air pollution can lead to heart attack and stroke and cardiometabolic diseases like diabetes is also growing.

In the present research, the results show that air pollution can be added as a risk factor for the development of such cardiometabolic diseases similar to an unhealthy diet and lack of exercise. The research team has shown exposure to air pollution can increase the likelihood of the same risk factors that lead to heart diseases, such as insulin resistance and type 2 diabetes.

In its statement, the University Hospitals Cleveland Medical Center explains that the mouse model study involved three groups: a control group receiving clean filtered air, a group exposed to polluted air for 24 weeks, and a group fed a high-fat diet. Both the pollution-exposed group and the high-fat diet group showed insulin resistance and abnormal metabolism—similar to a pre-diabetic state.

“The good news is that these effects were reversible, at least in our experiments. Once the air pollution was removed from the environment, the mice appeared healthier, and the pre-diabetic state seemed to reverse,” said Dr Rajagopalan.

The results could have a significant contribution in responding to severe heart attack and other such cardio-related risks. As a next step, the researchers are planning to involve more experts and the National Institute of Health, to explore the possibility of clinical trials to compare heart health and the level of air pollution.

The researchers are hopeful that the study will encourage policymakers to act on the reduction of air pollution in highly polluted regions like India and China.

The study was published in the Journal of Clinical Investigation last week.

750 Million Genetically Modified Mosquitoes Will Be Released in the Florida Keys

There have been no reports of health or environmental harm in other locations where genetically modified mosquitoes have been introduced over the last decade.

By Lisa Winter

With the aim of reducing rates of the mosquito-borne illnesses yellow fever and dengue, a pilot program will release 750 million genetically modified mosquitoes into the Florida Keys in 2021, thanks to approval by the barrier islands’ Mosquito Control District Board of Commissioners at a meeting on Tuesday (August 18).

The strain of GM mosquitoes, known as OX513A, is an altered form of Aedes aegypti created by UK-based biotech firm Oxitec. Released mosquitoes will be all male, as male mosquitoes do not bite and generally only feed on nectar. Thanks to a conditionally lethal genetic variant, when OX513A mosquitoes mate with wild females, their offspring should die before they are old enough for females to begin biting.

Over the last 10 years, Oxitec deployed these GM mosquitoes in the Cayman Islands and Brazil. This will be the first release of any GM mosquitoes in the US. The Centers for Disease Control and Prevention (CDC) and scientists at the University of Florida will oversee program.

“It’s gone extremely well,” Oxitec scientist Kevin Gorman tells the AP. “We have released over a billion of our mosquitoes over the years. There is no potential for risk to the environment or humans.”

A September 2019 study published in Scientific Reports concluded that female progeny of Oxitec’s GM mosquitoes were not dying off as intended in Brazil. Less than a week after it was published, an editor’s note about criticisms was appended. In May 2020, the paper received a formal Editorial Expression of Concern about the study design and erroneous or misleading claims.

Oxitec’s journey to releasing the mosquitoes in the Florida Keys has been several years in the making. The company commissioned 25 studies to obtain approval from the CDC, the US Environmental Protection Agency (EPA), and seven state and local agencies in Florida, Oxitec reports. The pilot program will target the Florida Keys because A. aegypti mosquitoes are invasive there and are increasingly resistant to insecticides meant to control their numbers, according to reports.

“The science is there. This is something Monroe County needs,” Jill Cranny-Gage, a supporter of the program, said at the Mosquito Control District’s meeting, according to the AP. “We’re trying everything in our power, and we’re running out of options.”

Oxitec has also received federal approval to release the mosquitoes in Texas, BBC News reports, but will face a similar battle to get the go-ahead from state and local agencies.

Your ‘Surge Capacity’ Is Depleted — It’s Why You Feel Awful

By Tara Haelle

It was the end of the world as we knew it, and I felt fine. That’s almost exactly what I told my psychiatrist at my March 16 appointment, a few days after our children’s school district extended spring break because of the coronavirus. I said the same at my April 27 appointment, several weeks after our state’s stay-at-home order.

Yes, it was exhausting having a kindergartener and fourth grader doing impromptu distance learning while I was barely keeping up with work. And it was frustrating to be stuck home nonstop, scrambling to get in grocery delivery orders before slots filled up, and tracking down toilet paper. But I was still doing well because I thrive in high-stress emergency situations. It’s exhilarating for my ADHD brain. As just one example, when my husband and I were stranded in Peru during an 8.0-magnitude earthquake that killed thousands, we walked around with a first aid kit helping who we could and tracking down water and food. Then I went out with my camera to document the devastation as a photojournalist and interview Peruvians in my broken Spanish for my hometown paper.

Now we were in a pandemic, and I’m a science journalist who has written about infectious disease and medical research for nearly a decade. I was on fire, cranking out stories, explaining epidemiological concepts in my social networks, trying to help everyone around me make sense of the frightening circumstances of a pandemic and the anxiety surrounding the virus.

I knew it wouldn’t last. It never does. But even knowing I would eventually crash, I didn’t appreciate how hard the crash would be, or how long it would last, or how hard it would be to try to get back up over and over again, or what getting up even looked like.

In those early months, I, along with most of the rest of the country, was using “surge capacity” to operate, as Ann Masten, PhD, a psychologist and professor of child development at the University of Minnesota, calls it. Surge capacity is a collection of adaptive systems — mental and physical — that humans draw on for short-term survival in acutely stressful situations, such as natural disasters. But natural disasters occur over a short period, even if recovery is long. Pandemics are different — the disaster itself stretches out indefinitely.

“The pandemic has demonstrated both what we can do with surge capacity and the limits of surge capacity,” says Masten. When it’s depleted, it has to be renewed. But what happens when you struggle to renew it because the emergency phase has now become chronic?

By my May 26 psychiatrist appointment, I wasn’t doing so hot. I couldn’t get any work done. I’d grown sick of Zoom meetups. It was exhausting and impossible to think with the kids around all day. I felt trapped in a home that felt as much a prison as a haven. I tried to conjure the motivation to check email, outline a story, or review interview notes, but I couldn’t focus. I couldn’t make myself do anything — work, housework, exercise, play with the kids — for that whole week.

Or the next.

Or the next.

Or the next.

I know depression, but this wasn’t quite that. It was, as I’d soon describe in an emotional post in a social media group of professional colleagues, an “anxiety-tainted depression mixed with ennui that I can’t kick,” along with a complete inability to concentrate. I spoke with my therapist, tweaked medication dosages, went outside daily for fresh air and sunlight, tried to force myself to do some physical activity, and even gave myself permission to mope for a few weeks. We were in a pandemic, after all, and I had already accepted in March that life would not be “normal” for at least a year or two. But I still couldn’t work, couldn’t focus, hadn’t adjusted. Shouldn’t I be used to this by now?

“Why do you think you should be used to this by now? We’re all beginners at this,” Masten told me. “This is a once in a lifetime experience. It’s expecting a lot to think we’d be managing this really well.”

It wasn’t until my social media post elicited similar responses from dozens of high-achieving, competent, impressive women I professionally admire that I realized I wasn’t in the minority. My experience was a universal and deeply human one.

An unprecedented disaster

While the phrase “adjusting to the new normal” has been repeated endlessly since March, it’s easier said than done. How do you adjust to an ever-changing situation where the “new normal” is indefinite uncertainty?

“This is an unprecedented disaster for most of us that is profound in its impact on our daily lives,” says Masten. But it’s different from a hurricane or tornado where you can look outside and see the damage. The destruction is, for most people, invisible and ongoing. So many systems aren’t working as they normally do right now, which means radical shifts in work, school, and home life that almost none of us have experience with. Even those who have worked in disaster recovery or served in the military are facing a different kind of uncertainty right now.

“I think we maybe underestimate how severe the adversity is and that people may be experiencing a normal reaction to a pretty severe and ongoing, unfolding, cascading disaster,” Masten says. “It’s important to recognize that it’s normal in a situation of great uncertainty and chronic stress to get exhausted and to feel ups and downs, to feel like you’re depleted or experience periods of burnout.”

Research on disaster and trauma focuses primarily on what’s helpful for people during the recovery period, but we’re not close to recovery yet. People can use their surge capacity for acute periods, but when dire circumstances drag on, Masten says, “you have to adopt a different style of coping.”

Understanding ambiguous loss

It’s not surprising that, as a lifelong overachiever, I’ve felt particularly despondent and adrift as the months have dragged on, says Pauline Boss, PhD, a family therapist and professor emeritus of social sciences at the University of Minnesota who specializes in “ambiguous loss.”

“It’s harder for high achievers,” she says. “The more accustomed you are to solving problems, to getting things done, to having a routine, the harder it will be on you because none of that is possible right now. You get feelings of hopelessness and helplessness, and those aren’t good.”
That’s similar to how Michael Maddaus, MD, a professor of thoracic surgery at the University of Minnesota, felt when he became addicted to prescription narcotics after undergoing several surgeries. Now recovered and a motivational speaker who promotes the idea of a “resilience bank account,” Maddaus had always been a fast-moving high achiever — until he couldn’t be.

“I realized that my personal operating system, though it had led to tremendous success, had failed me on a more personal level,” he says. “I had to figure out a different way of contending with life.”

That mindset is an especially American one, Boss says.

“Our culture is very solution-oriented, which is a good way of thinking for many things,” she says. “It’s partly responsible for getting a man on the moon and a rover on Mars and all the things we’ve done in this country that are wonderful. But it’s a very destructive way of thinking when you’re faced with a problem that has no solution, at least for a while.”
That means reckoning with what’s called ambiguous loss: any loss that’s unclear and lacks a resolution. It can be physical, such as a missing person or the loss of a limb or organ, or psychological, such as a family member with dementia or a serious addiction.

“In this case, it is a loss of a way of life, of the ability to meet up with your friends and extended family,” Boss says. “It is perhaps a loss of trust in our government. It’s the loss of our freedom to move about in our daily life as we used to.” It’s also the loss of high-quality education, or the overall educational experience we’re used to, given school closures, modified openings and virtual schooling. It’s the loss of rituals, such weddings, graduations, and funerals, and even lesser “rituals,” such as going to gym. One of the toughest losses for me to adapt to is no longer doing my research and writing in coffee shops as I’ve done for most of my life, dating back to junior high.

“These were all things we were attached to and fond of, and they’re gone right now, so the loss is ambiguous. It’s not a death, but it’s a major, major loss,” says Boss. “What we used to have has been taken away from us.”

Just as painful are losses that may result from the intersection of the pandemic and the already tense political division in the country. For many people, issues related to Covid-19 have become the last straw in ending relationships, whether it’s a family member refusing to wear a mask, a friend promoting the latest conspiracy theory, or a co-worker insisting Covid-19 deaths are exaggerated.

Ambiguous loss elicits the same experiences of grief as a more tangible loss — denial, anger, bargaining, depression, and acceptance — but managing it often requires a bit of creativity.

A winding, uncharted path to coping in a pandemic

While there isn’t a handbook for functioning during a pandemic, Masten, Boss, and Maddaus offered some wisdom for meandering our way through this.

Accept that life is different right now
Maddaus’ approach involves radical acceptance. “It’s a shitty time, it’s hard,” he says. “You have to accept that in your bones and be okay with this as a tough day, with ‘that’s the way it is,’ and accept that as a baseline.”

But that acceptance doesn’t mean giving up, he says. It means not resisting or fighting reality so that you can apply your energy elsewhere. “It allows you to step into a more spacious mental space that allows you to do things that are constructive instead of being mired in a state of psychological self torment.”

Expect less from yourself

Most of us have heard for most of our lives to expect more from ourselves in some way or another. Now we must give ourselves permission to do the opposite. “We have to expect less of ourselves, and we have to replenish more,” Masten says. “I think we’re in a period of a lot of self discovery: Where do I get my energy? What kind of down time do I need? That’s all shifted right now, and it may take some reflection and self discovery to find out what rhythms of life do I need right now?”

She says people are having to live their lives without the support of so many systems that have partly or fully broken down, whether it’s schools, hospitals, churches, family support, or other systems that we relied on. We need to recognize that we’re grieving multiple losses while managing the ongoing impact of trauma and uncertainty. The malaise so many of us feel, a sort of disinterested boredom, is common in research on burnout, Masten says. But other emotions accompany it: disappointment, anger, grief, sadness, exhaustion, stress, fear, anxiety — and no one can function at full capacity with all that going on.

Recognize the different aspects of grief

The familiar “stages” of grief don’t actually occur in linear stages, Boss says, but denial, anger, bargaining, depression, and acceptance are all major concepts in facing loss. Plenty of people are in denial: denying the virus is real, or that the numbers of cases or deaths are as high as reported, or that masks really help reduce disease transmission.
Anger is evident everywhere: anger at those in denial, anger in the race demonstrations, anger at those not physically distancing or wearing masks, and even anger at those who wear masks or require them. The bargaining, Boss says, is mostly with scientists we hope will develop a vaccine quickly. The depression is obvious, but acceptance… “I haven’t accepted any of this,” Boss says. “I don’t know about you.”

Sometimes acceptance means “saying we’re going to have a good time in spite of this,” Boss says, such as when my family drove an hour outside the city to get far enough from light pollution to look for the comet NEOWISE. But it can also mean accepting that we cannot change the situation right now.

“We can kick and scream and be angry, or we can feel the other side of it, with no motivation, difficulty focusing, lethargy,” Boss says, “or we can take the middle way and just have a couple days where you feel like doing nothing and you embrace the losses and sadness you’re feeling right now, and then the next day, do something that has an element of achievement to it.”

Experiment with “both-and” thinking

This approach may not work for everyone, but Boss says there’s an alternative to binary thinking that many people find helpful in dealing with ambiguous loss. She calls it “both-and” thinking, and sometimes it means embracing a bit of the irrational.

For the families of soldiers missing in action in Vietnam that Boss studied early in her career, or the family members of victims of plane crashes where the bodies aren’t recovered, this type of thinking means thinking: “He is both living and maybe not. She is probably dead but maybe not.”

“If you stay in the rational when nothing else is rational, like right now, then you’ll just stress yourself more,” she says. “What I say with ambiguous loss is the situation is crazy, not the person. The situation is pathological, not the person.”

An analogous approach during the pandemic might be, “This is terrible and many people are dying, and this is also a time for our families to come closer together,” Boss says. On a more personal level, “I’m highly competent, and right now I’m flowing with the tide day-to-day.”

It’s a bit of a Schrödinger’s existence, but when you can’t change the situation, “the only thing you can change is your perception of it,” she says.

Of course, that doesn’t mean denying the existence of the pandemic or the coronavirus. As Maddaus says, “You have to face reality.” But how we frame that reality mentally can help us cope with it.

Look for activities, new and old, that continue to fulfill you

Lots of coping advice has focused on “self-care,” but one of the frustrating ironies of the pandemic is that so many of our self-care activities have also been taken away: pedicures, massages, coffee with friends, a visit to the amusement park, a kickboxing class, swimming in the local pool — these activities remain unsafe in much of the country. So we have to get creative with self-care when we’re least motivated to get creative.

“When we’re forced to rethink our options and broaden out what we think of as self-care, sometimes that constraint opens new ways of living and thinking,” Masten says. “We don’t have a lot of control over the global pandemic but we do over our daily lives. You can focus on plans for the future and what’s meaningful in life.”

For me, since I missed eating in restaurants and was tired of our same old dinners, I began subscribing to a meal-kit service. I hate cooking, but the meal kits were easy, and I was motivated by the chance to eat something that tasted more like what I’d order in a restaurant without having to invest energy in looking through recipes or ordering the right ingredients.

Okay, I’ve also been playing a lot of Animal Crossing, but Maddaus explains why it makes sense that creative activities like cooking, gardening, painting, house projects — or even building your own imaginary island out of pixels — can be fulfilling right now. He references the book The Molecule of More, which explores how dopamine influences our experiences and happiness, in describing the types of activities most likely to bring us joy.

“There are two ways the brain deals with the world: the future and things we need to go after, and the here and now, seeing things and touching things,” Maddaus says. “Rather than being at the mercy of what’s going on, we can use the elements of our natural reward system and construct things to do that are good no matter what.”
Those kinds of activities have a planning element and a here-and-now experience element. For Maddaus, for example, it was simply replacing all the showerheads and lightbulbs in the house.

“It’s a silly thing, but it made me feel good,” he says.

Focus on maintaining and strengthening important relationships

The biggest protective factors for facing adversity and building resilience are social support and remaining connected to people, Masten says. That includes helping others, even when we’re feeling depleted ourselves.

“Helping others is one of those win-win strategies of taking action because we’re all feeling a sense of helplessness and loss of control about what’s going on with this pandemic, but when you take action with other people, you can control what you’re doing,” she says. Helping others could include checking in on family friends or buying groceries for an elderly neighbor.

Begin slowly building your resilience bank account

Maddaus’ idea of a resilience bank account is gradually building into your life regular practices that promote resilience and provide a fallback when life gets tough. Though it would obviously be nice to have a fat account already, he says it’s never too late to start. The areas he specifically advocates focusing on are sleep, nutrition, exercise, meditation, self-compassion, gratitude, connection, and saying no.

“Start really small and work your way up,” he says. “If you do a little bit every day, it starts to add up and you get momentum, and even if you miss a day, then start again. We have to be gentle with ourselves and keep on, begin again.”

After spending an hour on the phone with each of these experts, I felt refreshed and inspired. I can do this! I was excited about writing this article and sharing what I’d learned.
And then it took me two weeks to start the article and another week to finish it — even though I wanted to write it. But now, I could cut myself a little more slack for taking so much longer than I might have a few months ago. I might have intellectually accepted back in March that the next two years (or more?) are going to be nothing like normal, and not even predictable in how they won’t be normal. But cognitively recognizing and accepting that fact and emotionally incorporating that reality into everyday life aren’t the same. Our new normal is always feeling a little off balance, like trying to stand in a dinghy on rough seas, and not knowing when the storm will pass. But humans can get better at anything with practice, so at least I now have some ideas for working on my sea legs.