Thursday, May 06, 2021

Prenatal environmental contaminants and childhood disease

PEDIATRIC ACADEMIC SOCIETIES

A state of the art plenary session during the Pediatric Academic Societies (PAS) 2021 Virtual Meeting discussed prenatal environmental contaminants and childhood disease, and the latest evidence for epigenetic mechanisms associated with transgenerational disease and public policy implications.

Three generational animal models now conclusively demonstrate that fetal exposure to the same environmental chemicals now found in virtually every human pregnancy is linked to multigenerational disease. The diseases range from onset of puberty abnormalities, obesity, immune disorders, cancer, polycystic ovaries, abnormal sperm, behavioral abnormalities and perinatal complications. The mechanism of transmission of disease across generations appears to be non-genetic and correlates with epigenetic changes seen in exposed offspring and their descendants.

This session presented the latest animal data after fetal exposure to: pesticides (DDT, permethrin, vinclozolin, atrazine, glyphosate, DEET), dioxins, jet fuel, plastics and BPA. Presenters discussed the latest data on human pesticide exposures and outcomes of pregnancy (glyphosate) and long-term outcomes after organophosphate exposures in pregnancy. Diseases which have been induced in third generation descendants in rodents were compared with human disease trends and latest funded research was reviewed.

Environmental contaminants are pervasive in pregnant women, and diseases which they cause in animals are increasing in humans. Can we begin to apply what has been learned in animals to human health (while we wait the 100 years it might take to follow a three generational human study)? Finally, presenters discussed the state of governmental agencies whose mandate to protect pregnant mothers and children from environmental contamination.

Presentations included:

Pesticides in Pregnancy: Implications for Children's Health & Environmental Health Policy; presenter: Paul D. Winchester, MD, MA - Indiana University School of Medicine
Environmental Toxicant Induced Epigenetic Transgenerational Inheritance of Disease: Generational Toxicology; presenter: Michael Skinner, PhD - Washington State University
In utero exposure to pesticides and child development in an agricultural population; presenter: Brenda Eskenazi, PhD - University of California Berkeley
Protecting Children from Environmental Hazards; presenter: Ruth Etzel, MD, PhD - George Washington University

The objectives of the session were to review:

epigenetic transgenerational inheritance of disease in animal data including DNA methylation, Histone retention and non-coding RNA expression after fetal exposures.
how toxicant-induced transgenerational disease may be transmitted to non-exposed third generation descendants.
human data suggestive of adverse outcomes linked to fetal exposure to pesticides and other toxicants.
pathways to discovering biomolecular mechanisms of disease and to mitigation measures available now and in the future.
how practitioners, basic scientists, government regulators and industry might cooperate to achieve health and wealth in this unusual moment in history.

Dr. Winchester chaired the plenary, "Prenatal Environmental Contaminants and Childhood Disease: Latest Evidence for Epigenetic Mechanisms Associated With Transgenerational Disease and Public Policy Implications," on Saturday, May 1 at 5:30 p.m. EDT. Reporters interested in an interview with the presenters should contact PAS2021@piercom.com.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit http://www.pas-meeting.org.

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About the Pediatric Academic Societies Meeting

The Pediatric Academic Societies (PAS) Meeting connects thousands of pediatricians and other health care providers worldwide. This international gathering offers opportunities for a global audience of physician-scientists, clinicians, and educators to share research, explore new ideas, build career opportunities, and collaborate on future projects. The PAS Meeting is produced through a partnership of four pediatric organizations that are leaders in the advancement of pediatric research and child advocacy: American Pediatric Society, Society for Pediatric Research, Academic Pediatric Association and American Academy of Pediatrics. For more information, please visit http://www.pas-meeting.org. Follow us on Twitter @PASMeeting, Instagram PASMeeting and #PAS2021, and like us on Facebook PASMeeting.

Neighborhood disadvantage may be an environmental risk factor for brain development

USC study suggests improving social and educational resources could alleviate risk

UNIVERSITY OF SOUTHERN CALIFORNIA

Research News

A new USC study suggests that certain neighborhoods - particularly those characterized by poverty and unemployment - may pose an environmental risk to the developing brains of children, impacting neurocognitive performance and even brain size.

The research was published May 3 in the journal JAMA Pediatrics.

These findings highlight the importance of neighborhood environments for child and adolescent brain development, the researchers said, and suggest that policies, programs and investments that help improve local neighborhood conditions and empower communities could support children's neurodevelopment and long-term health.

"This is the first large, national study of neurodevelopment to determine that the role of neighborhood disadvantage is similar across all regions of the country, and we found that what mattered most were the local differences in neighborhood disadvantage within each city, rather than how cities differ from each other overall," said lead author Daniel Hackman, assistant professor at the USC Suzanne Dworak-Peck School of Social Work.

Researchers from the USC Suzanne Dworak-Peck School of Social Work and the Keck School of Medicine of USC used data from the Adolescent Brain and Cognitive Development (ABCD) Study, collected from October 2016 - 2018. The ABCD Study is the largest long-term study of brain development and child health in the United States.

Neighborhood disadvantage, after accounting for family socioeconomic status and perceptions of neighborhood safety, showed associations with multiple aspects of neurocognition and smaller total cortical surface area, particularly in the frontal, parietal and temporal lobes.

"Our findings aren't specific to the child's home life, as we adjusted for socioeconomic factors at each child's home. But the research suggests neighborhoods may have different levels of social and educational resources and opportunities that can impact a child's neurodevelopment," said senior author Megan Herting, assistant professor at the department of preventive medicine at the Keck School of Medicine at USC.

In addition, the researchers said, disadvantaged neighborhoods may lack quality health services, access to nutritional foods, and well-maintained parks and rec facilities; they may also expose residents to more pollutants or social stressors.

"This research is important as it not only highlights that neighborhoods matter, but it also suggests that promoting neighborhood equity based on the unique local conditions within cities may improve short and long-term health and development of children and adolescents," said Hackman.

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In addition to Herting and Hackman, other study authors include Dora Cserbik, Jiu-Chiuan Chen, and Rob McConnell of the department of preventive medicine at the Keck School; Bita Minaravesh of the USC Dornsife Spatial Sciences Institute; and Kiros Berhane of the Department of Biostatistics at Columbia University Mailman School of Public Health.

The study was supported with grants from the National Institute of Environmental Health Sciences (P30ES007048-23S1 and P01ES022845), the National Institutes of Health (R01ES031074 and R21HD099596) and the Rose Hills Foundation.

For a PDF of the study, contact Leigh Hopper at lhopper@usc.edu

PRIVATIZED HEALTHCARE

Study explores how private equity acquisitions impact hospitals

RICE UNIVERSITY

Research News

HOUSTON - (May 4, 2021) - Private equity investment in hospitals has grown substantially in the 21st century, and it accelerated in the years leading up the COVID-19 pandemic. Now a new study of short-term acute care hospitals acquired by private equity firms finds they not only have higher markups and profit margins, they're also slower to expand their staffs.

In a study published in Health Affairs, a multi-institutional team of investigators led by Dr. Anaeze C. Offodile II, a nonresident scholar in the Center for Health and Biosciences at Rice University's Baker Institute for Public Policy, the Gilbert Omenn Fellow at the National Academy of Medicine and an assistant professor of plastic and reconstructive surgery at The University of Texas MD Anderson Cancer Center, examined private involvement in short-term acute care hospitals and combed through proprietary databases to identify private equity transactions involving such hospitals between 2003 and 2017.

"Hospital spending accounts for one-third of U.S. health care expenditures, and there have been multiple news accounts of private equity investments in hospitals. But we know so little about how private equity acquisition influences hospitals' finance and operations," said Marcelo Cerullo, a surgical resident at Duke University Medical Center and the second author on the paper.

The researchers compared private equity-acquired hospitals to hospitals not involved in private equity deals using information drawn from Medicare cost reports and Area Health Resource Files. The study examined differences among private equity versus nonprivate equity hospitals in 2003 (before the acquisitions occurred) and 2017 (after the private equity deals were completed).

Over that period, private equity firms acquired 282 unique hospitals (some more than once) in leveraged buyouts in 36 different states. The study estimates that of all patient discharges in 2017, about 11% were from a hospital that had at one point been acquired by private equity. In 2003, hospitals that were subsequently acquired by private equity investors had higher charge-to-cost ratios, higher profit margins and comparable staffing ratios. However, post-acquisition in 2017, private equity-acquired hospitals had developed higher markups, even higher profit margins and saw slower rates of growth of staffing ratios. Notably, private equity-acquired hospitals had overall lower costs per each patient discharged.

"Our main findings highlight the overall solvency of private equity-acquired facilities, with strong baseline financial performance," Offodile said. "Our results challenge the prevailing narrative of financially distressed institutions seeking infusion of outside private equity capital. Post-acquisition, these hospitals appeared to continue to boost profits by restraining growth in cost per patient, in part by limiting staffing growth."

Hospitals acquired by private equity firms between 2003 and 2017 had operating margins that were 5.6 percentage points higher than nonprivate hospitals at the start of the period; that gap widened to 8.6 percentage points by 2017.

The authors also surveyed the press releases and industry-specific reports for private equity deals. Private equity firms often touted large capital investments that would maintain employment and commitments to the hospital's central mission. "We found a mixed track record of investors keeping specific promises after acquisition," Cerullo said. "Often, private equity firms would announce the dollar figure attached to renovations, new facilities, or give a time frame for staying open or maintaining raises."

The study forms a foundation for future investigations into how private equity acquisitions change hospital operations and clinical quality, the authors said.

"We need to conduct more detailed analyses before making specific policy recommendations involving private equity-acquired hospitals," said co-author Vivian Ho, a professor of economics at Rice and professor of medicine at Baylor College of Medicine. "For-profit hospitals have operated for several decades, but we need to determine whether the added presence of private equity induces additional efforts to maximize profits at the cost of harming patient welfare."

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Other authors on the paper are Mohini Bindal, a former research assistant at the Baker Institute who is now a student at Baylor College of Medicine, and Alejandro Rauh-Hain, assistant professor of gynecologic oncology and reproductive medicine at MD Anderson.

For more information or to schedule an interview with one of the authors, contact Jeff Falk, director of national media relations at Rice, at 713-348-6775 or jfalk@rice.edu.

Related materials

Article: http://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2020.01535

Offodile bio: http://www.bakerinstitute.org/experts/anaeze-c-offodile-ii

Cerullo bio: https://surgery.duke.edu/education-and-training/our-trainees/marcelo-cerullo

Ho bio: http://www.bakerinstitute.org/experts/vivian-ho

Disclaimer: AAAS and EurekAlert! are not responsible for th

A pediatric policy council plenary: The role of research in reducing gun violence

PEDIATRIC ACADEMIC SOCIETIES

Research News

A Pediatric Policy Council state of the art plenary session during the Pediatric Academic Societies (PAS) 2021 Virtual Meeting explored the role of public health research in iterative policymaking to reduce gun violence in America.

The toll of gun violence on young people represents one of the most significant public health challenges facing contemporary America. In recent years, firearm-related injury and death has made headlines routinely, including mass shootings at schools, public festivals, and places of worship, while daily occurrences of gun violence affect local communities.

Gun violence touches young people directly, impacting them, their family members and friends. Additionally, the ongoing threat of gun violence, reinforced through regular active shooter drills in schools and media reports, extends the detrimental effects of gun violence further through biological stress mechanisms.

Despite the frequency of these tragic events, too little research into interventions and public policies to reduce gun violence has been conducted in over two decades due in large part to a reticence on the part of the federal government to fund such work.

In 2019, the Pediatric Policy Council engaged in successful advocacy efforts that helped to appropriate $25 million to the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to administer grants for firearm research. Still, the U.S. has lagged behind its peers in identifying and implementing policies to address this problem.

"I'm eager to speak candidly with our expert panel about the challenges of advocating for firearm policy and the unique position of pediatricians to engage in this critical work," said Shale Wong, MD, MSPH. "Our president has charged Congress to act. Together with the power of youth advocates, we must garner the energy, confidence and perseverance to put our children first and decrease access to firearms. Our actions can save lives."

Presentations included:

Policies that work to reduce gun violence; presenter: Joshua Sharfstein, MD - Johns Hopkins Bloomberg School of Public Health
Research and evidence to reduce firearm injuries; presenter: Lois Lee, MD, MPH - Boston Children's Hospital/Harvard Medical School
Role of physician advocacy for gun violence prevention; presenter: Benjamin Hoffman, MD - OHSU

Dr. Wong and Shetal Shah, MD, chaired the session, "The Role of Research in Reducing Gun Violence: A Pediatric Policy Council State of the Art Plenary," on Sunday, May 2 at 10 a.m. EDT. Reporters interested in an interview with the presenters should contact PAS2021@piercom.com.

The PAS Meeting connects thousands of pediatricians and other health care providers worldwide. For more information about the PAS Meeting, please visit http://www.pas-meeting.org.

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About the Pediatric Academic Societies Meeting

Juvenile incarceration has mixed effects on future convictions

Juvenile incarceration is a double-edged sword and rehabilitation programs may improve welfare of convicted juveniles

UNIVERSITY OF CALIFORNIA - RIVERSIDE

Research News

Harsh prison sentences for juvenile crimes do not reduce the probability of conviction for violent crimes as an adult, and actually increase the propensity for conviction of drug-related crimes, finds a new study by economists at UC Riverside and the University of Louisiana. Harsh juvenile sentences do reduce the likelihood of conviction for property crimes as an adult. But the increase in drug-related crimes cancels out any benefit harsh sentences might offer, researchers found.

"Juvenile incarceration is a double-edged sword which deters future property crimes but makes drug convictions more likely in adulthood. Thus, it's hard to make firm policy recommendations about sentencing," said first author Ozkan Eren, a professor of economics at UC Riverside. "That said, reducing time spent in prison combined with incorporating better rehabilitation programs into nonincarceration punishment may produce welfare-improving outcomes for convicted juveniles."

Eren and Naci Mocan at the University of Louisiana obtained special permission to view juvenile conviction records from the Louisiana Department of Public Safety and Corrections, Youth Services, Office of Juvenile Justice and reviewed records from the Louisiana Department of Public Safety and Corrections, Adult Services from 1996-2012. Each case record included demographic information about the juvenile or adult, the exact statute offense committed, and details about convictions and sentencing.

To measure recidivism, the researchers focused on juvenile case files from 1996 to 2004. This corresponded to the cohorts born between 1979 and 1987 and the researchers followed them until each one reached 25, observing their criminal conviction activity as young adults. All juveniles included in the study had been randomly assigned to a judge.

The average juvenile incarceration rate was about 25%, with an average age at conviction of 15 years old. Property and drug-related juvenile offenses comprised half of all juvenile convictions. As adults, about 39% of juvenile delinquents were convicted of another crime by age 25. Adults who had been incarcerated as juveniles had a 54.7% conviction rate. Those who had received probation or punishment other than incarceration as juveniles had a much lower conviction rate-- 33.5%.

Eren and Mocan found that juvenile incarceration overall had basically no effect on adult crime. They found, however, that incarceration influenced the types of crimes for which adults were convicted. While incarceration as juveniles had no effect on adult convictions for violent crimes, it reduced the likelihood of property crimes and increased the probability of drug convictions by 28%.

"In summary, juvenile incarceration, triggered by exposure to a harsher juvenile judge, has a deterrent effect on adult property crime conviction, a positive impact on conviction from a drug offense as an adult, and no effect on adult violent crime," the authors write.

The authors suggest a reason for these outcomes is that, during the period studied, Louisiana offered well-monitored, well-structured treatment programs for the incarcerated. Incarcerated juveniles had to participate in case-specific services and programs with quarterly evaluations of their rehabilitation by professional caseworkers. These plans included vocational training, which could lead to better job prospects and reduced propensity to commit property crimes.

But life in prison took an emotional toll. Of the individuals later convicted as adults for drug-related offenses, 95% received suspended sentences or probation, indicating that the overwhelming majority of convictions were for drug use rather than selling. The authors suggest that the stress and stigma of incarceration early in life contributed to substance abuse.

They also noted that incarceration had a detrimental impact on high school completion in earlier cohorts, but it had no impact on later cohorts. This is arguably because the school reforms Louisiana implemented in the early 2000s made it more difficult to obtain a high school diploma. That led to a decline in the graduation rate of the non-incarcerated population, while not altering the already-low graduation rate of those who are incarcerated.

The study concludes that less prison time¬--non-carceral options such as probation, or shorter sentences-- and better rehabilitation programs would maintain or improve current recidivism rates and possibly make a big reduction in drug-related crimes by reducing emotional distress.

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The paper, "Juvenile punishment, high school graduation, and adult crime: evidence from idiosyncratic judge harshness," is published in The Review of Economics and Statistics.

U of A researchers successfully use 3-D 'bioprinting' to create nose cartilage

Technological leap offers a simpler, safer way to provide cartilage for surgeries

UNIVERSITY OF ALBERTA FACULTY OF MEDICINE & DENTISTRY

Research News

VIDEO: THE RESEARCHERS USE A SPECIALLY DESIGNED HYDROGEL THAT COULD BE MIXED WITH CELLS COLLECTED FROM A PATIENT AND THEN PRINTED IN A SPECIFIC SHAPE. OVER ABOUT FOUR WEEKS, THE MATERIAL... view more

CREDIT: UNIVERSITY OF ALBERTA

A team of University of Alberta researchers has discovered a way to use 3-D bioprinting technology to create custom-shaped cartilage for use in surgical procedures. The work aims to make it easier for surgeons to safely restore the features of skin cancer patients living with nasal cartilage defects after surgery.

The researchers used a specially designed hydrogel--a material similar to Jell-O--that could be mixed with cells harvested from a patient and then printed in a specific shape captured through 3-D imaging. Over a matter of weeks, the material is cultured in a lab to become functional cartilage.

"It takes a lifetime to make cartilage in an individual, while this method takes about four weeks. So you still expect that there will be some degree of maturity that it has to go through, especially when implanted in the body. But functionally it's able to do the things that cartilage does," said Adetola Adesida, a professor of surgery in the Faculty of Medicine & Dentistry.

"It has to have certain mechanical properties and it has to have strength. This meets those requirements with a material that (at the outset) is 92 per cent water," added Yaman Boluk, a professor in the Faculty of Engineering.

Adesida, Boluk and graduate student Xiaoyi Lan led the project to create the 3-D printed cartilage in hopes of providing a better solution for a clinical problem facing many patients with skin cancer.

Each year upwards of three million people in North America are diagnosed with non-melanoma skin cancer. Of those, 40 per cent will have lesions on their noses, with many requiring surgery to remove them. As part of the procedure, many patients may have cartilage removed, leaving facial disfiguration.

Traditionally, surgeons would take cartilage from one of the patient's ribs and reshape it to fit the needed size and shape for reconstructive surgery. But the procedure comes with complications.

"When the surgeons restructure the nose, it is straight. But when it adapts to its new environment, it goes through a period of remodelling where it warps, almost like the curvature of the rib," said Adesida. "Visually on the face, that's a problem.

"The other issue is that you're opening the rib compartment, which protects the lungs, just to restructure the nose. It's a very vital anatomical location. The patient could have a collapsed lung and has a much higher risk of dying," he added.

The researchers say their work is an example of both precision medicine and regenerative medicine. Lab-grown cartilage printed specifically for the patient can remove the risk of lung collapse, infection in the lungs and severe scarring at the site of a patient's ribs.

"This is to the benefit of the patient. They can go on the operating table, have a small biopsy taken from their nose in about 30 minutes, and from there we can build different shapes of cartilage specifically for them," said Adesida. "We can even bank the cells and use them later to build everything needed for the surgery. This is what this technology allows you to do."

The team is continuing its research and is now testing whether the lab-grown cartilage retains its properties after transplantation in animal models. The team hopes to move the work to a clinical trial within the next two to three years.

CAPTION

3-D printed cartilage is shaped into a curve suitable for use in surgery to rebuild a nose. The technology could eventually replace the traditional method of taking cartilage from the patient's rib, a procedure that comes with complications.

CREDIT

University of Alberta

The research was supported by grants from the Canadian Institutes of Health Research, Alberta Cancer Foundation, Canadian Foundation for Innovation, University Hospital Foundation, Natural Sciences and Engineering Research Council of Canada and Edmonton Civic Employees Charitable Assistance Fund.

The study, "Bioprinting of human nasoseptal chondrocytes?laden collagen hydrogel for cartilage tissue engineering," was published in The FASEB Journal.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Monsters by Barry Windsor-Smith – a great, grim slab of postwar angst

This long-awaited epic makes superhuman strength an unsettling backdrop to family drama

‘Windsor-Smith does give us shootouts, stakeouts and chases, but Monsters

James Smart

Thu 6 May 2021

There are epic waits, and there’s the wait for Barry Windsor-Smith’s new epic. This great, grim 366-page slab of postwar angst began its life as a Hulk story that Windsor-Smith planned for Marvel in 1984. Now, 37 years later, it finally emerges, its striking cover bearing the ruined face of a man, a Stars and Stripes thrust in one ear, his torn lip exposing a cavernous jaw, a tear trickling from one half-open eye. This is Bobby Bailey, the young man at the centre of this forcefully told and thoroughly affecting drama.

Windsor-Smith’s return is big news. The Londoner got his break after sending sketches to Marvel in the late 60s. He drew staples such as the Avengers and Daredevil, and brought romanticism and style to the award-winning Conan series. But Windsor-Smith has always had his own vision, and his relationship with an industry that has historically kept creatives on a tight leash has rarely been easy. “The business,” he declared in a 2013 interview, “stinks.” In the 70s and beyond, Windsor-Smith spent spells within the industry – writing and drawing the Wolverine origin story Weapon X for Marvel, working on several series for Valiant and creating the Storyteller anthology for Dark Horse – and long stretches out of it. He has published virtually no new work for 15 years; his website’s news section stops in 2011.

Fittingly, the ambitious Monsters uses time lapses to great effect. It opens in 1949 with brutal violence, as Bobby’s mother, Janet, defends her young son against his raging father, Tom. Fifteen years later, Bobby follows in his veteran father’s footsteps, and walks into an army recruitment office. His claim that he has no family or qualifications sees him chosen for an ominous trial. A few months later, he is dotted with wires and suspended in a stinking pool, his skin swollen with muscles and gouged with scars. His chemically enhanced body is now an army investment, but Bailey has an unexpected ally with an escape plan.

It feels a well trodden set-up, part Captain America, part Frankenstein’s monster. The secret project begins with a Nazi scientist who adjusts his glasses with a claw-hand, while Bailey’s noble saviour is an African American man with “hoodoo” powers. A lesser writer might crank up the cliches another notch, and focus on the violence and drama of a super-soldier on the loose in 60s America. Windsor-Smith does give us shootouts, stakeouts and chases, but Monsters is more interested in turning back the clock. It’s a book about how we got here; a story about a lost boy, his put-upon mother and his brutal, traumatised father, about fraught dinners and PTSD, and about how it takes a monster to make one. And its telling is often brilliant.

Windsor-Smith’s brooding, dramatic panels later show a young Tom and Janet, happy before the war. The new father sends tender notes back from the front, his eye for a scene such that he “could describe the French countryside and the sounds of war in the same sentence”. But after a shock discovery in the chaos of the German retreat, he returns a changed man. The hands that once penned love letters instead reach for the whiskey bottle, and lash out at his wife and son.

Monsters hums with suppressed violence and regret, and Windsor-Smith renders both with real power. His command of pose and gesture – Tom’s thick arms bunching with tension, Janet’s shoulders slumping in resignation – brings his cast to life. Some images stay with you: a bike with buckled wheels in long grass, smoke oozing over a dinner table in an officer’s mess, cross-hatched shadow stretching across a face like a cowl. Alongside the naturalism sits stranger stuff: sausages turn into severed fingers and memories swirl into the present, their echoes turning simple conversations into a deafening hubbub. At the heart of the book, the adult Barry relives his childhood traumas, his great, twisted face and freakish frame balled up on the stairs as arguments burst out around him.

Perhaps inevitably, given its long gestation period and ambitious scope, Monsters can feel disjointed. Its mix of sci-fi, body horror, fateful coincidences, psychic powers and family drama isn’t always coherent; at times the dialogue falls flat. Windsor-Smith’s grotesque visions of butchered cadavers and dark experiments seem distant and almost comedic when set against the real menace and claustrophobia of domestic violence.

Yet that dissonance helps illuminate the book. Pulp fiction has asked again and again what might happen if you could create someone who was more than human. Windsor-Smith’s answer is that such a birth would be a trauma, not the spark for quips and pyrotechnics, but the heart of a very American tragedy. Fittingly for a writer who’s never felt comfortable spending too long in the comics mainstream, he has created a tale in which wild moments of excess and scenes of superhuman strength form an unsettling backdrop rather than the main event. Instead, a family drama of kindness, cruelty and redemption takes centre stage, offering the chance for a broken man to shed his skin, and begin again.

Monsters by Barry Windsor-Smith is published by Jonathan Cape (£25)

PUBLIC HEALTH

Reckless Rush to Reopen Threatens Chile’s Exemplary Vaccination Strategy

Easing restrictions without clear risk communication undercuts some of the country’s hard-won progress in fighting the pandemic

By Luke Taylor on May 5, 2021

People wait for their turn to be vaccinated with the Pfizer-BioNTech vaccine against COVID-19 at the Medalla Milagrosa Church in Valparaíso, Chile, on April 6, 2021.

Credit: Javier Torres Getty Images

COVID-19 vaccine campaigns in Latin America lag well behind those in the global north. But Chile has been an outlier. It has defied the regional trend and plowed ahead with a campaign that has fully vaccinated a higher percentage of its population than any other country with more than 10 million inhabitants. By the end of March more than one in three Chileans had received a full course of vaccination for COVID-19.

But while it has celebrated its successes, Chile has also served as a cautionary tale about the dangers of vaccine complacency. Coronavirus infections have surged there in recent months, reaching a record high of 9,151 daily cases on April 9. Most intensive care units have been operating near capacity for the past month as around 100 COVID-19 deaths have been recorded each day.

Chile swiftly rolled back public health restrictions in 2021, after securing large vaccine deals with global pharmaceutical companies—primarily Sinovac but also other firms, including the Pfizer-BioNTech collaboration. It began vaccinating frontline health workers on December 24, 2020. In March schools reopened, and high-risk activities such as indoor sports, gyms and casinos were allowed to resume.

The reopening was premature, public health experts say. Now, unlike Israel and the U.K., which are smoothly peeling back restrictions as more vaccines are rolled out, Chile has had to make a U-turn and clamp down on personal freedoms once again. Later in March authorities reimposed strict lockdowns on most of the country and even paused permits that allowed Chileans to buy groceries in what they called a “last effort” to bring infections down.

“We started relaxing lockdowns and social distancing measures before we had a significant percentage of the population effectively immunized against COVID-19,” says Juan Carlos Said, an internal medicine specialist at the Sótero del Río Care Complex in Santiago, Chile. “Now we are in a situation where, even though we have vaccinated a lot of people, we still do not have the pandemic under control.”

A study published in Science on April 27 found that COVID-19 infections and fatalities were higher in poor communities in Santiago. Lower socioeconomic status (SES) areas had not adhered as much to stay-at-home orders, “possibly because people from lower SES areas are unable to work from home, leaving them at a higher disease risk,” according to the paper. The worst-hit areas also had inferior testing and tracing. The government, Said says, should have recognized where to focus public health measures to drive down infections before relaxing restrictions. Instead it issued permits that allowed millions of people to travel around the country.

“It’s the same as treating a patient in a hospital,” Said says. “You cannot say, ‘I’m just going to perform a good surgery, but I’m not going to take care of rehabilitation or antibiotics.’ You need to do a lot of steps very well, and I think that we placed a lot of confidence in one thing.”

Public health in Chile was also undermined by politicians who were eager to ensure that they would score points for the nation’s vaccination campaign instead of emphasizing the need for a multipronged strategy that would embrace safety measures, says Claudia Cortés, an infectious diseases specialist at the University of Chile. “It was like a party every time a new batch of vaccinations arrived, with the president and health minister celebrating them at the airport,” she says. “It gives a message, not just in words but in the feeling of extreme happiness and success, that ‘we have the first batch of vaccines, and we are done.’”

In the first months of the year, millions of Chileans, fatigued with the pandemic after almost a year of restrictions, vacationed around the country. They abandoned the use of masks and gathered in crowds. Chile’s health minister admitted in March that the careless behavior of holidaymakers caused the spike in infections and that authorities should have been clearer that vaccines alone are not a panacea.

Cortés hopes other nations will be more cautious in their tone and coherent in conveying the message that vaccines are not an instant solution. “You need to keep telling the entire population that they need to take care of themselves, wash their hands, use a mask and avoid crowds,” she says. “The message needs to be very, very clear and very explicit.”

The spike in cases also highlights the need to ensure that members of the public are aware that they will not be fully protected until they get all of their prescribed vaccine doses, says Eduardo Undurraga, a global health expert at the Pontifical Catholic University of Chile.

A study presented by researchers at the University of Chile on April 6 found that the CoronaVac vaccine, made by the Chinese manufacturer Sinovac Biotech, was 56.5 percent effective in preventing infections two weeks after a second dose. But it only reached 3 percent after the first shot.

Of the vaccines administered, 85 percent were CoronaVac, and most Chileans did not understand that they would not have a strong immune response until two weeks after the second dose, Undurraga says. By early 2020 the majority of Chileans had only received one dose rather than two, and they may have been transmitting the coronavirus unknowingly or even getting sick themselves.

“We need to transmit a consistent message to avoid this idea of a silver bullet, because we know there’s no silver bullet for this pandemic,” Undurraga says.

New variants of the coronavirus that are better at spreading and evading antibodies—such as P.1, which originated in Brazil—are also believed to have driven up infection rates in Chile. As the spread of new variants pushes the herd immunity threshold higher across the world, the public must remain patient, and governments need to stay firm, with restrictions for a while longer, Said says.

“[The Chilean government] did a good job in buying vaccines, but they lacked the confidence to keep doing the public health measures that were needed to stop the circulation of the virus,” Said says. “The key message here is that you cannot focus your strategy only on one thing. There’s only one way to do things properly but many different ways to fail.”

Read more about the coronavirus outbreak from Scientific American here. And read coverage from our international network of magazines here.

ABOUT THE AUTHOR
Luke Taylor is a freelance journalist covering Colombia, Venezuela and wider Latin America. He is particularly interested in the relationship between political and military conflict and issues like deforestation, the international drug trade and migration.

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April 21, 2021 — Smriti Mallapaty and Nature magazine

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What's Causing Michigan's COVID Surge, and Who's Getting Sick?

April 20, 2021 — Tanya Lewis

PUBLIC HEALTH
Slovakia Offers a Lesson in How Rapid Testing Can Fight COVID

April 8, 2021 — Tanya Lewis

LA REVUE GAUCHE - Left Comment

Thursday, May 06, 2021

Neighborhood disadvantage may be an environmental risk factor for brain development

A pediatric policy council plenary: The role of research in reducing gun violence

Juvenile incarceration has mixed effects on future convictions

U of A researchers successfully use 3-D 'bioprinting' to create nose cartilage

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CREDIT

Monsters by Barry Windsor-Smith – a great, grim slab of postwar angst

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