CAPITALI$TS IN SPACE

Commercial space cowboys reach for the stars

If you've run out of ideas of where to go on holiday and want to take it to the next level, space tourism could be your thing — if you have the money to spare. Here's a look at some of the pros and cons.

  

Richard Branson beat his fellow space tourism competitors into suborbital space

In the wake of NASA's Apollo and space shuttle missions, it seemed that the halcyon days of space exploration had had their run. Interest waned and many people no longer saw the point.

More recently, however, interest has been piqued again, not least by the myriad of international missions to Mars.

The latest craze is commercial space tourism as offered by several private spaceflight companies. The three leading contenders are currently showing the world who has the biggest, er, rocket to take themselves and anyone who has enough spare change into space.

British entrepreneur Richard Branson, the founder of Virgin Galactic, beat fellow billionaire Jeff Bezos into space when he and five crew members successfully launched into suborbital space — defined as reaching outer space but with a trajectory that does not take it into orbit — last Sunday, arriving at an altitude of 80 kilometers (50 miles), which is the boundary of outer space as recognized by the United States.

To date, Virgin Galactic had about 600 bookings for the 1-1/2 hour flight, priced at around $250,000 (€212,000).

Next in line is Bezos, who plans to embark on his own space adventure on Tuesday aboard his Blue Origin LLC's rocket. The winning bidder, a private individual who had planned to join Bezos, his brother Mark and an unnamed astronaut, paid more than $28 million for the 11-minute ride. But the bidder backed out at the last minute last Thursday, and will be replaced by the 18-year-old son of another bidder instead.

Bezos has said he wants to make space travel environmentally sustainable

And then there's Elon Musk, whose SpaceX company has signed a deal with Houston-based space tourism company Axiom to send three private citizens and a former NASA astronaut into space. Axiom passengers will pay $55 million for the flight and a stay on the International Space Station in early 2022.

What is the environmental impact of space tourism?

Though these billionaires are at the forefront of the current space tourism boom, they're by no means the first to embark on a commercial space adventure. Twenty years ago, on April 28, 2001, Dennis Tito, an American engineer, paid a massive $20 million for a seat on a Russian Soyuz rocket, becoming the first civilian to visit the International Space Station.

It comes as no surprise that space tourism has polarized public opinion.

Aside from health issues such as exposure to harmful radiation from the sun, one of the criticisms cited regularly is the impact that launching rockets into space has on the environment. 

"The aspect that has been most focused on is depletion of ozone in the protective stratospheric ozone layer. The advantage, at least with the Virgin Galactic and Blue Origin rockets, is that they don't have chlorine, but they do have other components that can produce nitrogen oxides. And when that's released into the stratosphere, that can contribute to ozone depletion," Eloise Marais, an associate professor in physical geography at the University College London who's working on a study on pollutant emissions from rocket launches, told DW.

In terms of next week's Blue Origin launch, the BE-3 engine used in the New Shepard propulsion rocket will be using liquid hydrogen and liquid oxygen. "Both will have an impact. Hydrogen and oxygen can produce water and water released into the dry stratosphere can influence the climate," Marais said.

Carbon dioxide emissions are also a concern, as that is the most long-lasting greenhouse gas causing climate change. Virgin Galactic's VSS Unity space plane uses conventional rocket fuel, and emits CO2 about equivalent to a round-trip trans-Atlantic passenger jet flight. In contrast, Blue Origin's New Shepard rocket uses hydrogen fuel, which does not emit CO2 — although production of that hydrogen fuel likely has.

Economic and technological benefits

Space tourism is expected to become grow as a commercial sector and renew interest in space exploration. As a result, there will be more financial backing to support innovation in the industry. Technology developed for space tourism could result in spinoffs, and one day even be applied to other domains beyond space missions.

"We have gotten a lot of products that are safe in a space environment that we copy in a safe way for the benefit of people on Earth," Annette Toivonen, a space tourism lecturer at Helsinki's Haag-Helia University of Applied Sciences and author of Sustainable Space Tourism: An Introduction, told DW.

Manufacturing new and better spacecraft will also create job opportunities. In early 2021, NASA announced that it was offering $45 million in support to about 350 small businesses and research institutions to develop cutting-edge technologies.

"That's the good side, when we have three rich men using their own funds for these developments, and that it's not coming from the taxpayer," Toivonen said. "Private individuals are willing to use their money for these kinds of developments and technological innovations."

Some of those technological innovations might also pave the way to find more sustainable fuel sources that could benefit other industries. "Now, there's a lot of money for trying to create alternatives for fossil fuels. Then they might discover some kind of hydrogen fuel system that could be copied for airplanes," said Toivonen.

Space tourism is becoming a booming industry. In a report last year, Swiss investment bank UBS estimated that suborbital and orbital space tourism could have a market value of $3 billion by 2030.

Space tourism is here to stay

One question that pops up regularly is whether the space outside the Earth is meant for humans.

"There is a big ethical issue there. We have destroyed our planet; and then we go to space and destroy that as well. Legislation is completely lacking. It looks like the Wild West at the moment," Toivonen said.

Whatever your take is, the commercial race to space is in full flight.

If strapping in on a rocket isn't your thing, the spaceflight company Space Perspective is planning to take passengers to the edge of space in a high-tech version of a hydrogen-powered hot air balloon "the size of a football stadium." The first flights are planned for early 2024, with tickets priced at a more affordable $125,000 per person.

And, if you're planning a different type of holiday, the company Orbital Assembly Corporation plans to open a luxury space hotel in 2027. The Voyager Station features a restaurant, gym and Earth-viewing bars. A 3-1/2 day stay will set you back only $5 million.

German firms search for clues on future of remote working

After they were forced to send their staff home during the pandemic, firms have come to realize how well their employees managed to work remotely, even while juggling jobs and family duties. 

What comes next, they wonder?


A quarter of all employees in Germany work from home now


As both the global COVID-19 pandemic and work-from-home experiments appear to be stretching on for a while longer, there's a dawning realization among company heads that "hybrid" forms of work may become the new normal. Hybrid working involves flexible travel to the office on some days and working remotely on others.

Germany's traditionally strong sector of small and medium-sized enterprises (SMEs), also known as Mittelstand, used to be especially skeptical about the pandemic-induced drive to work remotely, criticizing government efforts to force them to send staff home. But now, executives said in a survey they are amazed at how well their workers are coping.

During the pandemic, about 30% to 40% of the staff of typical Mittelstand companies based in the Ruhr Valley industrial heartland were, or are still, working from home, said Dirk Erlhöfer, managing director of the Ruhr/Westfalen Employers' Association, a lobby group that represents 430 SMEs in the region.

"This high number has surprised even us because most of our members are active in the industrial sector," he told DW.

More light than darkness

As well as offering protection from the pandemic, remote working has also led to better work-life balance, which Erlhöfer says has boosted productivity. In addition, the number of sick days has dropped significantly, he said, and work-from-home offers have become increasingly important in recruiting young executives and specialists.

But a wider adoption of new ways of working is going to be challenging, said Erlhöfer, pointing to some of the problems that have emerged. "It is, for example, more difficult to coordinate processes between administration and production. Technical problems also come into play; and the gradual evolving of a kind of divided, two-class staff could disturb company peace."

Despite the downsides, Erlhöfer said member firms cherish the advantages, as about 80% of them said they are planning to continue remote-work arrangements.

Employers are no longer required to allow staff to work from home — but at the same time, not everybody wants to go back to the office

Flexible work environment

German chemical company BASF is currently developing a hybrid work model that would allow its employees to choose between in-person meetings in the office and virtually connecting to their co-workers. Valeska Schößler, a spokesperson for the corporation, said the model intentionally abstains from imposing binding rules for all.

"We are giving our teams a larger degree of flexibility in organizing their work," she told DW, noting that the number of days employees would want to work from home are to be negotiated between the employee and her or his team leader individually, and "under due consideration of actual work requirements."

"You cannot oversee a test run in a laboratory from home, nor can our plants be maintained and repaired remotely," Schössler pointed out. Furthermore, some people would insist on drawing a clear line between private and work life, on the one hand; or, they find face-to-face encounters "the key to success" in developing their creative ideas, on the other hand.

Some people who work from home find it more difficult to separate work and personal time

Designing the office of the future

As more companies are transitioning back to the office amid the subsiding pandemic, the new era of flexible work is, however, bound to alter workplace design. Studies have shown that frequent in-person interaction leads to commitment, support, and cooperation among co-workers. But how can this be ensured if some of the employees prefer to stay at home?

A recent paper circulated by Germany's National Academy of Science and Engineering says that the office design of the future should be providing "optimal support for activity profiles, with a focus on social interaction, collaboration and innovation."

The paper, which was compiled by the academy's human resource working group (acatech), which brings together staff managers from large German corporations, also says that in such offices it would be possible to book rooms for quiet working or for employees to work together with others in flexibly designed meeting rooms and project rooms or in collaborative open workspaces.

"For concentrated, focused work and routine work, employees will be encouraged increasingly to work from home or in places other than on company premises," the paper adds.

Young startup firms, meanwhile, have been readily adopting remote work because it cuts travel expenses and allows them to attract talent from all over the world thanks to virtual meetings, machine translation and digital contracts based on Blockchain technology.

OroraTech from Munich, for example, uses the Donut app that randomly pairs co-workers and reminds them to meet up, whether it's for coffee or just a 15-minute Slack call. And the employees of Cloud & Heat, a German data center provider, have regularly met for virtual after-hours gaming nights to stay in touch during lockdowns.

Could collaborative arrangements be the future of post-pandemic work?

'Experimental phase'

Working from home, with all its digital and virtual underpinnings, can also turn out to be problematic, as German recruitment platform Campusjäger (campus hunter) has found out.

Workers of the firm took part in a field test recently in which they were required to wear pulse-rate meters to find out how distracting and stressful interruptions caused by electronic communications could be. Inactivating digital notifications, it turned out, allowed people to remain focused for longer — 19% longer at the office, and even longer when working at home.

"Flexible and hybrid working models require a balance between trust and transparency," acatech notes in its paper. Static annual performance assessments must be replaced by "continuous, transparent ad-hoc feedback, which takes account of peer feedback and is employee-driven rather than management-driven."

Acatech proposes that companies begin the transition by establishing "experimental zones," because there is no "master plan" for shaping the future of work that would provide guidelines anticipating all relevant developments.

Chemical firm BASF is currently trialing mobile working at its headquarters in Ludwigshafen within its "flex work" project. This is intended to create concepts for "office design [and] IT solutions as well as providing advice on how to forge cooperation in flexible work teams," said Schössler.

BASF has set up pilot teams tasked with guiding employees through the first phase of the flexible-working project. They have a special digital toolkit at their disposal that will help staff organize workshops, conduct surveys, and meet administrative requirements. For staff in management positions, virtual tutorials are available about how to lead from a distance.


This article was adapted from German.

RIP

Danish Mohammed cartoonist Kurt Westergaard dies aged 86

Danish artist Kurt Westergaard, famed for drawing a caricature the Prophet Mohammed which sparked outrage around the Muslim world, has died at the age 86, his family told Danish media on Sunday.

Is Coffee Good For You?

YES A THOUSAND TIMES YES


The New York Times
  

Service Sector
In this photo taken Monday, Nov. 4, 2019, barista Porter Hahn makes an iced coffee drink for a customer in a coffee shop in Seattle. (AP Photo/Elaine Thompson)

We’ve come a long way from the cans of Folgers that filled our grandparents’ cupboards, with our oat milk lattes, cold brews and Frappuccinos. Some of us are still very utilitarian about the drink while others perform elaborate rituals. The fourth most popular beverage in the country, coffee is steeped into our culture. Just the right amount can improve our mood; too much may make us feel anxious and jittery.

Is coffee good for me?

Yes.

In moderation, coffee seems to be good for most people — that’s 3 to 5 cups, or up to 400 milligrams of caffeine.


“The evidence is pretty consistent that coffee is associated with a lower risk of mortality,” said Erikka Loftfield, a research fellow at the National Cancer Institute who has studied the beverage.

For years, coffee was believed to be a possible carcinogen, but the 2015 Dietary Guidelines helped to change perception. For the first time, moderate coffee drinking was included as part of a healthy diet. When researchers controlled for lifestyle factors, like how many heavy coffee drinkers also smoked, the data tipped in coffee’s favor.

A large 2017 review on coffee consumption and human health in the British Medical Journal also found that most of the time, coffee was associated with a benefit, rather than a harm. In examining more than 200 reviews of previous studies, the authors observed that moderate coffee drinkers had less cardiovascular disease, and premature death from all causes, including heart attacks and stroke, than those skipping the beverage.

In addition, experts say some of the strongest protective effects may be with Type 2 diabetes, Parkinson’s disease and liver conditions such as cirrhosis, liver cancer and chronic liver disease. For example, having about five cups of coffee a day, instead of none, is correlated with a 30% decreased risk of Type 2 diabetes, according to a meta-analysis of 30 studies.

The potential benefit from coffee might be from the polyphenols, which are plant compounds that have antioxidant properties, according to Dr. Giuseppe Grosso, an assistant professor in human nutrition at University of Catania in Italy and the lead author of an umbrella review in the Annual Review of Nutrition.

However, coffee isn’t for everyone. There are concerns about overconsumption. This is especially true for expecting mothers because the safety of caffeine during pregnancy is unclear. While the research into coffee’s impact on health is ongoing, most of the work in this field is observational.

“We don’t know for sure if coffee is the cause of the health benefits,” said Jonathan Fallowfield, a professor at the University of Edinburgh and co-author of the British Medical Journal review. “These findings could be due to other factors of behaviors present in coffee drinkers.”

Does the way coffee is prepared matter?

Yes. Do you prefer a dark or light roast? Course grinding or fine? Arabica or robusta?

“All of these different aspects affect the taste but also affect the compounds within the coffees,” said Neal Freedman, a senior investigator with the National Cancer Institute. “But it’s not clear at all how these different levels of compounds may be related to health.”

Roasting, for example, reduces the amount of chlorogenic acids, but other antioxidant compounds are formed. Espresso has the highest concentration of many compounds because it has less water than drip coffee.

A study in JAMA Internal Medicine examined the coffee habits of nearly 500,000 people in the U.K. and found that it didn’t matter if they drank one cup or chain-drank eight — regular or decaf — or whether they were fast metabolizers of coffee or slow. They were linked to a lower risk of death from all causes, except with instant coffee, the evidence was weaker.

The way you prepare your cup of joe may influence your cholesterol levels, too. “The one coffee we know not suitable to be drinking is the boiled coffee,” said Marilyn Cornelis, an assistant professor in preventive medicine at the Northwestern University Feinberg School of Medicine and co-author of the JAMA Internal Medicine study.

Examples of this include the plunge-happy French press, Scandinavian coffee, or Greek and Turkish coffee — the kind commonly consumed in the Middle East. (When poured, the unfiltered grounds settle on the tiny cup’s bottom like sludge. To peek into the future, elders in the region have a tradition of reading the sediment of an overturned cup, like a crystal ball.)

The oil in boiled coffee has cafestol and kahweol, compounds called diterpenes. They are shown to raise LDL, the bad cholesterol, and slightly lower HDL, what’s known as the good kind.

“If you filter the coffee, then it’s no issue at all,” said Rob van Dam, a professor at Saw Swee Hock School of Public Health at National University of Singapore. “For people with cholesterol issues, it’s better to switch to other types of coffee.” He’s been studying coffee for two decades. (And, yes, he’s had a lot of coffee in that time.)

However, other researchers say not to throw out the boiled coffee just yet. The clinical significance of such small increases in cholesterol may be questionable, given that it’s not associated with an increase in cardiovascular deaths.

Many consumers have also swapped loose grounds for coffee pods. While there are environmental concerns with single-use pods, researchers believe them to hold the same benefits as, say, drip coffee. The latter applies to cold brew, too, but more research is needed.

Do all kinds of coffee have the same amount of caffeine?

No. Espresso has the highest concentration of caffeine, packing about 70 milligrams into a one-ounce shot but is consumed in less quantities. By comparison, a typical 12-ounce serving of drip coffee has 200 milligrams of caffeine, more than instant’s 140. And, yes, brewed decaf has caffeine, too — 8 milligrams — which can add up.

When buying coffee, you never really know what you’re going to get. At one Florida coffee house, over a six-day period, the same 16-ounce breakfast blend fluctuated from 259 milligrams all the way up to 564 — which goes beyond federal recommendations.

But for some of us, knowing how much caffeine is in our coffee can be especially important. You’ve probably noticed it before. How a friend can pound quadruple espresso shots at 10 p.m. and sleep afterward, while you can’t have any past noon or you’ll be watching “Seinfeld” reruns until dawn. Some of us have a polymorphism, a genetic variant that slows our metabolism for caffeine. It’s these individuals that Grosso recommends limit their refills. “They take a coffee, and then they have the second and the third, and they still have the caffeine of the first,” he said.

You can even find out whether you are a fast or slow metabolizer through a variety of direct-to-consumer testing services, including 23andMe.

Is coffee addictive?

Evidence suggests there can be a reliance on the drink, and tolerance builds over time. Withdrawal symptoms include a headache, fatigue, irritability, difficulty concentrating and depressed mood.

Indeed, caffeine is a psychoactive drug, and coffee is its biggest dietary source. About a half-hour after sipping a cup of joe, the caffeine kicks in and is quickly absorbed. Blood vessels constrict. Blood pressure increases. A moderate amount of caffeine can wake you up, boost your mood, energy, alertness, concentration and even athletic performance. On average, it takes four to six hours to metabolize half the caffeine.

For those knocking back more than 400 milligrams of caffeine a day, there’s not enough evidence to assess the safety, according to the Dietary Guidelines. Higher doses can lead to caffeine intoxication, with its shakiness, nervousness and irregular heartbeat. Caffeine is also linked with delaying the time it takes for you fall asleep, how long you stay there and the reported quality of that shut eye.

“I think that caffeine is so common and so ingrained in our culture, and daily habits, that we often don’t think about it as a potential source of problems,” said Mary Sweeney, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

Cutting down coffee may help with gastroesophageal reflux, too. A new study found that women drinking caffeinated beverages — coffee, tea or soda — were associated with a small but increased risk of symptoms, like heartburn. The study’s authors predicted fewer symptoms when substituting two servings of the drinks with water.

Current available research hasn’t determined what amount of caffeine can be safely consumed during pregnancy, according to the American College of Obstetricians and Gynecologists. Caffeine does cross the placenta so some doctors may recommend pregnant women stay below 200 milligrams of coffee daily.

Extremely high doses of caffeine can be fatal. But researchers say that’s more likely to occur accidentally with caffeine powder or pills. “You don’t see a lot of people going into the emergency room because they accidentally drank too much coffee,” said van Dam.

What is a coffee bean?

Inside the red fruit of coffea lie two coffee beans. Green in color, the duo spoon together, the rich brown hue to appear only after roasting. In fact, they aren’t beans at all. “It’s like a cherry you pick off the tree,” said Patrick Brown, a professor of plant sciences at University of California, Davis. Unlike the cherry, though, the seed is the prize and the flesh is discarded.

In addition to caffeine, coffee is a dark brew of a thousand chemical compounds that could have potential therapeutic effects on the body. One key component, chlorogenic acid, is a polyphenol found in many fruits and vegetables. Coffee is also a good dietary source of vitamin B3, magnesium and potassium.

“People often see coffee just as a vehicle for caffeine, but, of course, it’s a very complex plant beverage,” said van Dam.

With coffea’s estimated 124 species, most of flavors remain untapped and perhaps will be forever, with an estimated 60% under threat of extinction, largely from climate change, disease, pests and deforestation. What fills our mugs at cafes, the office, and on road trips are from two species: arabica and canephora, known as robusta. Arabica fills specialty cafes and costs more than robusta, which fuels instant coffees and some espressos.

For all of the pomp swirling around arabica, the fact remains it is an extremely homogeneous little seed. Almost all of the world’s arabica coffee traces itself back a few plants from Ethiopia, coffee’s birthplace, or Yemen.

Does adding milk or sugar cancel out benefits?

Doctors don’t know. One 2015 study found that those adding sugar, cream or milk had the same associated benefit as those who preferred it black. But the coffee industry has exploded since the ’90s when the older adults in the study filled out their dietary history. “It was only about a tablespoon of cream or milk, and a teaspoon of sugar,” said the study’s lead author, Loftfield, with the National Cancer Institute. “This is very different, potentially, than some of these coffee beverages you see on the market today.”

Sweet coffee and tea are the fourth largest source of sugar in the diets of adults, according to the October survey from the U.S. Department of Agriculture. That includes dessert-like beverages, like the Dunkin’ 860-calorie creamy frozen coconut caramel coffee drink, with 17 grams of saturated fat and 129 grams of total sugars. Experts say some of these drinks bear little relation to the two-calorie cup of black coffee of the past, worrying health officials.

“When you talk about a drink that has that load of unhealthy fats and that much sugar, can’t possibly be a healthy beverage on balance,” Dr. Jim Krieger, a clinical professor of medicine and health services at the University of Washington. “That amount of sugar alone is astronomical compared to the current recommendations of U.S. Dietary Guidelines of 50 grams of sugar a day.”

The concern is heightened, experts say, especially because an estimated 43% of teens are now drinking coffee — nearly doubling since 2003 — according to the research firm Kantar, driven partly by sweet drinks.

“People should worry a lot about what they put in the coffee and what the food and beverage industry puts in it,” said Laura Schmidt, a professor at the University of California San Francisco School of Medicine. “And sweetened coffee is one of the things that the beverage industry is pushing on the public now that consumers have turned away from soda for health reasons.”

Should I start pounding down more coffee?

It depends on your goals in life.

If you are enjoying the drink in moderation, doctors say continue onward and savor those sips. And for those patients with a sensitivity to the beverage, Dr. Sophie Balzora, a gastroenterologist, weighs the benefits and risks very carefully. The clinical associate professor of medicine at NYU School of Medicine understands its cultural significance and knows to tread lightly. As she put it: “Robbing people of their coffee seems cruel.”

This article originally appeared in The New York Times.•February 15, 2020

© 2020 The New York Times Company

 

Of lives and life years: 1918 influenza vs COVID-19

Next time, vaccination may be too little, too late

SOCIETY FOR DISASTER MEDICINE AND PUBLIC HEALTH, INC.

Research News

 

IMAGE: HTTPS://WWWNC.CDC.GOV/EID/ARTICLE/12/1/05-0979_ARTICLE view more 

CREDIT: CDC EMERGING INFECTIOUS DISEASES, JANUARY 2006

From the onset of the COVID-19 pandemic there have been countless comparisons to the 1918 influenza pandemic in terms of overall medical impact. Many of the comparisons addressed overall cases which, given the lack of a confirmatory lab test in 1918 and no meaningful case definitions for both pandemics, make such comparisons patently invalid. Overall mortality comparisons, although methodologically flawed as well, do offer a reasonably comparative outcome measure and offers a greater degree of validity. This measure is further enhanced when adjusted for population and average life years lost (see accompanying table for mortality comparisons presented 3 ways). The resulting value(s) can also be used to assess and better quantify the cumulative health impacts of our interventions and give a more objective base for our decision-making. A concluding observation is presented on the impact of a rapidly developed vaccine on a 1918 type event.

###

Preparing for the next pandemic: Harmonize vaccinations in Canada

CANADIAN MEDICAL ASSOCIATION JOURNAL

Research News

To prepare for the next pandemic and provide a coordinated approach to vaccination across the country, Canada should create Canadian Immunization Services based on the Canadian Blood Services model, authors propose in CMAJ (Canadian Medical Association Journal).

The authors, including a leading health policy and immunization expert, a blood system expert and a former federal minister of health, are Dr. Kumanan Wilson, professor, Department of Medicine and member of the Centre for Health Law, Policy and Ethics, University of Ottawa; Dr. Graham Sher, CEO, Canadian Blood Services; and Dr. Jane Philpott, Dean, Faculty of Health Sciences, Queen's University.

"If we want to be better prepared for the next pandemic, it is time to chart a bold new path forward," said Dr. Kumanan Wilson. "We propose intergovernmental collaboration through an arms-length entity, which was successful after the tainted blood scandal, one of Canada's biggest public health crises. We have done this before, emerging stronger from a public health crisis and creating a world-class blood system. We can do it again."

Various reports, including from the federal auditor general, have documented the problems with how Canada's federal, provincial and territorial governments work together. Different vaccination schedules for each province and territory, different terminology and variations in immunization tracking have made Canada's system fragmented.

"It is challenging to coordinate pan-Canadian disease surveillance and mass immunization responses without harmonized data and systems," said Dr. Wilson. "Our response to COVID-19 has been plagued by many of the challenges facing public health over the last 20 years."

As the responsibility for managing public health threats is largely the responsibility of the provinces and territories, unilateral federal mandates are difficult to implement.

The authors propose an independent not-for-profit corporation -- Canadian Immunization Services -- funded by participating provinces and territories, and potentially the federal government, based on the Canadian Blood Services model.

"Twenty-three years ago, Canadian Blood Services assumed full responsibility for the operation of the national blood supply outside Quebec, taking over a system that was unquestionably broken," said Dr. Graham Sher. "We were founded to restore confidence in the blood system, and over the past two decades, our journey has been one from tragedy to trust. We now have one of the safest blood systems in the world. We believe that Canada can effectively prepare for the next pandemic by establishing a world-class vaccination system based on this model as well."

Canadian Immunization Services would provide:

• Ability to procure vaccines in bulk for Canada

• Vaccine surveillance and supply chain management by single entity versus many

• Common data standard to enable data sharing between provinces and territories

• Ability to access expertise rapidly without government barriers to hiring

"If we hope for public health to be better prepared for the next pandemic, now is the time to implement needed changes," the authors conclude.

"Preparing for the next pandemic by creating Canadian Immunization Services" is published July 19, 2021.

###

Exploring the Gap Between Excess Mortality and COVID-19 Deaths in 67 Countries

Francesco Sanmarchi, MD¹; Davide Golinelli, MD¹; Jacopo Lenzi, PhD¹; et alFrancesco Esposito, MD¹; Angelo Capodici, MD¹; Chiara Reno, MD¹; Dino Gibertoni, PhD¹

Author Affiliations Article Information

JAMA Netw Open. 2021;4(7):e2117359. doi:10.1001/jamanetworkopen.2021.17359

COVID-19 Resource Center

Introduction

During the SARS-CoV-2 pandemic, a surge in overall deaths has been recorded in many countries, most of them likely attributable to COVID-19. However, COVID-19 confirmed mortality (CCM) is considered an unreliable indicator of COVID-19 deaths because of national health care systems’ different capacities to correctly identify people who actually died of the disease.^1,2 Excess mortality (EM) is a more comprehensive and robust indicator because it relies on all-cause mortality instead of specific causes of death.³ We analyzed the gap between the EM and CCM in 67 countries to determine the extent to which official data on COVID-19 deaths might be considered reliable.

Methods

In this cross-sectional study, we retrieved aggregated country-level data on population and COVID-19 overall confirmed cases, deaths, and testing as of December 31, 2020, from Our World in Data. Data on countries’ overall deaths from 2015 to 2020 were obtained from the World Mortality Data set (eAppendix in the Supplement). This research was based on public use datasets that do not include identifiable personal information and, per the Common Rule, was exempt from Institutional Review Board review and approval. For the same reason, no informed consent was required. This study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.

Negative binomial regression models were used to estimate projected deaths in 2020 using mortality data from 2015 to 2019. Two-sided 95% CIs for country-specific projected deaths were calculated applying the normal approximation to the Poisson distribution. EM in the pandemic period (ie, February 26 to December 31, 2020) was estimated as the difference between cumulative observed deaths and projected deaths. Countries’ testing capacity was assessed with their cumulative test-to-case ratio (eAppendix in the Supplement). The association between country-specific cumulative CCM and EM per 100 000 population of 2020 was displayed using a scatterplot, in which the identity line discriminates countries with EM exceeding CCM from those with EM lower than CCM. A color was assigned to countries based on their decile of testing capacity. All analyses were performed using R version 4.0.4 (R Project for Statistical Computing). Details on the analytic approach are available in the eAppendix in the Supplement.

Results

Most of the 67 countries experienced an increase in mortality during 2020 (Table). Among countries with increased mortality (ie, those located above 0 on the y-axis in the Figure), a small number appeared under the identity line, showing lower-than-expected mortality after subtracting COVID-19 deaths. Countries located above the identity line can be visually classified into 2 groups: 1 with several Latin American and East European countries, which exhibit a large gap between EM and CCM (eg, Mexico, 212 excess deaths vs 96 COVID-19 deaths per 100 000 population); the other, more heterogeneous group showed a moderate EM beyond CCM (eg, Greece, 57 excess deaths vs 45 COVID-19 deaths per 100 000 population). Countries with negative EM also had very low CCM and were mainly located in East Asia. The lowest figures of EM and CCM generally belonged to countries with higher testing capacity (in green) and the largest differences between EM and CCM to countries with poorer testing capacity (in red).

Discussion

This comparison of CCM and EM revealed the different national health systems’ capacity to test and diagnose COVID-19 and their responsiveness to the health crisis. Underreporting of COVID-19 deaths because of strained health care systems’ capacity might explain our findings for countries where EM exceeded CCM.^2,4 In contrast, the effects of nonpharmaceutical interventions on populations’ main causes of deaths, such as the decrease in work and road accidents, could be responsible for the reduction in overall mortality in countries where CCM exceeded EM.⁵ Notably, most of the countries that presented reduced overall mortality during 2020 had extremely high testing capacity and were praised for their effective response measures against the pandemic.⁶

Limitations of our analysis include the lack of stratification by age and sex, the underrepresentation of some areas of the world, and not considering nonpharmaceutical interventions. Despite these drawbacks, our findings corroborate the evidence that in many countries the accuracy in quantifying the death toll of COVID-19 is still a missed target. The global action against the pandemic is being conditioned by diverse responses to the crisis, but reliable evidence should be the pillar on which effective prevention measures are built.

Back to top

Article Information

Accepted for Publication: May 13, 2021.

Published: July 16, 2021. doi:10.1001/jamanetworkopen.2021.17359

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Sanmarchi F et al. JAMA Network Open.

Corresponding Author: Davide Golinelli, MD, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum–University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy (davide.golinelli@unibo.it).

Author Contributions: Dr Sanmarchi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Sanmarchi, Golinelli, Capodici, Gibertoni.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Sanmarchi, Golinelli, Capodici.

Critical revision of the manuscript for important intellectual content: Sanmarchi, Golinelli, Lenzi, Esposito, Reno, Gibertoni.

Statistical analysis: Sanmarchi, Lenzi, Capodici, Gibertoni.

Supervision: Golinelli, Gibertoni.

Conflict of Interest Disclosures: None reported.

References

1.

Bilinski  A, Emanuel  EJ.  COVID-19 and excess all-cause mortality in the US and 18 comparison countries.   JAMA. 2020;324(20):2100-2102. doi:10.1001/jama.2020.20717
ArticlePubMedGoogle ScholarCrossref

2.

Karanikolos  M, McKee  M; European Observatory on Health Systems and Policies. How comparable is COVID-19 mortality across countries? Eurohealth. 2020;26(‎2):45-50. Accessed June 12, 2021. https://apps.who.int/iris/handle/10665/336295

3.

Garber  AM.  Learning from excess pandemic deaths.   JAMA. 2021. Published online April 02, 2021. doi:10.1001/jama.2021.5120
ArticlePubMedGoogle Scholar

4.

Woolf  SH, Chapman  DA, Sabo  RT, Zimmerman  EB.  Excess deaths from COVID-19 and other causes in the US, March 1, 2020, to January 2, 2021.   JAMA. 2021;325(17):1729-1730. doi:10.1001/jama.2021.5199
ArticlePubMedGoogle ScholarCrossref

5.

Davies  NG, Kucharski  AJ, Eggo  RM, Gimma  A, Edmunds  WJ; Centre for the Mathematical Modelling of Infectious Diseases COVID-19 working group.  Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study.   Lancet Public Health. 2020;5(7):e375-e385. doi:10.1016/S2468-2667(20)30133-XPubMedGoogle ScholarCrossref

6.

Wang  CJ, Ng  CY, Brook  RH.  Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing.   JAMA. 2020;323(14):1341-1342. doi:10.1001/jama.2020.3151
ArticlePubMedGoogle ScholarCrossref

 

Three key habitat-building corals face worrying future due to climate crisis

FRONTIERS

Research News

The climate crisis will lead to changes in distribution and habitat loss of stony corals in the tropical Atlantic, shows a new study published by the open access publisher Frontiers. The loss of such coral species could have devastating consequences for the marine ecosystems they inhabit. The results of the study highlight an urgent need for coral reef management in the Atlantic.

Researchers at the University of São Paulo projected current and future distributions of three key reef building corals of the tropical Atlantic (Mussismilia hispida, Montastraea cavernosa and the Siderastrea complex). They conclude that all three species will experience changes in range due to the climate crisis, which will elicit negative cascading effects on the biodiversity of reef ecosystems. The results are published in the journal Frontiers in Marine Science.

Nature's engineers are threatened

Mussismilia hispida, Montastraea cavernosa and the Siderastrea complex are stony corals of the eastern and western Atlantic. They are ecosystem engineers: much like beavers who contribute to the structure of their terrestrial habitats by building dams, stony corals help build reefs by depositing calcium carbonate. They are vital for the health and function of these reefs, which are among the most diverse ecosystems on Earth.

"Coral reefs provide essential ecosystem services such as food provision, coastal protection and nutrient cycling, that benefit millions of people - including those who live far from any coral reef," says lead author and PhD candidate Silas Principe of the University of São Paulo.

"If species that are important in structuring the coral reefs are lost, the provision of all those services is consequently also threatened."

Human activity has long harmed corals worldwide, and coral reefs are already some of the most threatened ecosystems on the planet. Intense and long-lasting mass bleaching events, ocean acidification, pollution, urbanization, fisheries, and tourism are all leading to reduction and loss of coral cover. Now, the climate crisis is adding to those threats.

Climate change leads to changes in coral distribution, with key coral species moving within the tropics or to temperate waters at higher latitudes. Changes in distributions of these key species may have unprecedented cascading effects on entire marine wildlife communities, such as drastic changes in the structural complexity of reef ecosystems.

Concerning findings

Researching possible changes in stony coral distribution is important for planning and management of coral reef conservation. The researchers collected data on M. hispida, M. cavernosa and the Siderastrea complex from different databases and used species distribution models to model their suitability on their current habitat. They also modeled future changes in range under three different climate change scenarios (most pessimistic, most optimistic, and moderate).

They found that, even in the most optimistic scenario, all three species could experience changes in their distributions. Especially in the western Atlantic, decreases in the abundance of stony corals are expected under all three scenarios. Several areas along the Brazilian coast and the Caribbean will lose habitat suitability. These projections are especially critical for the Brazilian coast, where there are fewer habitat-building coral species.

The researchers urge conservation and management efforts to be focused on regions such as the Abrolhos region, northeast coast of Brazil, western Caribbean, and the Gulf of Mexico. "We show that important reef builder species of the Atlantic will face shifts in its distribution due to climate change," Principe said.

"Certain areas, such as the Abrolhos region in the coast of Brazil, will completely lose at least one of its species in any of the future scenarios. Major areas in the Caribbean will also lose species in the future, although in the coast of Africa some species may expand their current range."

But the results also indicate that there is hope for Atlantic stony corals. "Although our results predict major negative impacts on Atlantic shallow reefs, we also identified several areas where none or less changes are predicted. Managers and policy makers can use this to support the planning process of conservation areas." Principe concludes: "Researchers and conservationists can use these results to focus research efforts on the so-called 'refuge areas' that may constitute safe areas for coral species in the future."

###