From an outbreak of mysterious lung-injury deaths to America’s near loss of measles elimination status, the beginning of the end of the U.S. HIV epidemic to the Ebola outbreak in the Democratic Republic of the Congo (DRC), CDC worked around the clock – and around the globe – to protect Americans from domestic and global health threats in 2019.
Here’s a closer look at some of the biggest health issues that CDC tackled this year:
Responding to outbreaks and threats
Lung Injuries linked to E-Cigarette use, Vaping, (EVALI)-
CDC continues investigating the outbreak of lung injury associated with the use of e-cigarette, or vaping, products, together with state and local health departments and federal partners, such as the U.S. Food and Drug Administration (FDA).
As of December 10, CDC reported 52 deaths and 2,409 cases of hospitalized EVALI by all 50 states, Washington D.C, Puerto Rico, and the U.S. Virgin Islands.
In a breakthrough, CDC laboratories detected vitamin E acetate in the lungs of EVALI patients – direct evidence suggesting that this sticky substance is present in many EVALI cases. Investigation into other possible causes continues.
In September, CDC activated its Emergency Operations Center (EOC) to enhance the inter-agency response to the EVALI outbreak. EOC activation allowed the agency to increase its coordinated operational support for the response to meet the outbreak’s evolving challenges. CDC is providing assistance in epidemiology, disease surveillance, pathologic consultation, clinical guidance development, and communication.
Drug overdoses continue to be a major problem across America. There were over 70,000 U.S. drug overdose deaths in 2017, the most recent year for which final data are available.
Over two-thirds involved opioids, including heroin and synthetic opioids (such as illicitly manufactured fentanyl and fentanyl analogs). There have also been recent increases in overdose deaths involving cocaine (largely due to contamination with opioids) and methamphetamines and other psychostimulants with misuse potential (both with and without opioids).
The prescribing and dispensing of the overdose-reversing drug naloxone is a critical part of the public health response to the opioid overdose epidemic. Naloxone saves lives – but only if it’s readily available when an overdose occurs.
Antibiotic (AR) and Antimicrobial Resistance (AMR)-
Antibiotic-resistant (AMR) bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year, according to a November 13 CDC report. These are sometimes referred to as antimicrobial-resistant germs.
On average, every 11 seconds someone in the United States gets an antibiotic-resistant (AR) infection – and every 15 minutes, someone dies. When Clostridioides difficile, a bacterium that is not typically resistant but can cause severe diarrhea resulting in death and is associated with antibiotic use, is added to these, the U.S. toll of all the threats exceeds 3 million infections and 48,000 deaths annually.
There were nearly twice as many annual deaths from AR infections as CDC originally reported in 2013. The update comes from previously unavailable data sources. Since then, prevention efforts have reduced deaths from AR infections by 18% overall and by nearly 30% in hospitals. Without continued vigilance, this progress may be challenged by the increasing burden of some infections.
Throughout 2019, CDC investigated and resolved more than 75 outbreaks related to food or animal contact. Notable Salmonella outbreaks were linked to ground beef, raw turkey, pre-cut melons, and papayas. E. coli outbreaks were linked to flour, ground bison, and romaine lettuce. Additionally, there was the largest ever outbreak of Salmonella infections linked to backyard chickens, and an outbreak of drug-resistant Salmonella infections linked to pig-ear dog treats.
A recent Morbidity and Mortality Weekly Report (MMWR) documented persistent racial and ethnic disparities in pregnancy-related deaths. American Indian, Alaska Native, and black women were two to three times as likely to die from a pregnancy-related cause as were white women.
According to a 2019 CDC Vital Signs report, 3 in 5 pregnancy-related deaths could have been prevented. Overall, heart disease and stroke cause more than 1 in 3 pregnancy-related deaths—other leading causes include infections and severe bleeding. The leading causes of death differ by time period throughout pregnancy and after delivery.
Ensuring quality care for mothers throughout pregnancy and the postpartum period can reduce preventable maternal deaths.
This year, there were more U.S. measles cases than in any of the last 25 years. As of December 5, CDC reported 1,276 cases of measles in 31 states for 2019. This is the largest number of cases reported in the U.S. since 1992 (963 cases).
The U.S. maintained its measles elimination status of nearly 20 years after a nearly year-long outbreak in New York City and New York State ended in the fall. The high number of cases in 2019 was primarily the result of a few large outbreaks – one in Washington State and two large outbreaks in New York that started in late 2018, all of them among close, tight-knit communities. Despite high nationwide coverage with the measles, mumps, and rubella vaccine, there are still communities where low vaccination rates leave people vulnerable to these dangerous diseases.
Immunization and Vaccination-
According to a 2019 CDC Vital Signs report, nearly two-thirds of pregnant women in the United States have not received the two vaccines recommended during pregnancy for influenza and whooping cough (pertussis). Low rates of vaccination during pregnancy leave expecting moms and babies unprotected and at high risk for hospitalization and even death.
To date, influenza activity for the 2019-2020 season in the United States remains low. Receiving a seasonal influenza vaccine each year remains the best way to prevent seasonal flu. CDC recommends annual influenza vaccination for everyone 6 months and older with any licensed, influenza vaccine that is appropriate for the recipient’s age and health status. In addition to keeping you from getting sick with flu, the vaccine has other benefits including being life-saving for children, protecting pregnant women and their babies, and reducing the risk of a heart attack in people with heart disease.
A recent study published in CDC’s Morbidity and Mortality Weekly Report revealed that an estimated 92% of cancers caused by the human papilloma virus (HPV) could be prevented by the HPV vaccine. CDC recommends that all preteens get the multi-dose HPV vaccine when they are 11 or 12 years old – before they are ever exposed to the virus. However, according to the 2018 National Immunization Survey Teen, only 51% of all teens received all recommended doses of the HPV vaccine.
Domestic Preparedness and Global Health Security
As the outbreak in the Democratic Republic of the Congo (DRC) continues, the number of Ebola cases has reached 3,313 and more than 2,204 deaths. To rapidly identify cases and prevent further spread of Ebola, CDC continues to work with the U.S. embassy in DRC to rapidly respond to “hotspots” where the security situation is permissible. CDC also continues to closely coordinate with partners across the Department of Health and Human Services on continuing efforts to fight this outbreak.
In June, CDC activated its Emergency Operations Center (EOC) to support the coordinated inter-agency response to the outbreak in eastern DRC. As of December 13, 2019, CDC staff have conducted 573 deployments to the DRC, neighboring countries, and WHO headquarters. CDC has permanent staff in the three high-risk countries bordering the outbreak (South Sudan, Rwanda, Uganda), including staff in DRC.
DRC has more than 300 graduates of CDC’s Field Epidemiology and Laboratory Training Program who are playing a central role in this public health response.
2020: Looking Ahead-
In 2020 CDC will remain vigilant to combat these and other urgent threats. Health threats can arise at any time – at home or abroad – and CDC’s most important mission is always to protect the health of the American public from the unexpected.
To learn more about the work of CDC visit : CDC.gov
Thayer School of Engineering at Dartmouth College in Hanover, New Hampshire, has accepted an invitation to partner with Qaanaaq, an Arctic hunting and fishing community in northwestern Greenland, as the residents transition to renewable energy and an affordable, sustainable future.
Funded by a US$2.6 million grant from the National Science Foundation, the project is expected to produce sustainable technological solutions that will also benefit other communities facing the effects of the climate crisis, including areas in the mid-latitudes.
Formerly and still popularly known as Thule or New Thule, Qaanaaq is one of the northernmost towns in the world.
The people of Qaanaaq, many of whom make their living by hunting and fishing through sea ice, asked Mary Albert, a professor of engineering at Thayer, to collaborate with them in their transition to affordable, renewable energy. Albert has worked in Greenland for many years studying snow and climate. She knows the citizens from her previous work and has agreed to lead the new team.
The Thayer team expects to travel to Qaanaaq for two weeks in the spring and two weeks in the fall each year for the next four years starting in April 2020. Previous funding from the Arthur L. Irving Institute for Energy and Society at Dartmouth enabled the team to visit Qaanaaq earlier this year to help identify the area’s needs.
Professor Albert says their work will support the Qaanaaq residents’ hunting and fishing way of living, which is currently unsustainable.
Albert says the people of Qaanaaq are excited about the prospect of decreasing their dependence on diesel and other fossil fuels, which are expensive and unsustainable.
Today, 70 percent (already pretty impressive) of Greenland’s energy is renewable hydropower from melt-fed rivers, but due to the conditions in the Qaanaaq area, many sources of sustainable energy, such as hydropower, are not feasible.
“It’s not a straightforward problem – it’s multifaceted. It involves equity, policy, the economy, ecosystems, societal culture, as well as engineering principles. All those aspects come into innovative solutions for this community,” said Albert.
Albert is confident the team, which includes research scientists, practitioners, and community members in Greenland, will be able to improve living standards as well as create sustainable solutions through the combination of technology innovation, youth education, and governmental policy change.
“In order to have a healthy community, we need to address the economic issues that accompany our energy needs and help promote a more sustainable society,” said Lene Kielsen Holm, who is the Greenland lead for the project. “Economic change would produce many beneficial side effects such as enabling more independence and bringing people back to a more balanced everyday life.”
“This project demonstrates engaged science in action,” said Stephen Doig, who contributed to the grant proposal and will travel with the research team to Greenland as research director at the Irving Institute. “It’s about understanding common goals and aspirations and then helping create and act on a plan.”
The Qaanaaq area in northwestern Greenland was first settled around 2000 BC by the Paleo-Eskimo people migrating from the Canadian Arctic.
The town of Qaanaaq was established in the winter of 1953 when the United States expanded Thule Air Base and forcibly relocated the population of two villages to the north within four days.
The settlement was subsequently moved another 100 km (62 miles) north.
With 656 inhabitants as of 2013, Qaanaaq is now the largest settlement in Greenland’s far north. Its population has been stable with only minor fluctuations since the mid-1990s. With its relatively low population and tradition of hunting, the village currently has more huskies than human residents.
Qaanaaq hosts a remote Comprehensive Nuclear-Test-Ban Treaty Organization infrasound listening station called IS-18, which uses an array of barometric sensors to detect possible nuclear tests around the world. The station is maintained by the Danish Meteorological Institute.
Rounding out the Dartmouth-Qaanaaq team will be Christopher Polashenski, adjunct assistant professor of engineering, and Weiyang (Fiona) Li, an assistant professor of engineering, as well as three Thayer PhD students and a postdoctoral fellow.
“This is an amazing opportunity to link science and human needs directly,” said Polashenski. “Only by understanding the complex linkages between environmental change and human activities can we plan for our future.”
The National Science Foundation grant is part of the NSF’s 10 Big Ideas program, which identifies and invests in research areas at the frontiers of science and engineering.
Navigating the New Arctic, one of the 10 Big Ideas, recognizes that biological, physical, chemical, and social changes in the Arctic will fundamentally alter climate, weather, and ecosystems globally with profound impacts on the world’s economy and security.
© Environment News Service (ENS) 2020. All rights reserved.
If you have an adult family member who is incapable of caring for themselves due to a physical or mental condition, it may be necessary to establish a legal guardianship for that person. A guardian is basically someone appointed by a judge to make decisions on behalf of an incapacitated person, who is known as the “ward.”
Because the ward loses significant legal rights under a guardianship, Florida requires family members and judges to take certain steps before a guardian can be named. One of these steps is for the court to appoint an examining committee of three people. This committee must conduct a “comprehensive examination” of the person under consideration for guardianship. Depending on the circumstances, this must include a physical examination, a mental health examination, and a “functional assessment” of the individual.
Court: Examining Committee Failed to Properly Examine Ward
In a recent decision, Cook v. Cook, the Florida Fourth District Court of Appeals dug a little deeper into this law, looking at what meets the “comprehensive examination” requirement. In this case, a group of siblings asked a judge in Palm Beach County to appoint a guardian for their brother, who they said had been “living like a recluse” in his condo for several years and was “unable to plan for his affairs or make practical decisions.”
The judge appointed the three-member examining committee as required by law. The committee included a primary care doctor, a licensed psychologist, and a layperson. The doctor interviewed the ward, reviewed his file, and determined the ward suffered from “psychosis.” The psychiatrist conducted a similar review and concluded the ward suffered from clinical depression. The layperson said the ward “was in denial” about his mental health.
Based on this and other evidence, the judge decided to place the ward in a guardianship. The ward appealed this decision. And by a 2-1 vote, the Fourth District reversed the trial court's ruling after determining the examining committee failed in its duty to conduct a “comprehensive examination.”
The two-judge majority pointed to the following problems with how the committee completed its task:
● None of the committee members actually “performed a physical examination” of the ward, nor did they explain why they neglected to conduct such an exam.
● The psychologist only conducted a basic mental health exam of the ward. The psychologist also told the court the ward needed “further evaluation.” But the psychologist never performed such an evaluation.
The dissenting judge argued the examining committee did its job properly, and that additional evidence–such as the testimony of the ward's family–was sufficient to justify appointing a guardian.
As you can see from this case, the decision to place an incapacitated adult under a guardianship is not a simple one. Even if you are 100 percent convinced a sibling, parent, or other relative can no longer care for themselves, the law still affords that person certain protections that must be respected. So if you are looking to establish a guardianship, you should speak with an experienced Fort Myers estate planning lawyer who can advise and assist you with the process. Contact the Kuhn Law Firm, P.A., at 239-333-4529 to schedule a free consultation with a member of our team today.
Fifteen years after the U.S. invaded Iraq to turn Saddam Hussein's dictatorship into a beacon of democracy, Iraq's Parliament, amid shouts of "Death to America!" voted to expel all U.S. troops from the country.
Though nonbinding, the expulsion vote came after mobs trashed the U.S. embassy in an assault that recalled Tehran 1979.
What provoked Iraq's Parliament into demanding the ouster of all U.S. troops?
First, the five December U.S. strikes on Iraq's Popular Mobilization Forces in retaliation for a dozen Kataib Hezbollah rocket attacks on U.S. bases, which killed a contractor and wounded four U.S. soldiers.
Then came President Donald Trump's decision to launch a drone-strike and kill Iranian General Qassem Soleimani at Baghdad International Airport. Killed in the same strike was the
Shiite Iraqi leader of Kataib Hezbollah.
During his return flight to Washington Sunday, Trump warned Iraq: Follow through on your demand that all U.S. troops get out, and we will insist that Baghdad repay the money we just spent on a major air base.
Moreover, said Trump, if Iraqis expel U.S. troops, then we will impose upon them "sanctions like they've never seen before, ever. It'll make Iranian sanctions look somewhat tame."
Where do we stand now in Iraq?
Though Sunnis and Kurds abstained, the Iraqi parliament has voted to expel all our troops. The State Department has urged U.S. civilians to flee Iraq. 82nd Airborne units have moved into the region to protect the U.S. embassy. U.S. troops fighting ISIS alongside Iraqi troops have separated themselves and stood down. In Iraq, the war on terrorism is on hold.
Across the Middle East, U.S. diplomats, soldiers and civilians are on alert. The acting prime minister of Iraq, in an echo of Tehran and radical Shiites, is demanding that all 5,200 U.S. soldiers in Iraq depart.
How can our troops, detested by the PMF militias and their thousands of fighters, unwanted by the Iraqi Parliament majority, the acting prime minister, and much of the Shiite majority, remain safely inside the capital city of Baghdad or the country?
What a difference a presidential decision can make.
Two months ago, crowds were in the streets of Iraq protesting Iran's dominance of their politics. Crowds were in the streets of Iran cursing that regime for squandering the nation's resources on imperial adventures in Iraq, Syria, Lebanon, Yemen. Things were going America's way.
Now it is the Americans who are the targets of protests.
Over three days, crowds numbering in the hundreds of thousands and even millions have packed Iraqi and Iranian streets and squares to pay tribute to Soleimani and to curse the Americans who killed him.
As emotions are running high and America's friends in the region are mute, the twin goals of Iran and its militia allies appear clear:
Tehran wants to avoid a war with the United States, but to direct the passions of the moment toward forcing an expulsion of the Americans from the Middle East, beginning with their ouster from Iraq.
Thus, Tehran has signaled that its retaliation, its revenge for the death of Soleimani, a military man, will be proportionate. Tehran is telegraphing an attack on the U.S. military. Hassan Nasrallah, the head of Hezbollah in Lebanon, has called on his followers not to attack innocent Americans in the region but to zero in on U.S. military targets.
Oddly, what the America-haters of the Middle East seek is what Soleimani wanted, and what Trump promised in his campaign of 2016 -- an end to U.S. involvement in the forever wars of the Middle East.
Perhaps, rather than sending troops into Iraq and Kuwait to defend U.S. troops already there, we should accede to the local nationalist demands, start bringing our troops home, and let Iranians, Iraqis, Libyans, Syrians, Yemenis and Afghans settle their quarrels.
Despite the rage in Iran over the killing of Soleimani, the political imperatives that existed before last Friday's drone strike remain.
Iran does not want war with the United States. And Trump wants no war with Iran.
But Iran made a mistake in its extrapolation from that truth.
Assuming that because Trump did not want war, he would recoil from a fight, Soleimani believed he could kill Americans with impunity, as long as his
fingerprints were not on the murder weapon.
Killing Soleimani was just. But what is just is not always wise.
Yet, his killing restores Trump's credibility as a Jacksonian who avoids wars but who, wounded, will stab the enemy who cut him.
Trump has a red line. It is not shooting at American drones but shooting at American soldiers, the drawing of American blood.
The message the rulers of Iran should have received?
If they retaliate for Soleimani by killing American soldiers, diplomats or civilians, using either Iranian troops or proxy militias, Trump will retaliate against Iran itself.
Otherwise, "Come Home, America," George McGovern's slogan from the 1972 presidential campaign, has rarely seemed more relevant.
Patrick J. Buchanan
Hollywood loves taking apart conservatives. So when presented with the idea of men in the highest reaches of the conservative media sexually harassing women at the office, it was manna from heaven.
You'll not find a TV dramatization of Harvey Weinstein's predations ripped from the headlines. There's no movie on the alleged sexual misconduct by Matt Lauer at his hellish NBC offices, or Charlie Rose's at CBS. There is only "Bombshell," a fictionalized account of the hostile, sexist atmosphere at Fox News.
The filmmaker on this one is Jay Roach, who has made a series of comically leftist movies for HBO, such as one on Al Gore being denied the presidency ("Recount") and one on Sarah Palin's losing turn as vice presidential nominee ("Game Change"). Roach's idea of a hero movie was "Trumbo," based on screenwriter Dalton Trumbo, who, in the '40s, slavishly plopped Stalinist talking points into movies and belonged to the Communist Party USA, for which he was blacklisted.
Woe is anyone who goes to these movies expecting a faithful recounting of history. What you get instead is rampant editorializing and fiction. Characters are made up out of whole cloth and placed into real events. In "Bombshell," Fake Megyn Kelly and Fake Gretchen Carlson are digitized into actual Fox News footage. Two other central characters in this anti-Fox hit job -- an evangelical Christian beauty and a snarky, Hillary Clinton-loving lesbian Fox staffer -- are pure inventions.
The lesbian staffer describes the Fox ethos in this way: "You have to adopt the mentality of an Irish street cop. The world is a bad place. People are lazy morons. Minorities are criminals. Sex is sick but interesting. ... Ask yourself, 'What would scare my grandmother or piss off my grandfather?' And that's a Fox story."
Virtually everyone, and this includes Fox employees, has no idea what here is actually true and what is entirely made up. The media suggest the details aren't that important. What's important is "starting a conversation."
So long as that conversation isn't about liberal predators.
To his credit, CNN's Brian Stelter asked Roach: "I'm thinking myself, where's the -- where's the Matt Lauer movie? Where's the Les Moonves? Are those coming? I'm serious." Roach insisted there's a Harvey Weinstein documentary coming, and that someone will make a film about Ronan Farrow's struggles with NBC News in reporting on Weinstein's abuses.
"I would happily make that movie," he claimed. Don't bet a nickel on it.
Oh, how they objected to the concept of composite characters in movies based on real events when the subject was Clint Eastwood's "Richard Jewell," where it's implied that an actual Atlanta Journal-Constitution reporter (now deceased) offered sex for information from a fictional FBI agent. But these voices are silent when it comes to the Fox News-bashing movie.
The same thing is happening with "The Two Popes," a Netflix film spinning a tale about the relationship between crusty, traditionalist Pope Benedict XVI and his forward-looking successor, Pope Francis. Entire conversations are manufactured to dramatize the differences between conservative and liberal takes on the Catholic Church.
Catholic journalist Raymond Arroyo was poignant in saying: "It's a nicely acted fantasia, unmoored from fact, that misses the true character of both men. It is slanderous toward 1 Pope and overly fawning toward the other, serving neither the audience nor history."
If you're looking for historical truth in Hollywood movies, you're looking in the wrong spot.
L. Brent Bozell III
and Tim Graham