tag:theconversation.com,2011:/ca/topics/respiratory-illness-1738/articlesRespiratory illness – The Conversation2023-11-27T13:40:53Ztag:theconversation.com,2011:article/2139982023-11-27T13:40:53Z2023-11-27T13:40:53ZChlorine is a highly useful chemical that’s also extremely dangerous − here’s what to know about staying safe around it<figure><img src="https://images.theconversation.com/files/560460/original/file-20231120-27-fge83s.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C3484%2C2326&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jordanian forensics experts inspect the site of a chlorine gas explosion in the Port of Aqaba in June 2022. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/jordanian-forensics-experts-inspect-the-site-of-a-toxic-gas-news-photo/1241583752">Khalil Mazraawi/AFP via Getty Images</a></span></figcaption></figure><p>Many people encounter chlorine in their daily lives, whether it’s as an ingredient in household bleach or an additive that sanitizes water in swimming pools. Chlorine is also used as an antiseptic, a bleaching agent in the production of paper and cloth, and to kill microorganisms in drinking water.</p>
<p>But this familiar chemical is also extremely toxic. And because it’s ubiquitous in many industries across the U.S., it often is released in chemical accidents and spills. </p>
<p>As a <a href="https://scholar.google.com/citations?user=yI9ON-UAAAAJ&hl=en">pharmaceutical scientist</a>, I study ways in which chemicals and other materials affect the human body. Currently, I am working to develop <a href="https://ehsrc.public-health.uiowa.edu/ehsrc-investigators-receive-niehs-award-to-develop-cationic-camkiin-nanoparticles-that-reduce-chlorine-induced-airway-oxidative-stress/">therapies to counteract chlorine gas exposure</a> and to understand the mechanism by which chlorine harms people. One promising therapy that we are developing is inhalable nanoparticles that counteract lung damage following chlorine gas exposure. </p>
<h2>A common and dangerous chemical</h2>
<p><a href="https://www.rsc.org/periodic-table/element/17/chlorine">Chlorine</a> is an extremely toxic and widely used chemical. In the U.S., it is one of the top five chemicals by production volume, with an output of about 12 million tons (11 million metric tons) <a href="https://www.statista.com/statistics/299725/total-us-plastics-and-chemicals-shipments-by-type/">per year</a>. </p>
<p>A yellow-green gas at room temperature, chlorine is highly reactive, which means that it <a href="https://chemistrytalk.org/chlorine-element/">readily forms compounds with many other chemicals</a>. These reactions often are very intense. Chlorine <a href="https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750024.html">reacts explosively or forms explosive compounds</a> with many common substances, including hydrogen, turpentine and ammonia.</p>
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<a href="https://images.theconversation.com/files/560471/original/file-20231120-26-48hv06.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Poster explaining how to use chlorine and other pool chemicals safely." src="https://images.theconversation.com/files/560471/original/file-20231120-26-48hv06.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560471/original/file-20231120-26-48hv06.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=785&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560471/original/file-20231120-26-48hv06.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=785&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560471/original/file-20231120-26-48hv06.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=785&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560471/original/file-20231120-26-48hv06.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=986&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560471/original/file-20231120-26-48hv06.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=986&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560471/original/file-20231120-26-48hv06.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=986&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Even in everyday uses, chlorine requires special handling and precautions.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/healthywater/swimming/pdf/Pool-Chemical-Safety-USE-poster-p.pdf">CDC</a></span>
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<p>Chlorine gas exposure, even for short periods of time and <a href="http://dx.doi.org/10.1513/pats.201001-008SM">at low levels</a>, leads to eye, throat and nose irritation and causes coughing and breathing problems and burning in the eyes. <a href="http://dx.doi.org/10.1513/pats.201001-008SM">Higher exposure levels</a> can cause chest pain, severe breathing difficulties, pneumonia, vomiting and fluid in the lungs. Very high levels can cause death. Chlorine also can be absorbed through the skin, resulting in pain, swelling, inflammation and blistering. </p>
<p>Our research has shown that exposure to chlorine gas leads to airway inflammation and <a href="http://dx.doi.org/10.1378/chest.123.3_suppl.411s">airway hyperreactivity</a> – swelling and narrowing of the bronchial tubes that carry air to and from your lungs, which makes it harder to breathe. This condition is a characteristic feature of asthma. </p>
<p>Chlorine’s toxicity made it one of the first chemical weapons used on a large scale in warfare. German troops <a href="https://www.denix.osd.mil/rcwmprogram/history/">released it against French and Canadian forces</a> in World War I. More recently, international observers report that <a href="https://apnews.com/article/syria-government-bashar-assad-3b283b4dd01f1765027aa567e53c24be">Syria has used chlorine weapons repeatedly</a> in that country’s civil war. In Iraq, insurgents <a href="https://www.reuters.com/article/us-iraq1/chlorine-bombs-mark-new-guerrilla-tactics-u-s-idUSKRA14854020070222/">used chlorine bombs against U.S. forces</a> in 2007 in and around Baghdad, and the Islamic State reportedly later <a href="https://www.bbc.com/news/world-middle-east-31847427">used chlorine in crude roadside bombs</a> in Iraq.</p>
<h2>Large-scale releases worldwide</h2>
<p>Some recent accidents show how commonly the release or mishandling of chlorine can create life-threatening situations. For example, on April 27, 2023, five workers at a spa in Brooklyn were hospitalized after employees <a href="https://abc7ny.com/midwood-brooklyn-world-spa-hazmat/13190043/">mixed two cleaning chemicals</a>, releasing chlorine gas – a reaction that is <a href="https://doh.wa.gov/community-and-environment/contaminants/bleach-mixing-dangers">surprisingly easy to generate</a>. </p>
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<a href="https://images.theconversation.com/files/560483/original/file-20231120-27-e5h8a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A huge grey plume billows from an industrial facility." src="https://images.theconversation.com/files/560483/original/file-20231120-27-e5h8a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560483/original/file-20231120-27-e5h8a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560483/original/file-20231120-27-e5h8a7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560483/original/file-20231120-27-e5h8a7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560483/original/file-20231120-27-e5h8a7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560483/original/file-20231120-27-e5h8a7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560483/original/file-20231120-27-e5h8a7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A fire burns at the BioLab Inc. chemical plant in Westlake, La., on Aug. 27, 2020. Winds from Hurricane Laura damaged several buildings, and rainwater reached the chemicals stored there, triggering a fire that released a chlorine plume. The U.S. Chemical Safety and Hazard Investigation Board later concluded that the facility was not adequately prepared for extreme weather.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/TropicalWeatherLouisiana/d351c48226b3451d91311a08a5f5ff31/photo">AP Photo/Gerald Herbert</a></span>
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<p>In a larger event, on April 18, 2022, a compressor fire caused a chlorine gas spill inside a <a href="https://www.theadvocate.com/baton_rouge/news/environment/at-least-23-hospitalized-after-chlorine-leak-at-chemical-plant-near-plaquemine-officials-say/article_bef9acf0-c1b8-11ec-98d7-5b060fdac504.html">Dow Chemicals facility</a> close to Plaquemine, Louisiana. Liquid chlorine quickly vaporized into the air and spread into adjoining neighborhoods. At least 23 people were hospitalized. </p>
<p>Large-scale shipments of chlorine can cause widespread injuries and even deaths in the event of accidents. For example, when a freight train derailed in Graniteville, South Carolina, in 2005, a tanker car ruptured and <a href="https://doi.org/10.1177/003335490712200610">released 60 tons of chlorine</a>. Nine people died, 72 were hospitalized and 525 received outpatient medical treatment.</p>
<p>The most dramatic recent case occurred at the <a href="https://www.reuters.com/world/middle-east/four-dead-70-injured-toxic-gas-leak-jordans-aqaba-port-state-tv-2022-06-27/">Port of Aqaba in Jordan</a> on June 27, 2022. A crane dropped a container loaded with 25 tons of chlorine onto a docked ship, where it broke and produced a massive release of toxic gas. The spill killed 13 people and injured more than 260.</p>
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<figcaption><span class="caption">A deadly cloud of chlorine fumes was released after a tank fell onto the deck of a ship while being moved in the Jordanian Port of Aqaba on June 27, 2022.</span></figcaption>
</figure>
<h2>Protecting people from chlorine gas exposure</h2>
<p>Although the risks from chlorine gas exposure have been well understood for over a century, there are no current antidotes. This is because chlorine is a strong oxidizing agent that can <a href="https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx">cause major tissue damage</a> in the body.</p>
<p>People who handle chlorine in the workplace should use respiratory equipment that meets <a href="https://www.cdc.gov/niosh/npg/npgd0115.html">federal regulatory standards</a>. They also should have rubber gloves, a protective apron or other protective clothing, goggles or a face mask, and access to a shower and eye-washing station.</p>
<p>Signs that <a href="https://chemtech-us.com/articles/what-does-chlorine-gas-smell-like-7-telling-signs-of-a-chlorine-gas-leak/">chlorine may be present</a> include a pungent, irritating odor, like very strong cleaning products; a yellowish-green gas; and irritation to the eyes and throat. If you suspect that you may have been exposed to chlorine gas, the <a href="https://www.cdc.gov/chemicalemergencies/factsheets/chlorine.html#anchor_63694">Centers for Disease Control and Prevention recommend</a> moving away from the area and removing all clothing and showering if possible. </p>
<p>Symptoms of chlorine exposure can be treated in a hospital. Therapies include providing patients with humidified oxygen, which is less irritating to the nose and throat than conventional oxygen, and inhaled <a href="https://www.ncbi.nlm.nih.gov/books/NBK548685/">beta-adrenergic agents</a> – medications that are widely used to manage bronchial asthma by relieving lung spasms and reducing airway resistance.</p>
<p>Researchers are studying <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2908650/">other medications</a> that may help reduce the severity of lung injury and help patients recover lung function. These include inhalable therapies that reduce lung damage following chlorine gas exposure and oral tablets or injectable therapies that reduce lung inflammation.</p>
<p>Chlorine is a safe and effective disinfectant <a href="https://www.ready.gov/household-chemical-emergencies">when handled appropriately</a>. But as with other household chemicals, it is very important to understand its risks, read labels before using it, store it in its original container in a secure place and dispose of it safely.</p><img src="https://counter.theconversation.com/content/213998/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aliasger K. Salem receives funding from the National Institutes of Health. He serves on the Executive Board of the American Association for Pharmaceutical Scientists.</span></em></p>Chlorine is a widely used industrial chemical that’s frequently a factor in toxic accidents and workplace injuries. A pharmaceutical expert explains why it’s so hazardous.Aliasger K. Salem, Associate Vice President for Research and Bighley Chair and Professor of Pharmaceutical Sciences, University of IowaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2114812023-09-18T12:20:18Z2023-09-18T12:20:18ZDesert dust storms carry human-made toxic pollutants, and the health risk extends indoors<figure><img src="https://images.theconversation.com/files/547793/original/file-20230912-15-tvy18y.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2995%2C1922&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A massive dust storm billows across the western desert of Iraq on April 26, 2005.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-this-picture-released-by-the-u-s-marine-corps-a-dust-news-photo/52726143">Shannon Arledge/USMC via Getty Images</a></span></figcaption></figure><p>Humans have contended with dust storms for thousands of years, ever since early civilizations appeared in the Middle East and North Africa. But modern desert dust storms are different from their preindustrial counterparts.</p>
<p>Around the world, deserts now increasingly border built structures, including urban dwellings, manufacturing, transportation hubs, sewage treatment and landfills. As a result, desert dust lifts a growing load of <a href="https://openknowledge.worldbank.org/entities/publication/0b891a90-3047-5115-8a3f-2c724b6bec36">airborne pollutants</a> and transports these substances over long distances. </p>
<p>This is happening throughout the Global Dust Belt, an arid to semiarid region that stretches from western China through Central Asia, the Middle East and North Africa. Similar storms occur in the U.S. Southwest and central Australia.</p>
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<a href="https://images.theconversation.com/files/544747/original/file-20230825-29-vmv4js.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="World map showing a concentration of dust storms in the Middle East and North Africa." src="https://images.theconversation.com/files/544747/original/file-20230825-29-vmv4js.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/544747/original/file-20230825-29-vmv4js.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=260&fit=crop&dpr=1 600w, https://images.theconversation.com/files/544747/original/file-20230825-29-vmv4js.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=260&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/544747/original/file-20230825-29-vmv4js.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=260&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/544747/original/file-20230825-29-vmv4js.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=327&fit=crop&dpr=1 754w, https://images.theconversation.com/files/544747/original/file-20230825-29-vmv4js.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=327&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/544747/original/file-20230825-29-vmv4js.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=327&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Global pattern of dust frequency estimated from weather records, 1974-2012.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1002/jgrd.50836">Shao et al., 2013</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>To our thinking, modern desert dust storms have been overlooked as a public health crisis. Elevated exposure to these events is likely to contribute to rising respiratory and other diseases, including <a href="https://doi.org/10.1111/all.15392">asthma and chronic obstructive pulmonary disease</a>. We are <a href="https://scholar.google.com/citations?user=KmHgnMkAAAAJ&hl=en">environmental</a> <a href="https://scholar.google.com/citations?user=sCeK0g8AAAAJ&hl=en">researchers</a> whose work shows a need for better public health practices to protect people from dust storm pollutants. </p>
<h2>Massive, fast-moving dust storms</h2>
<p>To appreciate the scale of the threat, consider the Arabian Peninsula, where asthma rates have been the <a href="https://doi.org/10.1515/reveh-2017-0030">world’s highest for the past two decades</a>. </p>
<p>In spring 2011, one of the <a href="https://doi.org/10.1016/j.aeolia.2020.100592">most severe desert dust storms in recent decades</a> swept across the Middle East at the peak of the dust storm season. Its plumes spread from the west coast of the Persian Gulf to the eastern shores of the Caspian Sea, covering northern Saudi Arabia, southern Iraq, Kuwait and western Iran. One quadrant of this large storm alone covered most of the Arabian Peninsula. </p>
<p>This storm reached vertically as high as 5.5 miles (9 kilometers) above the ground. Its wind speeds exceeded 45 mph (72 kilometers per hour) – higher than average wind speeds in the region. Dust particle concentrations peaked at <a href="https://doi.org/10.1016/j.aeolia.2020.100592">530,000 micrograms per cubic foot</a> (15,000 micrograms per cubic meter), blocking sunlight for days. </p>
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<figcaption><span class="caption">This satellite video shows a large dust storm heading southward over the Arabian Peninsula on March 25, 2011. The persistent dark magenta hue of the leading dust front indicates its exceptionally high dust density.</span></figcaption>
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<p>One study found that a large proportion of individuals exposed to sandstorms <a href="http://dx.doi.org/10.12669/pjms.292.3065">had symptoms</a> that included increased cough, runny nose, wheezing, acute asthmatic attack, eye irritation and redness, headache, sleep disturbance and psychological disturbances. Another study reported that increased dust storm exposure in western Iran led to <a href="https://doi.org/10.1016/j.apr.2016.11.005">increases in hospital admissions</a> for chronic obstructive pulmonary disease and more deaths from respiratory causes. </p>
<h2>Needed: A climate + health framework</h2>
<p>Researchers study desert dust storms in a dozen different fields, each with its own terminology, expertise and body of knowledge. This work includes analyzing satellite images, creating simulation models for predicting dust particle transport, and identifying each dust storm’s particle content. So far, however, the health effects of desert dust storms and their changing particle content have gotten scant attention.</p>
<p>As we discussed in a recent review article, studies have found <a href="https://doi.org/10.1007/s10661-023-11287-6">pollutants in dust storms</a> that include bioreactive metals such as <a href="https://doi.org/10.1016/j.envpol.2020.116190">copper, chromium, nickel, lead and zinc</a>, as well as pesticides, herbicides, radioactive particulates and aerosolized sewage. The extent to which desert dust storms transport a special class of pollution particles, those even smaller than one micron – or one millionth of a meter – is not yet clear.</p>
<p>This is the class of submicron pollutants, abbreviated as PM1.0, which includes degraded microplastics, metallic nanoparticles, diesel exhaust and fine particles from degraded tires. Of all particulate matter classes, submicron particles are the <a href="https://airquality.gsfc.nasa.gov/health#">most harmful to human health</a> because when once inhaled, they enter the bloodstream, affecting every organ in the body, and even crossing the blood-brain barrier.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CMbrgymjOuh/?utm_source=ig_web_copy_link\u0026igshid=MzRlODBiNWFlZA==","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Public health recommendations</h2>
<p>We offer several practices here that we believe would help public health agencies successfully tackle the problem of polluted dust storms.</p>
<p>1: Identify particle content for each dust storm. </p>
<p>Existing technology now makes it possible to identify the types of particles being carried in any particular storm. Scientists can already conduct particle trajectory analysis to trace dust and pollutant particles <a href="https://doi.org/10.1016/j.scitotenv.2014.09.025">back to their sources</a>. </p>
<p>Knowing the particle content of dust storms can identify ways to make these storms less hazardous, whether capping sewage systems or securing waste at ports to prevent materials from being picked up by dust storms. </p>
<p>2: Archive samples from each desert dust storm.</p>
<p>One physical catalog for dust storm particles already exists at the <a href="https://doi.org/10.1111/j.1462-2920.2007.01461.x">19th-century dust storm archive</a> kept by the Natural History Museum at Humboldt University in Berlin. We see a need for a modern archive that collects digital data on particle types, particle trajectory analysis, spatial coordinates and meteorological data. </p>
<p>Keeping both physical samples and data from each dust storm would allow for a comparative understanding of how and why particle content is changing. This has been done to analyze particle content related to <a href="https://doi.org/10.3390/rs12091526">military activity in the Middle East</a>.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/B7TqO55pETL/?utm_source=ig_web_copy_link\u0026igshid=MzRlODBiNWFlZA==","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>3: Protect indoor and closed spaces from the smaller dust storm particles. </p>
<p>During a major dust storm, high-speed winds blow fine particles around windows and doors for days. The particles most likely to penetrate indoors include the smallest, most harmful submicron class. </p>
<p>Typically, a gray, fluffy residue appears inside buildings after a dust storm, but data are not available on the identity and size of these particles. Our concern is that submicron pollutant particles are highly concentrated in this residue.</p>
<p>For a safe cleanup, we recommend that people should avoid dry vacuuming, which lofts particles back into the air. Instead, it is better to remove residues with water and a wet mop. We also recommend wearing face masks indoors before, during and after dust storms, since particulate concentrations start to rise ahead of the main storm. In our view, people should treat dust storm residue inside built structures as hazardous material until studies show otherwise. </p>
<p>4: Educate biomedical and meteorological experts together.</p>
<p>The rising human-made content of desert dust storms, particularly fine and ultrafine submicron particles, is a neglected public health concern that we believe calls for combined medical and meteorological expertise. </p>
<p>By educating biomedical and meteorological experts jointly about dust storms, public health agencies would have more complete strategies for <a href="https://doi.org/10.1002/eap.2275">how to best protect people</a>. It would be valuable to have teams of health and weather experts carry out joint analyses of dust storm exposure data, and then apply the best statistical methods to both civilian and military health records.</p>
<p>Climate change is making already-dry areas around the world <a href="https://www.ipcc.ch/srccl/chapter/chapter-3/">more arid</a>. As deserts increasingly adjoin cities, industry and transportation corridors, desert dust storms will increasingly mirror human activity on land. These storms are becoming flying waste dumps, and we believe a public health perspective will help produce more effective responses.</p><img src="https://counter.theconversation.com/content/211481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fatin Samara has received funding from the American University of Sharjah and the Sharjah Research Academy.</span></em></p><p class="fine-print"><em><span>Claire Williams Bridgwater does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Desert dust storms are increasingly picking up materials like sewage, herbicides and other human-made waste and transporting them on tiny particles that are easy to inhale.Claire Williams Bridgwater, Research Professor in Environmental Science, American UniversityFatin Samara, Professor of Environmental Science, American University of SharjahLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2025942023-04-12T12:09:29Z2023-04-12T12:09:29ZHuman metapneumovirus, or HMPV, is filling ICUs this spring – a pediatric infectious disease specialist explains this little-known virus<figure><img src="https://images.theconversation.com/files/520067/original/file-20230410-5874-jymbdf.jpg?ixlib=rb-1.1.0&rect=34%2C22%2C7634%2C4207&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Human metapneumovirus, or HMPV, peaks in North America from February to May, just on the heels of flu season.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-visiting-young-mother-at-home-for-routine-royalty-free-image/1471832871?phrase=children%20lung%20infection&adppopup=true">martin-dm/E+ via Getty Images</a></span></figcaption></figure><p>In the year 2000, Dutch scientists went on a mission of exploration – not to discover lands or riches, but to identify unknown causes of acute respiratory infections. </p>
<p>These illnesses, from the common cold to pneumonia, have been a plague on mankind throughout history. Most are caused by viruses, so if you’ve ever been told “you probably have a virus” by a clinician, they were likely correct. However, respiratory illnesses can be much more severe than simple colds.</p>
<p>Respiratory infections are the <a href="https://doi.org/10.1016/S0140-6736(12)60560-1">leading cause of death in children under 5 globally</a> and a major reason for hospitalization of children in developed countries. They are also a major cause of disease and death among people at high risk for severe disease, such as premature infants, older adults and those with underlying conditions. </p>
<p>However, meticulous research studies by many groups over decades had failed to identify a virus or bacteria in every person with an acute respiratory illness. Did this failure to detect a microbe result from tests that weren’t good enough, or viruses that doctors and scientists didn’t know about? The answer was partly the first; modern molecular tests are much better, so doctors find more known viruses. </p>
<p>But the Dutch group discovered a new virus, <a href="https://doi.org/10.1038/89098">human metapneumovirus</a>, abbreviated HMPV or MPV, which turns out to be a leading cause of respiratory infections. HMPV often presents like other common respiratory viruses, with congestion, cough and fever.</p>
<p>As a <a href="https://www.pediatrics.pitt.edu/people/john-v-williams-md">pediatric infectious disease specialist and virologist</a>, I have led my team in <a href="https://scholar.google.com/citations?user=Bar0h_8AAAAJ&hl=en">HMPV research for over 20 years</a>, and I’ve personally cared for many children with this infection. I’ve received emails from colleagues, clinicians and parents all over the country and the world with questions about severe and tragically fatal cases. </p>
<p>The U.S. saw a <a href="https://www.cdc.gov/surveillance/nrevss/hmpv/natl-trend.html">spike in HMPV detections</a> during the first few months of 2023. This trend is similar to the <a href="https://theconversation.com/rsv-treatments-for-young-children-are-lacking-but-the-record-2022-cold-and-flu-season-highlights-the-urgency-for-vaccines-and-other-preventive-strategies-195700">higher-than-normal case rates</a> of <a href="https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html">respiratory syncytial virus, or RSV</a>, and influenza in the fall of 2022 and winter of 2023, likely related to decreased population immunity after two years of wearing face masks and social distancing. </p>
<p>Still, I find that many people even in health care are unfamiliar with this virus.</p>
<p><iframe id="eIbPJ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/eIbPJ/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Origins of human metapneumovirus</h2>
<p>The human metapneumovirus was isolated from people with acute respiratory infection and sequenced in 2001 using a combination of specialized culture and molecular techniques.</p>
<p>It is related to RSV, which is the <a href="https://doi.org/10.1136/thoraxjnl-2018-212212">leading cause of serious respiratory infection in children</a> and a major problem in adults. Both viruses are in the same large group with measles, mumps and parainfluenza viruses, all of which are <a href="https://doi.org/10.1128/CMR.00015-11">leading causes of childhood disease</a>. </p>
<p>However, abundant data shows that HMPV is distinct from its cousin RSV in many ways. First, the order of genes in its <a href="https://doi.org/10.1006/viro.2001.1355">genome is quite different</a>. In addition, HMPV is missing two genes that RSV uses to overcome the immune response that would normally target it; yet HMPV has its own ways to <a href="https://doi.org/10.3390/v10090505">block immunity</a>.</p>
<p>Third, genetic analysis by several different groups shows that the <a href="https://doi.org/10.1099/vir.0.2008/006957-0">closest recent ancestor of HMPV</a> is a bird virus, <a href="https://doi.org/10.1099/vir.0.19043-0">avian metapneumovirus</a>. This is an agricultural pathogen of chickens and turkeys. Evolutionary and genetic analysis suggests that the human virus diverged from the bird virus <a href="https://doi.org/10.1371/journal.pone.0152962">several hundred years ago</a>. This is an example of a zoonosis: an <a href="https://theconversation.com/what-is-spillover-bird-flu-outbreak-underscores-need-for-early-detection-to-prevent-the-next-big-pandemic-200494">animal virus that jumps to humans</a>. In this case, HMPV became established as a permanent pathogen of humans. </p>
<p>Understanding how HMPV successfully made the leap might help predict which other animal viruses could be capable of transforming into primary human pathogens. The <a href="https://theconversation.com/as-bird-flu-continues-to-spread-in-the-us-and-worldwide-whats-the-risk-that-it-could-start-a-human-pandemic-4-questions-answered-200204">recent H5N1 bird flu outbreak</a> – which has been transmitted to humans only to a limited extent – illustrates this risk.</p>
<figure>
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<figcaption><span class="caption">HMPV is a common respiratory illness during the spring months that can cause a narrowing of the airways, a barking cough and other nasty symptoms, particularly in children and older adults.</span></figcaption>
</figure>
<h2>HMPV in children</h2>
<p>Despite its being recognized only two decades ago, many studies have confirmed that HMPV is a major cause of respiratory infection in humans. Initial research groups focused on children and quickly discovered that HMPV caused respiratory infections in children worldwide, including <a href="https://doi.org/10.3201/eid0906.030017">Canada</a>, <a href="https://doi.org/10.3201/eid1708.051239">Australia</a>, <a href="https://doi.org/10.1128/JCM.42.1.126-132.2004">Japan</a>, <a href="https://doi.org/10.3201/eid0906.030009">Hong Kong</a>, <a href="https://doi.org/10.1097/INF.0b013e3180621192">South Africa</a> and <a href="https://doi.org/10.1086/383350">Argentina</a>. </p>
<p>Indeed, HMPV is a common cause of acute respiratory disease in children in <a href="https://doi.org/10.1016/S2214-109X(20)30393-4">every country</a> examined, and most children get the infection <a href="https://doi.org/10.1128/JCM.43.3.1213-1219.2005">for the first time by age 5</a>. One study using samples collected over 25 years in the U.S. found that HMPV was the <a href="https://doi.org/10.1056/NEJMoa025472">second most common</a> cause of lung infection in children after RSV. Other studies of multiple children’s hospitals in U.S. cities found that HMPV was the second most common cause of respiratory infections, leading to <a href="https://doi.org/10.1056/NEJMoa1204630">hospitalization</a> and <a href="https://doi.org/10.1056/NEJMoa1405870">pneumonia</a>.</p>
<p>Children with underlying risk factors, such as <a href="https://doi.org/10.2147/RRN.S76270">those born prematurely</a> and those with conditions like <a href="https://doi.org/10.1097/INF.0000000000002038">asthma</a>,
or those who have compromised immune systems, such as organ transplant recipients or children being treated for cancer, are at <a href="https://doi.org/10.1093/jpids/piu100">higher risk for severe HMPV</a>. Most children who become hospitalized with HMPV are otherwise healthy before they acquire it, yet <a href="https://doi.org/10.1093/jpids/piv027">many require intensive care</a> from the illness. </p>
<h2>Not just for kids</h2>
<p>HMPV is also a common cause of <a href="https://doi.org/10.1097/INF.0b013e3181684dac">serious lung infections among adults</a>. This is especially true in adults over 65 years old, or those with underlying conditions. A New York study over four winters found that HMPV was as common in hospitalized older adults as RSV or influenza, <a href="https://doi.org/10.1001/archinte.168.22.2489">with similar rates of ICU care and death</a>. </p>
<p>Studies over three winters in Nashville of adults over age 50 detected <a href="https://doi.org/10.1093/infdis/jis309">rates of HMPV hospitalization</a> and <a href="https://doi.org/10.1111/irv.12234">emergency department visits</a> that were similar to RSV and influenza. HMPV and RSV were more common than the flu in people 65 and older, presumably because many were vaccinated against the flu.</p>
<p>Another national study of adults hospitalized for pneumonia showed that <a href="https://doi.org/10.1056/NEJMoa1500245">HMPV was as common as RSV</a>, and nearly as common as influenza. As in children, HMPV is a particular problem for adults with chronic conditions such as <a href="https://doi.org/10.1086/444392">asthma</a>, <a href="https://doi.org/10.1002/cncr.30599">cancer</a> or <a href="https://doi.org/10.1016/j.jinf.2005.11.010">chronic obstructive pulmonary disease, also called COPD</a>.</p>
<p>Similar to the dire effects of flu and <a href="https://www.politico.com/news/2023/02/15/pandemic-nursing-home-covid-00082913">COVID-19 in nursing homes</a>, HMPV has also caused numerous outbreaks among vulnerable older adults in <a href="https://doi.org/10.3201/eid2502.181298">long-term care facilities</a>.</p>
<h2>Why HMPV is still so underrecognized</h2>
<p>Despite being a common cause of serious respiratory disease, HMPV remains underdiagnosed by clinicians and little recognized by the general population. Most people with an acute respiratory illness don’t get any testing, and if they do, only complex molecular testing can detect HMPV. But this testing is usually done only for hospitalized patients under select circumstances. </p>
<p>People tend to believe what they see, and therefore even health care professionals are most aware of diseases they test for frequently. But HMPV circulates predictably every year, and in North America the <a href="https://doi.org/10.1056/NEJMoa025472">peak is typically February through May</a>. So if you’ve had a cold recently this winter or spring, <a href="https://www.cdc.gov/surveillance/nrevss/hmpv/natl-trend.html">HMPV was a likely culprit</a>. Children’s hospitals around the country are seeing an <a href="https://time.com/6264539/respiratory-virus-not-covid-spring-2023/">increased number of cases</a>, including many in the ICU. Based on past research, this is almost certainly happening in adults too – it’s just that usually only those patients with severe illness are tested for HMPV. </p>
<h2>A dearth of treatments</h2>
<p>Right now, there are no specific antiviral drugs to treat HMPV as there are for flu and COVID-19. As with the many other respiratory viruses that cause colds, most infected people will do just fine with rest and fluids. </p>
<p>But some may develop trouble breathing and need to seek medical attention. Children or adults with serious underlying conditions should be especially careful, and just as with COVID-19, using hand sanitizer and washing hands can <a href="https://theconversation.com/yes-we-should-be-keeping-the-healthier-hand-washing-habits-we-developed-at-the-start-of-the-pandemic-169892">reduce transmission</a>.</p>
<p>Preventive vaccines and antibodies for HMPV are <a href="https://doi.org/10.1128/CVI.00230-15">in development</a> but are still a way off. So, for the moment, wear a mask if you’re sick and avoid others who are sick. You may dodge a repeat engagement with this virus that you’ve had but hadn’t heard of.</p><img src="https://counter.theconversation.com/content/202594/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John V. Williams receives funding from the NIH and CDC. He previously served on a scientific advisory board for Quidel and an independent data monitoring committee for GlaxoSmithKline, neither related to the subject of the article. </span></em></p>Similar to the patterns seen with COVID-19, flu and RSV, HMPV is making a comeback after years of being repressed by people wearing masks and social distancing.John V. Williams, Professor of Pediatrics, Microbiology and Molecular Genetics, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2017872023-03-14T15:51:51Z2023-03-14T15:51:51ZFuel poverty makes you sick – so why has nothing changed since I was a child living in a cold home?<figure><img src="https://images.theconversation.com/files/515162/original/file-20230314-3582-jzxxf9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4928%2C3280&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/child-boy-hand-draws-on-cold-563924788">ARIMAG/Shutterstock</a></span></figcaption></figure><p>During the 1970s and 1980s I grew up in a cold home. On very cold mornings, ice would be crusted on my bedroom window and my every breath would condense in the air.</p>
<p>Things had to be done in a rush to avoid the cold. I remember not wanting to get out of bed, then once I was up, rushing to get dressed in clothes that felt damp before hurrying downstairs to warm them in front of the fan heater. We only ventured from the one warm room in the house each evening if necessary, usually to dash to the toilet or quickly make a cup of tea. Bedrooms were no-go areas until you had to go to sleep – a nightly ritual which involved putting a hot water bottle under the covers half an hour before bedtime then layering up in night clothes, socks and blankets, only to wake up in a cold room once more. </p>
<p>I have been researching cold homes for almost 30 years. The war in Ukraine, rising energy prices and inflation have driven <a href="https://www.theguardian.com/society/2023/feb/28/pressure-jeremy-hunt-as-2m-more-households-fall-into-fuel-poverty">millions more</a> households into fuel poverty. But the fact that this problem has endured over four decades has a lot to do with the poor condition of housing in the UK. Much of it is badly insulated, draughty or hard to ventilate and heat.</p>
<p>Since I started my career, the variety of health consequences of living in cold homes has become widely recognised and well documented. Yet the problem is worse now than when I was a child. </p>
<h2>Cold homes are sickly homes</h2>
<p>For instance, we now know that being unable to afford sufficient heating <a href="https://www.instituteofhealthequity.org/resources-reports/fuel-poverty-cold-homes-and-health-inequalities-in-the-uk/read-the-report.pdf">increases your risk</a> of developing heart disease and respiratory problems. Your mental health suffers too: <a href="https://www.sciencedirect.com/science/article/pii/S0277953622007675">anxiety, stress and depression</a> are more common among residents of inadequately heated homes. Cold homes also exacerbate conditions such as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0360132319300472">arthritis</a> and make you more likely to catch <a href="https://www.sciencedirect.com/science/article/abs/pii/S0301421510000625?via%3Dihub">colds, flu and pneumonia</a>. Living in a cold home was even found to make people less dexterous, increasing the likelihood of <a href="https://www.instituteofhealthequity.org/resources-reports/the-health-impacts-of-cold-homes-and-fuel-poverty/the-health-impacts-of-cold-homes-and-fuel-poverty.pdf">accidents and unintentional injury</a>.</p>
<p>Research has revealed that those at greatest risk of health problems include <a href="https://link.springer.com/article/10.1007/s11356-016-6235-y">older people</a>, <a href="https://www.fuelpovertylibrary.info/sites/default/files/EAGA20%20%282008%29%20%20REPORT%20The%20dynamics%20of%20bad%20housing%20on%20the%20living%20standards%20of%20children.pdf">babies and children</a>, and people with a longstanding illness or disability. </p>
<p>We know that these groups are often more susceptible to the cold and are particularly vulnerable as they tend to spend more time at home. A child living in inadequate housing is at a greater risk of chest and breathing issues, including <a href="https://www.fuelpovertylibrary.info/sites/default/files/EAGA20%20%282008%29%20%20REPORT%20The%20dynamics%20of%20bad%20housing%20on%20the%20living%20standards%20of%20children.pdf">asthma and bronchitis</a>. Young people in cold homes are unhappier than those living in warmer housing, and children living in cold, damp homes <a href="https://www.instituteofhealthequity.org/resources-reports/fuel-poverty-cold-homes-and-health-inequalities-in-the-uk/read-the-report.pdf">miss more school days</a> due to illness and find it harder to study at home.</p>
<figure class="align-center ">
<img alt="Wallpaper marked by black mould in the corner of a room." src="https://images.theconversation.com/files/515165/original/file-20230314-24-sbm6z7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515165/original/file-20230314-24-sbm6z7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515165/original/file-20230314-24-sbm6z7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515165/original/file-20230314-24-sbm6z7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515165/original/file-20230314-24-sbm6z7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515165/original/file-20230314-24-sbm6z7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515165/original/file-20230314-24-sbm6z7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mould can spread in a cold house and poses a big health risk.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mold-fungus-problem-near-heater-hanging-567487411">Cegli/Shutterstock</a></span>
</figcaption>
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<p>The comparatively high number of <a href="https://www.jrf.org.uk/report/cold-comfort-social-and-environmental-determinants-excess-winter-deaths-england-1986-1996">excess winter deaths</a> in the UK compared to other European countries with colder winters has been linked to the country’s poorly insulated housing combined with high levels of fuel poverty. The energy efficiency of a house <a href="https://www.nice.org.uk/guidance/ng6/evidence/evidence-review-1-factors-determining-vulnerability-to-winter-and-coldrelated-mortalitymorbidity-pdf-544621933">largely determines</a> how vulnerable the occupants will be to cold-related health risks.</p>
<p>An inability to meet basic energy needs, such as heating or having a warm bath, is one of the <a href="https://pubmed.ncbi.nlm.nih.gov/25726123/">main contributors</a> to chronic stress in low-income households. Fuel poverty accompanies and <a href="https://wires.onlinelibrary.wiley.com/doi/full/10.1002/wene.455">exacerbates existing inequalities</a>. As well as enduring inadequate housing, those living in fuel poverty are much more likely to experience other forms of deprivation, all of which contribute to a cumulative burden on their health. For example, at present disabled people face <a href="https://www.sciencedirect.com/science/article/abs/pii/S2214629621005430">spiralling energy poverty</a> due to <a href="https://eprints.whiterose.ac.uk/153068/">a combination</a> of their disability, ill health and reduced earning capacity. Being a single parent, experiencing a mental health problem and being out of work are all <a href="https://www.sciencedirect.com/science/article/pii/S0301421519301879">factors</a> which can push people into fuel poverty.</p>
<h2>The benefits of improving homes</h2>
<p>Higher energy prices and the cost of living crisis mean many more people will experience fuel poverty and endure the health consequences. Yet there is abundant evidence demonstrating that tackling cold, inefficient and poorly insulated properties and providing suitable ventilation can benefit asthma and respiratory symptoms, mental wellbeing and <a href="https://pubmed.ncbi.nlm.nih.gov/35742650/">health more generally</a>. Improving the energy efficiency of homes has <a href="https://www.oecd-ilibrary.org/energy/multiple-benefits-of-energy-efficiency_9789264220720-en">multiple benefits</a> for society: by reducing energy use, it can <a href="https://www.sciencedirect.com/science/article/pii/S0301421513002413">cut carbon emissions</a> and <a href="https://www.tandfonline.com/doi/pdf/10.1080/09613218.2017.1314641">improve the finances</a> of people living in them.</p>
<figure class="align-center ">
<img alt="A man fitting insulating foam between wooden buttresses in a roof." src="https://images.theconversation.com/files/515167/original/file-20230314-4604-cpaicg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515167/original/file-20230314-4604-cpaicg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515167/original/file-20230314-4604-cpaicg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515167/original/file-20230314-4604-cpaicg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515167/original/file-20230314-4604-cpaicg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515167/original/file-20230314-4604-cpaicg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515167/original/file-20230314-4604-cpaicg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Installing insulation in household cavities can trap more heat indoors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/worker-overall-setting-thermal-insulating-material-154455053">Kzenon/Shutterstock</a></span>
</figcaption>
</figure>
<p>The most vulnerable people are likely to enjoy the <a href="https://www.sciencedirect.com/science/article/pii/S1353829210001486">biggest health improvements</a> from warmer homes. People with chronic respiratory disease have seen their <a href="https://www.tandfonline.com/doi/pdf/10.1080/09613218.2017.1314641">symptoms improve</a> as a result of lower humidity and increased warmth in winter, which also <a href="https://www.sciencedirect.com/science/article/abs/pii/S027795361500088X">boosts heart health</a>. Making housing more energy efficient and affordable to heat can also <a href="https://www.sciencedirect.com/science/article/pii/S0277953614007758">improve personal relationships</a>, increase feelings of autonomy and <a href="https://shura.shu.ac.uk/18167/1/CRESR_WF_final+Nav%20(2).pdf">reduce distress</a>.</p>
<p>Not only would this improve millions of lives, but recent studies have also shown that large-scale home insulation schemes and programmes to upgrade homes to a decent standard <a href="https://www.bmj.com/content/371/bmj.m4571">reduce hospital admissions</a>, alleviating pressure on health services.</p>
<p>And so I ask, given all this evidence, why hasn’t anything changed since I was a child living in a cold home?</p>
<hr>
<figure class="align-right ">
<img alt="Imagine weekly climate newsletter" src="https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
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<p><strong><em>Don’t have time to read about climate change as much as you’d like?</em></strong>
<br><em><a href="https://theconversation.com/uk/newsletters/imagine-57?utm_source=TCUK&utm_medium=linkback&utm_campaign=Imagine&utm_content=DontHaveTimeTop">Get a weekly roundup in your inbox instead.</a> Every Wednesday, The Conversation’s environment editor writes Imagine, a short email that goes a little deeper into just one climate issue. <a href="https://theconversation.com/uk/newsletters/imagine-57?utm_source=TCUK&utm_medium=linkback&utm_campaign=Imagine&utm_content=DontHaveTimeBottom">Join the 10,000+ readers who’ve subscribed so far.</a></em></p>
<hr><img src="https://counter.theconversation.com/content/201787/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jan Gilbertson undertakes research on cold homes which examines the impact of home improvements on health. These projects have received funding from government, local authorities, third sector organisations and the ESRC. </span></em></p>After decades of research revealing the long-term damage of fuel poverty, the problem is worse than ever.Jan Gilbertson, Senior Research Fellow, Centre for Regional Economic and Social Research, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1994282023-02-09T06:07:02Z2023-02-09T06:07:02ZSeven ways to protect your health when cooking with gas<figure><img src="https://images.theconversation.com/files/508883/original/file-20230208-21-44fnwq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2725%2C1830&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A gas stove can expose you to harmful indoor air pollution.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-preparing-food-kitchen-518576872">Goodbishop/Shutterstock</a></span></figcaption></figure><p>Cooking can pollute the air inside your house to such an extent that breathing in your kitchen may be as safe as breathing by a busy roadside. A poor supply of oxygen can prevent gas or solid fuels burning properly, which produces harmful pollutants such as fine particulate matter and nitrogen oxides which can irritate lungs, increase the risk of asthma, lung cancer and heart disease such as stroke. </p>
<p>The extent of pollution depends on the types of fuel used. In the developed world, the most common fuel is gas and electricity. In developing countries, people depend on more polluting options such as coal, charcoal, wood and cow dung. Children, the elderly, pregnant women and those with existing health conditions are the most vulnerable to the resulting pollution.</p>
<p>About <a href="https://doi.org/10.3390/ijerph20010075">one in eight cases</a> of childhood asthma in the US has been linked to gas cooking stoves. President Biden’s <a href="https://institutions.newscientist.com/article/2332499-what-does-the-inflation-reduction-act-mean-for-us-carbon-emissions/">Inflation Reduction Act</a> will offer households up to US$1,340 to switch from a gas to an electric induction stove.</p>
<p>With colleagues, we <a href="https://doi.org/10.1016/j.envint.2022.107155">measured</a> fine particulate matter concentration in 60 different types of kitchens across 12 cities in Asia, the Middle East, Africa and South America. About 33% of homes used natural gas for cooking, followed by liquid petroleum gas (LPG, 27%), electric stoves (17%), charcoal (14%), kerosene (8%) and ethanol (1%). Interestingly, in-kitchen exposure to this pollution was only 30% lower when using natural gas compared with one of the most polluting fuels, charcoal.</p>
<figure class="align-center ">
<img alt="A clay pot on top of smouldering charcoal fuel." src="https://images.theconversation.com/files/508885/original/file-20230208-27-owqnes.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508885/original/file-20230208-27-owqnes.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508885/original/file-20230208-27-owqnes.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508885/original/file-20230208-27-owqnes.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508885/original/file-20230208-27-owqnes.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508885/original/file-20230208-27-owqnes.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508885/original/file-20230208-27-owqnes.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Charcoal stoves are particularly dangerous to use indoors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thai-traditional-charcoal-burning-clay-stove-425661262">BonNontawat/Shutterstock</a></span>
</figcaption>
</figure>
<p>Policies to replace gas stoves are slow and difficult to implement. If you have one in your home, there are things you can do now to reduce your exposure. Here are our top <a href="https://doi.org/10.15126/900568">seven</a>.</p>
<h2>1. Fry less</h2>
<p>Frying emits more particulate pollution than other methods and can contribute more than half of the total emissions during cooking. Boil and steam food where possible.</p>
<h2>2. Shorten cooking sessions</h2>
<p>Choose recipes and meals that take less time to cook to reduce overall in-kitchen pollution. Vegetarian meals are usually simple, fast and healthy to cook.</p>
<h2>3. Monitor kitchen air quality</h2>
<p>Exposure to indoor carbon dioxide (CO₂) levels <a href="https://learn.kaiterra.com/en/resources/carbon-dioxide-co2#:%7E:text=Around%201000%20ppm%2C%20a%20very,headache%20and%20feel%20physically%20uncomfortable.">exceeding 1,000 parts per million</a> (ppm) can cause headaches and drowsiness, while airborne fine particle concentrations over 15 μgm³ can harm your health. Monitor levels of these pollutants in your kitchen and take steps to improve ventilation when safe levels are exceeded.</p>
<h2>4. Increase ventilation</h2>
<p>Turning on an extraction fan during cooking can reduce your average exposure to airborne fine particles and reduce in-kitchen humidity by up to 40%. Opening kitchen windows and doors during cooking can reduce CO₂ levels by up to 54% more than opening doors alone. Mechanical ventilation using an extraction fan coupled with open doors and windows can reduce your in-kitchen exposure by a <a href="https://doi.org/10.1016/j.envint.2022.107155">factor of two</a> compared with natural ventilation alone. </p>
<figure class="align-center ">
<img alt="A hand presses a button on an extraction fan above an oven." src="https://images.theconversation.com/files/508884/original/file-20230208-27-2nvyyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508884/original/file-20230208-27-2nvyyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508884/original/file-20230208-27-2nvyyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508884/original/file-20230208-27-2nvyyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508884/original/file-20230208-27-2nvyyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508884/original/file-20230208-27-2nvyyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508884/original/file-20230208-27-2nvyyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Always ventilate your kitchen while using the stove.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hood-kitchen-controls-white-extractor-1388056862">Mikhail Artamonov/Shutterstock</a></span>
</figcaption>
</figure>
<h2>5. Use cleaner fuels</h2>
<p>Using natural gas instead of charcoal can reduce your average fine particle exposure during cooking by 1.3 times – and 3.1 for LPG. Kitchens using a combination of LPG and electric cookers reduced in-kitchen CO₂ levels by <a href="https://doi.org/10.1016/j.jobe.2022.105254">more than a third</a> compared with those using kerosene.</p>
<h2>6. Stay out of the kitchen</h2>
<p>Congregating in the kitchen while someone is cooking exposes more people to emissions unnecessarily. It also increases the CO₂ levels, which can be over 7% higher with two or more occupants compared with one.</p>
<h2>7. Reduce fuel stacking</h2>
<p>Relying on multiple fuel types in the kitchen, like a combination of an electric oven and a gas stove, is referred to as fuel stacking and it can prevent people adopting clean cooking practices. People can be encouraged to switch to cleaner cooking fuels and stoves if the relevant fuels and compatible cookstoves and devices are made accessible and affordable.</p>
<figure class="align-center ">
<img alt="A hand switches an electric hob on." src="https://images.theconversation.com/files/508887/original/file-20230208-29-c7sy0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508887/original/file-20230208-29-c7sy0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508887/original/file-20230208-29-c7sy0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508887/original/file-20230208-29-c7sy0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508887/original/file-20230208-29-c7sy0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508887/original/file-20230208-29-c7sy0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508887/original/file-20230208-29-c7sy0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Induction stoves are clean and energy-efficient.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-hand-turns-on-electric-hob-406938001">Africa Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Switching from gas to electric cooking is an obvious choice to reduce in-kitchen exposure to air pollutants and also limit the emissions of greenhouse gases. Policies, infrastructure and public information campaigns are needed to hasten this switch. </p>
<p>Each year <a href="https://www.who.int/news-room/fact-sheets/detail/household-air-pollution-and-health">3.2 million</a> people die prematurely from illnesses associated with household air pollution, largely in the developing world where people lack access to gas for cooking. These areas, mostly rural, are also unlikely to have secure supplies of electricity. Alternative options, such as <a href="https://science.howstuffworks.com/environmental/green-science/solar-cooking1.htm">solar-powered stoves</a>, are much more accessible and affordable, and making such options more widely available could help more people get rid of polluting kitchen equipment.</p>
<hr>
<figure class="align-right ">
<img alt="Imagine weekly climate newsletter" src="https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434988/original/file-20211201-21-13avx6y.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<p><strong><em>Don’t have time to read about climate change as much as you’d like?</em></strong>
<br><em><a href="https://theconversation.com/uk/newsletters/imagine-57?utm_source=TCUK&utm_medium=linkback&utm_campaign=Imagine&utm_content=DontHaveTimeTop">Get a weekly roundup in your inbox instead.</a> Every Wednesday, The Conversation’s environment editor writes Imagine, a short email that goes a little deeper into just one climate issue. <a href="https://theconversation.com/uk/newsletters/imagine-57?utm_source=TCUK&utm_medium=linkback&utm_campaign=Imagine&utm_content=DontHaveTimeBottom">Join the 10,000+ readers who’ve subscribed so far.</a></em></p>
<hr><img src="https://counter.theconversation.com/content/199428/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prashant Kumar receives funding from the EPSRC, NERC, ESRC, and Horizon Europe, a charity and industrial organisation. He is affiliated with the not-for-profit organisation Zero Carbon Guildford. </span></em></p>Fry less, open doors and windows and switch to an electric stove if possible.Prashant Kumar, Professor & Chair in Air Quality and Health; Founding Director, Global Centre for Clean Air Research (GCARE), Co-Director, Institute for Sustainability, University of Surrey, University of SurreyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952922022-11-27T13:09:07Z2022-11-27T13:09:07ZRSV FAQ: What is RSV? Who is at risk? When should I seek emergency care for my child?<figure><img src="https://images.theconversation.com/files/497240/original/file-20221124-14-7r3k7l.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5100%2C2868&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">RSV is the leading cause for hospital stays in infants in developed countries.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><h2>What is RSV?</h2>
<p>Respiratory syncytial virus (RSV) is <a href="https://doi.org/10.1093/cid/ciaa1719">one of many viruses that causes infection of the ear, nose, throat and lungs</a>. It <a href="https://doi.org/10.7150/ijbs.64762">infects people of all ages</a> and can be found worldwide.</p>
<h2>Who is at risk of RSV?</h2>
<p>RSV is an important cause of lung infections in children under two years of age, and is the leading reason for <a href="https://doi.org/10.1155/2017/4521302">hospital stays in children under one year of age (infants) in developed countries</a>. Premature infants, adults above 65 years of age and those with chronic heart and lung conditions are at <a href="https://doi.org/10.1056/nejmoa043951">higher risk for severe disease and hospitalization</a>.</p>
<h2>Why is RSV so prevalent this season?</h2>
<p>Infections due to RSV occur throughout the year, with higher numbers of infections in the late fall to early spring in North America. The start and end of RSV season changes slightly each year, <a href="http://dx.doi.org/10.15585/mmwr.mm6702a4">and infections peak in January and February</a>. Typically, RSV infections occur in two-year cycles — <a href="https://doi.org/10.1001/jamanetworkopen.2021.24650">a year of increased numbers and higher severity of illness alternating with a milder year</a>.</p>
<p>Most children will have had one RSV infection by two years of age, and some may have had more than one infection. Unfortunately, having been infected by RSV does not provide long lasting immunity, although re-infections are usually milder. Although antibodies (proteins made by the immune system in response to infection) are made against RSV, they only last six to 12 months and <a href="https://doi.org/10.1093/infdis/jiac192">require repeated exposure to keep high antibody levels</a>. </p>
<p>This likely explains why RSV infections have an alternating severe-mild cycle: in a bad year, patients develop high levels of antibodies that help protect against infection or a bad infection in the subsequent year.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rsv-experts-explain-why-rates-of-this-virus-are-surging-this-year-194403">RSV: experts explain why rates of this virus are surging this year</a>
</strong>
</em>
</p>
<hr>
<h2>How does RSV spread?</h2>
<p>RSV is spread through two ways:</p>
<ul>
<li><p>Contact with an object that has been sneezed on, coughed on, drooled on, touched or been in the mouth of a person who is sick with RSV. That person, who now has germs on their hands, becomes sick when he/she touches their nose or mouth.</p></li>
<li><p>Breathing in the virus when the infected person coughs or sneezes, within one metre of others, without covering their nose or mouth.</p></li>
</ul>
<h2>What are the symptoms of RSV?</h2>
<p>In general, approximately three to seven days after being infected, people will develop symptoms of a common cold including fever, runny or stuffy nose, sore throat, cough and decreased energy. Patients may complain of muscle aches and their appetite may decrease. Some may have difficulty breathing. The symptoms of infection due to RSV are identical to the symptoms of other respiratory viruses.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/KlHjKaGiWFY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">CBC covers the surge in children needing treatment for respiratory viruses.</span></figcaption>
</figure>
<p>Some patients develop pneumonia (infection of the lungs). Infants may develop bronchiolitis — inflammation (swelling) of the very small tubes that deliver air (oxygen) to the lungs. Infants with bronchiolitis commonly have wheezing — a whistling sound when they breathe out. This whistling sound sometimes is only heard using a stethoscope, but sometimes can be heard even without one. </p>
<p>Bronchiolitis and pneumonia can lead to lower oxygen levels in the blood in some patients. It is important to remember that other respiratory viruses can also lead to pneumonia and bronchiolitis.</p>
<h2>How is RSV treated?</h2>
<p>Since RSV is a virus, use of antibiotics will not lead to shortening of the illness nor will it lead to shortening the period that sick people are infectious to others. There are no antivirals for treatment of RSV infections. Most patients can be managed at home:</p>
<ul>
<li><p>Antipyretics (medications to lower fever) if fever is present. Lowering the fever does not lead to shortening of the illness, but will also treat any muscle aches and the general feeling of being unwell.</p></li>
<li><p>Saline sprays or drops help with nasal congestion, and can be used often without the risk of overdose.</p></li>
<li><p>Commercially available nasal aspirators can be used to help infants and children breathe easier </p></li>
<li><p>Encourage fluids to reduce the risk of dehydration — offer small amounts, but offer often. Fluids for infants should be breastmilk or formula. Older children can be offered a variety of fluids including oral rehydration fluids like <a href="https://www.webmd.com/drugs/2/drug-11147/pedialyte-oral/details">Pedialyte</a>, chicken broth, popsicles, ice cream and jello. Extended periods of only water should be avoided, as should relying on soda. A few days without solid food is not harmful.</p></li>
</ul>
<h2>When should I seek emergency care for my child for RSV?</h2>
<p>Although most patients can be managed at home, there are several reasons to seek medical care. They include:</p>
<ul>
<li>Breathing too hard to sleep or feed properly even when fever is not present;</li>
<li>For infants, feeding has been significantly reduced below normal; </li>
<li>Being excessively sleepy or difficult to wake;</li>
<li>Not urinating in 12 hours.</li>
</ul>
<p>Patients with RSV infections will need to be hospitalized if they need:</p>
<ul>
<li>extra oxygen;</li>
<li>intravenous fluids if they are dehydrated.</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a hospital sign directing people to EMERGENCY CHILDREN / URGENCE ENFANTS" src="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=439&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=439&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497244/original/file-20221124-7159-xc0qpb.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=439&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ontario has asked thousands of family health-care workers to work evenings and weekends to help ease the burden on overwhelmed children’s hospitals.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<h2>How do I protect myself and my family from RSV?</h2>
<p>Although there are no vaccines against RSV, a scientifically prepared antibody, palivizumab, <a href="https://doi.org/10.14745/ccdr.v48i78a08">is recommended to reduce the risk of complications of RSV infection in premature infants and children with chronic lung or heart disease who meet certain criteria</a>. Palivizumab is given as monthly injections during RSV season.</p>
<p>The same general measures that protect against COVID-19 and other respiratory viruses lead to reduced risk of getting infected with RSV:</p>
<ul>
<li>Wash your hands well and often;</li>
<li>Stay two meters from others when in public places — patients with RSV may be infected and capable of infecting others before they have symptoms;</li>
<li>Wear a mask when in enclosed public places.</li>
</ul>
<p>Be a good neighbour and reduce the risk that others will get sick:</p>
<ul>
<li>Stay home from school or work if you are sick;</li>
<li>Cough etiquette — cough into your elbow or a tissue. This reduces the chance that viruses are on your hands, which can then be passed onto others or objects that others may handle.</li>
</ul><img src="https://counter.theconversation.com/content/195292/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Athena McConnell is affiliated with Sanofi as a member of an advisory board related to the development of nirsevimab, an alternate monoclonal antibody against RSV. </span></em></p>As visits to emergency departments surge — and in some cases overwhelm hospitals — here are answers to frequently asked questions about Respiratory syncytial virus (RSV).Athena McConnell, Associate Professor, Pediatric Infectious Diseases, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1936002022-11-21T13:14:55Z2022-11-21T13:14:55ZAir pollution harms the brain and mental health, too – a large-scale analysis documents effects on brain regions associated with emotions<figure><img src="https://images.theconversation.com/files/495285/original/file-20221115-12-5koaz.jpg?ixlib=rb-1.1.0&rect=270%2C90%2C4741%2C3013&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As the planet heats up, air pollution is getting worse.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/california-los-angeles-smog-over-los-angeles-royalty-free-image/916896750?phrase=air%20pollution&adppopup=true">Westend61/Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>People who breathe polluted air experience changes within the brain regions that control emotions, and as a result, they may be more likely to develop anxiety and depression than those who breathe cleaner air. These are the key findings of a systematic review that my colleagues and I recently published in <a href="https://doi.org/10.1016/j.neuro.2022.10.011">the journal NeuroToxicology</a>. </p>
<p>Our interdisciplinary team reviewed more than 100 research articles from both animal and human studies that focused on the effects of outdoor air pollution on mental health and regions of the brain that regulate emotions. The three main brain regions we focused on were the hippocampus, amygdala and the prefrontal cortex. </p>
<p>In our analysis, 73% of the studies reported higher mental health symptoms and behaviors in humans and animals, such as rats, that were exposed to higher than average levels of air pollution. Some exposures that led to negative effects occurred in air pollution ranges that are currently considered “safe” by the <a href="https://www.epa.gov/pm-pollution/national-ambient-air-quality-standards-naaqs-pm">Environmental Protection Agency’s standards</a>. In addition, we discovered that 95% of studies examining brain effects found significant physical and functional changes within the emotion-regulation brain regions in those exposed to increased levels of air pollution. </p>
<p>Most of these studies found that exposure to elevated levels of air pollution is associated with increased <a href="https://theconversation.com/what-is-inflammation-two-immunologists-explain-how-the-body-responds-to-everything-from-stings-to-vaccination-and-why-it-sometimes-goes-wrong-193503">inflammation</a> and changes to the regulation of neurotransmitters, which act as the brain’s chemical messengers.</p>
<h2>Why it matters</h2>
<p>Research into the physical health effects associated with air pollution exposure, such as asthma and respiratory issues, have been <a href="https://www.mdpi.com/1660-4601/17/17/6212">well documented</a> for decades. </p>
<p>But only over the last 10 years or so have researchers begun to understand how air pollution can affect the brain. Studies have shown that small air pollutants, such as ultrafine particles from vehicle exhaust, can affect the brain either <a href="https://doi.org/10.1080/08958370490439597">directly</a>, by traveling through the nose and into the brain, or <a href="https://doi.org/10.1016/j.pharmthera.2020.107523">indirectly</a>, by causing inflammation and altered immune responses in the body that can then cross into the brain.</p>
<p>At the same time, researchers are increasingly documenting the association between air pollution and its negative effects on mental health.</p>
<p>Unfortunately, research suggests that <a href="https://www.epa.gov/air-research/air-quality-and-climate-change-research">air pollution will only worsen</a> as climate change intensifies and carbon emissions remain <a href="https://www.npr.org/2022/06/30/1103595898/supreme-court-epa-climate-change">unregulated</a>. </p>
<p>For this reason, more research into the health effects of air pollution exposure that goes beyond respiratory health outcomes into the realm of biological psychiatry is badly needed. For instance, the neurobiological mechanisms through which air pollution increases risk for mental health symptoms are still poorly understood.</p>
<h2>What still isn’t known</h2>
<p>In addition to our primary findings, our team also identified some notable gaps within the research that need to be addressed in order to paint a fuller picture of the relationship between air pollution and brain health. </p>
<p>Relatively few studies examined the effects of air pollution exposure during early life, such as infancy and toddlerhood, and in childhood and adolescence. This is especially concerning given that the brain <a href="https://doi.org/10.1196/annals.1308.009">continues to develop</a> until young adulthood and therefore may be particularly susceptible to the effects of air pollution. </p>
<p>We also found that within the studies investigating air pollution effects on the brain, only 10 were conducted in humans. While research on animals has extensively
shown that air pollution can cause a host of <a href="https://doi.org/10.1016/j.neuint.2021.104989">changes within the animal brain</a>, the research on how air pollution affects the human brain is much more limited. What’s more, most of the existing brain studies in humans have focused on physical changes, such as differences in overall brain size. More research is needed that relies on a technique called functional brain imaging, which could enable researchers like us to detect subtle or smaller changes that may occur before physical changes. </p>
<p>In the future, our team plans to use brain imaging methods to study how air pollution increases the risk of anxiety during adolescence. We plan to use a variety of techniques, including <a href="https://www.habitatmap.org/airbeam">personal air monitors</a> that children can wear as they go about their day, allowing us to more accurately assess their exposure.</p><img src="https://counter.theconversation.com/content/193600/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clara G. Zundel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In a systematic review of existing studies, researchers found that air pollution such as fine particulate matter can interfere with regions of the brain responsible for emotional regulation.Clara G. Zundel, Postdoctoral Research Fellow in Psychiatry and Behavioral Neurosciences, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1902352022-10-05T23:41:02Z2022-10-05T23:41:02ZPollen does more than make you sneeze. It can cause thunderstorm asthma, even if you’re not asthmatic<figure><img src="https://images.theconversation.com/files/488192/original/file-20221004-23-z8yzc0.jpg?ixlib=rb-1.1.0&rect=204%2C548%2C5259%2C3088&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-has-reflux-acids-park-551855089">Shutterstock</a></span></figcaption></figure><p>Climate change has caused melting icebergs, flooding, and landslides. It can also bring about an <a href="https://pubmed.ncbi.nlm.nih.gov/33228867/">increase</a> in pollen levels, prolong the duration of pollen season, and <a href="https://ehp.niehs.nih.gov/doi/10.1289/EHP173">cause more</a> pollen-related health problems.</p>
<p>Pollen grains landing on the moist membranes of the nose or eyes cause “hay fever” (allergic rhinitis) in <a href="https://www.aihw.gov.au/reports/chronic-respiratory-conditions/allergic-rhinitis-hay-fever/contents/allergic-rhinitis">one in five people</a>. This often leads to a runny or blocked nose and itchy eyes.</p>
<p>During the pollen season, people with asthma are at greater risk of a flare-up. </p>
<p>Pollen can also trigger <a href="https://pubmed.ncbi.nlm.nih.gov/31759647/">thunderstorm asthma</a>, even in those <a href="https://pubmed.ncbi.nlm.nih.gov/33996193/">who haven’t been diagnosed</a> with asthma and hay fever. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lush-grasslands-higher-allergy-risks-what-hay-fever-sufferers-can-expect-from-another-la-nina-season-189982">Lush grasslands, higher allergy risks – what hay fever sufferers can expect from another La Niña season</a>
</strong>
</em>
</p>
<hr>
<h2>What is thunderstorm asthma?</h2>
<p>Thunderstorms <a href="https://pubmed.ncbi.nlm.nih.gov/29880157/">cause</a> a drop in temperature and a sudden rise in humidity. This <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30120-7/fulltext">can cause</a> whole grass pollen grains to rupture into particles that are tiny enough to penetrate deeper into the lungs, which causes thunderstorm asthma. </p>
<p>Because of this, a lot of people – even those with no known asthma – can be affected. </p>
<p>The largest thunderstorm asthma event occurred in Melbourne during the 2016 grass pollen season – some <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13410">10,000 people</a> were affected and hospital emergency departments were over-capacity by <a href="https://pubmed.ncbi.nlm.nih.gov/29880157/">at least 3,000</a> respiratory-related cases. Sadly, ten people also died from asthma that night. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/TMQxBZ9M8g8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">This short Better Health Channel video gives a quick overview of thunderstorm asthma.</span></figcaption>
</figure>
<h2>Who is at risk of thunderstorm asthma?</h2>
<p>Even people who do not have a history of asthma are at risk of thunderstorm asthma. However, research has shown some people can be more susceptible to pollen than others. This includes:</p>
<ul>
<li>those with <a href="https://pubmed.ncbi.nlm.nih.gov/29229087/">pollen allergy</a>, specifically <a href="https://pubmed.ncbi.nlm.nih.gov/34774618/">ryegrass pollen allergy</a></li>
<li>people who have respiratory conditions such as <a href="https://www.jacionline.org/article/S0091-6749(21)01689-4/fulltext">asthma</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29229087/">hay fever</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/26048665/">a cold</a>, and <a href="https://www.safercare.vic.gov.au/clinical-guidance/covid-19/epidemic-thunderstorm-asthma">COVID</a></li>
<li>being outdoors at <a href="https://pubmed.ncbi.nlm.nih.gov/29229087/">the time of the thunderstorm</a></li>
<li>people who are <a href="https://pubmed.ncbi.nlm.nih.gov/29573176/">of Asian ethnicity</a></li>
<li>people living in areas with <a href="https://pubmed.ncbi.nlm.nih.gov/33131877/">lots of plant life</a></li>
<li>children with <a href="https://pubmed.ncbi.nlm.nih.gov/35398553/">a food allergy or eczema</a></li>
<li>those with exposure to high levels of <a href="https://pubmed.ncbi.nlm.nih.gov/34116012/">air pollution</a></li>
<li>those with lower <a href="https://pubmed.ncbi.nlm.nih.gov/15723767/">socioeconomic status</a>, as reduced access to health care and poor quality housing can exacerbate symptoms. </li>
</ul>
<p>In our research, we found people with <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/all.14566">co-existing allergic conditions</a> (such as asthma and hay fever) to be more impacted by pollen compared to those with single allergic conditions (such as asthma only). </p>
<h2>How else can pollen cause harm?</h2>
<p>Even outside of thunderstorms, pollen alone can <a href="https://www.mdpi.com/1660-4601/19/12/7541">cause</a> asthma attacks requiring hospitalisations, respiratory symptoms such as wheezing and runny nose, and reduced lung function, making it harder to breath.</p>
<p>Despite a low mortality rate, allergic asthma and hay fever can cause further <a href="https://pubmed.ncbi.nlm.nih.gov/15698810/">burdens</a> such as additional <a href="https://erj.ersjournals.com/content/21/1/116">health-care costs</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/11029350/">poorer physical and mental health</a>. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1577143799859535874"}"></div></p>
<p>Our yet-to-be-published research has shown grass pollen may trigger a general state of heightened immune responses, leading to increased risk of eczema flares in children. </p>
<p>Other <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15321904">studies</a> have indicated children with eczema experience more symptoms such as a higher intensity of itchiness and rash on days with high levels of grass pollen.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sneezing-with-hay-fever-native-plants-arent-usually-the-culprit-190336">Sneezing with hay fever? Native plants aren't usually the culprit</a>
</strong>
</em>
</p>
<hr>
<h2>How can you prepare?</h2>
<p>So, what can you do to prepare for the grass pollen season and the threat of thunderstorm asthma?</p>
<ul>
<li>download your state’s emergency services app, such as the Victorian Emergency App, which can provide thunderstorm asthma alerts</li>
<li>keep an eye on pollen counts (see below for useful websites)</li>
<li>keep doors and windows closed on high pollen days</li>
<li>use air purifiers<br></li>
<li>stay indoors during high pollen counts or thunderstorm asthma alerts</li>
<li>plant non-allergenic flowers if you have a garden</li>
<li>keep wearing a face mask. <a href="https://pubmed.ncbi.nlm.nih.gov/34277327/">Masks</a> have shown to be very effective in reducing the risk of COVID-19 infection and pollen-induced respiratory symptoms</li>
<li>take anti-asthma medications. Reliever medications are available over-the-counter. Preventer medications offer much stronger protection but require a prescription from a doctor. They also need to be used preventatively in the setting of pollen-induced asthma, or in severe hay fever, to prevent thunderstorm asthma </li>
<li>take antihistamines such as Zyrtec, which can be used both on an as-needed basis or more regularly through the pollen season. However, it does not treat or prevent asthma. </li>
</ul>
<figure class="align-center ">
<img alt="Person uses an asthma inhaler" src="https://images.theconversation.com/files/488189/original/file-20221004-12421-cqj3xb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488189/original/file-20221004-12421-cqj3xb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488189/original/file-20221004-12421-cqj3xb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488189/original/file-20221004-12421-cqj3xb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488189/original/file-20221004-12421-cqj3xb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488189/original/file-20221004-12421-cqj3xb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488189/original/file-20221004-12421-cqj3xb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with diagnosed asthma should take their preventer medication regularly during the pollen season.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/health-medicine-young-girl-using-blue-1503422258">Shutterstock</a></span>
</figcaption>
</figure>
<p>If you know you suffer from asthma, hay fever or pollen allergy, you are at risk of thunderstorm asthma. Aside from taking advantage of warning systems and staying out of the storm, you should see your doctor and have an asthma puffer at hand through the pollen season to keep yourself safe. Your doctor can advise you on the correct treatment. </p>
<p>Research including our own has shown pollen exposure can have a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/all.14566">lagged effect</a> on the lungs and airways. This means asthma attacks or respiratory symptoms can sometimes occur a few days after exposure. So, if you forget to take medications pre-emptively, it’s not too late. However, go to a hospital if it gets severe. </p>
<p>Refer to the following websites for useful daily pollen information in Australia: <a href="https://airrater.org/">AirRater</a> or <a href="https://www.pollenforecast.com.au/">AusPollen</a>.</p><img src="https://counter.theconversation.com/content/190235/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shyamali Dharmage receives funding from the Australian National Health and Medical Research Council (NHMRC). She currently holds investigator-initiated grants from GSK and AstraZeneca for unrelated work. </span></em></p><p class="fine-print"><em><span>Jo Douglass has received honoraria for educational presentations from Astra-Zeneca, GSK, Novartis, Shire, & CSL. She has served on advisory boards: Sanofi-Aventis, Novartis, GSK, Astra-Zeneca, Shire, Immunosis, Equilium and CSL. She has undertaken contracted or investigator-initiated research for unrelated work on behalf of: GSK, Novartis, Immunosis, AstraZeneca, Sanofi-Aventis, Grifols, CSL, BioCryst & Equilium. She has a personal superannuation shareholding in CSL.</span></em></p><p class="fine-print"><em><span>Sabrina Idrose receives funding from the NHMRC Centre for Food and Allergy Research and LifeCourse PhD scholarships.</span></em></p>Pollen can trigger thunderstorm asthma, even in those without diagnosed asthma.Shyamali Dharmage, NHMRC Professorial Fellow, The University of MelbourneJo Douglass, Professor of Medicine, The University of MelbourneSabrina Idrose, PhD Candidate, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1908262022-09-22T12:40:17Z2022-09-22T12:40:17ZWhen should you get the new COVID-19 booster and the flu shot? Now is the right time for both<figure><img src="https://images.theconversation.com/files/485731/original/file-20220920-16871-cf9dvv.jpg?ixlib=rb-1.1.0&rect=140%2C60%2C6569%2C4386&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It is safe to get the newly formulated COVID-19 booster shot and the flu shot at the same time.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-photo-female-nurse-giving-vaccine-to-woman-royalty-free-image/1361778753?adppopup=true">SDI Productions/ E+ via Getty Images</a></span></figcaption></figure><p>At this point in the COVID-19 pandemic, nearly everyone has experienced the panic and uncertainty that come with having mild COVID-like symptoms – such as a cough and sore throat – only to test negative day after day. With cold and flu season just around the corner, that state of frustrating uncertainty is likely to strike most of us again. </p>
<p>Both COVID-19 and the flu are contagious respiratory illnesses that have <a href="https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm">similar symptoms</a>, making it difficult to distinguish between the two viral infections without a lab test. Testing is the only way to know which virus is causing your symptoms. In fact, labs are working to create one test that can detect <a href="https://doi.org/10.1001/jama.2022.11031">both COVID-19 and the flu</a>. </p>
<p>As a <a href="https://hhs.purdue.edu/directory/elizabeth-libby-richards/">nursing professor</a> with <a href="https://scholar.google.com/citations?user=Pdh4gSgAAAAJ&hl=en&oi=ao">experience in public health promotion</a>, I am often asked about the differences between the flu and COVID-19. This year I am fielding many questions about the timing of getting the new COVID-19 booster and the flu shot and whether they can be given together.</p>
<h2>Parsing the symptoms</h2>
<p>Symptoms of both COVID-19 and the flu can range from mild – or no noticeable symptoms at all – to severe. While flu infection does not typically affect one’s ability to taste or smell, <a href="https://my.clevelandclinic.org/health/symptoms/16708-loss-of-taste-and-smell">loss of taste or smell</a> has been a common symptom associated with COVID-19 infection. Both infections can cause fevers, chills, body aches and fatigue. More severe symptoms of either infection include difficulty breathing and subsequent infections like pneumonia. </p>
<p>During the 2021-2022 flu season, <a href="https://www.washingtonpost.com/health/2022/01/05/flurona-coronavirus-flu-symptoms/">the term “flurona”</a> made its way into the COVID-19 vernacular. Flurona refers to a simultaneous infection with both the flu and COVID-19. While only a few cases of co-infections <a href="https://doi.org/10.3389/fmed.2021.681469">have been reported</a>, it would not be surprising to see more of them this coming flu season. Vaccination for both the flu and COVID-19 is your best protection against both.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/JV4WmFSQwmk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">What flurona is – and isn’t.</span></figcaption>
</figure>
<h2>Timing the shots</h2>
<p>With the <a href="https://theconversation.com/will-omicron-specific-booster-shots-be-more-effective-at-combating-covid-19-5-questions-answered-189610">newly formulated COVID-19 booster shot</a> now available and flu season just around the corner, a natural question is whether there is an optimal timing for the two shots.</p>
<p>The answer to that question is to get both as soon as possible. It is important to consider that it takes approximately two weeks after vaccination for the body to develop antibodies from both the <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html">COVID-19 vaccines</a> and the <a href="https://www.cdc.gov/flu/prevent/keyfacts.htm">flu vaccine</a>. </p>
<p>As long as you have completed your primary COVID-19 vaccine series and it has been at least eight weeks since your last COVID-19 booster, now is the time to <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html?">get the updated COVID-19 vaccine</a> that targets both the original strain of SARS-CoV-2 – the virus that causes COVID-19 – and the most recent omicron subvariants. The original COVID-19 vaccines and booster series have dramatically reduced the <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7023e2.htm">number of COVID-19 infection and death rates</a>, as well as <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7112e1.htm">cases of severe COVID-19</a> that lead to hospitalization. </p>
<p>While everyone 6 months of age and older are recommended to receive both the COVID-19 and flu vaccines, certain populations have a higher risk for severe infection, such as <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html">pregnant women</a>, and should be extra vigilant about getting vaccinated. </p>
<p>Further, among those vaccinated against COVID-19, symptoms during an infection <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/breakthrough-infections-coronavirus-after-vaccination#">tend to be milder</a>. However, due in part to the quickly evolving nature of the virus, it’s become clear that immune protection from COVID-19 vaccination or infection does not last forever. While studies show that the primary COVID-19 series maintains efficacy against severe disease and death six months after vaccination, protection against infection decreases by between <a href="https://doi.org/10.1016/S0140-6736(22)00152-0">20% to 30% by six months</a> after vaccination. </p>
<p>This decline in immune protection is exactly <a href="https://www.yalemedicine.org/news/covid-19-booster">why booster shots are so critical</a>. Without a large uptake of <a href="https://theconversation.com/low-vaccine-booster-rates-are-now-a-key-factor-in-covid-19-deaths-and-racial-disparities-in-booster-rates-persist-187272">booster shots in the population</a>, COVID-19 infection rates could surge again.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/UyheqSbbZGA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The updated COVID-19 booster shots are now available.</span></figcaption>
</figure>
<p>Timing is also important with the flu vaccine. Flu cases typically begin to rise in October and peak between December and February, <a href="https://www.cdc.gov/flu/about/season/flu-season.htm">but can last through May</a>. Ideally, people should get vaccinated before flu begins to spread, making <a href="https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm">September or early October</a> the ideal flu vaccination time. </p>
<h2>A difficult flu season ahead</h2>
<p>Due to lockdowns, reduced travel, school closures and mask mandates in the first and second years of the pandemic, both the <a href="https://www.cdc.gov/flu/about/burden/past-seasons.html">2020-2021 and 2021-2022 flu seasons</a> were estimated to have fewer hospitalizations and deaths from the flu compared to many of the pre-pandemic years. </p>
<p>In the fall of 2021, experts became concerned about the potential for a <a href="https://theconversation.com/flu-season-paired-with-covid-19-presents-the-threat-of-a-twindemic-making-the-need-for-vaccination-all-the-more-urgent-169011">COVID-19 and flu “twindemic,”</a> especially as COVID-19 restrictions were lifting and masks were coming off. Fortunately, the worst didn’t bear out – flu numbers in the 2021-2022 season did not return to pre-pandemic levels. However, the possibility of a “twindemic” is not out of the picture for the coming flu season.</p>
<p>Flu seasons are <a href="https://www.cdc.gov/flu/about/burden/faq.htm">inherently difficult to predict</a>. With most people traveling again, schools open, mask mandates lifted and workers headed back to the office, people are undoubtedly going to be exposed to germs that they have been more protected from for the last two and a half years. </p>
<p>To further compound this, flu vaccine rates <a href="https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html#">have been lower during the pandemic</a>, suggesting that Americans may be out of the habit of getting their annual flu shot. </p>
<h2>Pairing the shots</h2>
<p>Many are also wondering whether they can or should get both the updated COVID-19 booster and the flu shot at the same time. The good news is, <a href="https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm">yes, it is safe</a> for both adults and children 12 years of age and up who are eligible for the updated COVID-19 booster to get these vaccines simultaneously. </p>
<p>A recent study found that common vaccine side effects such as pain at the injection site <a href="https://doi.org/10.1001/jamanetworkopen.2022.22241">occurred at slightly higher rates</a> when someone received the flu vaccine and a COVID-19 vaccine at the same time, as opposed to receiving only a COVID-19 booster. However, those reactions, including fatigue and headache, were mild and resolved within a day or two.</p>
<p>You don’t need to make two separate vaccine visits as long as you are due for your next COVID-19 shot. However, I don’t recommend waiting to get your flu shot if you are not yet due for a COVID-19 booster. The Centers for Disease Control and Prevention suggests everyone receive their flu vaccine by <a href="https://www.cdc.gov/flu/season/faq-flu-season-2022-2023.htm">the end of October</a>. But if you miss that deadline, it is absolutely better to get vaccinated later in the season than not at all.</p>
<h2>Community matters too</h2>
<p>Getting the flu and COVID-19 vaccines isn’t just about your own health, it’s about family and community health too. Communities with higher vaccination rates have <a href="https://theconversation.com/what-is-herd-immunity-a-public-health-expert-and-a-medical-laboratory-scientist-explain-170520">fewer opportunities to spread the virus</a>. </p>
<p>Keep in mind <a href="https://www.cdc.gov/flu/prevent/whoshouldvax.htm">that many people cannot be vaccinated</a> because they have weakened immune systems or are undergoing treatments. They depend on those around them for protection. While one person may experience mild symptoms if they contract the flu or COVID-19, they could spread the virus to others who could become severely ill. Because it’s impossible to predict how people will react if they get sick, getting the flu and COVID-19 vaccines is the best prevention strategy.</p><img src="https://counter.theconversation.com/content/190826/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Libby Richards has received funding from the National Institutes of Health. She is is affiliated with the American Public Health Association. </span></em></p>When COVID-19 and the flu co-infect, it’s ‘flurona.’ But such cases are rare, and there are effective ways to protect yourself from both viruses.Libby Richards, Associate Professor of Nursing, Purdue UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1895162022-09-22T12:39:51Z2022-09-22T12:39:51ZCOVID-19 can cause lasting lung damage – 3 ways long COVID patients’ respiration can suffer<figure><img src="https://images.theconversation.com/files/485402/original/file-20220919-12-mtp5y0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2944%2C2036&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lung disease can manifest in a number of ways.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/lung-3d-rendering-imaging-royalty-free-image/1214718462">Mr. Suphachai Praserdumrongchai/iStock via Getty Images Plus</a></span></figcaption></figure><p>“I just can’t do what I used to anymore.” </p>
<p>As <a href="https://uvahealth.com/findadoctor/profile/jeffrey-m-sturek">pulmonologists and</a> <a href="https://uvahealth.com/findadoctor/profile/alexandra-kadl">critical care doctors</a> treating patients with lung disease, we have heard many of our patients recovering from COVID-19 tell us this even months after their initial diagnosis. Though they may have survived the most life-threatening phase of their illness, they have yet to return to their pre-COVID-19 baseline, struggling with activities ranging from strenuous exercise to doing laundry. </p>
<p>These lingering effects, called <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">long COVID</a>, have affected as many as <a href="https://www.statnews.com/2022/07/06/understanding-long-covid-estimates/">1 in 5 American adults diagnosed with COVID-19</a>. Long COVID includes a <a href="https://doi.org/10.1038/s41591-022-01909-w">wide range of symptoms</a> such as brain fog, fatigue, cough and shortness of breath. These symptoms can result from damage to or malfunctioning of <a href="https://doi.org/10.1038/s41591-021-01283-z">multiple organ systems</a>, and understanding the causes of long COVID is a special research focus of the <a href="https://www.hhs.gov/about/news/2022/08/03/biden-harris-administration-releases-two-new-reports-long-covid-support-patients-further-research.html">Biden-Harris administration</a>.</p>
<p>Not all breathing problems are related to the lungs, but in many cases the <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs">lungs are affected</a>. Looking at the lungs’ basic functions and how they can be affected by disease may help clarify what is on the horizon for some patients after a COVID-19 infection.</p>
<h2>Normal lung function</h2>
<p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK539907/">main function of the lungs</a> is to bring oxygen-rich air into the body and expel carbon dioxide. When air flows into the lungs, it is brought into close proximity with the blood, where oxygen diffuses into the body and carbon dioxide diffuses out. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WIAoGZPw0zE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The lungs bring oxygen into and carbon dioxide out of the body.</span></figcaption>
</figure>
<p>This process, as simple as it sounds, requires an extraordinary coordination of air flow, or ventilation, and blood flow, or perfusion. There are <a href="https://www.ncbi.nlm.nih.gov/books/NBK537353/">over 20 divisions</a> in your airway, starting at the main windpipe, or the trachea, all the way out to the little balloons at the end of the airway, called alveoli, that are in close contact with your blood vessels. </p>
<p>By the time a molecule of oxygen gets down to the end of the airway, there are about <a href="https://doi.org/10.1164/rccm.200308-1107OC">300 million</a> of these little alveoli it could end up in, with a total surface area of <a href="https://www.healthline.com/health/alveoli-function#alveoli-structure">over 1,000 square feet (100 square meters)</a> where gas exchange occurs.</p>
<p>Matching ventilation and perfusion rates is critical for basic lung function, and damage anywhere along the airway can lead to difficulty breathing in a number of ways.</p>
<h2>Obstruction – decreased airflow</h2>
<p>One form of lung disease is obstruction of airflow in and out of the body.</p>
<p><a href="https://doi.org/10.1016/j.jaci.2010.01.003">Two common causes</a> of impairments like these are chronic obstructive pulmonary disease and asthma. In these diseases, the airways become narrowed because of either damage from smoking, as is common in COPD, or allergic inflammation, as is common in asthma. In either case, patients experience difficulty blowing air out of their lungs. </p>
<p>Researchers have observed ongoing airflow obstruction in <a href="https://doi.org/10.1148/radiol.212170">some patients who have recovered from COVID-19</a>. This condition is typically treated with inhalers that deliver <a href="https://doi.org/10.1016%2Fj.rmed.2021.106401">medications that open up the airways</a>. Such treatments may also be helpful while recovering from COVID-19.</p>
<h2>Restriction – reduced lung volume</h2>
<p>Another form of lung disease is referred to as <a href="https://www.ncbi.nlm.nih.gov/books/NBK560880/">restriction</a>, or difficulty expanding the lungs. Restriction decreases the volume of the lungs and, subsequently, the amount of air they can take in. Restriction often results from the formation of scar tissue, also called <a href="https://www.mayoclinic.org/diseases-conditions/pulmonary-fibrosis/symptoms-causes/syc-20353690">fibrosis</a>, in the lungs due to injury. </p>
<p>Fibrosis thickens the walls of the alveoli, which makes gas exchange with the blood more difficult. This type of scarring can occur in chronic lung diseases, such as <a href="https://www.nhlbi.nih.gov/health/idiopathic-pulmonary-fibrosis">idiopathic pulmonary fibrosis</a>, or as a result of severe lung damage in a condition called <a href="https://www.nhlbi.nih.gov/health/ards">acute respiratory distress syndrome</a>, or ARDS. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health care provider tests a ventilation helmet on a patient." src="https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485406/original/file-20220919-8366-ys0duh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Patients with acute respiratory distress syndrome due to COVID-19 may be treated with a helmet that provides oxygen, reducing the need for intubation.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/health-workers-test-a-helmet-that-allows-injecting-oxygen-news-photo/1297081646">Guillermo Legaria/Stringer via Getty Images News</a></span>
</figcaption>
</figure>
<p>ARDS can be caused by injuries originating in the lungs, like pneumonia, or severe disease in other organs, like pancreatitis. Around <a href="https://advances.massgeneral.org/research-and-innovation/article.aspx?id=1238">25% of patients</a> who recover from ARDS go on to develop restrictive lung disease. </p>
<p>Researchers have also found that patients who have <a href="https://doi.org/10.1038/s41591-021-01283-z">recovered from COVID-19</a>, especially those who had <a href="https://doi.org/10.1016%2Fj.chest.2021.02.062">severe disease</a>, can later develop restrictive lung disease. COVID-19 patients who require a ventilator may also have recovery rates similar to those who require a ventilator for <a href="https://doi.org/10.1164/rccm.202110-2335oc">other conditions</a>. Long-term recovery of lung function in these patients is still unknown. Drugs treating fibrotic lung disease after COVID-19 are currently undergoing <a href="https://clinicaltrials.gov/ct2/show/NCT04856111">clinical trials</a>.</p>
<h2>Impaired perfusion – decreased blood flow</h2>
<p>Finally, even when air flow and lung volume are unaffected, the lungs cannot complete their function if blood flow to the alveoli, where gas exchange occurs, is impaired. </p>
<p>COVID-19 is associated with an <a href="https://doi.org/10.1001/jama.2022.13072">increased risk for blood clots</a>. If blood clots travel to the lungs, they can cause a life-threatening <a href="https://www.healthline.com/health/pulmonary-embolus">pulmonary embolism</a> that restricts blood flow to the lungs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of alveolus and gas exchange, where oxygen diffuses into the bloodstream and carbon dioxide diffuses out" src="https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485407/original/file-20220919-6421-eq9toa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The alveoli of the lungs are where oxygen diffuses into the bloodstream and carbon dioxide diffuses out.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/alveolus-gas-exchange-royalty-free-illustration/530484347">ttsz/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>In the long term, blood clots can also cause chronic problems with blood flow to the lungs, a condition called <a href="https://foundation.chestnet.org/lung-health-a-z/chronic-thromboembolic-pulmonary-hypertension-cteph/">chronic thromboembolic pulmonary hypertension</a>, or CTEPH. Only <a href="https://doi.org/10.1183/13993003.01792-2016">0.5% to 3% of patients</a> who develop a pulmonary embolism for reasons other than COVID-19 go on to develop this chronic problem. However, there is evidence that severe COVID-19 infections can <a href="https://doi.org/10.1056/NEJMoa2015432">damage the blood vessels of the lung</a> directly and <a href="https://doi.org/10.1111/resp.14101">impair blood flow</a> during recovery.</p>
<h2>What’s next?</h2>
<p>Lungs can work less optimally in these three general ways, and COVID-19 can lead to all of them. Researchers and clinicians are still figuring out ways to best treat the long-term lung damage seen in long COVID. </p>
<p>For clinicians, closely following up with patients who have recovered from COVID-19, particularly those with persistent symptoms, can lead to quicker diagnoses of long COVID. Severe cases of COVID-19 are associated with <a href="https://www.ncbi.nlm.nih.gov/books/NBK570608/">higher rates of long COVID</a>. <a href="https://doi.org/10.1016/j.cell.2022.01.014">Other risk factors</a> for development of long COVID include preexisting Type 2 diabetes, presence of virus particles in the blood after the initial infection and certain types of abnormal immune function.</p>
<p>For researchers, long COVID is an opportunity to study <a href="https://theconversation.com/long-covid-19-and-other-chronic-respiratory-conditions-after-viral-infections-may-stem-from-an-overactive-immune-response-in-the-lungs-186970">the underlying mechanisms</a> of how different types of lung-related conditions that result from COVID-19 infection develop. Uncovering these mechanisms would allow researchers to develop targeted treatments to speed recovery and get more patients feeling and breathing like their pre-pandemic selves once again.</p>
<p>In the meantime, everyone can <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html">stay up to date on recommended vaccinations</a> and use <a href="https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html">preventive measures</a> such as good hand hygiene and masking when appropriate.</p><img src="https://counter.theconversation.com/content/189516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jeffrey M. Sturek has received funding from the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Alexandra Kadl does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Understanding how injury and disease, including COVID-19, can impair lung function can help researchers and clinicians better help patients who are experiencing chronic conditionsJeffrey M. Sturek, Assistant Professor of Medicine, University of VirginiaAlexandra Kadl, Assistant Professor of Medicine and Pharmacology, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1864542022-09-13T12:34:43Z2022-09-13T12:34:43ZAre gas stoves bad for your health? Here’s why the federal government is considering new safety regulations<figure><img src="https://images.theconversation.com/files/503825/original/file-20230110-16-nqlofo.jpg?ixlib=rb-1.1.0&rect=24%2C0%2C8155%2C5457&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Federal regulators are examining the health effects of emissions from gas stoves.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cooking-on-gas-royalty-free-image/1369588167">SolStock via Getty Images</a></span></figcaption></figure><p>Cooks love their gadgets, from countertop slow cookers to instant-read thermometers. Now, there’s increasing interest in <a href="https://theconversation.com/magnetic-induction-cooking-can-cut-your-kitchens-carbon-footprint-151422">magnetic induction cooktops</a> – surfaces that cook much faster than conventional stoves, without igniting a flame or heating an electric coil. </p>
<p>Some of this attention is overdue: Induction has long been popular in Europe and Asia, and it is more energy-efficient than standard stoves. But recent studies have also raised concerns about indoor air emissions from gas stoves. </p>
<p><a href="https://doi.org/10.1021/acs.est.1c04707">Academic researchers</a> and agencies such as the <a href="https://ww2.arb.ca.gov/resources/documents/indoor-air-pollution-cooking">California Air Resources Board</a> have reported that gas stoves can release hazardous air pollutants while they’re operating, and even when they’re turned off. A 2022 study by U.S. and Australian researchers estimates that <a href="https://doi.org/10.3390/ijerph20010075">nearly 13% of current childhood asthma cases</a> in the U.S. are attributable to gas stove use.</p>
<p>Dozens of U.S. cities have adopted or are considering regulations that <a href="https://www.instituteforenergyresearch.org/wp-content/uploads/2021/08/Natural-Gas-Ban-Report_Updated.pdf">bar natural gas hookups in new-construction homes</a> after specified dates to speed a transition away from fossil fuels. At the same time, at least 20 states have adopted laws or regulations that <a href="https://www.cnn.com/2022/02/17/politics/natural-gas-ban-preemptive-laws-gop-climate/index.html">prohibit bans on natural gas</a>. </p>
<p>On Jan. 9, 2023, the U.S. Consumer Product Safety Commission announced that it will consider measures to <a href="https://www.bloomberg.com/news/articles/2023-01-09/us-safety-agency-to-consider-ban-on-gas-stoves-amid-health-fears">regulate hazardous emissions from gas stoves</a>. The agency has not proposed specific steps yet, and said that any regulation will “<a href="https://www.cnn.com/2023/01/09/business/gas-stove-ban-federal-agency/index.html">involve a lengthy process</a>.” On Jan. 11, CPSC Chair Alexander Hoehn-Saric further clarified that the agency was looking for ways to reduce indoor air quality hazards, but <a href="https://www.cpsc.gov/About-CPSC/Chairman/Alexander-Hoehn-Saric/Statement/Statement-of-Chair-Alexander-Hoehn-Saric-Regarding-Gas-Stoves">did not plan to ban gas stoves</a>.</p>
<p>As an <a href="https://scholar.google.com/citations?user=iR82G3IAAAAJ&hl=en">environmental health researcher</a> who does work on housing and indoor air, I have participated in studies that <a href="https://doi.org/10.1016/j.envres.2020.110561">measured air pollution in homes</a> and built models to predict how indoor sources would <a href="https://doi.org/10.1016/j.scitotenv.2022.156625">contribute to air pollution in different home types</a>. Here is some perspective on how gas stoves can contribute to indoor air pollution, and whether you should consider shifting away from gas. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/q_I8xc9hLoU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Natural gas has long been marketed as a clean fuel, but research on its health and environmental effects is calling that idea into question.</span></figcaption>
</figure>
<h2>Respiratory effects</h2>
<p>One of the main air pollutants commonly associated with using gas stoves is nitrogen dioxide, or NO₂, which is a byproduct of fuel combustion. Nitrogen dioxide exposures in homes have been associated with <a href="http://dx.doi.org/10.1097/EDE.0b013e318280e2ac">more severe asthma</a> and <a href="https://doi.org/10.1016/j.envres.2017.07.052">increased use of rescue inhalers in children</a>. This gas can also affect asthmatic adults, and it contributes to both the <a href="https://doi.org/10.1164/rccm.201909-1744OC">development</a> and <a href="httP://dx.doi.org/10.1183/13993003.03432-2020">exacerbation</a> of chronic obstructive pulmonary disease. </p>
<p>Nitrogen dioxide in homes comes both from outdoor air that infiltrates indoors and from indoor sources. Road traffic is the most significant outdoor source; unsurprisingly, levels are higher <a href="https://doi.org/10.1021/acs.est.7b01148">close to major roadways</a>. Gas stoves often are the <a href="https://doi.org/10.3390/ijerph17238972">most substantial indoor source</a>, with a greater contribution from <a href="https://doi.org/10.1021/acs.est.1c04707">large burners that run longer</a>.</p>
<p>The <a href="https://www.aga.org/research/fact-sheets/indoor-air-quality-and-residential-gas-ranges/">gas industry’s position</a> is that gas stoves are a minor source of indoor air pollutants. This is true in some homes, especially with respect to exposures averaged over months or years.</p>
<p>But there are many homes in which gas stoves contribute more to indoor nitrogen dioxide levels than pollution from outdoor sources does, especially for short-term “peak” exposures during cooking time. For example, a study in Southern California showed that around half of homes exceeded a health standard based on the highest hour of nitrogen dioxide concentrations, <a href="https://doi.org/10.1289/ehp.1306673">almost entirely because of indoor emissions</a>. </p>
<p>How can one gas stove contribute more to your exposure than an entire highway full of vehicles? The answer is that outdoor pollution disperses over a large area, while indoor pollution concentrates in a small space. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ZRqOUcVs52k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Ventilation is an essential tool for improving indoor air quality in homes.</span></figcaption>
</figure>
<p>How much indoor pollution you get from a gas stove is affected by the structure of your home, which means that indoor environmental exposures to NO₂ are <a href="https://doi.org/10.2105/AJPH.2011.300119">higher for some people than for others</a>. People who live in larger homes, have working range hoods that vent to the outdoors and have well-ventilated homes in general will be less exposed than those in smaller homes with poorer ventilation.</p>
<p>But even larger homes can be affected by gas stove usage, especially since the air in the kitchen does not immediately mix with cleaner air elsewhere in the home. Using a range hood when cooking, or other ventilation strategies such as opening kitchen windows, can bring down concentrations dramatically. </p>
<h2>Methane and hazardous air pollutants</h2>
<p>Nitrogen dioxide is not the only pollutant of concern from gas stoves. Some pollution with potential impacts on human health and Earth’s climate occurs when stoves aren’t even running. </p>
<p>A 2022 study estimated that U.S. gas stoves not in use emit <a href="https://www.britannica.com/science/methane">methane</a> – a colorless, odorless gas that is the main component of natural gas – at a level that traps as much heat in the atmosphere as <a href="https://doi.org/10.1021/acs.est.1c04707">about 400,000 cars</a>. </p>
<p>Some of these leaks can go undetected. Although gas distributors add an odorant to natural gas to ensure that people will smell leaks before there is an explosion risk, the smell may not be strong enough for residents to notice small leaks. </p>
<p>Some people also have a much stronger sense of smell than others. In particular, those who have lost their sense of smell – whether from COVID-19 or other causes – <a href="https://doi.org/10.10%20that%20were%2021/acs.est.1c08298">may not smell even large leaks</a>. One recent study found that <a href="https://www.usnews.com/news/health-news/articles/2022-07-01/gas-used-in-homes-has-links-to-cancer-leaks-often-undetected">5% of homes had leaks</a> that owners had not detected that were large enough to require repair. </p>
<p>This same study showed that leaking natural gas contained <a href="https://doi.org/10.1021/acs.est.1c08298">multiple hazardous air pollutants</a>, including benzene, a cancer-causing agent. While measured concentrations of benzene did not reach health thresholds of concern, the presence of these hazardous air pollutants could be problematic in homes with substantial leaks and poor ventilation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/503716/original/file-20230110-20-gm9uml.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Infographic showing methane leakage rates from the natural gas system" src="https://images.theconversation.com/files/503716/original/file-20230110-20-gm9uml.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/503716/original/file-20230110-20-gm9uml.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=418&fit=crop&dpr=1 600w, https://images.theconversation.com/files/503716/original/file-20230110-20-gm9uml.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=418&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/503716/original/file-20230110-20-gm9uml.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=418&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/503716/original/file-20230110-20-gm9uml.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/503716/original/file-20230110-20-gm9uml.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/503716/original/file-20230110-20-gm9uml.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Methane leaks from natural gas at all stages of production and use.</span>
<span class="attribution"><a class="source" href="https://www.news.ucsb.edu/sites/default/files/slideshow_images/2014/methane%20figure%201.jpg">UC Santa Barbara</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Reasons to switch: Health and climate</h2>
<p>So, if you live in a home with a gas stove, what should you do and when should you worry? First, do what you can to improve ventilation, such as running a range hood that vents to the outdoors and opening kitchen windows while cooking. This will help, but it won’t eliminate exposures, especially for household members who are in the kitchen while cooking takes place. </p>
<p>If you live in a smaller home or one with a smaller closed kitchen, and if someone in your home has a respiratory disease like asthma or chronic obstructive pulmonary disease, exposures may still be concerning even with good ventilation. Swapping out a gas stove for one that uses magnetic induction would eliminate this exposure while also providing climate benefits. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1480940927359221760"}"></div></p>
<p>There are multiple incentive programs to support gas stove changeovers, given their importance for slowing climate change. For example, the recently signed <a href="https://www.congress.gov/bill/117th-congress/house-bill/5376/text">Inflation Reduction Act of 2022</a>, which includes many provisions to address climate change, offers rebates for the purchase of <a href="https://www.consumerreports.org/appliances/inflation-reduction-act-and-new-electric-appliance-rebates-a3460144904/">high-efficiency electric appliances such as stoves</a>. </p>
<p>Moving away from gas stoves is especially important if you are investing in home energy efficiency measures, whether you are doing it to take advantage of incentives, reduce energy costs or shrink your carbon footprint. Some weatherization steps can reduce air leakage to the outdoors, which in turn can increase indoor air pollution concentrations if residents don’t also <a href="https://doi.org/10.1111/ina.12446">improve kitchen ventilation</a>. </p>
<p>In my view, even if you’re not driven to reduce your carbon footprint – or you’re just seeking ways to cook pasta faster – the opportunity to have cleaner air inside your home may be a strong motivator to make the switch.</p>
<p><em>This article has been updated to reflect the Jan. 11, 2023 statement from the Consumer Product Safety Commission that the agency has no plans to ban gas stoves.</em></p><img src="https://counter.theconversation.com/content/186454/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Levy has received funding from the National Institutes of Health, the U.S. Environmental Protection Agency, the U.S. Department of Housing and Urban Development, and the Health Effects Institute for studies on the contribution of outdoor and indoor sources to air pollution levels in homes.</span></em></p>Natural gas has been marketed for decades as a clean fuel, but a growing body of research shows that gas stoves can contribute significantly to indoor air pollution, as well as climate change.Jonathan Levy, Professor and Chair, Department of Environmental Health, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1761412022-02-02T06:22:01Z2022-02-02T06:22:01ZMy child has croup. Could it be COVID? What do I need to know?<figure><img src="https://images.theconversation.com/files/443970/original/file-20220202-27-157oif1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/six-year-old-girl-coughs-diseased-248440243">Shutterstock</a></span></figcaption></figure><p>With the surge in Omicron cases, doctors are finding presentations of croup in children seeking hospital care for COVID in <a href="https://www.theage.com.au/national/victoria/children-s-hospitals-brace-for-post-holiday-rise-in-covid-cases-20220126-p59rbj.html">Australia</a> and <a href="https://www.medpagetoday.com/special-reports/exclusives/96654">internationally</a>. </p>
<p>In some cases, children presenting to hospital with croup are infected only with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490245/">SARS-CoV-2</a>, the virus that causes COVID. </p>
<p>In other cases, they’re <a href="https://www.ajemjournal.com/article/S0735-6757(21)00135-2/fulltext">co-infected</a> with SARS-CoV-2 and another virus that typically causes croup. </p>
<h2>What is croup and what are the symptoms?</h2>
<p>Croup (laryngotracheobronchitis) occurs when there is inflammation and swelling in the upper respiratory tract of young children (<a href="https://www.healthdirect.gov.au/croup">usually aged under five years</a>) in response to a viral infection. </p>
<p><a href="https://www.mayoclinic.org/diseases-conditions/croup/symptoms-causes/syc-20350348">The most common cause</a> is the parainfluenza virus. Other <a href="https://jamanetwork.com/journals/jama/fullarticle/2731180">culprits</a> include adenoviruses and respiratory syncytial virus (RSV). </p>
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Read more:
<a href="https://theconversation.com/move-over-flu-theres-more-than-one-respiratory-virus-around-5870">Move over flu, there's more than one respiratory virus around</a>
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<p>A typical sign of croup is a barking cough, which sounds like a seal or barking dog. </p>
<p>Croup is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3796596/">more common in boys</a> and typically lasts about <a href="https://www.mayoclinic.org/diseases-conditions/croup/symptoms-causes/syc-20350348">three to five days</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/znIciTc9aKM?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s what a typical croup cough sounds like.</span></figcaption>
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<p>Croup often presents initially <a href="https://jamanetwork.com/journals/jama/fullarticle/2731180">as a respiratory tract infection</a>, with a runny nose, sore throat, cough and fever. </p>
<p>As the inflammation progresses, the inflammatory chemicals that are produced cause capillaries (small blood vessels) to leak fluid, leading to <a href="https://jamanetwork.com/journals/jama/fullarticle/2731180">swelling of air passages</a> in the larynx (voice box), trachea (windpipe) and the bronchi (upper airways of the lungs). </p>
<p>Because young children have narrower airways than older children and adults, this swelling can lead to partial airway obstruction, particularly in younger or smaller children. </p>
<figure class="align-center ">
<img alt="Graphic of croup airways." src="https://images.theconversation.com/files/443964/original/file-20220202-25-769tkl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443964/original/file-20220202-25-769tkl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443964/original/file-20220202-25-769tkl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443964/original/file-20220202-25-769tkl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443964/original/file-20220202-25-769tkl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=451&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443964/original/file-20220202-25-769tkl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=451&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443964/original/file-20220202-25-769tkl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=451&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Swelling can block the airways .</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/croup-400140661">Shutterstock</a></span>
</figcaption>
</figure>
<p>This may lead to <a href="https://vimeo.com/177172985">inspiratory stridor</a> (a high pitched noise when breathing in) and increased work of breathing. </p>
<p>Their respiratory rate (number of breaths per minute) <a href="https://jamanetwork.com/journals/jama/fullarticle/2731180">may increase</a> and they may show signs of increased respiratory effort, for example, their nostrils flaring when taking a breath, and the area at the base of the throat sucking inwards when breathing in (tracheal tug). </p>
<p>As it gets more difficult to breath, the child uses their tummy muscles and muscles between their ribs to <a href="https://jamanetwork.com/journals/jama/fullarticle/2731180">help them breath</a>. They may also become anxious or distressed.</p>
<h2>Why might croup be related to COVID?</h2>
<p>Anything that causes inflammation and swelling in the upper airways of small children can lead to croup symptoms. </p>
<p>The Omicron variant, like the typical viruses that cause croup, is also a respiratory virus. </p>
<p>And unlike the Delta variant, Omicron causes causes most of its inflammation <a href="https://media.nature.com/original/magazine-assets/d41586-022-00007-8/d41586-022-00007-8.pdf">in the upper airways</a> rather than the lungs. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/got-a-child-with-covid-at-home-heres-how-to-look-after-them-166732">Got a child with COVID at home? Here's how to look after them</a>
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</em>
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<p>Croup from illnesses other than COVID is typically <a href="https://www.healthdirect.gov.au/croup">more common in autumn and winter</a>. </p>
<h2>How is croup treated?</h2>
<p>Mild croup – where your child does not have breathing difficulties and is able to eat and drink – can be <a href="https://jamanetwork.com/journals/jama/fullarticle/2731180">managed at home</a>. </p>
<p>Fevers and sore throats can be treated with ibuprofen (in children over three months of age) or paracetamol. Your doctor may also prescribe a steroid medication to reduce inflammation. </p>
<p>Make sure your child has <a href="https://jamanetwork.com/journals/jama/fullarticle/2731180">plenty of fluids</a> as they will lose fluid through fever. </p>
<p>Keep your child as <a href="https://www.healthdirect.gov.au/croup">calm as possible</a> as crying and distress make the condition worse. </p>
<figure class="align-center ">
<img alt="Dad takes African-Australian boy's temperature while he lays in bed." src="https://images.theconversation.com/files/443972/original/file-20220202-23-qbxzo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443972/original/file-20220202-23-qbxzo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443972/original/file-20220202-23-qbxzo7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443972/original/file-20220202-23-qbxzo7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443972/original/file-20220202-23-qbxzo7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443972/original/file-20220202-23-qbxzo7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443972/original/file-20220202-23-qbxzo7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Croup can often start with a runny nose and fever.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sick-little-boy-lying-bed-under-1835892958">Shutterstock</a></span>
</figcaption>
</figure>
<p>If the symptoms become worse, in moderate croup, <a href="https://www.rch.org.au/clinicalguide/guideline_index/Croup_Laryngotracheobronchitis/">steroids</a> are used to reduce inflammation and swelling. </p>
<p>In more severe cases, children are given <a href="https://www.rch.org.au/clinicalguide/guideline_index/Croup_Laryngotracheobronchitis/">nebulised adrenaline</a>, which works rapidly to reduce airway swelling. </p>
<p>Prevention of croup relies on preventing viral infections, so practice good hand hygiene and respiratory etiquette (coughing into your elbow). </p>
<p>Other measures to prevent SARS-CoV-2 infection include vaccination of eligible family members, good ventilation at home (get a good through draft with doors and windows open where possible), and having kids play outdoors. </p>
<h2>When to see a doctor or call an ambulance</h2>
<p>Seek immediate medical advice if your child is having trouble eating or drinking, showing signs of respiratory distress, is sick for more than four days, or aged less than six months of age. Or if you’re concerned for <a href="https://www.healthdirect.gov.au/croup">another reason</a>. </p>
<p>(For a more complete list of when to see a doctor for croup, see the government’s <a href="https://www.healthdirect.gov.au/croup">Healthdirect fact sheet</a>). </p>
<p>Call an ambulance if your child is <a href="https://www.healthdirect.gov.au/croup">struggling to breathe</a>, becomes pale and drowsy, looks very sick, starts drooling or can’t swallow, or develops cyanosis (blue lips).</p><img src="https://counter.theconversation.com/content/176141/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thea van de Mortel teaches into the graduate infection prevention and control program at Griffith University.</span></em></p>Doctors are finding presentations of croup in children seeking hospital care for COVID.Thea van de Mortel, Professor, Nursing and Deputy Head (Learning & Teaching), School of Nursing and Midwifery, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1710152021-11-09T10:42:41Z2021-11-09T10:42:41ZDitching fossil fuels will have immediate health benefits for millions – world leaders must seize the chance<figure><img src="https://images.theconversation.com/files/431017/original/file-20211109-15-2n5yq6.jpg?ixlib=rb-1.1.0&rect=0%2C188%2C5472%2C3448&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> </figcaption></figure><p>Carbon dioxide (CO₂) emitted by burning fossil fuels for energy today will only be removed from the atmosphere by natural sinks – like forests and the ocean – in the next <a href="https://www.ipcc.ch/report/ar4/wg1/">300 to 1,000 years</a>. That means the climate benefits of transitioning to clean energy become apparent on far longer timescales than political term limits and election cycles. <a href="https://www.pnas.org/content/118/46/e2104061118">A US study</a>, for example, found that deep cuts to emissions from the energy sector will not result in climate cooling until after 2100.</p>
<p>The costs of mitigating climate change outweigh the immediate benefits to the climate. Politicians seeking recognition for their actions at climate change conferences like COP26 in Glasgow have little motive to deliver policies which slash emissions quickly. But there is a large, short-term benefit to eradicating fossil fuels for global health. </p>
<p>The same fossil fuels producing the greenhouse gases warming the Earth’s atmosphere also form large quantities of air pollutants. The pollutants most hazardous to health are small particles which can penetrate deep into the lungs. These particles have diameters of no more than 2.5 micrometers, so are called PM2.5. At least 800 of these particles could fit end-to-end on the head of a pin. These fall out of the air when it rains, so they persist in the atmosphere for a much shorter time (<a href="https://ofmpub.epa.gov/eims/eimscomm.getfile?p_download_id=494959">just a few days</a>) than CO₂. </p>
<p>In <a href="https://www.sciencedirect.com/science/article/pii/S0013935121000487">a study</a> we published earlier in 2021 in collaboration with researchers at Harvard University, we estimated that exposure to air pollution from using fossil fuels globally accounts for one in five premature deaths. Our results suggest that at least 8.7 million early adult deaths could have been avoided in a single year if countries had already abandoned fossil fuels. This is equivalent to the population of Greater London. </p>
<h2>The health benefits of decarbonisation</h2>
<p>Our estimate of premature deaths <a href="https://www.pnas.org/content/116/15/7192">far exceeds</a> that of other researchers, as we used a model that simulates the sources and fate of air pollution to calculate its abundance on a much finer scale. This gives a more accurate picture of the concentrations of air pollution breathed in by people in urban areas. We then used this to estimate excess deaths using the most up-to-date health studies, which have found that air pollution is deadlier than previously assumed.</p>
<p>The most common causes of premature death from air pollution exposure are heart disease and lung cancer, but <a href="https://journal.chestnet.org/article/S0012-3692(18)32723-5/">researchers routinely report</a> additional illnesses. The World Health Organization (WHO) <a href="https://apps.who.int/iris/handle/10665/345329">recently published</a> much stricter health guidelines for air quality than it last recommended in 2005 based on substantial evidence that exposure to air pollution is even worse for public health than scientists had imagined. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/air-pollution-most-national-limits-are-unsafe-for-human-health-new-who-guidelines-168509">Air pollution: most national limits are unsafe for human health – new WHO guidelines</a>
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<p>Our study is probably an underestimate of the possible public health benefits of abandoning fossil fuels. We only accounted for one type of pollution, PM2.5, which arises from burning fossil fuels. A range of air pollutants form as byproducts in all other steps of the fossil fuel supply chain: from finding, extracting and processing fossil fuels, to storing and transporting them.</p>
<figure class="align-center ">
<img alt="Train cars loaded with coal with a power station in the background." src="https://images.theconversation.com/files/431035/original/file-20211109-19-spnjv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431035/original/file-20211109-19-spnjv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431035/original/file-20211109-19-spnjv2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431035/original/file-20211109-19-spnjv2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431035/original/file-20211109-19-spnjv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431035/original/file-20211109-19-spnjv2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431035/original/file-20211109-19-spnjv2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The fossil fuel industry is an enormous source of air pollution.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/train-coal-mining-export-shipment-1446922142">Mark Agnor/Shutterstock</a></span>
</figcaption>
</figure>
<p>One example is formaldehyde gas, which is emitted during petroleum refining and <a href="https://www.sciencedirect.com/science/article/pii/S1352231014007481">flaring of natural gas</a>. Formaldehyde reacts to form ozone in the lower atmosphere, where it is toxic and can exacerbate asthma symptoms.</p>
<p>We also only focused on adults. The relationship between air pollution and poor health in children isn’t completely understood, but studies so far have shown that exposure to air pollution stunts growth and impedes brain and lung development in children. In a <a href="https://www.theguardian.com/environment/2020/dec/16/girls-death-contributed-to-by-air-pollution-coroner-rules-in-landmark-case">landmark case</a> in 2020, air pollution was directly attributed to the death of Ella Kissi-Debrah, a nine-year-old girl in London. </p>
<p>The health benefits of transitioning to clean energy are substantial and can emerge quickly. They offer a tantalising opportunity for politicians to deliver immediate improvements in the lives of their voters. </p>
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<img alt="COP26: the world's biggest climate talks" src="https://images.theconversation.com/files/424739/original/file-20211005-17-cgrf2z.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/424739/original/file-20211005-17-cgrf2z.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424739/original/file-20211005-17-cgrf2z.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424739/original/file-20211005-17-cgrf2z.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424739/original/file-20211005-17-cgrf2z.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424739/original/file-20211005-17-cgrf2z.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424739/original/file-20211005-17-cgrf2z.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong>This story is part of The Conversation’s coverage on COP26, the Glasgow climate conference, by experts from around the world.</strong>
<br><em>Amid a rising tide of climate news and stories, The Conversation is here to clear the air and make sure you get information you can trust. <a href="https://page.theconversation.com/cop26-glasgow-2021-climate-change-summit/"><strong>More.</strong></a></em> </p>
<hr><img src="https://counter.theconversation.com/content/171015/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eloise Marais receives funding from the UK NERC, the European Commission, the UK DEFRA, and the SEI. </span></em></p><p class="fine-print"><em><span>Karn Vohra receives funding from the University of Birmingham Global Challenges Studentship. </span></em></p>Fossil fuels account for one in five premature adult deaths each year.Eloise Marais, Associate Professor in Physical Geography, UCLKarn Vohra, Research assistant, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1647762021-08-26T01:48:57Z2021-08-26T01:48:57ZRates of COVID might increase in winter, but it’s not necessarily because the virus thrives in the cold<figure><img src="https://images.theconversation.com/files/416755/original/file-20210818-15-d5s5wl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-wearing-medical-protective-mask-dusk-1850607568">Shutterstock</a></span></figcaption></figure><p>Colder weather has long been associated with coughs, colds and other respiratory illnesses. Seasonal influenza and common colds peak throughout the winter months in both hemispheres – usually <a href="https://www.immunisationcoalition.org.au/wp-content/uploads/2018/03/17Dec-Aust-Flu-Stats-2019.pdf">around August</a> in Australia. </p>
<p>Given many common colds are caused by coronaviruses, it seems logical that cases of SARS-CoV-2, the virus that causes COVID-19, would be driven upward as temperatures decline. </p>
<p>But while there are plausible biological explanations for why this occurs, we can’t be certain of the effect of temperature on SARS-CoV-2. There is too little data to make solid conclusions. </p>
<p>Behavioural factors, such as spending more time indoors where viruses are more easily transmitted, are also at play.</p>
<h2>What does the data say?</h2>
<p>COVID case numbers in Australia are at their highest now and were at their second-highest levels 12 months ago, in winter:</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417546/original/file-20210824-23-1s151w5.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/417546/original/file-20210824-23-1s151w5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417546/original/file-20210824-23-1s151w5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417546/original/file-20210824-23-1s151w5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417546/original/file-20210824-23-1s151w5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417546/original/file-20210824-23-1s151w5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417546/original/file-20210824-23-1s151w5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417546/original/file-20210824-23-1s151w5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Australia’s COVID-19 daily case numbers have been highest in August.</span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/coronavirus/country/australia">Our World In Data</a></span>
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</figure>
<p>But this is not true for other countries, especially those in the Northern Hemisphere. In the United Kingdom, for instance, cases peaked last winter, and then again in summer with the Delta variant:</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417934/original/file-20210825-18784-1muu8fy.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/417934/original/file-20210825-18784-1muu8fy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417934/original/file-20210825-18784-1muu8fy.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417934/original/file-20210825-18784-1muu8fy.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417934/original/file-20210825-18784-1muu8fy.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417934/original/file-20210825-18784-1muu8fy.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417934/original/file-20210825-18784-1muu8fy.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417934/original/file-20210825-18784-1muu8fy.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cases in the UK peaked in January 2021 and again last month.</span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/coronavirus/country/united-kingdom">Our World In Data</a></span>
</figcaption>
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<h2>Why do cases often rise in winter? Biological explanations</h2>
<p>Coronaviruses <a href="https://www.tandfonline.com/doi/full/10.1080/02786826.2020.1829536?casa_token=g0kUhMfPDQsAAAAA%3ASsHz6mweEa5jVNVnsAfvPc2fEoFYU0eX6_667ymtb6LqWLC0ThMA5T5lS4O3pSCNrfZdipXrqfTn57U">survive longer</a> in environments of decreased sunlight, lower temperatures and lower relative humidity. </p>
<p>So the amount of active virus in the environment might be greater during the winter months, and in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361302/">cold, dry climates</a>. </p>
<p>In environments with low humidity, there is less water vapour in the air (in other words, the air is dry), and when a COVID-19 positive person coughs, aerosolised particles stay suspended for <a href="https://www1.racgp.org.au/newsgp/clinical/new-research-finds-link-between-covid-19-and-lower">much longer in the air</a>. This increases the potential exposure and transmission to other people.</p>
<p>One study from 2020 reported a link between <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/tbed.13631">COVID-19 and lower humidity</a>. The researchers noted a 1% decrease in humidity could increase the number of COVID-19 cases by 6%. </p>
<p>Another recent <a href="https://bmjopen.bmj.com/content/11/2/e043863">study from the United States and China</a> found higher temperatures and higher relative humidity potentially suppressed COVID-19 transmission. </p>
<p><a href="https://theconversation.com/research-shows-coronavirus-thrives-in-dry-air-and-august-is-coastal-australias-least-humid-month-144508">In Sydney</a>, humidity is lowest in winter, particularly in August, and highest in summer. The same is true for most coastal areas in Australia.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/research-shows-coronavirus-thrives-in-dry-air-and-august-is-coastal-australias-least-humid-month-144508">Research shows coronavirus thrives in dry air (and August is coastal Australia's least humid month)</a>
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<h2>It’s in the air</h2>
<p>On April 30 this year, the <a href="https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-how-is-it-transmitted">World Health Organization updated its guidance</a> on how COVID-19 was transmitted:</p>
<blockquote>
<p>The virus can spread from an infected person’s mouth or nose in small liquid particles when they cough, sneeze, speak, sing or breathe. These particles range from larger respiratory droplets to smaller aerosols.</p>
</blockquote>
<p>These aerosols can remain suspended in the air for up to <a href="https://pubmed.ncbi.nlm.nih.gov/32568661/">16 hours</a>. </p>
<p>So, it’s the shared air that spreads the virus, and that’s why <a href="https://theconversation.com/are-you-wearing-gloves-or-a-mask-to-the-shops-you-might-be-doing-it-wrong-137393">face masks</a> are important.</p>
<h2>Behavioural explanations</h2>
<p>A range of other factors which coincide with winter are likely to have a greater impact on transmission than how the virus behaves in cold climates. </p>
<p>As the colder winter months arrive, we flee the outdoors, instead opting for indoor activities. Some indoor spaces – including shops, restaurants, homes – are poorly ventilated, allowing colds, flus and other <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ina.12766?casa_token=Zr_RRUxir7cAAAAA%3Az6iMhCXLI9fFqlQceF1kdnP6Nv2V_JrPsR_oGoIA5tPyOtD8QwQgO9r73U0QqW6UpJz3jt1UqzU68HFA">respiratory illness</a> such as COVID to spread more easily.</p>
<figure class="align-center ">
<img alt="A man sits on a couch, coughing into a tissue." src="https://images.theconversation.com/files/416761/original/file-20210818-25-qjx5ii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/416761/original/file-20210818-25-qjx5ii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/416761/original/file-20210818-25-qjx5ii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/416761/original/file-20210818-25-qjx5ii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/416761/original/file-20210818-25-qjx5ii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/416761/original/file-20210818-25-qjx5ii.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/416761/original/file-20210818-25-qjx5ii.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Respiratory illnesses spread more easily indoors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-man-getting-cold-flu-sitting-1355494856">Shutterstock</a></span>
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</figure>
<p>In the northern hemisphere, winter also coincides with the holiday season, which sees significant amounts of travel, both international and domestic, and a significant uptick in large social gatherings. In the United Kingdom in January this year, <a href="https://www.bbc.com/news/health-55587491">this caused a significant increase</a> in COVID-19 transmission. </p>
<h2>It’s unlikely due to vitamin D</h2>
<p>Another potential factor in COVID-19 transmission centres on the seasonal change in population-wide vitamin D levels. But so far, this isn’t backed up by evidence. </p>
<p>Vitamin D has received significant attention throughout the pandemic for a potentially protective effect against COVID-19. This was after a number of observational studies identified <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3561958">poorer outcomes in geographical areas</a> with high levels of vitamin D deficiency. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-vitamin-d-ward-off-coronavirus-dont-reach-for-the-supplements-yet-139063">Does vitamin D ward off coronavirus? Don't reach for the supplements yet</a>
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<hr>
<p>Other initial studies also showed <a href="https://www.mdpi.com/2072-6643/12/5/1359">lower levels of vitamin D</a> in those diagnosed with COVID-19. This was theorised to be due to the effect of vitamin D on the immune system, preventing some of the severe inflammatory impacts of the disease, and potentially improving the ability of the <a href="https://www.sciencedirect.com/science/article/pii/S0378512220303467#bib0105">individual to combat the infection</a>. </p>
<p>However, larger studies where one group was given vitamin D supplements and another weren’t have thrown doubt on these relationships, particularly in those <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00003-6/fulltext">who were not deficient</a>.</p>
<h2>Social distance and masks matter most</h2>
<p>While there does seem to be an increase in COVID-19 cases in the winter months, the cause of this is multi-factorial. </p>
<p>While certainly something for health care and policymakers to be aware of, the effect of weather and climate on COVID-19 is unlikely to have significant impact overall, and is readily countered by control measures. </p>
<p>Importantly, social distancing and mask use help to limit other winter viral infections such as the seasonal influenza, which was <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6937a6.htm">drastically reduced in winter 2020</a>. </p>
<p>Paying close attention to the public health advice, particularly when indoors, should counteract any increase in COVID-19 activity in the colder months. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-delta-defeating-us-heres-why-the-variant-makes-contact-tracing-so-much-harder-164780">Is Delta defeating us? Here's why the variant makes contact tracing so much harder</a>
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<img src="https://counter.theconversation.com/content/164776/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vasso Apostolopoulos' COVID-19 research has received internal funding from a Victoria University research grant and from philanthropic donations</span></em></p><p class="fine-print"><em><span>Jack Feehan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While there are plausible explanations for why this occurs, we can’t be certain of the effect of temperature on SARS-CoV-2. Being indoors in poorly ventilated spaces plays a big role.Vasso Apostolopoulos, Professor of Immunology and Associate Provost, Research Partnerships, Victoria UniversityJack Feehan, Research Officer - Immunology and Translational Research, Victoria UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1560022021-03-03T15:38:48Z2021-03-03T15:38:48ZHow 18th-century weather diaries shed light on the effects of an Icelandic volcanic eruption on Scotland<figure><img src="https://images.theconversation.com/files/387478/original/file-20210303-15-slkdek.jpeg?ixlib=rb-1.1.0&rect=25%2C12%2C4255%2C3196&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Holuhraun#/media/File:Fissure_eruption_in_Holurhraun_(Iceland),_13._September_2014.JPG">Joschenbacher/Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>On June 15 1783, Dr John Purcell went outside his house in Edinburgh, looked up at the clouds and wrote in his diary how dark and gloomy the sky was. The dark skies, he reported, continued for seven days followed by two or three days of fine weather. Then, on June 25 he began to describe the presence of a choking sulphurous haze that lingered over Edinburgh for the rest of the summer.</p>
<figure class="align-right ">
<img alt="The book cover of the 18th-century farming diary of Janet Burnet showing sheep in the snow." src="https://images.theconversation.com/files/387531/original/file-20210303-21-lf3kvh.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/387531/original/file-20210303-21-lf3kvh.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=938&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387531/original/file-20210303-21-lf3kvh.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=938&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387531/original/file-20210303-21-lf3kvh.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=938&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387531/original/file-20210303-21-lf3kvh.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1179&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387531/original/file-20210303-21-lf3kvh.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1179&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387531/original/file-20210303-21-lf3kvh.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1179&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><span class="license">Author provided</span></span>
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<p>Across Scotland, others were describing similar patterns of weather. At Gordon Castle in Morayshire, similar descriptions appear in an estate diary. In Aberdeenshire, Janet Burnet was recording in her farming diary how the leaves of her crops were withering and turning yellow, while on the estate of Henry, 3rd Duke of Buccleuch near Edinburgh, daily weather conditions were being measured with a thermometer, barometer and rain gauge.</p>
<p>What these people didn’t know was that on June 8, there had been a <a href="http://news.bbc.co.uk/1/hi/8624791.stm">huge volcanic eruption</a> at Laki in Iceland. As the world learned later, it was probably one of the largest outpourings of lava in the past 1,000 years, spewing out <a href="https://www.icelandtravel.is/attractions/laki-lakagigar/#:%7E:text=Although%20Laki%20is%20dormant%2C%20it,billion%20tons%20of%20basalt%20lava.">42 billion tonnes</a> of molten rock.</p>
<p>It not only released large volumes of volcanic ash into the atmosphere but also enormous amounts of <a href="https://www.nasa.gov/centers/langley/news/factsheets/Aerosols.html">sulphur dioxide aerosols</a> – over 120 megatons according to <a href="https://agupubs.onlinelibrary.wiley.com/doi/10.1029/2001JD002042">some estimates</a>. For comparison, the eruptions of 1783 were ten times the size of Iceland’s <a href="https://ncas.ac.uk/eyjafjallajokull-2010-how-an-icelandic-volcano-eruption-closed-european-skies/">2010 volcanic eruption</a> of Eyjafjallajokull, which resulted in an aviation shutdown across Europe.</p>
<p>News did not reach Scotland for several weeks, when the first brief account was published in the July issue of The Scots Magazine. Later, 1783 came to be known in Gaelic as <em>Bliadhne nan Sneachda Bhuidhe</em> or “the year of the yellow snow”. Famines recorded as far away as <a href="https://www.geoexpro.com/articles/2014/09/lakagigar-catastrophe-climate-change">Egypt and Japan</a> have been attributed to Laki, while it has even been <a href="https://www.theguardian.com/world/2010/apr/15/iceland-volcano-weather-french-revolution">claimed</a> that crop failures in Europe contributed to the outbreak of the French Revolution.</p>
<p>By the middle of July the choking haze had enveloped most of Europe. Throughout the summer, reports were widespread from many countries of thousands of people dying from respiratory illnesses. </p>
<p>What was always puzzling was that there was virtually no information known for Scotland during this time. Until now, apart from the Scots Magazine report a month after the eruption, the only published report was a brief reference from nearly a century ago of volcanic ash having fallen across parts of Caithness in 1783.</p>
<p>In our <a href="https://doi.org/10.1177/0959683620988052">research</a> we unearthed several undiscovered diaries and daily weather records for Scotland to reconstruct the patterns of weather and climate change that took place both before, during and following the eruption of the Laki volcano.</p>
<figure class="align-center ">
<img alt="An entry from the estate diary of Gordon Castle in November 1783 describing the weather six months after the Laaki eruption in Iceland." src="https://images.theconversation.com/files/387480/original/file-20210303-21-gd2os9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387480/original/file-20210303-21-gd2os9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=520&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387480/original/file-20210303-21-gd2os9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=520&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387480/original/file-20210303-21-gd2os9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=520&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387480/original/file-20210303-21-gd2os9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=654&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387480/original/file-20210303-21-gd2os9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=654&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387480/original/file-20210303-21-gd2os9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=654&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The weather noted in the estate diary of Gordon Castle in November 1783, six months after the Laki eruption in Iceland.</span>
<span class="attribution"><span class="source">Alastair Dawson</span>, <span class="license">Author provided</span></span>
</figcaption>
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<h2>Impact on weather</h2>
<p>The Laki eruption threw columns of smoke and ash between nine and 13 kilometres into the atmosphere, with individual eruptions of flood lava taking place along a very large fissure in the Earth’s crust and continuing for almost nine months.</p>
<p>The sulphur that was released into the Earth’s atmosphere reacted with moisture in the air to produce sulphate aerosols. These gas compounds were then transported by prevailing winds across northern and central Europe. In effect, a very dilute form of <a href="https://www.britannica.com/science/sulfuric-acid">sulphuric acid</a> was circulating across the lower part of the Earth’s atmosphere during the summer of 1783 and it proved very difficult to shift.</p>
<p>Climate scientists have long known that major volcanic eruptions often emit enormous volumes of volcanic ash into the atmosphere and have the effect of blocking the Sun’s radiation and cooling the Earth’s climate. The <a href="https://www.britannica.com/place/Mount-Tambora">eruption of Mt Tambora</a> in Indonesia during April 1815 is a famous example, often referred to as “the year without a summer”.</p>
<p>From the perspective of past climate in Scotland, scientists have long debated whether the succession of cold winters that followed were a direct result of the Laki volcanic eruptions. Certainly, the snowy winters of 1783-84 and 1784-85 were two of the coldest Scottish winters of recent centuries. Historians have speculated that the severity of these two cold winters and the crop failures and livestock losses that accompanied them, only helped <a href="https://www.eh-resources.org/volcanic-eruptions-and-european-history/">accelerate the pace of emigration</a> to North America at this time.</p>
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<h2>Choking haze</h2>
<p>Our analysis of these rare weather records from Scotland for this period paints a slightly different picture in the sense that we cannot demonstrate, as many have argued in the past, that the Laki eruptions by themselves caused immediate climate cooling across Europe. Instead, our studies suggest that the exceptionally cold winters were more likely to be the result of natural climatic variability.</p>
<p>The most important consequence of the Laki eruptions was by far the choking sulphuric haze in the atmosphere and the respiratory hazard that this presented. Thanks to the diaries, we now know that the haze blanketed eastern and northern Scotland during the summer and autumn of 1783 and certainly affected an area stretching from Inverness in the north to Edinburgh in the south. Most likely the haze was even more widespread.</p>
<p>No study of Scottish mortality has ever been conducted in respect of deaths caused by the sulphurous haze. Although Laki is now dormant, the eruptions of Eyjafjallajökull in 2010 and <a href="https://earthobservatory.nasa.gov/images/event/84283/holuhraun-eruption">Holuhraun in 2014</a>, and now news that Mt Keilir, just a few miles south of Reykjavik is showing signs of “<a href="https://www.theguardian.com/world/2021/mar/03/scientists-in-iceland-say-strong-signs-volcanic-eruption-is-imminent">near-constant seismic activity</a>”, demonstrates just how much volcanic eruption is an ever-present threat in Iceland. Were another eruption of Laki’s magnitude to occur, Scotland and the other countries of the British Isles could face a serious respiratory crisis.</p>
<figure class="align-center ">
<img alt="A dramatic image of the snow-covered volcano Mt Keilir just south of Reykjavik in Iceland." src="https://images.theconversation.com/files/387618/original/file-20210303-13-1ja7r6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/387618/original/file-20210303-13-1ja7r6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387618/original/file-20210303-13-1ja7r6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387618/original/file-20210303-13-1ja7r6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387618/original/file-20210303-13-1ja7r6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387618/original/file-20210303-13-1ja7r6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387618/original/file-20210303-13-1ja7r6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Mt Keilir, a volcano just south of Reykjavik is showing signs of imminent eruption.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Keilir_(mountain)">Soffía Snæland/Flickr/Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>We have shown that the weather conditions in the summer of 1783 represented almost a worst-case scenario of sustained high atmospheric pressure and the presence of an air mass capable of bringing the poisonous aerosols into contact with the Scottish population. </p>
<p>This raises the question of how to address a poorly known natural hazard that takes place relatively infrequently but which poses a potentially serious environmental threat. Clearly, this risk needs to be considered very carefully in health and safety planning. Thanks to Laki, the summer of 1783 can remind us of the significant impact that major volcanic eruptions can have on weather, climate and public health.</p><img src="https://counter.theconversation.com/content/156002/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Martin Kirkbride receives funding from UK Research Councils, learned societies, and charitable organisations.</span></em></p><p class="fine-print"><em><span>Alastair Dawson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research challenges the idea that Laki caused years of extreme weather in Scotland and has implications for how we deal with sudden, forced climate change today.Alastair Dawson, Professor of Geography and Environmental Science, University of DundeeMartin Kirkbride, Reader Geography and Environmental Science, University of DundeeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1421232020-07-09T07:17:24Z2020-07-09T07:17:24ZWhy it’s important to know how fluids move<figure><img src="https://images.theconversation.com/files/346341/original/file-20200708-3991-1rr7ktw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Knowing how fluids move can help us understand virus transmission better.</span> <span class="attribution"><span class="source">Stock image/Getty Images</span></span></figcaption></figure><p>COVID-19 has sharply brought into focus the impact of respiratory infectious diseases on humanity. It has also shown that the greatest defence against health crises is government policy that is strongly rooted in science.</p>
<p>In an attempt to contain the spread of the disease many governments have implemented policies that prevent physical interaction. This has a direct impact on our daily lives: the way people move, where they work and how they interact with each other. </p>
<p>These policies are a good first step, but they are limited because they don’t fully account for how the virus physically spreads from person to person – that is, the physical routes of transmission. Some of the answers may lie in a field of study called fluid mechanics – understanding how fluids move.</p>
<p>Understanding how fluids move can help us get to grips with how a virus like the one causing COVID-19 travels from an infected person to others. This is because when we cough or sneeze we expel micro-droplets whose motion is governed by the principles of fluid mechanics. Understanding the way the virus is transmitted can inform public health interventions to minimise the risk.</p>
<p>Recent insights at the interface between fluid mechanics and epidemiology are already beginning to unlock at least some understanding of COVID-19’s physical routes of transmission. <a href="https://jamanetwork.com/journals/jama/fullarticle/2763852">For example</a>, recent work has shown that a cough or sneeze consists of a multiphase chaotic gas cloud. This gas cloud transports viral pathogens much further than predicted. </p>
<p>The mounting evidence has led the World Health Organisation (WHO) to <a href="https://www.bbc.com/news/world-53329946">acknowledge</a> that the coronavirus can be spread by tiny particles suspended in the air.</p>
<h2>The study of fluid mechanics</h2>
<p><a href="https://www.britannica.com/science/fluid-mechanics">Fluid mechanics</a> is the study of how fluids move. That may sound simple, but it’s actually very complex.</p>
<p>First, it’s important to understand what it means to move. The physicist <a href="https://www.britannica.com/biography/Isaac-Newton">Sir Isaac Newton</a> showed that something called a force is required to change how an object moves. This force must be applied to the object and the magnitude and direction of this force is the product of the object’s mass and acceleration. </p>
<p>Acceleration refers to how something’s velocity changes with time (rate of change of velocity). Additionally, an object’s velocity refers to the distance it travels in a certain amount of time. Therefore, Newton’s laws of motion can help us predict how an object moves through space and time. This helps us calculate the object’s position at any given time.</p>
<p>We can apply Newton’s <a href="https://www.sciencedirect.com/topics/engineering/newtons-second-law">laws of motion to fluids</a> in an attempt to explain how fluids move. A fluid is a substance whose particles move a lot relative to each other when a force is applied to it.</p>
<p>In other words the defining property of a fluid is the ease with which the fluid can be deformed. Fluids have no defined shape. Any liquid such as water is a good example, but the air around us can also be treated as a fluid. The line between fluids and solids is not distinct and in some instances solid objects such as jelly, dry paint and asphalt can behave like fluids and <a href="https://fyfluiddynamics.com/2012/09/many-common-fluidslike-air-and-waterare/">vice versa</a>. </p>
<p>An important characteristic of fluids is that they transport “things”; these “things” could be heat, pollutants, pathogens or other fluids. Therefore the study of fluid mechanics is fundamental to understanding the world we live in. For example fluid mechanics can help us model and predict how heat from the sun gets transported around the world (think climate change). Another example is the applications of fluid mechanics to the transport of respiratory diseases such as COVID-19.</p>
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Read more:
<a href="https://theconversation.com/is-the-airborne-route-a-major-source-of-coronavirus-transmission-141198">Is the airborne route a major source of coronavirus transmission?</a>
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<h2>Applying fluid mechanics to COVID-19</h2>
<p><a href="https://doi.org/10.1017/jfm.2020.330">Recent studies</a> have shown that our current understanding of the routes of transmission of respiratory diseases is limited and based on an oversimplified model. <a href="https://doi.org/10.1017/jfm.2014.88">Recent developments</a> in fluid mechanics and epidemiology have shown that turbulent puffs, emitted by sneezing or coughing, transport pathogens much further than expected. </p>
<p>The characteristics of the “puff” or “plume” that is emitted when we breathe, cough or sneeze are important for understanding how the fluid droplets are transported. </p>
<p>Fluid droplets inside the “puff” get distorted by the complex air flow patterns associated with the “puff” or “plume” and its interaction with the ambient air. This process can break up a fluid droplet into several pieces that fall out of suspension, contaminating many surfaces. Of course the break-up process can also result in smaller particles that can travel further than the larger ones. </p>
<p>It’s also been shown that the flow field, temperature and humidity affect how far these droplets travel. This has implications for the WHO’s 1-2m (3-6 ft) physical distancing <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public">guidelines</a>. Research has <a href="https://doi.org/10.1017/jfm.2014.88">shown</a> that these droplets can travel as far as 7m (20ft). This doesn’t take into account the micro-droplets that can be transported even further because of building ventilation systems. </p>
<p>In an open letter to the WHO more than 200 scientists <a href="https://www.bbc.com/news/world-53329946">recently accused</a> the organisation of underestimating the possibility of airborne transmission of COVID-19. Given the WHO’s <a href="https://www.bbc.com/news/world-53329946">recent statement</a>, these guidelines are likely to be revised.</p>
<p>The principles of fluid mechanics are <a href="https://books.google.co.za/books?id=Z94ilYqgmy4C&pg=PR16&lpg=PR16&dq=fluid+mechanics+design+occupational+health&source=bl&ots=WG0UVrM_rw&sig=ACfU3U0MS2aYVtvclGencf3ww80OWpa6Yw&hl=en&sa=X&ved=2ahUKEwjsn7T1_rzqAhWsTBUIHZa9CDUQ6AEwA3oECAYQAQ#v=onepage&q=fluid%20mechanics%20design%20occupational%20health&f=false">already used</a> in ventilation design and occupational health; it’s possible that our new understandings about fluid mechanics and epidemiology could be used to help improve building ventilation systems. What we’re learning may also inform government policy to reduce the spread of future pandemics like COVID-19.</p><img src="https://counter.theconversation.com/content/142123/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Justin Pringle receives funding from the National Research Foundation of South Africa. </span></em></p>Fluid mechanics can be applied to the transport of respiratory diseases such as COVID-19.Justin Pringle, Lecturer in Environmental Fluid Mechanics, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1396222020-07-02T14:04:43Z2020-07-02T14:04:43ZMexico City buried its rivers to prevent disease and unwittingly created a dry, polluted city where COVID-19 now thrives<figure><img src="https://images.theconversation.com/files/345131/original/file-20200701-141278-xa8j31.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3445&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Situated on a plateau and surrounded by mountains, Mexico City – seen here in a haze on May 20, 2018 – is a 'bowl' that traps smog and dust.</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Mexico-Pollution/bf0cb5c6c58140afa6693a2e8c0157cd/75/0">AP Photo/Marco Ugarte</a></span></figcaption></figure><p><em>Leer <a href="https://theconversation.com/contaminacion-el-silencioso-enemigo-de-la-cdmx-en-la-lucha-contra-el-covid-19-143504">en español</a></em></p>
<p>Mexico City is a dust bowl, a <a href="https://www.redalyc.org/pdf/312/31204702.pdf">polluted megalopolis</a> where breathing is hard and newly washed clothes hung out to dry turn stiff by evening. Even before the COVID-19 pandemic began clobbering this capital city, residents regularly wore face masks during the <a href="https://www.cnn.com/2019/05/17/americas/mexico-city-pollution-in-photos-intl/index.html">frequent air quality emergencies</a> there. </p>
<p>Now Mexico City’s bad air pollution – which contributes to high rates of <a href="https://www.gob.mx/inecc/documentos/coronavirus-sars-cov-2-contaminacion-atmosferica-y-riesgos-a-la-salud">respiratory and cardiovascular diseases</a> – is making the metropolitan area’s 21 million people more vulnerable to the coronavirus. </p>
<p>Mexico City wasn’t always an ecological and health disaster. As the center of the Aztec empire, it was verdant and diverse. As late as the early 20th century, 45 rivers ran through the Mexican capital.</p>
<p>The decision to bury and pave over its rivers, creating today’s arid metropolis, was a 20th-century plan meant to protect residents from disease – specifically, cholera, <a href="http://oa.upm.es/57891/1/TFG_20_CODERCH_CARRETERO_PAULA.pdf">malaria and other waterborne illnesses brought on by frequent flooding</a>.</p>
<h2>Origins of Mexico City</h2>
<p>I’m a <a href="https://scholar.google.com/citations?user=LA4-pCYAAAAJ&hl=en">scholar who studies poverty</a> with a focus on urban areas, and Mexico City is my gray, concrete hometown. The relationship between its geography, history and health outcomes are relevant today, as the city struggles with its latest disease outbreak.</p>
<p><a href="https://www.redalyc.org/pdf/312/31204702.pdf">Mexico City was founded</a> by the people now called Aztecs – but who called themselves Tenochcas – in 1325. The Aztecs built their city on a rock in Lake Texcoco, mostly because the more prime locations along the shore were already taken. </p>
<p>By 1427 the powerful Aztecs had defeated their lakeshore neighbors and built a shining capital that spanned the lake. The city, called Tenochtitlan, was built amid water by the development of “<a href="http://zaloamati.azc.uam.mx/handle/11191/5077">chinampas</a>” – small plots of lake filled in with debris, pottery and soil to create solid land, with channels flowing around them. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>The foremost chronicler of Spain’s colonization of Mexico, <a href="https://www.gutenberg.org/files/32474/32474-h/32474-h.htm">Bernal Díaz del Castillo</a>, described Tenochtitlan as crisscrossed by engineering marvels like causeways and removable bridges, and full of “splendid” palaces. Diaz del Castillo reports that the city market was larger and better regulated than those of <a href="https://www.gutenberg.org/files/32474/32474-h/32474-h.htm">Constantinople and Rome</a>. As in the Roman empire, aqueducts supplied the city with <a href="https://www.gutenberg.org/files/32474/32474-h/32474-h.htm">fresh water</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/345079/original/file-20200701-53-1eotava.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/345079/original/file-20200701-53-1eotava.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/345079/original/file-20200701-53-1eotava.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=368&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345079/original/file-20200701-53-1eotava.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=368&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345079/original/file-20200701-53-1eotava.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=368&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345079/original/file-20200701-53-1eotava.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=462&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345079/original/file-20200701-53-1eotava.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=462&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345079/original/file-20200701-53-1eotava.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=462&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Replica of Tenochtitlan, with its causeways and canals.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/4ULeHK">Randal Sheppard/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Tenochtitlan looked like Venice – gorgeous – and had the same health problems, including contaminated water, mosquitoes and unpleasant smells. But the Aztecs <a href="https://www.redalyc.org/pdf/312/31204702.pdf">managed the city well and prevented flooding</a>. Their dikes and waterways permitted a <a href="https://www.jstor.org/stable/pdf/40315074.pdf?refreqid=excelsior%3A92c9cb15fd681165ffef84e7676e5128">great diversity of plants and animals to flourish</a>, and the chinampa agricultural system – in which land was replenished with soil dredged from the lake bottom – was <a href="https://www.jstor.org/stable/pdf/40315074.pdf?refreqid=excelsior%3A92c9cb15fd681165ffef84e7676e5128">one of the most productive</a> the world has ever known. </p>
<h2>Spanish incompetence</h2>
<p>That good urban management <a href="https://www.redalyc.org/pdf/312/31204702.pdf">ended with the Spanish conquest in 1521</a>. Tenochtitlan was destroyed, its <a href="https://www.gutenberg.org/files/32474/32474-h/32474-h.htm">palaces and causeways turned to rubble at the bottom of the lake</a>.</p>
<p>The Spaniards did not understand the watery ecology of the area, nor <a href="https://www.redalyc.org/pdf/312/31204702.pdf">did they understand or respect</a> Aztec engineering. To rebuild their capital, they drained the lake. </p>
<p>This strategy led to both drought and an inadequate water supply for most of the year. Rainy season, however, brought <a href="https://www.jstor.org/stable/pdf/40315074.pdf?refreqid=excelsior%3A92c9cb15fd681165ffef84e7676e5128">tremendous floods</a>. In 1629, the worst flood in Mexico City’s recorded history is said to have lasted five years and killed more than 30,000 people due to drowning and disease. Churches reportedly <a href="http://oa.upm.es/57891/1/TFG_20_CODERCH_CARRETERO_PAULA.pdf">held rooftop masses</a>. </p>
<p>Rainy season turned parts of the city turned into cesspools, spawning waterborne diseases like <a href="http://www.hmc.mil.ar/webResources/Documentos/inundaciones.pdf">cholera and malaria</a>, as well as meningitis. Gastrointestinal illnesses festered, too, because residents used Mexico City’s rivers for dumping garbage and sewage. <a href="http://oa.upm.es/57891/1/TFG_20_CODERCH_CARRETERO_PAULA.pdf">Human</a> and <a href="http://www.hmc.mil.ar/webResources/Documentos/inundaciones.pdf">animal</a> bodies floated in the stagnant waters, emitting a terrible stench.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/345061/original/file-20200701-159785-1btcp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/345061/original/file-20200701-159785-1btcp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/345061/original/file-20200701-159785-1btcp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345061/original/file-20200701-159785-1btcp7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345061/original/file-20200701-159785-1btcp7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345061/original/file-20200701-159785-1btcp7p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345061/original/file-20200701-159785-1btcp7p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345061/original/file-20200701-159785-1btcp7p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Canals in Xochimilco, a part of Mexico City that retains its ancient waterways.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-aztec-canals-at-the-floating-gardens-of-xochimilco-the-news-photo/152201035?adppopup=true">Werner Forman/Universal Images Group/Getty Images</a></span>
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</figure>
<h2>Mexico goes deep</h2>
<p>Mexico gained independence from Spain in 1810. To deal once and for all with its flooding problems, city leaders decided in the 1890s to channel rain, flood waters and sewage away from the city via a <a href="https://blogdelagua.com/actualidad/inundaciones-en-mexico/">30-mile desagüe, or drainage channel</a>. </p>
<p>Around this time, the <a href="https://www.jstor.org/stable/pdf/40315074.pdf?refreqid=excelsior%3A92c9cb15fd681165ffef84e7676e5128">population of the capital began to explode</a>. Mexico City had 350,000 residents in 1900 and 3 million in 1950. By the <a href="http://zaloamati.azc.uam.mx/handle/11191/5077">1930s</a>, its novel sanitation system was already insufficient. Plus, residents were still using Mexico City’s many rivers for <a href="https://www.eluniversal.com.mx/entrada-de-opinion/colaboracion/mochilazo-en-el-tiempo/nacion/sociedad/2017/06/21/los-rios-de-la">washing clothes, as garbage pits and as sewers</a>. </p>
<p>In 1938, the architect Carlos Contreras proposed <a href="http://zaloamati.azc.uam.mx/handle/11191/5077">enclosing</a> three polluted rivers – the Piedad, the Consulado and the Verónica – and turning them into one giant viaduct to <a href="https://www.eluniversal.com.mx/entrada-de-opinion/colaboracion/mochilazo-en-el-tiempo/nacion/sociedad/2017/06/21/los-rios-de-la">prevent flooding, disease and death</a>. Political conditions did not allow this idea to move forward at the time, but the idea of <a href="https://www.eluniversal.com.mx/entrada-de-opinion/colaboracion/mochilazo-en-el-tiempo/nacion/sociedad/2017/06/21/los-rios-de-la">putting Mexico City’s filthy waterways into enormous pipes</a> and burying them stuck. </p>
<p>Over the following decades, rivers began to be put underground. Between 1947 and 1952 most of Mexico City’s 45 rivers were <a href="http://oa.upm.es/57891/1/TFG_20_CODERCH_CARRETERO_PAULA.pdf">channeled into giant tubes, buried and paved over</a>. Today, these rivers are visible only in the names <a href="http://zaloamati.azc.uam.mx/handle/11191/5077">of the streets that run over them</a>: Rio Mixcoac Avenue, Rio Churubusco Avenue and others.</p>
<h2>Smog bowl</h2>
<p>This system gave mid-century Mexico City enough sewer capacity, roads and buildings to serve its population. The foul smell and unsanitary conditions also diminished, because people couldn’t dump garbage into covered waterways. </p>
<p>But without its rivers, Mexico City dried up and grew dusty. And because of its geography – <a href="https://en.mxcity.mx/2016/04/mexico-citys-mountains/">located</a> on a plateau, surrounded by mountains – the dust was unable to escape. Mexico City is in a bowl that traps whatever floats in the air. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/345073/original/file-20200701-13398-bqmlmo.jpg?ixlib=rb-1.1.0&rect=26%2C6%2C4440%2C2967&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/345073/original/file-20200701-13398-bqmlmo.jpg?ixlib=rb-1.1.0&rect=26%2C6%2C4440%2C2967&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/345073/original/file-20200701-13398-bqmlmo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/345073/original/file-20200701-13398-bqmlmo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/345073/original/file-20200701-13398-bqmlmo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/345073/original/file-20200701-13398-bqmlmo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/345073/original/file-20200701-13398-bqmlmo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/345073/original/file-20200701-13398-bqmlmo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ruins of Teotihuacan, outside Mexico City, March 19, 2020.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Virus-Outbreak-Mexico-Equinox-Closure/4059b21152624ee09a59daf200a6b542/12/0">AP Photo/Rebecca Blackwell</a></span>
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<p>Starting in the 1980s, the number of cars <a href="https://www.sciencedirect.com/science/article/pii/S096669231500023X">grew into the millions</a>, trapping pollution too. Today, Mexico City is <a href="https://www.washingtonpost.com/world/2019/05/16/scary-images-mexico-citys-pollution-emergency/">notorious for its smog</a> and for the terrible <a href="https://www.iqair.com/blog/air-quality/air-pollution-particles-in-hearts">health consequences</a> pollution brings, including asthma and heart disease. </p>
<p>The coronavirus outbreak wasn’t caused by polluted air. But the city’s bad air quality – together with <a href="https://www.jornada.com.mx/2009/05/25/capital/043n1cap">overcrowding and other poverty-related factors</a> – creates the conditions for COVID-19 to severely sicken and kill more people.</p>
<p>In trying to eliminate waterborne illness, the Mexican capital ended up helping an airborne virus find more hosts. It’s an irony of history the Aztecs would surely mourn.</p>
<p><em>Editor’s note: A photo caption incorrectly dating Teotihuacan to the Aztec people has been corrected.</em></p><img src="https://counter.theconversation.com/content/139622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elena Delavega does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Aztecs had a shining city on a lake, with canals, causeways and aqueducts – until the Spanish came. Mexico City is still suffering the consequences of their bad public health decisions.Elena Delavega, Associate Professor of Social Work, University of MemphisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1343982020-03-30T01:29:12Z2020-03-30T01:29:12ZHow are the most serious COVID-19 cases treated, and does the coronavirus cause lasting damage?<p>As the number of COVID-19 cases around the world continues to climb, hospitals are under increased pressure to provide emergency care for the most severely ill patients. What does this involve, and how does the coronavirus damage the respiratory system?</p>
<p>The virus first invades our bodies by <a href="https://link.springer.com/article/10.1007/s00134-020-05985-9">attaching to a protein called ACE2</a> on cells in the mouth, nose and airways. For the first week of infection, symptoms are relatively mild, with sore throat, cough and fever. Some people, <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2003717">particularly children</a>, may carry the virus with <a href="https://www.sciencedirect.com/science/article/pii/S1684118220300402?via%3Dihub">few if any symptoms</a> at all. </p>
<hr>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/coronavirus-how-long-does-it-take-to-get-sick-how-infectious-is-it-will-you-always-have-a-fever-covid-19-basics-explained-132963">Coronavirus: how long does it take to get sick? How infectious is it? Will you always have a fever? COVID-19 basics explained</a>
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<p>But this early stage also seems to be the time at which people are <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30232-2/fulltext">most infectious to others</a>. </p>
<p><iframe id="tc-infographic-468" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/468/4cca7fc4babafadfa8a81d793d79d4dcaddf7407/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>The Wuhan data</h2>
<p>As the place where the pandemic originated, the Chinese city of Wuhan has yielded the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext">biggest and most useful set of cases</a> from which we can analyse the disease’s typical progression. </p>
<p>From days four to nine after infection, the symptoms worsen, with increasing breathlessness and cough. In those ill enough to be admitted to hospital, more than half require assistance with oxygen, usually in a standard hospital ward. Some patients suffer worsening breathing difficulties that necessitate admission to an intensive care unit (ICU), typically eight to fifteen days after the illness began.</p>
<h2>What happens in ICU?</h2>
<p>In ICU, various treatments can support these more serious breathing problems. This includes high-flow humidified oxygen, delivered via a nasal mask. The oxygen is warmed and its humidity artificially increased so as to avoid uncomfortable dryness. It is gently pumped into the lungs at a comfortable rate that still allows the patient to speak and eat. </p>
<p>If breathing worsens further, the patient is then intubated. This involves inserting a tube through the mouth and into the windpipe, through which oxygen is delivered via a ventilator. Intubated patients need to be sedated (kept asleep) until their lungs recover enough to work without assistance. </p>
<p>In the most severe cases, where the lungs fail and it is not possible to deliver enough oxygen by ventilator, patients are given <a href="https://www.mja.com.au/journal/2009/191/3/extracorporeal-membrane-oxygenation">extracorporeal membrane oxygenation</a>, which effectively outsources the work normally done by the heart and lungs to an external machine. Blood is carried from the body, and carbon dioxide removed and oxygen added, before it returns to the patient’s circulation. This is the most advanced form of life support, but also carries the highest risks and the longest recovery times.</p>
<p><iframe id="tc-infographic-470" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/470/93e666dfdf6f9976c633d51eecf9605b6efa40af/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>An <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext">analysis of adult COVID-19 patients treated at two Wuhan hospitals</a> found that 50 of the 191 cases studied required ICU treatment.</p>
<p>Of these 50 ICU patients, 41 received high-flow humidified oxygen, 33 were intubated, and 3 received extracorporeal membrane oxygenation. </p>
<p>Only 8 of the 41 patients treated with high-flow oxygen survived, and just one of the intubated patients. Overall, 11 of the 50 ICU patients survived. But those who did recover seemed to do so reasonably rapidly: 75% were discharged within 25 days.</p>
<p>Data from outside China is more limited, but offers more grounds for optimism. A <a href="https://jamanetwork.com/journals/jama/fullarticle/2762688">review</a> of 18 hospitalised patients in Singapore found that six needed oxygen support with oxygen, but just two were admitted to ICU and only one was intubated, and this patient was able to go home a mere six days after coming off respiratory support. </p>
<p>From Washington state in the US, among <a href="https://jamanetwork.com/journals/jama/fullarticle/2763485">21 cases admitted to the ICU</a>, 17 were admitted to ICU within 24 hours of hospital admission and 15 required intubation. Besides their respiratory distress, seven developed heart damage, four suffered kidney failure, and three liver damage. As of March 17, 11 of the patients had died, two had left the ICU, and eight still needed ventilation.</p>
<p><iframe id="tc-infographic-471" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/471/58bf6dc8384260d482c9338060390626e2291bc0/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Does the disease cause long-term symptoms?</h2>
<p>At this stage there is no data on the long-term effects of COVID-19. But we can look at the after-effects of other acute viral respiratory diseases such as <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/path.4454">influenza, SARS and Middle East respiratory syndrome (MERS)</a>. </p>
<p>In these diseases, collectively called acute respiratory distress syndromes (ARDS), the fragile small airways and air sacs become damaged by inflammation, can become blocked by fluid and blood, and are replaced by scar tissue as they heal. This can stiffen the lungs – at first from fluid and then from scar tissue – impairing their ability to transfer oxygen and making breathing more laboured. In SARS and MERS this damage appears to occur as the virus is being destroyed by the immune response.</p>
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Read more:
<a href="https://theconversation.com/how-does-coronavirus-kill-130864">How does coronavirus kill?</a>
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<p>How long does it take to recover from ARDS? One <a href="https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-019-0544-5">survey of 396 German patients</a> found that 50% were hospitalized for 48 days or longer during the year following their original recovery. A smaller review of <a href="https://journal.chestnet.org/article/S0012-3692(12)60501-7/fulltext">37 ICU survivors of pandemic influenza in 2009</a>, found that roughly half still complained of severe breathlessness on exertion but, more promisingly, 83% had returned to work.</p>
<p>At this stage our best course of action is to focus on slowing the coronavirus’s spread and protecting the most vulnerable. The death rate from COVID-19 is worse in countries where health services have become overwhelmed. Our best bet is to maximise our resources by minimising the number of people who suffer severe symptoms.</p><img src="https://counter.theconversation.com/content/134398/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Wark receives funding from the National Health and Medical Research Council of Australia and the Medical Research Futures Fund.</span></em></p>In the most severe cases, COVID-19 patients need oxygen pumped directly into their airways, or even be hooked up to a machine that does the job of their heart and lungs.Peter Wark, Conjoint Professor, School of Medicine and Public Health, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1188282019-07-25T19:59:15Z2019-07-25T19:59:15ZA wet cough for four weeks means it’s time to get it checked out<figure><img src="https://images.theconversation.com/files/285648/original/file-20190725-110191-1jomx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lung disease can often be prevented with culturally appropriate health care and information.</span> <span class="attribution"><span class="source">Pamela Larid</span></span></figcaption></figure><p>As respiratory clinicians, we have been conducting outreach clinics to the Kimberley, in northern Western Australia, for about ten years, treating children with <a href="https://www.healthdirect.gov.au/bronchiectasis">bronchiectasis</a>, a chronic lung disease in which the breathing tubes in the lungs are damaged. </p>
<p>If left untreated, bronchiectasis can eat away at the lungs and cause devastating long-term effects. </p>
<p>Our research, published today in the journal <a href="https://onlinelibrary.wiley.com/journal/14401843">Respirology</a>, shows how Aboriginal health providers, visiting clinicians, and Aboriginal families can work together to detect illness that may lead to bronchiectasis as symptoms first appear, using local language, stories, and resources. </p>
<p>These resources, including an animated video, highlight that chronic wet cough, in the absence of any other symptom or sign, can be the earliest and often only warning sign of lung disease. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/822rxbYIZcU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Let’s kick this wet cough.</span></figcaption>
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<h2>Why early detection is key</h2>
<p>A persistent, low-grade wet cough is often a sign of mucus in the airway that has become infected. Over time, this mucus begins to destroy the lung tissue. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/285646/original/file-20190725-110170-1d6vwlw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/285646/original/file-20190725-110170-1d6vwlw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285646/original/file-20190725-110170-1d6vwlw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=346&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285646/original/file-20190725-110170-1d6vwlw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=346&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285646/original/file-20190725-110170-1d6vwlw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=346&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285646/original/file-20190725-110170-1d6vwlw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=435&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285646/original/file-20190725-110170-1d6vwlw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=435&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285646/original/file-20190725-110170-1d6vwlw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=435&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/bronchiectasis-labeled-diagram-471053129?src=KyaB5ZRzmYFgk5z8TeBDSg-1-3&studio=1">Joshya/Shutterstock</a></span>
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<p>Limiting the extent of lung damage is predicated on timely recognition and management of the chronic wet cough. Treatment may include antibiotics and chest physiotherapy.</p>
<p>If left untreated, the disease can progress and result in a lot of coughing, feeling breathless, losing sleep, feeling worried and helpless, and, eventually, early death.</p>
<p>In Australia, lung infections are the <a href="https://www.aihw.gov.au/about-our-data/our-data-collections/national-hospitals-data-collection">most common reason</a> Aboriginal children are hospitalised. Young Aboriginal children in WA are <a href="https://doi.org/10.1111/j.1440-1754.2007.01110.x">up to 13 times more likely</a> to be admitted for lung infections than non-Aboriginal children.</p>
<p>More than a quarter of young Aboriginal children admitted with lung infections will <a href="https://www.mja.com.au/journal/2003/178/10/respiratory-morbidity-central-australian-aboriginal-children-alveolar-lobar">go on to develop</a> potentially life-shortening chronic lung disease.</p>
<p>Lung disease is a major contributor to the gap in life expectancy between Indigenous and other Australians. Indigenous Australians hospitalised with bronchiectasis die, on average, <a href="https://doi.org/10.1111/resp.13280">24 years earlier</a> than non-Indigenous Australians with the condition. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-australians-die-cause-4-chronic-lower-respiratory-diseases-58926">How Australians Die: cause #4 – chronic lower respiratory diseases</a>
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<h2>Understanding the delay</h2>
<p>Each quarter, Perth Children’s Hospital sends a multidisciplinary team to see about 30 children, mostly Aboriginal, who have been referred for specialist care by doctors from across the vast Kimberley region.</p>
<p>We have witnessed the consequences of lung disease being diagnosed too late. We once treated an adolescent Aboriginal boy with end-stage bronchiectasis. He was so sick that he was unable to walk or lie flat. His lung function was less than 25%, well below the threshold for lung transplantation. </p>
<p>This boy was dying from an illness that could have been halted or reversed had someone treated him effectively before his disease had progressed this far. A note in his medical record stated: “Lost to the system.”</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/words-from-arnhem-land-aboriginal-health-messages-need-to-be-made-with-us-rather-than-for-us-100655">Words from Arnhem land: Aboriginal health messages need to be made with us rather than for us</a>
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<p>In our clinics, we noticed a high prevalence of Aboriginal children with lung disease who were seen too late, when preventable lung damage was already permanent. </p>
<p>We found we were not always eliciting accurate histories from families. Specifically, when we asked engaged parents if their children had a wet cough, the parents would say “no” when, in fact, the children did have a wet cough. </p>
<p>Accurate medical history taking is crucial to providing good medical care, as is the provision of culturally appropriate care. But we realised a barrier was preventing us from communicating effectively with families, and preventing those families seeking timely medical care for their children.</p>
<h2>From mucus to goonbee</h2>
<p>We addressed the issues through partnerships with Aboriginal families, researchers, Aboriginal health providers, and government. We identified the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jpc.14305">barriers and enablers</a> for both families and clinicians to recognise and manage early lung disease and stop it progressing to serious life-limiting illness.</p>
<p>We interviewed 77 Aboriginal families and clinicians in the Kimberley, and discovered that families had never heard that a daily wet cough for more than four weeks could indicate serious infection. </p>
<p>Coughing was so prevalent among Aboriginal children that symptoms were being normalised. </p>
<p>When families were given culturally appropriate health information, they sought medical help. Parents also gave an accurate history about the presence of wet cough once they better understood the topic.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/285650/original/file-20190725-110187-4d3792.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285650/original/file-20190725-110187-4d3792.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285650/original/file-20190725-110187-4d3792.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285650/original/file-20190725-110187-4d3792.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285650/original/file-20190725-110187-4d3792.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285650/original/file-20190725-110187-4d3792.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285650/original/file-20190725-110187-4d3792.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This child, accompanied by her siblings and mother, undergoes chest physiotherapy as part of her daily routine to combat chronic lung disease.</span>
<span class="attribution"><span class="source">Pamela Laird</span></span>
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</figure>
<p>Culturally appropriate information included use of local language terms – such as <em>goonbee</em> for mucus in Yawuru language – and use of stories or images that families could relate to. </p>
<p>Clinicians can liken the lungs to an upside-down tree, for instance, where the tree trunk is the windpipe, the branches are the breathing tubes, and the leaves are the air sacs where oxygen is transferred to the blood. </p>
<p>We also developed culturally relevant educational resources for clinicians and families, including an animated film and an <a href="https://www.telethonkids.org.au/globalassets/media/documents/research-topics/wet-cough-flipchart.pdf">information flip chart</a>.</p>
<p>Through collaboration, mutual respect, and knowledge translation in our clinics, we are now witnessing little lungs growing stronger, Aboriginal families empowered with knowledge and advocating for their children, and clinicians skilled to provide culturally informed care to children. These observations are being supported by research soon to be published.</p>
<p>By engaging and working together, we will find sustainable solutions to kick chronic wet cough and help prevent Aboriginal children with sick lungs from flying beneath the radar.</p>
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<strong>
Read more:
<a href="https://theconversation.com/have-you-been-feeling-your-spirit-was-sad-culture-is-key-when-assessing-indigenous-australians-mental-health-119463">'Have you been feeling your spirit was sad?' Culture is key when assessing Indigenous Australians' mental health</a>
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<img src="https://counter.theconversation.com/content/118828/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr André Schultz and Ms Pamela Laird receive funding from the NHMRC and Hot North grant funding through Menzies School of Health Research. Ms Laird also receives funding through the Child and Adolescent Health Service of Western Australia and a Stan and Jean Perron Top up scholarship. </span></em></p><p class="fine-print"><em><span>Andre Schultz receives funding from an NHMRC TRIP Fellowship. He is Research Fellow at the Telethon Kids Intitute; Paediatrician, Perth Children’s Hospital; Clinician Senior Lecturer, University of WA.</span></em></p>Lung infections are the most common reason for Aboriginal children to be hospitalised. But many cases can be prevented by seeking treatment for wet coughs that last for four weeks or more.Pamela Laird, Senior Respiratory Physiotherapsit & Researcher, Telethon Kids InstituteAndre Schultz, Paediatric Respiratory Physician and Research Fellow, Telethon Kids InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1204442019-07-22T14:32:40Z2019-07-22T14:32:40ZThere are lots of myths about flu: we debunk six of them<figure><img src="https://images.theconversation.com/files/284461/original/file-20190717-147318-k5wm80.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many myths make the rounds during flu season.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Despite the availability of vaccines for influenza – or flu – the virus continues to kill people across the world. According to the World Health Organisation, flu epidemics result in <a href="https://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal)">3 million to 5 million</a> cases of severe illness and about <a href="https://www.who.int/mediacentre/news/statements/2017/flu/en/">290 000 to 650 000 deaths each year</a>.</p>
<p>Whenever there’s an outbreak of flu – usually over the winter months – various myths begin to circulate, some as contagious as the flu itself. These range from confusion about what flu actually is, to speculation about how it’s transmitted. </p>
<p>Flu is a contagious respiratory tract illness caused by the influenza virus. There are three different strains that can cause seasonal flu in humans. They are called influenza A(H1N1), influenza A(H3N2) and influenza B. Here are six common myths which regularly do the rounds.</p>
<h2>Flu is just a bad cold</h2>
<p><strong>False:</strong> Both flu and colds are <a href="http://www.nicd.ac.za/diseases-a-z-index/influenza/">respiratory illnesses</a>, but they are caused by different viruses. Flu is generally worse than a cold. Flu presents with a sudden onset (within a few hours) of some or all of the following: fever, upper respiratory symptoms (such as runny and congested nose), cough, tiredness, muscle pains, body aches, headaches, cold shivers and hot sweats. </p>
<p>A cold presents with a runny nose or congestion and generally does not result in serious complications. </p>
<p>Flu can lead to serious complications including pneumonia. Pneumonia is an infection of the lung which results from either the influenza virus alone (viral pneumonia) or from co-infection with a bacteria (secondary bacterial pneumonia). Other possible serious complications triggered by flu can be heart, brain or muscle tissue inflammation and multi-organ failure. This happens when the flu virus in the lungs causes an inflammatory response throughout the body causing a number of organs to fail. This could include respiratory and kidney failure.</p>
<p>A serious flu infection may require admission to hospital especially in high-risk groups for severe influenza complications. These include pregnant women, people over 65, children under 2, people with underlying medical conditions such as kidney or lung disease and diabetes. </p>
<p>Most people will recover from flu within three to seven days.</p>
<h2>The influenza vaccine can give you flu</h2>
<p><strong>False:</strong> <a href="http://www.nicd.ac.za/influenza-season-not-too-late-to-vaccinate/">The vaccine</a> does not contain live virus so you cannot ‘catch’ flu from the vaccine. At the time when influenza vaccine is recommended (just before the flu season), there are many other types of respiratory viruses around that can cause similar signs and symptoms to flu. There is a high chance of being infected with one of these viruses and people often – incorrectly – attribute the illness to a flu shot they’ve just had. </p>
<p>The vaccine also takes two weeks to work so you could catch flu during this period, especially if you receive the influenza vaccine after the flu season has started.</p>
<p>One more fact on vaccines: the flu vaccine needs to be repeated every year as the flu viruses change slightly each year.</p>
<h2>A vaccination is enough to prevent flu</h2>
<p><strong>False:</strong> The vaccine is not 100% effective. In addition, effectiveness depends on the age and health of the person being vaccinated. The efficacy of the vaccine also varies from year to year depending on how the vaccine matches the circulating influenza strain.</p>
<p>To prevent being infected with flu you need to wash your hands frequently with soap and water or an alcohol-based hand rub. It’s also important to avoid contact with sick people. </p>
<h2>Being exposed to cold weather will give me flu</h2>
<p><strong>False:</strong> The only way to catch flu is by being exposed to the flu virus. The flu season coincides with the cold weather and so naturally people associate the two. </p>
<p>The influenza virus spreads mainly by droplets from infected people when they cough, sneeze or talk. You can also come in contact with the influenza virus through contaminated surfaces or objects (for example, door handles) and then touching your mouth, eyes or nose.</p>
<h2>People can get swine flu</h2>
<p><strong>False:</strong> The term swine flu is sometimes used to incorrectly refer to the influenza A(H1N1) strain which emerged globally during the 2009 pandemic. When the strain emerged, scientists noted that it was similar to some strains of flu which had been seen in pigs. That’s why some people started calling it ‘swine flu’. </p>
<p>Since its emergence in 2009 influenza A(H1N1) has become one of our normal seasonal influenza circulating strains in humans. The term swine flu should not be used as this term means flu in pigs. Patients infected with influenza A(H1N1) strain should be treated as if they have any other seasonal strain of influenza.</p>
<h2>Antiviral medication should always be prescribed for flu</h2>
<p><strong>False:</strong> Treatment for flu is largely directed at reducing the signs and symptoms of flu, like a runny nose, body pains and tiredness. Bed rest, plenty of fluids and symptom relief of cough, congestion and fever are advised. </p>
<p>Individuals at risk of serious complications or very sick individuals may be prescribed antiviral medication. But this needs to be prescribed in the first 24-48 hours from onset of symptoms for it to be most effective.</p>
<p><em>Dr Bracha Chiger, a medical doctor at the NICD Centre for Respiratory Diseases and Meningitis, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/120444/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When it comes to flu, information can range from confusion about what it actually is, to speculation about how it’s transmitted.Sibongile Walaza, Medical Epidemiologist at the National Institute of Communicable Diseases and Lecturer at the School of Public Health, University of the WitwatersrandCheryl Cohen, co-head of the Centre for Respiratory Disease and Meningitis, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1191722019-07-22T03:01:07Z2019-07-22T03:01:07ZHealth Check: why do I have a cough and what can I do about it?<figure><img src="https://images.theconversation.com/files/284665/original/file-20190718-116539-sq5hx6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No wonder you feel so bad. Coughing can be physically exhausting. But it's your body's way of getting rid of irritants or extra mucus.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1166183737?src=pm3qp893thJlnYFyjEqlBA-1-27&studio=1&size=huge_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Dry, moist, productive, hacking, chesty, whooping, barking, throaty. These are just some of the terms people use to describe their cough.</p>
<p>While we’re deep into cold and flu season, it’s one of the most common reasons people see their family doctor.</p>
<p>But what is a cough anyway? And what’s the best way to get rid of it?</p>
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Read more:
<a href="https://theconversation.com/health-check-i-feel-a-bit-sick-should-i-stay-home-or-go-to-work-42759">Health Check: I feel a bit sick, should I stay home or go to work?</a>
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<h2>What is a cough?</h2>
<p>People can <a href="http://www.mattioli1885journals.com/index.php/actabiomedica/article/view/6182">cough on purpose or spontaneously in a protective reflex action</a>. The aim is to both protect the airways from material that shouldn’t be there (like dust) or to clear the secretions that come with respiratory diseases, such as the mucus and phlegm that come with colds and flu.</p>
<p>Nerve receptors throughout the lungs, and to a lesser extent in the sinuses, diaphragm and oesophagus (food pipe), detect the irritant or mucus. Then, they send messages via the vagus nerve to the brain. The brain, in turn, sends messages back through the motor nerves supplying the diaphragm, chest muscles and vocal cords.</p>
<p>This results in a sudden, forceful expulsion of air.</p>
<p>Your cough may be a one off. Alternatively, you can have a run of repeated coughs, especially in <a href="https://www.health.gov.au/health-topics/whooping-cough-pertussis">whooping cough</a>, which people describe as a bout, attack or episode.</p>
<h2>Which type of cough do I have?</h2>
<p>There are many different types of cough but no one definition that everyone agrees on. This can be confusing as patients classify their cough in descriptive terms like hacking or chesty, while doctors classify them on how long they last: acute (under three weeks), subacute (three to eight weeks) and chronic cough (more than eight weeks). </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1094553908001430?via%3Dihub">Neither of these approaches</a> tells us about the cause of the cough.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/284668/original/file-20190718-116557-nc7h43.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/284668/original/file-20190718-116557-nc7h43.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284668/original/file-20190718-116557-nc7h43.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284668/original/file-20190718-116557-nc7h43.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284668/original/file-20190718-116557-nc7h43.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284668/original/file-20190718-116557-nc7h43.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284668/original/file-20190718-116557-nc7h43.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284668/original/file-20190718-116557-nc7h43.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Patients tend to describe coughs using descriptive terms, like hacking or chesty, while doctors talk about how long the cough has lasted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/174192125?src=7zRjouRyTm8wacVcOWsFUw-1-2&studio=1&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>Coughs can also be called wet or dry. <a href="http://jtd.amegroups.com/article/view/25427/19122">Officially</a>, you have a wet cough when you produce more than 10mL of phlegm a day.</p>
<p>For people with chronic coughs, their cough can further be classified after an x-ray — either with lung pathology to indicate something like pneumonia or tuberculosis, or without signs of underlying disease (an x-ray negative cough).</p>
<h2>What caused my cough?</h2>
<p>Whether you have a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29080708">wet or dry cough</a> may tell you what has caused it.</p>
<p><a href="http://jtd.amegroups.com/article/view/25427/19122">A dry cough</a> indicates a non-infectious cough from conditions including <a href="https://www.nationalasthma.org.au/understanding-asthma/what-is-asthma">asthma</a>, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/emphysema">emphysema</a>, <a href="https://www.healthdirect.gov.au/gord-reflux">oesophageal reflux</a> and <a href="https://bestpractice.bmj.com/topics/en-us/1209">upper airway cough syndrome</a>, previously called post-nasal drip.</p>
<p><a href="http://jtd.amegroups.com/article/view/25427/19122">A wet cough</a> is more common in people with sinus and chest infections, including influenza, bronchitis and pneumonia, and serious infections such as <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/tuberculosis.aspx">tuberculosis</a>.
A smoker’s cough is usually wet, as the precursor to chronic bronchitis. As it progresses, or when complicated with infection, larger amounts of mucus may be coughed up daily.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-you-need-to-know-about-mucus-and-phlegm-33192">Health Check: what you need to know about mucus and phlegm</a>
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<p>Then there is a dry cough associated with a cold or flu that turns into a moist cough. People tend to describe this as “chesty” and it makes them worry the infection has moved to their lungs. </p>
<p>Yet mostly their lungs are clear of infectious sounds when examined with a stethoscope. Even a small amount of mucus stuck around the vocal cords or back of the throat may produce a moist sounding cough. But this is not necessarily a wet or “productive” (producing lots of mucus) cough.</p>
<p><a href="https://coughjournal.biomedcentral.com/articles/10.1186/1745-9974-2-1">One study</a> showed even doctors struggled to make an accurate diagnosis based only on the sound of the cough. Their diagnosis of the cough was correct only 34% of the time.</p>
<p>For people with chronic “unexplained cough”, a common hypothesis is that cough receptors <a href="https://www.atsjournals.org/doi/full/10.1164/rccm.200905-0665OC">become more sensitive</a> to irritation the more they are exposed to the irritant. These cough receptors are so sensitive that even <a href="https://www.ncbi.nlm.nih.gov/pubmed/20051447">perfumes, temperature changes, talking and laughing</a> may trigger the cough.</p>
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Read more:
<a href="https://theconversation.com/snout-sniff-and-sneeze-the-language-of-the-nose-76043">Snout, sniff and sneeze: the language of the nose</a>
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<p>People with <a href="https://bestpractice.bmj.com/topics/en-us/1209">upper airway cough syndrome</a> may feel mucus secretions moving down the back of the throat, causing them to cough. New evidence suggests the cough <a href="https://journal.chestnet.org/article/S0012-3692(19)31122-5/pdf">is caused by</a> the increased thickness of the mucus and slowness of that mucus being cleared by cilia (hair like structures in lining cells whose job is to move mucus along). </p>
<p>This mechanism keeps the chronic cough going through a feedback loop I call the “cough and mucus” cycle. In other words, the more the throat is irritated by the sticky mucus, the more you cough, but the cough is poor at shifting the mucus. Instead, coughing irritates the throat and fatigues the cilia, and the mucus becomes stickier and harder to shift, stimulating further coughing.</p>
<h2>When coughing gets too much</h2>
<p>Coughing is hard work so no wonder you can feel physically exhausted. <a href="https://www.ncbi.nlm.nih.gov/pubmed/7925902">In one study</a>, people with asthma coughed as many as 1,577 times in one 24-hour period. But for people with a chronic cough, it was up to 3,639 times.</p>
<p>The high pressures generated in vigorous coughing <a href="http://jtd.amegroups.com/article/view/25427/19122">can cause</a> symptoms including chest pains, a hoarse voice, and even rib fractures and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/hernias">hernias</a>. Other complications include vomiting, light-headedness, urinary incontinence, headaches and sleep deprivation. Chronic cough may also lead to people becoming embarrassed and avoiding others. </p>
<h2>Is it true?</h2>
<p>People still seemed surprised and worried when a cough persists after a cold and flu despite the fact cough outlasts other symptoms in most cases. When an <a href="https://search.informit.com.au/documentSummary;dn=380082015528918;res=IELHEA">Australian study</a> followed 131 healthy adults with an upper respiratory tract infection, 58% had a cough for at least two weeks and 35% for up to three weeks.</p>
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Read more:
<a href="https://theconversation.com/curious-kids-why-does-my-snot-turn-green-when-i-have-a-cold-98379">Curious Kids: Why does my snot turn green when I have a cold?</a>
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<p>Then there’s the colour of your mucus. Patients and doctors commonly interpret discoloured mucus, particularly if green, as a sign of bacterial infection. But there’s <a href="https://www.tandfonline.com/doi/full/10.1080/02813430902759663">clear evidence</a> that the colour alone is not able to differentiate between viral and bacterial infections in otherwise healthy adults. </p>
<p><a href="https://erj.ersjournals.com/content/38/1/119">Another study</a> found that people with acute cough who coughed up discoloured phlegm were more likely to be prescribed antibiotics, but they did not recover any faster than those not prescribed antibiotics. </p>
<h2>When and how should I treat my cough?</h2>
<p>Due to the multiple causes and types of cough there is not room to cover this question adequately. A safe approach is to diagnose the disease that is causing the cough and treat it appropriately. </p>
<p>For chronic dry coughs and coughs that last after acute upper respiratory tract infections, the cough is no longer serving a useful function and treatments can be targeted at breaking the cycle of irritation and further coughing. The evidence for effective treatments is patchy, but cough suppressants, steam inhalation and saline nasal irrigations, as well as prescribed anti-inflammatory sprays may help. </p>
<p>A spoonful of honey <a href="https://www.ncbi.nlm.nih.gov/pubmed/22869830">reduces cough</a> in children more than placebo and some cough mixtures. It is thought that the soothing effect on the throat is the way this works. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/284669/original/file-20190718-116562-1q8iwh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/284669/original/file-20190718-116562-1q8iwh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284669/original/file-20190718-116562-1q8iwh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284669/original/file-20190718-116562-1q8iwh7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284669/original/file-20190718-116562-1q8iwh7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284669/original/file-20190718-116562-1q8iwh7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284669/original/file-20190718-116562-1q8iwh7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284669/original/file-20190718-116562-1q8iwh7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">There’s no good evidence that cough medicines work, and they could harm children.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/515549014?src=MarXwDpxYfBtHcxpXiXHZw-1-0&studio=1&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>However, there is no good evidence for the effectiveness of commonly used over-the-counter medicine (cough medicine or syrup) to alleviate acute cough, yet they are still sold. Some contain drugs with the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25420096">potential to cause harm</a> in children, such as antihistamines, and codeine-like products.</p>
<p>Recent expert panel reports <a href="https://linkinghub.elsevier.com/retrieve/pii/S0012369217314083">don’t recommend the use of these cough medicines</a> for adults and children with acute cough, until they are shown to be effective. </p>
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Read more:
<a href="https://theconversation.com/health-check-do-cough-medicines-work-62425">Health Check: do cough medicines work?</a>
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<h2>When should I be concerned?</h2>
<p>It is fine to try to treat yourself, but if a cough persists or is bothersome, your doctor may be able to suggest or prescribe treatments to reduce your symptoms. </p>
<p>If you cough up blood or are becoming more unwell, consult a doctor, who will investigate further.</p>
<p>Children who cough up phlegm for more than four weeks <a href="https://www.ncbi.nlm.nih.gov/pubmed/28143696">have been found to benefit</a> from medical investigations and antibiotics.</p><img src="https://counter.theconversation.com/content/119172/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dry, moist, productive, hacking, chesty, whooping, barking, throaty. Which type of cough do you have and why?David King, Senior Lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1134842019-04-09T07:43:20Z2019-04-09T07:43:20ZChildren continue to be exposed to contaminated air in Port Pirie<figure><img src="https://images.theconversation.com/files/265484/original/file-20190324-36279-56ra44.jpg?ixlib=rb-1.1.0&rect=36%2C18%2C4068%2C2764&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Port Pirie has been a world-leading centre for lead and zinc smelting
and processing since 1889. </span> <span class="attribution"><span class="source">sondem/AAP</span></span></figcaption></figure><p>Current smelting emissions from the Nyrstar smelter in the South Australian city of Port Pirie continue to pose a clear risk of harm to local children, our research has found.</p>
<p>Port Pirie has been a world-leading centre for lead and zinc smelting and processing since 1889, exposing the adjoining community to dangerous lead contamination for more than a century. </p>
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Read more:
<a href="https://theconversation.com/lead-poisoning-of-port-pirie-children-a-long-history-of-looking-the-other-way-8296">Lead poisoning of Port Pirie children: a long history of looking the other way</a>
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<p><a href="https://www.sciencedirect.com/science/article/pii/S0160412018319810">A new study</a> led by Macquarie University examined blood lead and emergency department presentation data collected by South Australia Health. It also examined lead in air and sulfur dioxide data collected by the South Australian Environment Protection Authority to quantify health outcomes due to smelter emissions in Port Pirie.</p>
<p>In 2017, almost half of Port Pirie’s children under five years old had <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/0eaa74fc-0bd9-4a68-b45d-3515ec43581d/Port+Pirie+Blood+Lead+Levels+Analysis+for+2017+%281+January-31+December+2017%29.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-0eaa74fc-0bd9-4a68-b45d-3515ec43581d-mAOwoYN">unacceptably high</a> blood lead levels. Heightened blood lead levels in children can result in developmental problems and behavioural disorders.</p>
<p>Meanwhile, Port Pirie residents visited emergency departments for respiratory conditions at more than twice the rate of residents elsewhere in South Australia. Children under ten make up 11% of the Port Pirie population, yet they represent <a href="https://www.sciencedirect.com/science/article/pii/S0160412018319810">30% of emergency department respiratory cases</a>.</p>
<p>Emergency department presentations for respiratory illness might include asthma, bronchitis, and upper respiratory tract infections.</p>
<p>Based on our results, which are in turn based on government data, we would argue that protection of public health and the environment must be made a higher priority than the present focus on economic opportunities.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/265250/original/file-20190322-195104-18nru75.jpg?ixlib=rb-1.1.0&rect=40%2C0%2C4500%2C2903&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/265250/original/file-20190322-195104-18nru75.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/265250/original/file-20190322-195104-18nru75.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/265250/original/file-20190322-195104-18nru75.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/265250/original/file-20190322-195104-18nru75.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/265250/original/file-20190322-195104-18nru75.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/265250/original/file-20190322-195104-18nru75.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Half of children in Port Pirie exceed the maximum acceptable blood lead levels, according to Australian standards.</span>
<span class="attribution"><span class="source">David Mariuz/AAP</span></span>
</figcaption>
</figure>
<h2>Lead in children’s blood</h2>
<p>The maximum acceptable blood lead level in Australia is <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/chemicals+and+contaminants/lead">five micrograms per decilitre</a> (µg/dL).</p>
<p>Lead in blood, even at low levels, has a range of <a href="https://www.who.int/news-room/fact-sheets/detail/lead-poisoning-and-health">adverse health impacts</a>, including reducing IQ, lowering academic achievement, and socio-behavioural problems.</p>
<p>In 2018, the percentage of Port Pirie children under five exceeding the Australian intervention blood level of 5 µg/dL <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/about+us/news+and+media/media+releases/port+pirie+blood+lead+levels+2018+report">rose to 50.5%, compared with 47.4%</a> in 2017. Mean blood lead concentrations rose in all children to 4.8 µg/dL.</p>
<p>Blood lead levels in children aged two, who are considered the most sensitive indicator of lead exposure trends in the city, rose to an average of 5.8 µg/dL in 2018.</p>
<p>A recent <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ajpy.12096">University of Adelaide study</a> looked at children from Port Pirie and the New South Wales town of Broken Hill. It calculated that 13.5 IQ points were lost when a child’s blood lead level increased from 1 to 10 µg/dL.</p>
<p>Therefore, the estimate of loss for Port Pirie children with an average blood lead level is around 6 to 8 IQ points. To put this in perspective, the <a href="https://brainstats.com/average-iq-by-country.html">average IQ is around 100</a>. </p>
<p>Multiple studies of the long-term effects of lead exposure show its adverse effects do not improve with age. In one New Zealand study, children who had high lead exposures reported <a href="https://jamanetwork.com/journals/jama/fullarticle/2613157">lower cognitive function and socioeconomic status</a> at age 38 than those who didn’t.</p>
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Read more:
<a href="https://theconversation.com/pregnant-women-and-parents-misled-about-dangers-of-living-with-lead-pollution-52752">Pregnant women and parents misled about dangers of living with lead pollution</a>
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<h2>Monitoring lead levels</h2>
<p>Elevated concentrations of air lead results in the deposition of lead-rich dust, which Port Pirie children are <a href="https://www.nature.com/articles/7500512">seemingly unable to avoid</a>.</p>
<p>The smelter company, Nyrstar, monitors lead levels in the air daily. In 2017, the <a href="https://www.epa.sa.gov.au/business_and_industry/industry-updates/nyrstar-port-pirie">average lead</a> in air measured across all four of Port Pirie’s EPA monitors was more than double the Australian standard, at 1.13 µg/m³. </p>
<p>In 2018, the smelter only met the Australian standard by <a href="https://www.abc.net.au/news/2019-01-16/port-pirie-smelter-narrowly-avoids-breaching-licence/10716634">closing part of its operations</a> for several weeks.</p>
<p>Our study shows Port Pirie’s lead in air concentrations need to be 80% less than the current <a href="https://soe.environment.gov.au/theme/ambient-air-quality/topic/2016/national-air-quality-standards">Australian standard</a> of 0.5 µg/m³, at no more than 0.11 µg/m³. </p>
<p>Children under five would be better protected at this level, as it would help their blood levels remain below the maximum acceptable Australian blood lead level. However, to protect two-year-old children, lead in air concentrations need to be even lower at 0.082 µg/m³. </p>
<p>Therefore, application of the current Australian lead in air standard of 0.5 µg/m³ at Port Pirie fails to adequately protect children from adverse exposures.</p>
<h2>Sulfur dioxide and respiratory health</h2>
<p>Sulfur dioxide is a <a href="https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health">well-known health risk for respiratory diseases</a>. Surprisingly, our study is the first to examine its impact on respiratory health in Port Pirie despite it being a known problem in the city for decades.</p>
<p>Our research found elevated levels of sulfur dioxide in Port Pirie, and increased rates of emergency department respiratory presentations. </p>
<p>Port Pirie residents visited an emergency department with respiratory symptoms at a higher rate than the rest of South Australia, with children being disproportionately affected. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/263879/original/file-20190314-28479-1kvmom3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/263879/original/file-20190314-28479-1kvmom3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=579&fit=crop&dpr=1 600w, https://images.theconversation.com/files/263879/original/file-20190314-28479-1kvmom3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=579&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/263879/original/file-20190314-28479-1kvmom3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=579&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/263879/original/file-20190314-28479-1kvmom3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=728&fit=crop&dpr=1 754w, https://images.theconversation.com/files/263879/original/file-20190314-28479-1kvmom3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=728&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/263879/original/file-20190314-28479-1kvmom3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=728&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Port Pirie residents rates of Emergency Department presentations for respiratory symptoms are more than double those for the rest of South Australia.</span>
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</figure>
<p>The <a href="https://soe.environment.gov.au/theme/ambient-air-quality/topic/2016/national-air-quality-standards">Australian standard for sulfur dioxide</a> is 0.2 parts per million averaged over one hour. This value has been exceeded 896 times since 2003. </p>
<p>Remarkably, there is currently no legal requirement in <a href="https://www.epa.sa.gov.au/business_and_industry/industry-updates/nyrstar-port-pirie">Nyrstar’s environmental licence</a> for it to meet a particular air standard for sulfur dioxide in Port Pirie. </p>
<p>Even our national standards may be too generous as the sulfur dioxide levels recommended by the <a href="https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health">World Health Organisation</a> are even lower than those set by the Australian standards.</p>
<p>As a minimum, to better protect the residents of Port Pirie, the Australian standards for sulfur dioxide must be enforced. </p>
<h2>A matter of politics</h2>
<p>No other city in Australia experiences air quality like Port Pirie. The city’s population has <a href="https://www.sciencedirect.com/science/article/pii/S0160412018319810">the worst combined outcomes</a> for sulfur dioxide exposure and blood lead in Australia.</p>
<p>Established <a href="https://tlap.com.au/">public health programs</a> in Port Pirie have aimed to reduce blood lead in Port Pirie’s children. Playgrounds are washed and residents advised to wash their hands, surfaces and food. But previous research has found that playground washing results in only short-lived exposure reduction and <a href="https://www.sciencedirect.com/science/article/pii/S0269749115001050?via%3Dihub">effective treatment requires elimination of smelter emissions.</a></p>
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<p>
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Read more:
<a href="https://theconversation.com/toxic-chemicals-and-pollutants-affect-kids-brain-development-23342">Toxic chemicals and pollutants affect kids' brain development</a>
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<p>Of the political and government agency decision-makers, we ask: why did you not intervene sooner to prevent vulnerable members of the population from being exposed to toxic substances that are known to cause serious short- and long-term health problems? Would you be comfortable with bringing up your family in such an environment, where damaging but preventable toxic exposures <a href="https://www.nature.com/articles/7500512">are inescapable</a>?</p>
<p>We anticipate the outcomes of the approximately A$660 million <a href="https://www.sa.gov.au/__data/assets/pdf_file/0006/8619/Port_Pirie_PER_Part_1.pdf">Nyrstar smelter transformation project</a> with interest.</p>
<p>In a statement to The Conversation, Nyrstar noted it was undergoing the most significant transformation of the Port Pirie smelter in its history, and was committed to reducing emissions as a result:</p>
<blockquote>
<p>That is the focus of the company and its entire workforce and Nyrstar has been working closely with the community through the decommissioning process. When complete it will be among the world’s most advanced facilities of its kind; full ramp up and stable low emissions should be achieved by the end of 2019. – Nyrstar</p>
</blockquote>
<p>The most recent air quality, <a href="https://data.sa.gov.au/data/dataset/port-pirie-oliver-street-air-quality-monitoring-station-gaseous-data">particularly sulfur dioxide levels</a>, suggests there have been improvements, but there’s a still a long way to go. Importantly, these improvements do not help those already exposed. </p>
<p>This Nyrstar investment, supported by the SA government, includes a smelter refit with modern, clean technology and is expected to yield measurable benefits in health outcomes. </p>
<p>However, in the refit “transition” period since 2014, lead in air quality has got markedly worse, not better.</p><img src="https://counter.theconversation.com/content/113484/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Patrick Taylor is affiliated with: Broken Hill Lead Reference Group. LEAD Group Inc. (Australia). NSW EPA’s Broken Hill Environmental Lead Program.</span></em></p><p class="fine-print"><em><span>Cynthia Faye Barlow and John Glover do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lead and zinc smelting may be big business in Port Pirie, but it’s making the kids who live there sick. Something needs to change.Mark Patrick Taylor, Professor of Environmental Science, Macquarie UniversityCynthia Faye Barlow, Postdoctoral Research Fellow in Environmental Science, Macquarie UniversityJohn Glover, Director of Public Health Information Development Unit (PHIDU), Torrens University AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1149422019-04-08T10:34:15Z2019-04-08T10:34:15ZLondon’s Ultra Low Emission Zone – will it make the city healthier?<figure><img src="https://images.theconversation.com/files/268070/original/file-20190408-2898-sdn9co.jpg?ixlib=rb-1.1.0&rect=15%2C131%2C5136%2C3298&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">London: a clean future?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/london-england-january-10-2017-city-1216347856?src=b1lw_3Z1v_51zC1HwqD3kw-1-31">Magic Bones/Shutterstock.</a></span></figcaption></figure><p>A new Ultra Low Emission Zone (ULEZ) is being introduced in London, to reduce harmful emissions from traffic and improve air quality. Those who drive polluting vehicles into the city centre will face a daily charge – <a href="https://www.london.gov.uk/what-we-do/environment/pollution-and-air-quality/how-were-cleaning-londons-air/faqs-t-charge-and-ulez#acc-i-50405">£12.50</a> for cars, motorcycles and vans, and <a href="https://www.london.gov.uk/what-we-do/environment/pollution-and-air-quality/how-were-cleaning-londons-air/faqs-t-charge-and-ulez#acc-i-50405">£100</a> for lorries, buses and coaches – on top of the existing <a href="https://theconversation.com/london-congestion-charge-what-worked-what-didnt-what-next-92478">congestion charge</a>. By October 2021, the scheme will expand to cover an area 18 times larger. </p>
<p>The rationale for the ULEZ is clear: large numbers of people are living in areas with pollution levels well above the legal limits set by the European Union (EU). These limits are based on detailed evidence about the impacts of air pollution on people’s health – which can cause short term effects like worsening asthma symptoms, to a loss of healthy years of life in the longer term. </p>
<p>Other cities across the UK and beyond will be watching closely, as London’s ULEZ is effectively a test bed to gauge the effectiveness of such schemes at clearing up air pollution and improving the health of residents. </p>
<h2>Major health problems</h2>
<p>Over recent years, several London-based studies have shown that the city’s air pollution is associated with increased respiratory and cardiovascular <a href="https://www.ncbi.nlm.nih.gov/pubmed/26884048">hospital admissions</a>, increases in <a href="https://www.ncbi.nlm.nih.gov/pubmed/26464095">daily deaths</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27295599">stroke risk</a> and <a href="https://www.bmj.com/content/359/bmj.j5299">low birth weights</a>, as well as <a href="https://theconversation.com/london-air-pollution-is-restricting-childrens-lung-development-new-research-106909">reduced lung volumes</a> in children, <a href="https://bmjopen.bmj.com/content/8/9/e022404">dementia</a> among the elderly, and poor mental health <a href="https://www.sciencedirect.com/science/article/pii/S016517811830800X">in children</a> and <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2729441">adolescents</a>. </p>
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<p>
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Read more:
<a href="https://theconversation.com/london-air-pollution-is-restricting-childrens-lung-development-new-research-106909">London air pollution is restricting children's lung development – new research</a>
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<p>Clearly, the polluted air that people breathe in London is having profound effects on their health, throughout their entire lives. So, while some people will lose out – for example, those who need to drive in central London for work – that should be weighed against the clear need for action to reduce pollution, on health grounds. </p>
<p>As well as the current health concerns, there are legal reasons why London authorities have introduced the new charge. Much of the area covered by the ULEZ often exceeds the annual EU limit for nitrogen dioxide (NO₂) – especially near roads, where diesel vehicles are a major source of the gas. The EU annual limit for NO₂ is 40μg/m³ (that’s micrograms per metre cubed). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/268071/original/file-20190408-2909-16bacm7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/268071/original/file-20190408-2909-16bacm7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/268071/original/file-20190408-2909-16bacm7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/268071/original/file-20190408-2909-16bacm7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/268071/original/file-20190408-2909-16bacm7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/268071/original/file-20190408-2909-16bacm7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/268071/original/file-20190408-2909-16bacm7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/268071/original/file-20190408-2909-16bacm7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A map of annual mean NO₂ pollution levels across London, based on data from 2013. Areas coloured from yellow through to red exceed annual targets.</span>
<span class="attribution"><a class="source" href="https://www.londonair.org.uk/london/asp/annualmaps.asp">London Air/KCL.</a>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>There are also other legal limits set by the EU for airborne particulate matter of various sizes. If you consider fine particles – often referred to as PM₂.₅ (generally less than 2.5 microns in diameter) – then the picture looks better. Most of London meets the EU’s annual limit for PM₂.₅, which is 25μg/m³. </p>
<p>But <a href="http://www.euro.who.int/__data/assets/pdf_file/0004/193108/REVIHAAP-Final-technical-report-final-version.pdf?ua=1">numerous studies</a> have shown there are clear health impacts below this concentration, and the World Health Organisation (WHO) <a href="https://www.who.int/en/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-healt">recommends that</a> an annual target of 10μg/m³ would be best to protect people’s health. If this lower annual exposure limit was to be used, many areas across London would exceed it – just as they currently do with NO₂. </p>
<h2>Medicine worth taking</h2>
<p>The evidence shows that diesel exhaust emissions are the major driver of poor health outcomes due to air pollution. That doesn’t mean that other pollutant sources, such a biomass burning, agriculture, industry, or particles derived from brake and tyre wear, are not important – but it makes sense for cities to make reducing diesel emissions a priority. Will it work, though?</p>
<p>The ULEZ, like the Low Emission Zone before it, is designed to encourage the uptake of newer, low emission vehicles both by businesses and the general public with the aim of reducing air pollution in the target area. Current <a href="https://www.ncbi.nlm.nih.gov/pubmed/30448150">evidence does suggest</a> that air pollution concentrations are falling in London as a result of several measures, such as the <a href="https://tfl.gov.uk/modes/driving/low-emission-zone">Low Emission Zone</a>, but these improvements still need to be accelerated to deliver health benefits. </p>
<p>Since the ULEZ targets all vehicles, modelling <a href="https://www.london.gov.uk/sites/default/files/appendix_c1_supporting_information_document_-_copy.pdf">commissioned by the Greater London Authority</a> predicts that it will have significant impact on air quality, compared with earlier policies, which focused on restricting only certain types of vehicles. But this projection still needs to be validated. </p>
<p>If the ULEZ is the equivalent to the treatment to the air pollution problem, then like a clinical drug trial it requires independent evaluation, measuring both the changes in pollution concentration, and health improvements among Londoners. </p>
<p>Work is already ongoing to address these issues, such as the <a href="https://www.qmul.ac.uk/chill/">Children’s Health in London and Luton</a> (CHILL) project, which is examining children’s respiratory health and lung growth across the introduction of the ULEZ. But further work evaluating this scheme is needed, to keep ensuring that policies are developed based on evidence – and prove to the public that this is a medicine worth taking.</p><img src="https://counter.theconversation.com/content/114942/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Mudway receives funding from the National Institute for Health Research, the Natural Environment Research Council and the Medical Research Council.</span></em></p>Drivers of polluting vehicles will face a daily charge, but evidence suggests it’s a price worth paying.Ian Mudway, Lecturer in Respiratory Toxicology, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1074802018-11-23T12:47:14Z2018-11-23T12:47:14ZSydney’s orange sky reminds us how unpredictable dust storms can be<p>People in Sydney woke on <a href="https://www.bbc.co.uk/news/world-australia-46298309">the morning of Thursday November 22</a> to see a bright orange sky as the sun was blotted out by a dust storm. Visibility and air quality were very poor and people with heart and lung conditions were advised to stay indoors. Ambulance call-outs spiked and extra paramedics were called upon to <a href="https://www.theguardian.com/australia-news/2018/nov/22/dust-storm-nsw-air-quality-warning-as-front-descends-on-sydney">deal with the crisis</a>.</p>
<p>The dust cloud originated from north-western New South Wales, where strong winds ahead of a cold front met with dry, dusty soil. This lofted tiny dust particles into the atmosphere, which were carried hundreds of kilometers towards Sydney, and then onwards over the Pacific Ocean.</p>
<p>Any parts of the world which have an ample supply of soil dust particles, dry conditions, and strong winds are susceptible to dust storms. The “<a href="https://agupubs.onlinelibrary.wiley.com/doi/full/10.1029/2007GL029971">dust belt</a>” –- a train of dust hotspots stretching from the Sahara desert across the Middle East to Central Asia, dominates global dust activity. </p>
<p>Once dust particles are lifted into the atmosphere, they are transported thousands of kilometres by the prevailing winds due to their small size –- around 1 to 10 microns – smaller than the width of a human hair. Over the Sahara during summertime, intense solar heating and convection allow dust to reach altitudes of <a href="https://www.atmos-chem-phys.net/13/303/2013/acp-13-303-2013.html">up to 5 km</a>, from where the dust particles can take up to ten days to sediment out of the atmosphere and travel as far as the Americas, <a href="https://agupubs.onlinelibrary.wiley.com/doi/full/10.1002/2013GB004802">degrading Caribbean air quality</a>. </p>
<p>Although Australia has its fair share of dust hotspots, they are more abundant across the global dust belt and atmospheric dust loadings are much higher in these regions. However, many of the world’s largest dust hotspots are in sparsely inhabited regions such as the Sahara, so some of the worst impacts of dust storms are less frequently experienced by humans.</p>
<h2>Predicting future dust storms</h2>
<p>So what can we expect from the future in terms of dust storms? Predicting their frequency, intensity and transport requires forecasts of surface wind speeds, surface conditions such as land surface type and soil moisture, and therefore also precipitation. Accurately simulating these properties over remote, sparsely observed regions such as the Sahara even in the present day is a <a href="https://www.atmos-chem-phys.net/18/9025/2018/">challenge to models</a> due to the complex nature of the interaction between these parts of the climate system.</p>
<p>Climate models are a valuable tool for forecasting dust storms and how they will affect us in the future. It might be expected that, in a warmer future with more drought conditions, we would experience more dust storms. However, the environmental conditions that drive dust storms must be considered in combination. </p>
<p>For example, <a href="https://www.nature.com/articles/nature17149">one study</a> actually predicts a decrease in African dust emissions throughout the 21st century due to a slowdown of tropical circulation and therefore surface winds, which drive the dust uplift. This scenario would result in improved air quality in West Africa. </p>
<p>However elsewhere in <a href="https://www.nature.com/articles/s41598-017-05431-9">North America</a>, dust activity is predicted to increase by the end of the century over the Southern Great Plains largely due to reduced precipitation, enhanced land surface bareness and increased surface wind speed, while the opposite trend can be expected over the northern Great Plains.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/246933/original/file-20181122-182062-oxx4fg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246933/original/file-20181122-182062-oxx4fg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246933/original/file-20181122-182062-oxx4fg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246933/original/file-20181122-182062-oxx4fg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246933/original/file-20181122-182062-oxx4fg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246933/original/file-20181122-182062-oxx4fg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246933/original/file-20181122-182062-oxx4fg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Dust Bowl in Texas, 1935. Dust storms may return to skylines in the southern Great Plains in future.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Dust_Bowl#/media/File:Dust-storm-Texas-1935.png">George E. Marsh/Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Globally, <a href="https://www.atmos-chem-phys.net/18/12491/2018/acp-18-12491-2018.html">the trend in dust activity</a> projected across the next century by climate models is highly variable regionally and seasonally. For Australia, climate models predict more dust activity during the southern hemisphere autumn, driven by increases in surface wind speeds.</p>
<p>Our ability to forecast dust both in the short and long term requires an accurate understanding of the processes which drive dust uplift. Climate models need to be able to simulate surface wind speeds, precipitation, soil bareness and soil moisture, as well as the processes which drive transport in the atmosphere and allow dust particles to be <a href="https://agupubs.onlinelibrary.wiley.com/doi/full/10.1002/grl.50482">carried over long distances</a>. </p>
<p>Dust storms highlight how vulnerable societies are to these extreme weather events and how difficult predicting them is under a changing climate. They’re affected by soil conditions on a microscopic scale and large-scale atmospheric circulation, and so dust storms are uniquely challenging to predict and we urgently need to find out more about them if we are to adequately prepare ourselves for the future.</p><img src="https://counter.theconversation.com/content/107480/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Ryder receives funding from the Natural Environment Research Council. </span></em></p>Dust storms look spectacular but are a serious health hazard. As climate change dries up many areas of the world, what can we expect from these storms in future?Claire Ryder, Research Fellow in Meteorology, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1073232018-11-21T11:48:45Z2018-11-21T11:48:45ZWildfire smoke is becoming a nationwide health threat<figure><img src="https://images.theconversation.com/files/246493/original/file-20181120-161609-1s7kwwx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An image from the International Space Station captures plumes of smoke from California wildfires on August 4, 2018. </span> <span class="attribution"><a class="source" href="https://eol.jsc.nasa.gov/SearchPhotos/photo.pl?mission=ISS056&roll=E&frame=126709">NASA</a></span></figcaption></figure><p>The impacts of recent forest fires in California reach well beyond the burned areas. Smoke from the Camp Fire created <a href="https://sf.curbed.com/2018/11/16/18098615/sf-air-quality-bad-worst-bay-area-smoke">hazardous air quality conditions in San Francisco</a>, more than 170 miles to the southwest – but it didn’t stop there. Cross-country winds carried it across the United States, creating hazy conditions in locations <a href="https://www.phillyvoice.com/philadelphia-wildfire-california-haze-map-smoke-camp-fire/">as far east as Philadelphia</a>. </p>
<p>As an <a href="https://sites.google.com/umass.edu/peltieraerosollab/home">air pollution exposure scientist</a>, I worry about the extreme levels of air pollution that rise from these fires and affect many people across great distances. They can create unhealthy conditions in far-flung locations where residents probably never think about wildfires. But since major wildfires are becoming increasingly common, I believe it is important for all Americans to know some basics about smoke hazards.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/246496/original/file-20181120-161609-xcddk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/246496/original/file-20181120-161609-xcddk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246496/original/file-20181120-161609-xcddk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246496/original/file-20181120-161609-xcddk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246496/original/file-20181120-161609-xcddk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246496/original/file-20181120-161609-xcddk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=481&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246496/original/file-20181120-161609-xcddk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=481&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246496/original/file-20181120-161609-xcddk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=481&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Smoke and haze from wildfires obscure the San Francisco skyline on Nov. 15, 2018.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/California-Wildfires-Health/68a42784efbb442aa1b1b9fcfea5d064/1/0">AP Photo/Eric Risberg</a></span>
</figcaption>
</figure>
<h2>A complex and unpredictable threat</h2>
<p>Forest fires do not discriminate about what they burn. Along with woody materials from forests and homes, they consume homes’ contents, which may contain plastics, petroleum products, chemicals and metals. This produces thick plumes of smoke that contains very large quantities of particles and gases. Many of these airborne chemicals are <a href="https://www.epa.gov/sciencematters/danger-wildland-fire-smoke-public-health">known to be quite toxic to humans</a>. </p>
<p>Smoke plumes travel great distances, affecting communities hundreds of miles away. Winds tend to move from west to east across North America and carry these pollutants with them. Sometimes, depending on local weather conditions, the pollutants can be lifted up to high altitudes where wind speeds are faster and transported very quickly across the country. The pollutants can then descend back to the ground in locations far away from the fires, affecting everyone in their path.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/246546/original/file-20181120-161644-1tveank.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/246546/original/file-20181120-161644-1tveank.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/246546/original/file-20181120-161644-1tveank.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/246546/original/file-20181120-161644-1tveank.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/246546/original/file-20181120-161644-1tveank.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/246546/original/file-20181120-161644-1tveank.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/246546/original/file-20181120-161644-1tveank.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/246546/original/file-20181120-161644-1tveank.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Predicted smoke concentrations at ground level across the continental United States on Nov. 20, 2018.</span>
<span class="attribution"><a class="source" href="https://airquality.weather.gov/sectors/conus.php?period=2#tabs">NOAA</a></span>
</figcaption>
</figure>
<p>Relatively few studies have analyzed broad public health impacts from wood smoke. Agencies such as the <a href="https://www.niehs.nih.gov/index.cfm">National Institute of Environmental Health Sciences</a> are funding some research on this issue, but it can take a long time to produce convincing science, especially on subjects that are so unpredictable. </p>
<p>We do know that this kind of smoke contains chemicals that are toxic, including <a href="https://toxtown.nlm.nih.gov/chemicals-and-contaminants/polycyclic-aromatic-hydrocarbons-pahs">polycyclic aromatic hydrocarbons</a>, <a href="http://dx.doi.org/10.1007/978-3-7643-8340-4_6">heavy metals</a>, <a href="https://www.epa.gov/air-research/black-carbon-research">black carbon (soot)</a>, acids and <a href="http://dx.doi.org/10.1155/2011/487074">oxidizing compounds</a>. Exposure to some of these compounds can lead to lung irritation, cancer, hypertension, cardiovascular disease and even death. We know this because researchers <a href="https://wildfiretoday.com/2018/02/06/study-shows-firefighters-exposure-smoke-increases-disease-risk/">have studied</a> smoke exposure in firefighters for many years, and it’s likely that the risks also apply to people who aren’t firefighters.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/32YGGYaUTgE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In this segment from the Netflix series ‘Fire Chasers,’ a CAL FIRE crew battles an out-of-control fire in Los Angeles that threatens to overtake a house and one of the firefighting engines. Smoke exposure is a serious hazard for firefighters, but also affects the general public.</span></figcaption>
</figure>
<h2>When the smoke moves in</h2>
<p>Research has shown that many health effects from air pollution occur well after exposure has occurred. Sometimes these problems occur within a few hours, but in other cases it can be days or weeks later. This means that people may not feel the impacts of smoke inhalation until well after the smoke clears. </p>
<p>The most effective strategy is to limit exposure to poor-quality air through steps such as avoiding the outdoors when possible, closing windows and doors, and running central heat or air conditioning systems, which for the most part recirculate indoor air. For outdoor protection, the best option is an <a href="https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html">N95 facemask</a>, which is designed to fit snugly and filter out very small particles. Inexpensive cloth masks <a href="https://theconversation.com/millions-rely-on-cheap-cloth-masks-that-may-provide-little-protection-against-deadly-air-pollution-64791">do not provide effective protection</a>. </p>
<p>However, it can be difficult to achieve a good fit with N95 masks, and these masks are not very effective at removing toxic gases from smoke, which easily pass through the filter material. Avoiding exposure in the first place is the best strategy. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1029412925684047872"}"></div></p>
<p>Communities that are frequently exposed to wildfire smoke should consider creating locations where they can provide high-quality air filtration, such as a school or community center. These sites could offer safer conditions for people who are <a href="https://www.cdc.gov/features/wildfires/index.html">especially vulnerable to air pollution</a>, such as children, the elderly and people with respiratory ailments, in the same way that cities set up heating and cooling centers during extreme weather conditions.</p>
<p>Many factors appear to be increasing the number and scale of wildfires, including <a href="https://doi.org/10.1073/pnas.1718850115">development patterns</a> and <a href="https://theconversation.com/recreating-forests-of-the-past-isnt-enough-to-fix-our-wildfire-problems-59364">forest management practices</a>. But the biggest driver is likely to be climate change, which is <a href="https://theconversation.com/climate-change-and-wildfires-how-do-we-know-if-there-is-a-link-101304">making ecosystems hotter and drier</a>. This suggests that all Americans, wherever they live, will need to become more aware of wildfires and their long-range health effects.</p><img src="https://counter.theconversation.com/content/107323/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard E. Peltier receives funding from the Department of Energy Resources of Massachusetts</span></em></p>Haze from Northern California wildfires has drifted as far east as Philadelphia. Wildfire smoke contains many potentially toxic substances, so anyone exposed to it should take basic precautions.Richard E. Peltier, Associate Professor of Environmental Health Sciences, UMass AmherstLicensed as Creative Commons – attribution, no derivatives.