livescience--2020-09-18--Is Earth-moon space the US military's new high ground?

U.S. military space policy officials have increasingly flagged a new role in guarding American assets and interests in Earth-moon space .
This evolving doctrine extends to the moon 's surface , given NASA 's and American companies ' plans to mine moon resources such as water ice .
What do space experts say about extending military tactics to a new `` high ground '' domain beyond Earth orbit ?
Space.com asked experts for their opinions regarding an evolving military doctrine that builds on air , land and sea warfare strategies — and is now headed for the ocean of deep @ @ @ @ @ @ @ 's moon was spotlighted in a recent report , `` State of the Space Industrial Base 2020 : A Time for Action to Sustain US Economic & Military Leadership in Space . ''
The July 2020 report , which you can find , was based on a virtual workshop that brought together more than 150 thought leaders from industry , government and academia .
The mind-meld meeting was staged by NewSpace New Mexico , the Defense Innovation Unit , the Air Force Research Laboratory ( AFRL ) and the .
The summary report @ @ @ @ @ @ @ and inflection points in the final frontier .
In terms of cislunar ( Earth-moon ) space and the moon itself , there is a need to control critical `` choke points . ''
`` As space activities expand beyond geosynchronous orbit , the first nation to establish transportation infrastructure and logistics capabilities serving GEO [ geosynchronous Earth orbit ] and cislunar space will have superior ability to exercise control of cislunar space and in particular the Lagrange points and the resources of the moon , '' the report says .
( are gravitationally @ @ @ @ @ @ @ `` park , '' remaining in place without expending much fuel . )
More to the point , the recently published report observes that — especially ice-derived hydrogen and oxygen , which can provide spacecraft propellant for civil , commercial and national security applications — are key for access to asteroid resources and Mars , and to enable overall space commercial development .
`` Today 's has little to do with flags and footprints , '' the report states .
`` Strategically , it is a race to the great wealth of lunar @ @ @ @ @ @ @ economy and enable future exploration and settlement in the solar system . ''
Taking these report findings to a new level is next month 's first annual Cislunar Security Conference ( CLSC ) , to be held at the Johns Hopkins University Applied Physics Laboratory .
`` CLSC is a classified forum on the technology , policy , doctrine , and strategy implications of ensuring free access , transit , and use of the Earth-Moon system beyond GEO , '' .
This month , the Space Vehicles Directorate of the AFRL announced winning @ @ @ @ @ @ @ the next set of flight experiments , one of which is an experiment in space domain awareness beyond GEO all the way out to .
That winning concept is dubbed CHPS , short for the Cislunar Highway Patrol System .
`` The 21st century space economy is expanding beyond traditional orbits out to the moon with commercial companies seeking to harvest resources , and NASA and other countries returning to the moon , '' said AFRL 's David Buehler , a program manager .
`` This increase in activity will require greater domain @ @ @ @ @ @ @ trying to address . ''
Related : NASA wants to buy moon dirt from private companies '' There is indeed a reimagination of space to transcend simply LEO [ low Earth orbit ] and GEO to move onto the cislunar space , '' said Namrata Goswami , an independent analyst specializing in space policy .
From a period where going somewhere first in space , planting a flag for your nation or on humanity 's behalf was seen as optimal , today the space discourse is shifting , she told Space.com .
From @ @ @ @ @ @ @ said , it 's much more feasible to blind or damage a satellite in GEO or LEO , without being noticed , from cislunar space than from Earth 's surface .
`` Countries are beginning to understand this critical perspective , especially due to the growing dependence of modern warfare on LEO and GEO-supported space command and control , '' Goswami said .
What Goswami foresees is that space power projection — via civil , military and commercial efforts — will move beyond simply satellite presence , and the International Space Station to @ @ @ @ @ @ @ .
`` Once lunar permanent presence is achieved in the next decade or so , space thinkers , leaders , military space leaders will be forced to account for that new reality , whether they like it or not . ''
Related : The most dangerous space weapons concepts ever There 's lots of ongoing and planned activity beyond GEO , especially near or on the moon .
So to some extent it is natural that the U.S. military would want to pay more attention to that big patch of space , said @ @ @ @ @ @ @ security affairs at the Naval War College in Newport , Rhode Island .
Speaking in a personal capacity , Burbach said that , in principle , spacecraft in cislunar space can affect the many in lower Earth orbits , or be relevant to military operations on Earth .
So the presence of more non-US spacecraft in that region is a change , albeit a small one .
`` Organizationally , the whole point of creating a separate service [ the Space Force ] was to forge a space-centric culture , and it 's @ @ @ @ @ @ @ to take steps to differentiate itself from its parent and to show that it is actively taking on new missions , and as a corollary , needs new resources , '' Burbach said .
Given the increase in a variety of cislunar activity by multiple nations , `` it 's not surprising that a military organization wants to be able to know what 's going on in an area of potential relevance to their mission , '' he said .
Burbach said that he believes , institutionally , a central focus for the @ @ @ @ @ @ @ space domain awareness '' beyond GEO — being able to track , and likely listen in on , spacecraft out at lunar distances , which current U.S. surveillance systems are not optimized for .
There are some people in the U.S. space community , Burbach said , who envision the moon as the `` new El Dorado , '' a place of fabulous wealth or opportunity .
That wealth could come from mining , gathering up helium-3 fuel for nuclear reactors or moving our heavy industry to the moon .
So , some @ @ @ @ @ @ @ cislunar space , though Burbach and many other analysts are skeptical that this will happen in the next few decades .
And a few vocal backers figure that , just as a navy protects foreign commerce , or the U.S. Army set up forts to protect wagon trains moving west in the 1800s , `` the U.S. military should have a cislunar presence in order to facilitate U.S. companies and US citizens winning out in the lunar gold rush , and preventing others from shoving us aside and jumping our claims , '' @ @ @ @ @ @ @ big a role this reasoning plays in Defense Department and Space Force thinking , he added .
While NASA Administrator Jim Bridenstine , U.S. Secretary of Commerce Wilbur Ross and other high-ranking officials have strongly embraced the Trump Administration 's deep-space strategy , still missing is such an embrace or even acknowledgment from Space Force or Defense Department leadership .
That 's the view of Peter Garretson , an independent strategy consultant focusing on space and defense and a senior fellow in defense studies at the American Foreign Policy Council .
`` You @ @ @ @ @ @ @ the thought leader here … but so far the Space Force has ceded such thought leadership to others , and kept this out of their highest-level talking points , '' Garretson told Space.com .
Garretson expects that `` thinking boldly '' and designing for the next 100 years would include the articulation of a vision or strategy for cislunar or an in-space economy that excites future Space Force recruits .
But so far that thinking has come from innovation units outside the Space Force proper , he said .
Looking down or looking @ @ @ @ @ @ @ the that U.S. interests in space are moving beyond GEO .
And that being the case , there 's need to provide space security and defense of commerce wherever U.S. citizens are , '' Garretson said .
The current , Garretson suggested , is also fundamentally about whether or not the Force should be focused looking down or looking out — including at the moon and cislunar .
`` Those who favor a focus on space resources and development of the moon seem to favor naval rank , while those wanting the Space @ @ @ @ @ @ @ force favor status quo rank , '' he said .
Garretson said it will be interesting to see if the current generation of Space Force leadership , which grew up within the Earth-centric culture of the Air Force , will be able to bridge visionary thinking in their posture statements and then force design guidance .
`` Certainly that 's the criterion many of us will be using to grade those documents and statements on .
We are waiting to see whether or not the Space Force leadership has in fact embraced the @ @ @ @ @ @ @ intends to be merely a status quo continuation of Air Force Space Command and a puppet of the Air Force proper , '' Garretson added .
`` We will know there is real progress when cislunar becomes part of headquarters-level documents , vision , strategy and congressional testimony , '' he concluded .
Leonard David is author of the recently released book , `` Moon Rush : The New Space Race '' published by National Geographic in May 2019 .
A longtime writer for Space.com , David has been reporting on the space @ @ @ @ @ @ @ Follow us @ Spacedotcom , Facebook or Google+ .
This version of the story published on Space.com .

As multiple nations have exploration crosshairs on Earth's moon, including private sector interests, there's also increasing discussion of the military utility of cislunar space and lunar territory, too.
U.S. military space policy officials have increasingly flagged a new role in guarding American assets and interests in Earth-moon space.
This evolving doctrine extends to the moon's surface, given NASA's Artemis program of crewed lunar exploration and American companies' plans to mine moon resources such as water ice.
What do space experts say about extending military tactics to a new "high ground" domain beyond Earth orbit? Space.com asked experts for their opinions regarding an evolving military doctrine that builds on air, land and sea warfare strategies — and is now headed for the ocean of deep space.
Related: Military Space: Spacecraft, weapons and tech
Challenges, inflections and choke points
American military interest in Earth's moon was spotlighted in a recent report, "State of the Space Industrial Base 2020: A Time for Action to Sustain US Economic & Military Leadership in Space."
The July 2020 report, which you can find here , was based on a virtual workshop that brought together more than 150 thought leaders from industry, government and academia. The mind-meld meeting was staged by NewSpace New Mexico, the Defense Innovation Unit, the Air Force Research Laboratory (AFRL) and the United States Space Force .
The summary report explains that the U.S. faces major challenges and inflection points in the final frontier. In terms of cislunar (Earth-moon) space and the moon itself, there is a need to control critical "choke points."
"As space activities expand beyond geosynchronous orbit, the first nation to establish transportation infrastructure and logistics capabilities serving GEO [geosynchronous Earth orbit] and cislunar space will have superior ability to exercise control of cislunar space and in particular the Lagrange points and the resources of the moon," the report says. ( Lagrange points are gravitationally stable spots in space where probes can "park," remaining in place without expending much fuel.)
Race to the moon
More to the point, the recently published report observes that lunar resources — especially ice-derived hydrogen and oxygen, which can provide spacecraft propellant for civil, commercial and national security applications — are key for access to asteroid resources and Mars, and to enable overall space commercial development.
"Today's race to the moon has little to do with flags and footprints," the report states. "Strategically, it is a race to the great wealth of lunar resources which will fuel the greater space economy and enable future exploration and settlement in the solar system."
Taking these report findings to a new level is next month's first annual Cislunar Security Conference (CLSC), to be held at the Johns Hopkins University Applied Physics Laboratory. "CLSC is a classified forum on the technology, policy, doctrine, and strategy implications of ensuring free access, transit, and use of the Earth-Moon system beyond GEO," the conference website reads .
Winning concept
This month, the Space Vehicles Directorate of the AFRL announced winning concepts of a competition to decide on the next set of flight experiments, one of which is an experiment in space domain awareness beyond GEO all the way out to the moon . That winning concept is dubbed CHPS, short for the Cislunar Highway Patrol System.
"The 21st century space economy is expanding beyond traditional orbits out to the moon with commercial companies seeking to harvest resources, and NASA and other countries returning to the moon," said AFRL's David Buehler, a program manager. "This increase in activity will require greater domain awareness, which is what CHPS is trying to address."
Related: NASA wants to buy moon dirt from private companies
Power projection
"There is indeed a reimagination of space to transcend simply LEO [low Earth orbit] and GEO to move onto the cislunar space," said Namrata Goswami, an independent analyst specializing in space policy. From a period where going somewhere first in space, planting a flag for your nation or on humanity's behalf was seen as optimal, today the space discourse is shifting, she told Space.com.
From the perspective of space warfare, Goswami said, it's much more feasible to blind or damage a satellite in GEO or LEO, without being noticed, from cislunar space than from Earth's surface. "Countries are beginning to understand this critical perspective, especially due to the growing dependence of modern warfare on LEO and GEO-supported space command and control," Goswami said.
What Goswami foresees is that space power projection — via civil, military and commercial efforts — will move beyond simply satellite presence, anti-satellite technology and the International Space Station to include real-time presence on the lunar surface. "Once lunar permanent presence is achieved in the next decade or so, space thinkers, leaders, military space leaders will be forced to account for that new reality, whether they like it or not."
Related: The most dangerous space weapons concepts ever
Space-centric culture
There's lots of ongoing and planned activity beyond GEO, especially near or on the moon. So to some extent it is natural that the U.S. military would want to pay more attention to that big patch of space, said David Burbach, a professor of national security affairs at the Naval War College in Newport, Rhode Island.
Speaking in a personal capacity, Burbach said that, in principle, spacecraft in cislunar space can affect the many satellites in lower Earth orbits, or be relevant to military operations on Earth. So the presence of more non-US spacecraft in that region is a change, albeit a small one.
"Organizationally, the whole point of creating a separate service [the Space Force] was to forge a space-centric culture, and it's natural that a new organization would want to take steps to differentiate itself from its parent and to show that it is actively taking on new missions, and as a corollary, needs new resources," Burbach said.
Given the increase in a variety of cislunar activity by multiple nations, "it's not surprising that a military organization wants to be able to know what's going on in an area of potential relevance to their mission," he said.
New El Dorado?
Burbach said that he believes, institutionally, a central focus for the U.S. Space Force is getting better "space domain awareness" beyond GEO — being able to track, and likely listen in on, spacecraft out at lunar distances, which current U.S. surveillance systems are not optimized for.
There are some people in the U.S. space community, Burbach said, who envision the moon as the "new El Dorado," a place of fabulous wealth or opportunity.
That wealth could come from mining lunar water ice , gathering up helium-3 fuel for nuclear reactors or moving our heavy industry to the moon. So, some advocates see a near-term economic boom in cislunar space, though Burbach and many other analysts are skeptical that this will happen in the next few decades.
And a few vocal backers figure that, just as a navy protects foreign commerce, or the U.S. Army set up forts to protect wagon trains moving west in the 1800s, "the U.S. military should have a cislunar presence in order to facilitate U.S. companies and US citizens winning out in the lunar gold rush, and preventing others from shoving us aside and jumping our claims," Burbach said. It's unclear how big a role this reasoning plays in Defense Department and Space Force thinking, he added.
Talking points
While NASA Administrator Jim Bridenstine, U.S. Secretary of Commerce Wilbur Ross and other high-ranking officials have strongly embraced the Trump Administration's deep-space strategy, still missing is such an embrace or even acknowledgment from Space Force or Defense Department leadership.
That's the view of Peter Garretson, an independent strategy consultant focusing on space and defense and a senior fellow in defense studies at the American Foreign Policy Council.
"You'd think the Space Force would be the thought leader here … but so far the Space Force has ceded such thought leadership to others, and kept this out of their highest-level talking points," Garretson told Space.com.
Garretson expects that "thinking boldly" and designing for the next 100 years would include the articulation of a vision or strategy for cislunar or an in-space economy that excites future Space Force recruits. But so far that thinking has come from innovation units outside the Space Force proper, he said.
Looking down or looking out?
"There is recognition in the new Space Force doctrine that U.S. interests in space are moving beyond GEO. And that being the case, there's need to provide space security and defense of commerce wherever U.S. citizens are," Garretson said.
The current argument over military ranks for Space Force , Garretson suggested, is also fundamentally about whether or not the Force should be focused looking down or looking out — including at the moon and cislunar.
"Those who favor a focus on space resources and development of the moon seem to favor naval rank, while those wanting the Space Force to remain an overhead robotic monitoring force favor status quo rank," he said.
Wanted: visionary thinking
Garretson said it will be interesting to see if the current generation of Space Force leadership, which grew up within the Earth-centric culture of the Air Force, will be able to bridge visionary thinking in their posture statements and then force design guidance.
"Certainly that's the criterion many of us will be using to grade those documents and statements on. We are waiting to see whether or not the Space Force leadership has in fact embraced the vision of Congress and the administration or intends to be merely a status quo continuation of Air Force Space Command and a puppet of the Air Force proper," Garretson added.
"We will know there is real progress when cislunar becomes part of headquarters-level documents, vision, strategy and congressional testimony," he concluded.
Leonard David is author of the recently released book, "Moon Rush: The New Space Race" published by National Geographic in May 2019. A longtime writer for Space.com, David has been reporting on the space industry for more than five decades. Follow us @Spacedotcom, Facebook or Google+. This version of the story published on Space.com.


livescience--2020-09-18--'We just had no answers': COVID-19 'long-haulers' still learning why they're sick

Recurrent fevers , persistent constipation or diarrhea , intense bouts of fatigue , debilitating brain fog and vivid hallucinations — some people who catch COVID-19 experience symptoms like these for months on end , and we 're still learning why that is .
Data gathered early in the pandemic suggested that most people with COVID-19 recover within a few weeks , if they survive the illness .
But around April , stories began surfacing from those who remained sick for months after their initial symptoms emerged .
Many of these individuals came together online to form support groups , with @ @ @ @ @ @ @ . ''
Now , six months since the World Health Organization , formal studies of long-haulers are only just getting off the ground .
But patients are n't waiting for science to catch up ; they are organizing to collect data on their symptoms , tie those symptoms to biological explanations , and even to share potential — and unapproved — treatments .
Knowing whether any of those treatments can alleviate the long-lasting symptoms of COVID-19 , however , will take a more systematic approach and clinical trials , experts told Live Science @ @ @ @ @ @ @ epidemics and pandemics in history One of the biggest ways long-haulers have expanded knowledge of the condition is by thoroughly cataloguing their symptoms .
A patient-led research group , born out of the , published the results of a in May that detailed some of their most common symptoms .
`` At the time , we just had no answers , '' said Hannah Davis , a composer , independent researcher and core member of the .
Davis began experiencing symptoms of COVID-19 on March 25 , and to this day , many @ @ @ @ @ @ @ she said .
`` My first symptom was that I could n't read a text message , '' Davis told Live Science , and she said her most persistent symptom has been `` brain fog , '' or general cognitive dysfunction and trouble concentrating .
In the May survey , nearly 70 % of the 640 respondents reported experiencing either brain fog , insomnia or concentration issues , making these symptoms as common as a cough among long-haulers .
A smaller percentage reported memory loss , dizziness , involuntary tremors , numbness in @ @ @ @ @ @ @ unknown whether neurological symptoms like these mostly arise from increased inflammation in the body or from the directly infecting brain cells , though there 's evidence for both , .
Related : What are the symptoms of COVID-19 ?
In addition to brain fog , many of the survey participants reported shortness of breath , tightness in the chest , fatigue , chills , body aches and a slightly elevated temperature , between 98.8 degrees Fahrenheit ( 37.1 degrees Celsius ) and 100 F ( 37.7 C ) .
Some less common symptoms @ @ @ @ @ @ @ such as constipation lasting for weeks , bowel obstructions and diarrhea leading to rapid weight loss .
Long-haulers also reported seizures , , vision changes , sensitivity to light and phantom smells , or smelling things that are n't there .
`` For me , I 've definitely experienced at least 100 symptoms over the last five months , '' Davis said .
`` People call it a 'grab bag , ' '' because some symptoms persist for many months while others seem to randomly crop up then disappear , she said .
@ @ @ @ @ @ @ her main symptom , Davis said she had transient rib pain , phantom smells and even vivid hallucinations that lasted a day or two , then went away .
`` Long COVID is a whole spectrum of different conditions , '' said Paul Garner , a professor at the School of Tropical Medicine in Liverpool , England , who also developed his initial COVID-19 symptoms in March .
But one common refrain is a sense of overwhelming fatigue .
Garner is among long-haulers who experience such fatigue as one of their main symptoms @ @ @ @ @ @ @ ( ME/CFS ) , the exact cause of which is unknown .
When dealing with a new chronic illness , it 's difficult to know what activities will trigger symptoms , Garner said .
`` You don ’ t know the speed limit and you don ’ t know when the penalties will arrive .
You find out that when they do they are harsh , stopping you in your tracks for days , '' he wrote in a blog post published in June in .
He said he 's learned that ample @ @ @ @ @ @ @ keep his symptoms at bay , while physical activity and consuming alcohol can set them off .
Similarly , 89 % of respondents to the patient-led survey reported experiencing relapses in their symptoms , sometimes set off by exercise , stress , caffeine , alcohol or heat .
Related : 25 medical myths that just wo n't go away In the case of the fatigue she 's experienced after contracting COVID-19 , the sensation does n't set in like typical tiredness , which comes on gradually , Dr. Mady Hornig , a physician-scientist @ @ @ @ @ @ @ Public Health , told Live Science .
`` From my own experience , it 's more like you 're an electrical device and every once in a while someone pulls out the plug , '' she said .
Hornig developed symptoms of COVID-19 , including a fever and cough , back in April .
Now , `` I 've had to be on a toddler 's time table with self-enforced rest , '' she said .
But could a COVID-19 infection really trigger the onset of ME/CFS ?
Hornig said it 's possible @ @ @ @ @ @ @ been linked to the syndrome .
For instance , an estimated 10 % to 12 % of people with , caused by the Epstein-Barr , later develop a chronic course of ME/CFS , she said .
( This increased risk is associated with symptomatic mono , according to a commentary in ; most people carry the Epstein-Barr virus without developing any symptoms of illness . )
Hornig said that she expects that , similarly , a percentage of patients who catch COVID-19 may go on to develop ME/CFS .
Hornig is now leading @ @ @ @ @ @ @ at Columbia to determine whether and how many long-haulers develop ME/CFS , as well as what other conditions crop up after the initial infection subsides .
She also wants to track whether any long-haulers eventually stop experiencing symptoms ; blood or tissue samples from these people could hint at what helps the body `` bounce back '' after prolonged illness , she said .
One of the major challenges in devising such studies is deciding what `` post-COVID '' really means , Hornig noted .
`` What is post-COVID ?
… The before @ @ @ @ @ @ @ she said .
The acute , or short-term , phase of an infection is typically defined by characteristic symptoms that appear in a particular order , she said .
But with COVID-19 patients , the initial symptoms vary person to person , and some people do n't experience any overt symptoms , like cough or fever , but still go on to develop signs of organ damage .
`` We still have much to learn about the variations in the onset , symptoms , signs and time to resolution of the acute disease @ @ @ @ @ @ @ biomarkers might help predict long-term persistence of illness , '' Hornig said .
Hornig 's research group is collaborating with the ME/CFS focused nonprofit to develop a symptom tracking app for long-haulers , with the goal of tracking their symptoms over time and matching them up with patients ' verifiable medical records .
They are using data from long-hauler surveys , including ones conducted by the advocacy group , to craft their survey questions .
The medical records help confirm that when a patient reports experiencing brain inflammation , for example , brain @ @ @ @ @ @ @ Research group is also launching a new project in conjunction with University College London .
will cover the first seven months of symptoms and ask about test results , as some long-haulers do n't test positive for antibodies when assessed , Davis said .
This can become a sticking point when long-haulers seek medical care for their symptoms , because many never had a diagnostic test for COVID-19 when they first fell ill , she added .
Therefore , antibodies would provide the only medical proof that they caught the virus at all @ @ @ @ @ @ @ , April , you were only able to get a test if you were hospitalized .
And most long-haulers are not hospitalized , '' Davis said .
Even when long-haulers could get a diagnostic test , some got tested too late in the course of their illness , she said .
To account for that , the first patient-led survey included all symptomatic people , regardless of whether they had a positive COVID-19 diagnostic test or not .
And their results indirectly support the notion that long-haulers without a positive test likely had @ @ @ @ @ @ @ positive and those who tested negative was when they received their test .
On average , positive people got tested on day 10 after developing symptoms , while negative people got tested on day 16 .
The diagnostic tests work by detecting bits of viral , and are more likely to give false-negatives once the body has had time to fight off the infection and the amount of virus in their body decreases , .
Requiring a positive diagnostic or antibody test poses a problem for many people seeking treatment for long-COVID .
@ @ @ @ @ @ @ to be admitted , '' Davis said .
`` Diagnostic tests need to be deprioritized … Clinical diagnoses have to be enough , '' meaning long-haulers should be admitted based on what symptoms they show , she said .
She noted that , because long-haulers experience such a wide range of symptoms , patients should also receive a `` full workup '' of medical screenings , from pulmonary to cardiovascular to neurological .
Long-haulers all over the world have shared stories of doctors not believing that they had had COVID-19 , and brushing @ @ @ @ @ @ @ , Garner noted .
`` People were going in and being diagnosed with ; it was appalling , '' he said .
Hornig , a physician and psychiatrist herself , also encountered doubt from her health care providers when she tested negative for COVID-19 and for antibodies against the virus , she told in August .
But she also tested negative for 12 other respiratory pathogens , including influenza , and based on her symptoms and the course of her disease , COVID-19 was the best explanation for why she fell ill , @ @ @ @ @ @ @ about persistent COVID-19 symptoms it may help to come prepared with documents describing your medical history , timeline of COVID-19 symptoms and the top questions you have for them , JD Davids , a writer , strategist and contributor to the Patient-Led Research survey , told Live Science in an email .
It also helps to understand the medical practice inside and out , such as how long you might wait to see a specialist and who to call with insurance problems , he said .
As a long-time advocate for people with @ @ @ @ @ @ @ Davids said that the lack of support long-haulers face reflects a historic trend in how health care providers treat those with chronic conditions .
That 's why patient-led groups play such a vital role in gathering information about their disease and potential treatment options , he said .
Davids helped organize a seminar for long-haulers called `` COVID-19 ( Coronavirus ) Preparation for People Living with Chronic Illnesses in the U.S. , '' to provide guidance for those who might be experiencing chronic illness for the first time .
`` These social networks @ @ @ @ @ @ @ science communicates through long , rather boring papers that take months of preparation , '' Garner said .
The speed of information spread in social networks can also mean speculative or untested treatments become widely known very quickly .
For instance , some long-haulers say they have benefited from taking the heartburn medication famotidine , better known by the brand name Pepcid , Davis said .
Specifically , they say the drug seems to ease their shortness of breath and reduce brain fog .
Related : Treatments for COVID-19 : Drugs being tested @ @ @ @ @ @ @ 2 ( H2 ) blocker , meaning it works by blocking receptors for the compound histamine , one of several substances that trigger stomach acid production .
Beyond the stomach , histamine also helps kick the immune system into gear when it detects a pathogen , according to a commentary published in , a blog curated by the journal Science Translational Medicine .
However , this short-term immune response becomes overblown in some COVID-19 patients , which could explain why famotidine appears to help some long-haulers , the commentary notes .
Other long-haulers @ @ @ @ @ @ @ have said they found benefit from acupuncture , compression stockings and lymphatic massage , and some with primarily cardiovascular symptoms take salt tablets .
COVID-19 may sometimes be linked to dysfunction of the autonomic nervous system , which controls involuntary functions like breathing and heart rate , according to a case report in The American Journal of the Medical Sciences ; salt tablets may be used to treat the blood circulation problems and rapid heart rate that can arise from such disorders , according to the Cleveland Clinic .
But when it comes @ @ @ @ @ @ @ `` there is no evidence that these different treatments have benefits for a large number of patients , '' said Dr. Michael Matthay , a professor of medicine at University of California , San Francisco School of Medicine .
`` However , they may have value for individual patients . ''
In other words , if individual patients find a mild treatment like famotidine or massage helpful , then it 's reasonable for them to consider that treatment as long it does not cause significant side effects , he said .
Above all @ @ @ @ @ @ @ for months after their initial COVID-19 infection should be closely monitored by health care providers , in order to pinpoint the source of their prolonged symptoms and find solutions , Matthay added .
In the end , clinical trials will be needed to determine if any of these treatments actually work , and if so , how they work to alleviate specific symptoms .
As all that work gets underway , Davis said that doctors can start helping long-haulers by doing one simple thing : '' The easiest and first thing doctors can @ @ @ @ @ @ @ , ' '' she said .

Recurrent fevers, persistent constipation or diarrhea, intense bouts of fatigue, debilitating brain fog and vivid hallucinations — some people who catch COVID-19 experience symptoms like these for months on end, and we're still learning why that is.
Data gathered early in the pandemic suggested that most people with COVID-19 recover within a few weeks, if they survive the illness. But around April, stories began surfacing from those who remained sick for months after their initial symptoms emerged. Many of these individuals came together online to form support groups, with some referring to themselves "COVID long-haulers."
Now, six months since the World Health Organization declared COVID-19 a pandemic , formal studies of long-haulers are only just getting off the ground. But patients aren't waiting for science to catch up; they are organizing to collect data on their symptoms, tie those symptoms to biological explanations, and even to share potential — and unapproved — treatments. Knowing whether any of those treatments can alleviate the long-lasting symptoms of COVID-19, however, will take a more systematic approach and clinical trials, experts told Live Science.
Related: 20 of the worst epidemics and pandemics in history
A wide array of symptoms
One of the biggest ways long-haulers have expanded knowledge of the condition is by thoroughly cataloguing their symptoms. A patient-led research group, born out of the Body Politic COVID-19 Support Group , published the results of a survey of long-haulers in May that detailed some of their most common symptoms.
"At the time, we just had no answers," said Hannah Davis, a composer, independent researcher and core member of the Patient-Led Research for COVID-19 team . Davis began experiencing symptoms of COVID-19 on March 25, and to this day, many of her primary symptoms are neurological, she said.
"My first symptom was that I couldn't read a text message," Davis told Live Science, and she said her most persistent symptom has been "brain fog," or general cognitive dysfunction and trouble concentrating. In the May survey, nearly 70% of the 640 respondents reported experiencing either brain fog, insomnia or concentration issues, making these symptoms as common as a cough among long-haulers. A smaller percentage reported memory loss, dizziness, involuntary tremors, numbness in their extremities or hallucinations.
It's unknown whether neurological symptoms like these mostly arise from increased inflammation in the body or from the coronavirus directly infecting brain cells, though there's evidence for both, Live Science previously reported .
Related: What are the symptoms of COVID-19?
In addition to brain fog, many of the survey participants reported shortness of breath, tightness in the chest, fatigue, chills, body aches and a slightly elevated temperature, between 98.8 degrees Fahrenheit (37.1 degrees Celsius) and 100 F (37.7 C). Some less common symptoms included high fevers and severe gastrointestinal issues, such as constipation lasting for weeks, bowel obstructions and diarrhea leading to rapid weight loss. Long-haulers also reported seizures, migraines , vision changes, sensitivity to light and phantom smells, or smelling things that aren't there.
"For me, I've definitely experienced at least 100 symptoms over the last five months," Davis said. "People call it a 'grab bag,'" because some symptoms persist for many months while others seem to randomly crop up then disappear, she said. For instance, while brain fog remains her main symptom, Davis said she had transient rib pain, phantom smells and even vivid hallucinations that lasted a day or two, then went away.
Chronic fatigue?
"Long COVID is a whole spectrum of different conditions," said Paul Garner, a professor at the School of Tropical Medicine in Liverpool, England, who also developed his initial COVID-19 symptoms in March. But one common refrain is a sense of overwhelming fatigue.
Garner is among long-haulers who experience such fatigue as one of their main symptoms; some have compared the condition to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), the exact cause of which is unknown.
When dealing with a new chronic illness, it's difficult to know what activities will trigger symptoms, Garner said. "You don’t know the speed limit and you don’t know when the penalties will arrive. You find out that when they do they are harsh, stopping you in your tracks for days," he wrote in a blog post published in June in The British Medical Journal Opinion .
He said he's learned that ample rest and keeping a decent diet helps keep his symptoms at bay, while physical activity and consuming alcohol can set them off. Similarly, 89% of respondents to the patient-led survey reported experiencing relapses in their symptoms, sometimes set off by exercise, stress, caffeine, alcohol or heat.
Related: 25 medical myths that just won't go away
In the case of the fatigue she's experienced after contracting COVID-19, the sensation doesn't set in like typical tiredness, which comes on gradually, Dr. Mady Hornig, a physician-scientist at the Columbia University Mailman School of Public Health, told Live Science. "From my own experience, it's more like you're an electrical device and every once in a while someone pulls out the plug," she said. Hornig developed symptoms of COVID-19, including a fever and cough, back in April. Now, "I've had to be on a toddler's time table with self-enforced rest," she said.
But could a COVID-19 infection really trigger the onset of ME/CFS? Hornig said it's possible, given that other viral infections have been linked to the syndrome. For instance, an estimated 10% to 12% of people with infectious mono , caused by the Epstein-Barr virus , later develop a chronic course of ME/CFS, she said. (This increased risk is associated with symptomatic mono, according to a commentary in The Journal of Infectious Disease ; most people carry the Epstein-Barr virus without developing any symptoms of illness.) Hornig said that she expects that, similarly, a percentage of patients who catch COVID-19 may go on to develop ME/CFS.
Hornig is now leading a study of "post-COVID phenomena" at Columbia to determine whether and how many long-haulers develop ME/CFS, as well as what other conditions crop up after the initial infection subsides. She also wants to track whether any long-haulers eventually stop experiencing symptoms; blood or tissue samples from these people could hint at what helps the body "bounce back" after prolonged illness, she said.
One of the major challenges in devising such studies is deciding what "post-COVID" really means, Hornig noted. "What is post-COVID? … The before and after becomes very blurry," she said. The acute, or short-term, phase of an infection is typically defined by characteristic symptoms that appear in a particular order, she said. But with COVID-19 patients, the initial symptoms vary person to person, and some people don't experience any overt symptoms, like cough or fever, but still go on to develop signs of organ damage.
"We still have much to learn about the variations in the onset, symptoms, signs and time to resolution of the acute disease, let alone what clinical symptoms or biomarkers might help predict long-term persistence of illness," Hornig said.
Hornig's research group is collaborating with the ME/CFS focused nonprofit Solve ME to develop a symptom tracking app for long-haulers, with the goal of tracking their symptoms over time and matching them up with patients' verifiable medical records. They are using data from long-hauler surveys, including ones conducted by the advocacy group Survivor Corps , to craft their survey questions. The medical records help confirm that when a patient reports experiencing brain inflammation, for example, brain scans back that up.
Dealing with doctors
The Patient-Led Research group is also launching a new project in conjunction with University College London. Their second survey will cover the first seven months of symptoms and ask about antibody test results, as some long-haulers don't test positive for antibodies when assessed, Davis said. This can become a sticking point when long-haulers seek medical care for their symptoms, because many never had a diagnostic test for COVID-19 when they first fell ill, she added. Therefore, antibodies would provide the only medical proof that they caught the virus at all.
In the U.S. "in March, April, you were only able to get a test if you were hospitalized. And most long-haulers are not hospitalized," Davis said. Even when long-haulers could get a diagnostic test, some got tested too late in the course of their illness, she said.
To account for that, the first patient-led survey included all symptomatic people, regardless of whether they had a positive COVID-19 diagnostic test or not. And their results indirectly support the notion that long-haulers without a positive test likely had COVID-19.The main difference between people who tested positive and those who tested negative was when they received their test. On average, positive people got tested on day 10 after developing symptoms, while negative people got tested on day 16. The diagnostic tests work by detecting bits of viral genetic material , and are more likely to give false-negatives once the body has had time to fight off the infection and the amount of virus in their body decreases, Live Science previously reported .
Related: 14 coronavirus myths busted by science
Requiring a positive diagnostic or antibody test poses a problem for many people seeking treatment for long-COVID. "Many post-COVID clinics require positive tests to be admitted," Davis said. "Diagnostic tests need to be deprioritized … Clinical diagnoses have to be enough," meaning long-haulers should be admitted based on what symptoms they show, she said.
She noted that, because long-haulers experience such a wide range of symptoms, patients should also receive a "full workup" of medical screenings, from pulmonary to cardiovascular to neurological.
Long-haulers all over the world have shared stories of doctors not believing that they had had COVID-19, and brushing off their symptoms as psychiatric in origin, Garner noted. "People were going in and being diagnosed with anxiety ; it was appalling," he said. Hornig, a physician and psychiatrist herself, also encountered doubt from her health care providers when she tested negative for COVID-19 and for antibodies against the virus, she told Stat News in August. But she also tested negative for 12 other respiratory pathogens, including influenza, and based on her symptoms and the course of her disease, COVID-19 was the best explanation for why she fell ill, she said.
When seeing a doctor about persistent COVID-19 symptoms it may help to come prepared with documents describing your medical history, timeline of COVID-19 symptoms and the top questions you have for them, JD Davids, a writer, strategist and contributor to the Patient-Led Research survey, told Live Science in an email. It also helps to understand the medical practice inside and out, such as how long you might wait to see a specialist and who to call with insurance problems, he said.
Promising treatments, potential pitfalls
As a long-time advocate for people with chronic health conditions like HIV/AIDS and ME/CFS, Davids said that the lack of support long-haulers face reflects a historic trend in how health care providers treat those with chronic conditions. That's why patient-led groups play such a vital role in gathering information about their disease and potential treatment options, he said. Earlier in the year, Davids helped organize a webinar for people already living with chronic illness called "COVID-19 (Coronavirus) Preparation for People Living with Chronic Illnesses in the U.S.," to provide guidance for those who might face a heightened risk of severe disease, prolonged symptoms or death from COVID-19.
"These social networks are very fast at learning … medical science communicates through long, rather boring papers that take months of preparation," Garner said.
The speed of information spread in social networks can also mean speculative or untested treatments become widely known very quickly. For instance, some long-haulers say they have benefited from taking the heartburn medication famotidine, better known by the brand name Pepcid, Davis said. Specifically, they say the drug seems to ease their shortness of breath and reduce brain fog.
Related: Treatments for COVID-19: Drugs being tested against the coronavirus
Famotidine is a histamine 2 (H2) blocker, meaning it works by blocking receptors for the compound histamine, one of several substances that trigger stomach acid production. Beyond the stomach, histamine also helps kick the immune system into gear when it detects a pathogen, according to a commentary published in In The Pipeline , a blog curated by the journal Science Translational Medicine. However, this short-term immune response becomes overblown in some COVID-19 patients, which could explain why famotidine appears to help some long-haulers, the commentary notes.
Other long-haulers in the Body Politic COVID-19 Support Group have said they found benefit from acupuncture, compression stockings and lymphatic massage, and some with primarily cardiovascular symptoms take salt tablets. COVID-19 may sometimes be linked to dysfunction of the autonomic nervous system, which controls involuntary functions like breathing and heart rate, according to a case report in The American Journal of the Medical Sciences ; salt tablets may be used to treat the blood circulation problems and rapid heart rate that can arise from such disorders, according to the Cleveland Clinic .
But when it comes to these remedies for long-COVID symptoms, "there is no evidence that these different treatments have benefits for a large number of patients," said Dr. Michael Matthay, a professor of medicine at University of California, San Francisco School of Medicine. "However, they may have value for individual patients." In other words, if individual patients find a mild treatment like famotidine or massage helpful, then it's reasonable for them to consider that treatment as long it does not cause significant side effects, he said. Above all, people who continue to feel ill for months after their initial COVID-19 infection should be closely monitored by health care providers, in order to pinpoint the source of their prolonged symptoms and find solutions, Matthay added.
In the end, clinical trials will be needed to determine if any of these treatments actually work, and if so, how they work to alleviate specific symptoms.
As all that work gets underway, Davis said that doctors can start helping long-haulers by doing one simple thing:
"The easiest and first thing doctors can do is say 'I believe you,'" she said.
Editor's note: This story was updated on September 18, 12:15 p.m. EDT to correct the description of the webinar organized by JD Davids. The original story was published at 7 a.m. EDT the same day.
Originally published on Live Science.


livescience--2020-09-19--How Ruth Bader Ginsburg helped shape the modern era of women's rights

Chief Justice John Roberts that `` Our nation has lost a jurist of historic stature . ''
Even before her appointment , she had reshaped American law .
When he nominated Ginsburg to the Supreme Court , President Bill Clinton compared her legal work to the epochal work of Thurgood Marshall on behalf of African-Americans .
The comparison was entirely appropriate : As the legal strategy that culminated in , the 1954 case that outlawed segregated schools , Ginsburg coordinated a similar effort against sex discrimination .
Decades before she joined the court , Ginsburg 's work as an attorney @ @ @ @ @ @ @ rights , and the modern skepticism about sex-based policies stems in no small way from her lawyering .
Ginsburg 's work helped to change the way we all think about women — and men , for that matter .
I 'm and I served as a law clerk to Ginsburg when she was an appeals court judge .
In my opinion — as remarkable as Marshall 's work on behalf of African-Americans was — in some ways Ginsburg faced more daunting prospects when she started .
When in the 1930s , the Supreme @ @ @ @ @ @ @ discrimination even though it had upheld segregation .
When Ginsburg started her work in the 1960s , the Supreme Court had any type of sex-based rule .
Worse , it had rejected every challenge to laws that treated women worse than men .
For instance , in 1873 , the court allowed Illinois authorities to ban Myra Bradwell from becoming a lawyer because she was a woman .
Justice Joseph P. Bradley , widely viewed as a progressive , wrote that women were too fragile to be lawyers : `` The paramount destiny @ @ @ @ @ @ @ the noble and benign offices of wife and mother .
This is the . ''
And in 1908 , the court upheld an Oregon law that limited the number of hours that women — but not men — .
The opinion relied heavily on a famous brief submitted by Louis Brandeis to support the notion that women needed protection to avoid harming their reproductive function .
As late as 1961 , the court upheld a Florida law that for all practical purposes kept women from serving on juries because they were `` the @ @ @ @ @ @ @ '' and therefore need not incur the .
Ginsburg followed Marshall 's approach to promote women 's rights — despite some important differences between segregation and gender discrimination .
Segregation rested on the racist notion that Black people were less than fully human and deserved to be treated like animals .
Gender discrimination reflected paternalistic notions of female frailty .
Those notions placed women on a pedestal — but also denied them opportunities .
Either way , though , Black Americans and women got the short end of the stick .
Ginsburg started @ @ @ @ @ @ @ an requiring probate courts to appoint men to administer estates , even if there were a qualified woman who could perform that task .
Sally and Cecil Reed , the long-divorced parents of a teenage son who committed suicide while in his father 's custody , both applied to administer the boy 's tiny estate .
The probate judge appointed the father as required by state law .
Sally Reed appealed the case all the way to the Supreme Court .
Ginsburg did not argue the case , but wrote the brief that @ @ @ @ @ @ @ invalidate the state 's preference for males .
As the court 's decision stated , that preference was `` the very kind of forbidden by the Equal Protection Clause of the 14th Amendment . ''
Two years later , Ginsburg won in her first appearance before the Supreme Court .
She appeared on behalf of Air Force Lt. Sharron Frontiero .
Frontiero was required by federal law to prove that her husband , Joseph , was dependent on her for at least half his economic support in order to qualify for housing , @ @ @ @ @ @ @ Frontiero had been the soldier , the couple would have automatically qualified for those benefits .
Ginsburg argued that sex-based classifications such as the one Sharron Frontiero challenged should be treated the same as the now-discredited race-based policies .
By an 8–1 vote , the court in agreed that this sex-based rule was unconstitutional .
But the justices could not agree on the legal test to use for evaluating the constitutionality of sex-based policies .
In 1974 , Ginsburg suffered her only loss in the Supreme Court , in a case that she @ @ @ @ @ @ @ Kahn , a Florida widower , asked for the property tax exemption that state law allowed only to widows .
him .
Ginsburg , working with the national ACLU , stepped in after the local affiliate brought the case to the Supreme Court .
But a closely divided court as compensation for women who had suffered economic discrimination over the years .
Despite the unfavorable result , the Kahn case showed an important aspect of Ginsburg 's approach : her willingness to work on behalf of .
She reasoned that rigid attitudes about @ @ @ @ @ @ @ the all-male Supreme Court might more easily get the point in cases involving male plaintiffs .
She turned out to be correct , just not in the Kahn case .
Ginsburg represented in challenging a Social Security Act provision that provided parental benefits only to widows with minor children .
Wiesenfeld 's wife had died in childbirth , so he was denied benefits even though he faced all of the challenges of single parenthood that a mother would have faced .
The Supreme Court gave in 1975 , unanimously ruling that sex-based distinction @ @ @ @ @ @ @ Ginsburg successfully represented in to another sex-based provision of the Social Security Act : Widows automatically received survivor 's benefits on the death of their husbands .
But widowers could receive such benefits only if the men could prove that they were financially dependent on their wives ' earnings .
Ginsburg also wrote an influential brief in Craig v. Boren , the 1976 case that established the current standard for evaluating the constitutionality of sex-based laws .
Like Wiesenfeld and Goldfarb , the challengers in the Craig case were men .
Their claim @ @ @ @ @ @ @ allowed women to buy low-alcohol beer at age 18 but required men to be 21 to buy the same product .
But this illustrated the vices of sex stereotypes : Aggressive men ( and boys ) drink and drive , women ( and girls ) are demure passengers .
And those stereotypes affected everyone 's behavior , including the enforcement decisions of police officers .
Under the standard delineated by the justices in the Boren case , such a law can be justified only if it is substantially related to an important governmental @ @ @ @ @ @ @ satisfied this test was that punished sex with an underage female but not with an underage male as a way to reduce the risk of teen pregnancy .
These are only some of the Supreme Court cases in which Ginsburg played a prominent part as a lawyer .
She handled many lower-court cases as well .
She had plenty of help along the way , but everyone recognized her as .
In the century before Ginsburg won the Reed case , the Supreme Court never met a gender classification that it did n't @ @ @ @ @ @ @ usually have been struck down .
I believe President Clinton was absolutely right in comparing Ruth Bader Ginsburg 's efforts to those of Thurgood Marshall , and in appointing her to the Supreme Court .

U.S. Supreme Court Justice Ruth Bader Ginsburg testifies at her confirmation hearing before the Senate Judiciary Committee in July 1993.
Justice Ruth Bader Ginsburg died on Friday, the Supreme Court announced.
Chief Justice John Roberts said in a statement that "Our nation has lost a jurist of historic stature."
Even before her appointment, she had reshaped American law. When he nominated Ginsburg to the Supreme Court, President Bill Clinton compared her legal work on behalf of women to the epochal work of Thurgood Marshall on behalf of African-Americans.
The comparison was entirely appropriate: As Marshall oversaw the legal strategy that culminated in Brown v. Board of Education , the 1954 case that outlawed segregated schools, Ginsburg coordinated a similar effort against sex discrimination.
Decades before she joined the court, Ginsburg's work as an attorney in the 1970s fundamentally changed the Supreme Court's approach to women's rights, and the modern skepticism about sex-based policies stems in no small way from her lawyering. Ginsburg's work helped to change the way we all think about women — and men, for that matter.
I'm a legal scholar who studies social reform movements and I served as a law clerk to Ginsburg when she was an appeals court judge. In my opinion — as remarkable as Marshall's work on behalf of African-Americans was — in some ways Ginsburg faced more daunting prospects when she started.
Starting at zero
When Marshall began challenging segregation in the 1930s, the Supreme Court had rejected some forms of racial discrimination even though it had upheld segregation.
When Ginsburg started her work in the 1960s, the Supreme Court had never invalidated any type of sex-based rule. Worse, it had rejected every challenge to laws that treated women worse than men.
For instance, in 1873, the court allowed Illinois authorities to ban Myra Bradwell from becoming a lawyer because she was a woman. Justice Joseph P. Bradley, widely viewed as a progressive, wrote that women were too fragile to be lawyers: "The paramount destiny and mission of woman are to fulfill the noble and benign offices of wife and mother. This is the law of the Creator ."
And in 1908, the court upheld an Oregon law that limited the number of hours that women — but not men — could work . The opinion relied heavily on a famous brief submitted by Louis Brandeis to support the notion that women needed protection to avoid harming their reproductive function.
As late as 1961, the court upheld a Florida law that for all practical purposes kept women from serving on juries because they were "the center of the home and family life" and therefore need not incur the burden of jury service .
Challenging paternalistic notions
Ginsburg followed Marshall's approach to promote women's rights — despite some important differences between segregation and gender discrimination.
Segregation rested on the racist notion that Black people were less than fully human and deserved to be treated like animals. Gender discrimination reflected paternalistic notions of female frailty. Those notions placed women on a pedestal — but also denied them opportunities.
Either way, though, Black Americans and women got the short end of the stick.
Ginsburg started with a seemingly inconsequential case. Reed v. Reed challenged an Idaho law requiring probate courts to appoint men to administer estates, even if there were a qualified woman who could perform that task.
Sally and Cecil Reed, the long-divorced parents of a teenage son who committed suicide while in his father's custody, both applied to administer the boy's tiny estate.
The probate judge appointed the father as required by state law. Sally Reed appealed the case all the way to the Supreme Court.
Ginsburg did not argue the case, but wrote the brief that persuaded a unanimous court in 1971 to invalidate the state's preference for males. As the court's decision stated, that preference was "the very kind of arbitrary legislative choice forbidden by the Equal Protection Clause of the 14th Amendment."
Two years later, Ginsburg won in her first appearance before the Supreme Court. She appeared on behalf of Air Force Lt. Sharron Frontiero. Frontiero was required by federal law to prove that her husband, Joseph, was dependent on her for at least half his economic support in order to qualify for housing, medical and dental benefits.
If Joseph Frontiero had been the soldier, the couple would have automatically qualified for those benefits. Ginsburg argued that sex-based classifications such as the one Sharron Frontiero challenged should be treated the same as the now-discredited race-based policies.
By an 8–1 vote, the court in Frontiero v. Richardson agreed that this sex-based rule was unconstitutional. But the justices could not agree on the legal test to use for evaluating the constitutionality of sex-based policies.
Strategy: Represent men
In 1974, Ginsburg suffered her only loss in the Supreme Court, in a case that she entered at the last minute.
Mel Kahn, a Florida widower, asked for the property tax exemption that state law allowed only to widows. The Florida courts ruled against him.
Ginsburg, working with the national ACLU, stepped in after the local affiliate brought the case to the Supreme Court. But a closely divided court upheld the exemption as compensation for women who had suffered economic discrimination over the years.
Despite the unfavorable result, the Kahn case showed an important aspect of Ginsburg's approach: her willingness to work on behalf of men challenging gender discrimination . She reasoned that rigid attitudes about sex roles could harm everyone and that the all-male Supreme Court might more easily get the point in cases involving male plaintiffs.
She turned out to be correct, just not in the Kahn case.
Ginsburg represented widower Stephen Wiesenfeld in challenging a Social Security Act provision that provided parental benefits only to widows with minor children.
Wiesenfeld's wife had died in childbirth, so he was denied benefits even though he faced all of the challenges of single parenthood that a mother would have faced. The Supreme Court gave Wiesenfeld and Ginsburg a win in 1975, unanimously ruling that sex-based distinction unconstitutional.
And two years later, Ginsburg successfully represented Leon Goldfarb in his challenge to another sex-based provision of the Social Security Act: Widows automatically received survivor's benefits on the death of their husbands. But widowers could receive such benefits only if the men could prove that they were financially dependent on their wives' earnings.
Ginsburg also wrote an influential brief in Craig v. Boren, the 1976 case that established the current standard for evaluating the constitutionality of sex-based laws.
Like Wiesenfeld and Goldfarb, the challengers in the Craig case were men. Their claim seemed trivial: They objected to an Oklahoma law that allowed women to buy low-alcohol beer at age 18 but required men to be 21 to buy the same product.
But this deceptively simple case illustrated the vices of sex stereotypes: Aggressive men (and boys) drink and drive, women (and girls) are demure passengers. And those stereotypes affected everyone's behavior, including the enforcement decisions of police officers.
Under the standard delineated by the justices in the Boren case, such a law can be justified only if it is substantially related to an important governmental interest.
Among the few laws that satisfied this test was a California law that punished sex with an underage female but not with an underage male as a way to reduce the risk of teen pregnancy.
These are only some of the Supreme Court cases in which Ginsburg played a prominent part as a lawyer. She handled many lower-court cases as well. She had plenty of help along the way, but everyone recognized her as the key strategist .
In the century before Ginsburg won the Reed case, the Supreme Court never met a gender classification that it didn't like. Since then, sex-based policies usually have been struck down.
I believe President Clinton was absolutely right in comparing Ruth Bader Ginsburg's efforts to those of Thurgood Marshall, and in appointing her to the Supreme Court.


livescience--2020-09-18--CDC reverses controversial coronavirus testing guidelines

In its latest about-face , the Centers for Disease Control and Prevention ( CDC ) has reversed controversial COVID-19 testing guidelines that were posted to the agency 's website last month , reportedly over the objections of its own scientists .
On Aug. 24 , the CDC updated its testing guidelines to say that being exposed to a person with COVID-19 did n't necessarily warrant a test for those who are low-risk or not showing any symptoms , Live Science previously reported .
Now , the agency has reverted back to previous guidelines , saying that close contacts of a @ @ @ @ @ @ @ .
That 's because people can transmit the virus before , or without ever showing any symptoms .
If you have been in close contact with an infected person , such as within 6 feet ( 1.8 meters ) for at least 15 minutes and do not have symptoms , `` you need a test , '' the CDC 's guidance now reads .
Despite this flip-flopping , the science on asymptomatic or presymptomatic transmission has not changed : people who do n't show symptoms can transmit the virus .
That 's why @ @ @ @ @ @ @ was met with strong criticism from public health experts .
President Donald Trump has previously stated that less testing would lead to fewer cases , so some public health experts were concerned the guidelines were changed for political , rather than scientific reasons .
`` It is unconscionable that recommendations , which should follow only the science , are being modified to enable [ maybe even ensure ] underreporting of COVID-19 cases at this critical juncture , '' Krys Johnson , an assistant professor of instruction in the Department of Epidemiology and Biostatistics @ @ @ @ @ @ @ Live Science in an email .
It 's not clear what percentage of COVID-19 cases are asymptomatic , but the CDC estimates about 40 % of people never show symptoms .
`` If each of these people goes about their daily lives , this pandemic will continue to impact our country and daily lives for the foreseeable future , regardless of the advent of a vaccine , '' Johnson said at the time .
After the guidance was updated last month , the Department of Health and Human Services Assistant Secretary , Adm. @ @ @ @ @ @ @ CNN that the point of the new guidance was n't to do `` less '' testing , but more `` appropriate '' testing .
Citing internal documents and people familiar with the subject , a New York Times report published yesterday ( Sept. 18 ) alleged that the updated guidance was written by the Department of Health and Human Services , did not go through the rigors of the CDC 's scientific review process and was published on its website despite strong opposition from CDC scientists .
The CDC said today 's change @ @ @ @ @ @ @ many cases are driven by people who do n't show symptoms , asymptomatic people who have had close contact with SARS-CoV-2-positive people need to be tested , the clarification says .

In its latest about-face, the Centers for Disease Control and Prevention (CDC) has reversed controversial COVID-19 testing guidelines that were posted to the agency's website last month, reportedly over the objections of its own scientists.
On Aug. 24, the CDC updated its testing guidelines to say that being exposed to a person with COVID-19 didn't necessarily warrant a test for those who are low-risk or not showing any symptoms, Live Science previously reported.
Now, the agency has reverted back to previous guidelines, saying that close contacts of a person infected with SARS-CoV-2 should be tested. That's because people can transmit the virus before, or without ever showing any symptoms. If you have been in close contact with an infected person, such as within 6 feet (1.8 meters) for at least 15 minutes and do not have symptoms, "you need a test," the CDC's guidance now reads.
Related: Coronavirus live updates
Despite this flip-flopping, the science on asymptomatic or presymptomatic transmission has not changed: people who don't show symptoms can transmit the virus. That's why last month's abrupt switch in guidelines was met with strong criticism from public health experts.
President Donald Trump has previously stated that less testing would lead to fewer cases, so some public health experts were concerned the guidelines were changed for political, rather than scientific reasons.
"It is unconscionable that recommendations, which should follow only the science, are being modified to enable [maybe even ensure] underreporting of COVID-19 cases at this critical juncture," Krys Johnson, an assistant professor of instruction in the Department of Epidemiology and Biostatistics at Temple University in Pennsylvania previously told Live Science in an email.
It's not clear what percentage of COVID-19 cases are asymptomatic, but the CDC estimates about 40% of people never show symptoms. "If each of these people goes about their daily lives, this pandemic will continue to impact our country and daily lives for the foreseeable future, regardless of the advent of a vaccine," Johnson said at the time.
After the guidance was updated last month, the Department of Health and Human Services Assistant Secretary, Adm. Brett Giroir defended the decision, telling CNN that the point of the new guidance wasn't to do "less" testing, but more "appropriate" testing.
Citing internal documents and people familiar with the subject, a New York Times report published yesterday (Sept. 18) alleged that the updated guidance was written by the Department of Health and Human Services, did not go through the rigors of the CDC's scientific review process and was published on its website despite strong opposition from CDC scientists.
The CDC said today's change is a "clarification." Because many cases are driven by people who don't show symptoms, asymptomatic people who have had close contact with SARS-CoV-2-positive people need to be tested, the clarification says.
Originally published on Live Science.


What is glyphosate?

Glyphosate is a chemical compound that works as an effective herbicide , or weed killer .
It 's the most commonly used herbicide chemical in the world , according to a 2016 study in the journal Environmental Sciences Europe .
Glyphosate may be sprayed anywhere there are unwanted plants — from commercial farms to private backyards .
Henri Martin , a Swiss chemist , was the first to synthesize glyphosate while trying to develop new pharmaceuticals in 1950 , according to a review in the journal Pest Management Science .
But the chemical did n't have much use in the @ @ @ @ @ @ @ John E Franz , a chemist at the agrochemical company Monsanto , independently synthesized glyphosate after his colleagues found that chemicals similar to glyphosate were slightly harmful to plants .
Franz found that glyphosate was a highly efficient plant-killer .
Monsanto promptly patented the chemical and began selling its glyphosate herbicide under the trade name Roundup in 1974 .
Roundup took off in popularity when Monsanto began to sell `` Roundup-ready '' crops in 1996 .
These plants , which included soybeans and corn , are genetically modified to survive being sprayed with @ @ @ @ @ @ @ global glyphosate use grew 12-fold , according to the 2016 study published in Environmental Sciences Europe .
Monsanto 's patent on glyphosate expired in 2000 , making the product available for other companies to sell .
Today , there are hundreds of glyphosate herbicides on the market .
What is glyphosate used for ?
And how does it work ?
Glyphosate is most commonly used in agriculture , the Environmental Sciences Europe study found .
Farmers use the practical herbicide to kill weeds that compete with crops for sunlight , water and soil @ @ @ @ @ @ @ than any other agriculture chemical , with an estimated 8.6 billion kilograms ( 19 billion lbs . )
of it sprayed since 1974 to help grow everything from peppers to oranges .
When the chemical is sprayed onto a plant , it usually seeps into the plant via the leaves , said Ramdas Kanissery , a weed scientist at the University of Florida in Immokalee , Florida .
From there , glyphosate can travel from cell to cell and spread to the stem and the roots , infecting the entire plant .
Glyphosate @ @ @ @ @ @ @ glycine and plant cells treat glyphosate as though it were amino acid .
Plants use amino acids to build things like enzymes and proteins that it needs in order to grow , through a process called amino acid synthesis .
`` But once glyphosate ends up in [ the plant 's ] amino acid synthesis cycle , it will mess up everything , '' Kanissery said .
That 's because glyphosate interferes with a crucial enzyme production pathway that prevents the plant from creating necessary proteins , and within two to three weeks @ @ @ @ @ @ @ die .
People also use glyphosate at home to tame weeds , and some cities spray the chemical in their parks and other green spaces to control invasive plants that can take over and push out native plants .
However , many local governments , such as the city of Seattle , Washington , have ended this practice as people have become increasingly concerned about the chemical 's safety .
Related : This towering plant is invading the US , and it 's causing serious sunburns Why are people concerned about glyphosate ?
@ @ @ @ @ @ @ and helped landscapers remove invasive plants , people have grown increasingly skeptical about whether the benefits outweigh the risks to human and environmental health .
Recent research has shown that the chemical may be harming the wrong plants , in addition to wildlife and people .
Even if glyphosate is targeted at a specific plant , it can end up in unexpected places .
`` Glyphosate is a non-selective herbicide , '' Kanissery explained .
That means that it can hurt any plant it reaches , even native plants that it 's used @ @ @ @ @ @ @ weeds may accidentally aim some toward their grass , for example .
And when farmers spray it on their field on a hot and humid day , aerosolized droplets of the liquid herbicide can move through the air like a cloud and may eventually fall on neighboring fields , in a process called drift , according to the U.S. Environmental Protection Agency ( EPA ) .
And no matter how carefully someone sprays it , a large portion of the liquid solution will wind up in the soil below , Kanissery said , @ @ @ @ @ @ @ of non-targeted plants and kill them .
Glyphosate can persist in soil for months before microorganisms in the ground eat it and recycle it into carbon dioxide .
Glyphosate is sold for its unmatched ability to harm plants , but researchers have found that the powerful herbicide harms animals , too .
For example , a 2018 study published in the journal Proceedings of the National Academy of Sciences found that the chemical could alter the microbe communities in some bees ' guts , making the bees more susceptible to infection .
And @ @ @ @ @ @ @ PLOS ONE showed that honeybees exposed to glyphosate had smaller and more developmentally delayed larvae .
Other studies have shown that glyphosate exposure can disrupt bees ' sleep and navigation .
Nonetheless , Bayer ( the company which bought Monsanto in 2018 ) claims that glyphosate is safe for bees .
Their claim is supported by limited research , including a 2015 study from the United States Department of Agriculture that simulated the way bees would be sprayed with glyphosate on a field and concluded that the chemical did n't hurt the bees @ @ @ @ @ @ @ its suspected link to a class of cancers called non-Hodgkin lymphoma ( NHL ) .
The link has been debated in courtrooms and continues to be tested by scientists .
In 2015 , the World Health Organization ( WHO ) called the chemical `` probably carcinogenic to humans , '' based on animal studies , which constituted the best evidence at the time .
But the U.S. EPA maintains that glyphosate is `` unlikely to be a human carcinogen , '' based on several studies , including a large study of agriculture workers @ @ @ @ @ @ @ the National Cancer Institute , which found no link between glyphosate and cancer .
A 2019 review published by independent researchers in the journal Mutation Research/Reviews in Mutation Research examined data from several studies on glyphosate 's potential carcinogenic effects , including a large sample of farmworkers in the United States .
The review found that workers exposed to the highest amounts of glyphosate herbicides had a 41 % greater risk of developing NHL .
`` I 'm convinced that [ this number ] is still an underestimate , '' said the study @ @ @ @ @ @ @ toxicologist at the University of California , Berkeley .
The data the researchers analyzed was collected through 2010 , Zhang said , but glyphosate use has increased since then .
Plus , many years could pass between a person 's exposure to the chemical and resulting cancer , she said .
Additional studies on the health effects of glyphosate exposure have supported what Zhang and her colleagues discovered in their 2019 review .
For example , a separate 2019 study published in the International Journal of Epidemiology pooled data on glyphosate exposure and @ @ @ @ @ @ @ , France and Norway , and similarly found that exposure to the chemical was associated with some types of NHL .
Still , research on the subject remains sparse .
Scientists would need to conduct many more studies with human subjects and get similar results before glyphosate could be definitively linked to NHL or any other cancer .
And key questions remain unanswered .
For example , scientists do n't yet have a handle on how , exactly , the chemical could trigger cancer to develop .
And they do n't know how @ @ @ @ @ @ @ to pose a risk .
It 's unlikely that the amount of glyphosate that makes its way into food is enough to cause cancer , according to the WHO .
Those at greatest risk are farmworkers who could be inhaling the chemical and absorbing relatively large amounts of it through their skin and eyes when they spray it , Zhang said .
Some researchers suspect other diseases may also be linked to glyphosate exposure , such as celiac disease , Zhang added , but there 's very little evidence to support this .
@ @ @ @ @ @ @ After the WHO called glyphosate `` probably carcinogenic to humans '' in 2016 , people with NHL started filing lawsuits against Monsanto , and later Bayer , attributing their cancer to Roundup .
Tens of thousands of people have since filed lawsuits against Bayer over Roundup , according to the company .
The first Roundup cancer case to make it to trial was brought by a California school district groundskeeper named Dewayne Johnson in 2018 .
Johnson was awarded $ 289 million in damages and walked away with $ 78.5 million after it @ @ @ @ @ @ @ Baum Hedlund Law , the law office that represented Johnson .
Two more similar cases were filed against Bayer in 2019 .
Edwin Hardeman developed NHL after he sprayed Roundup on his property for decades .
He was awarded $ 80 million , which was later reduced to $ 25.2 million .
The third case to go before a jury was brought by a couple , Alva and Alberta Pilliod , who began using Roundup in the 1970s .
They were awarded more than $ 2 billion , which was reduced to $ @ @ @ @ @ @ @ cases were also represented by Baum Hedlund Law .
In June 2020 , Bayer agreed to pay more than $ 10 billion to settle nearly all of the 125,000 cases currently filed or expected to be filed against them .
The settlement does not include those of Johnson , Hardeman or the Pilliods , all of which are in the appeals process .
In settling , the company hopes to prevent years of costly litigation and `` return the conversation about the safety and utility of glyphosate-based herbicides to the scientific and regulatory @ @ @ @ @ @ @ science , '' said Bayer CEO Werner Baumann in a press release .
• Find answers to frequently asked questions about glyphosate from the U.S. FDA .
• Here are a few general facts about glyphosate , from the National Pesticide Information Center .
• Read more about the debate over the safety of glyphosate , from Frontiers in Public Health .

Glyphosate is the most commonly used agricultural chemical in the world. Farmers spray it on glyphosate-resistant crops to get rid of unwanted plants.
Glyphosate is a chemical compound that works as an effective herbicide, or weed killer. It's the most commonly used herbicide chemical in the world, according to a 2016 study in the journal Environmental Sciences Europe. Glyphosate may be sprayed anywhere there are unwanted plants — from commercial farms to private backyards.
Who invented glyphosate?
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Henri Martin, a Swiss chemist, was the first to synthesize glyphosate while trying to develop new pharmaceuticals in 1950, according to a review in the journal Pest Management Science. But the chemical didn't have much use in the pharmaceutical world.
Twenty years later, John E Franz, a chemist at the agrochemical company Monsanto, independently synthesized glyphosate after his colleagues found that chemicals similar to glyphosate were slightly harmful to plants. Franz found that glyphosate was a highly efficient plant-killer. Monsanto promptly patented the chemical and began selling its glyphosate herbicide under the trade name Roundup in 1974.
Roundup took off in popularity when Monsanto began to sell "Roundup-ready" crops in 1996. These plants, which included soybeans and corn, are genetically modified to survive being sprayed with Roundup. Between 1995 and 2014, global glyphosate use grew 12-fold, according to the 2016 study published in Environmental Sciences Europe.
Monsanto's patent on glyphosate expired in 2000, making the product available for other companies to sell. Today, there are hundreds of glyphosate herbicides on the market.
Roundup is the trade name for glyphosate and can be found in most garden stores. (Image credit: Shutterstock)
What is glyphosate used for? And how does it work?
Glyphosate is most commonly used in agriculture, the Environmental Sciences Europe study found. Farmers use the practical herbicide to kill weeds that compete with crops for sunlight, water and soil nutrients. Glyphosate has been used more than any other agriculture chemical, with an estimated 8.6 billion kilograms (19 billion lbs.) of it sprayed since 1974 to help grow everything from peppers to oranges.
When the chemical is sprayed onto a plant, it usually seeps into the plant via the leaves, said Ramdas Kanissery, a weed scientist at the University of Florida in Immokalee, Florida. From there, glyphosate can travel from cell to cell and spread to the stem and the roots, infecting the entire plant.
Glyphosate is derived from an amino acid called glycine and plant cells treat glyphosate as though it were amino acid. Plants use amino acids to build things like enzymes and proteins that it needs in order to grow, through a process called amino acid synthesis. "But once glyphosate ends up in [the plant's] amino acid synthesis cycle, it will mess up everything," Kanissery said. That's because glyphosate interferes with a crucial enzyme production pathway that prevents the plant from creating necessary proteins, and within two to three weeks of glyphosate exposure, the plant will die.
People also use glyphosate at home to tame weeds, and some cities spray the chemical in their parks and other green spaces to control invasive plants that can take over and push out native plants. However, many local governments, such as the city of Seattle, Washington, have ended this practice as people have become increasingly concerned about the chemical's safety.
Related: This towering plant is invading the US, and it's causing serious sunburns
Why are people concerned about glyphosate?
Although glyphosate has cut farmers' costs and helped landscapers remove invasive plants, people have grown increasingly skeptical about whether the benefits outweigh the risks to human and environmental health. Recent research has shown that the chemical may be harming the wrong plants, in addition to wildlife and people.
Even if glyphosate is targeted at a specific plant, it can end up in unexpected places. "Glyphosate is a non-selective herbicide," Kanissery explained. That means that it can hurt any plant it reaches, even native plants that it's used to protect.
Someone spraying it on weeds may accidentally aim some toward their grass, for example. And when farmers spray it on their field on a hot and humid day, aerosolized droplets of the liquid herbicide can move through the air like a cloud and may eventually fall on neighboring fields, in a process called drift, according to the U.S. Environmental Protection Agency (EPA).
And no matter how carefully someone sprays it, a large portion of the liquid solution will wind up in the soil below, Kanissery said, where it can travel into the roots of non-targeted plants and kill them. Glyphosate can persist in soil for months before microorganisms in the ground eat it and recycle it into carbon dioxide.
Glyphosate is sold for its unmatched ability to harm plants, but researchers have found that the powerful herbicide harms animals, too.
For example, a 2018 study published in the journal Proceedings of the National Academy of Sciences found that the chemical could alter the microbe communities in some bees' guts, making the bees more susceptible to infection. And a 2018 study published in the journal PLOS ONE showed that honeybees exposed to glyphosate had smaller and more developmentally delayed larvae. Other studies have shown that glyphosate exposure can disrupt bees' sleep and navigation.
Nonetheless, Bayer (the company which bought Monsanto in 2018) claims that glyphosate is safe for bees. Their claim is supported by limited research, including a 2015 study from the United States Department of Agriculture that simulated the way bees would be sprayed with glyphosate on a field and concluded that the chemical didn't hurt the bees.
Glyphosate has also made headlines for its suspected link to a class of cancers called non-Hodgkin lymphoma (NHL). The link has been debated in courtrooms and continues to be tested by scientists. In 2015, the World Health Organization (WHO) called the chemical "probably carcinogenic to humans," based on animal studies, which constituted the best evidence at the time. But the U.S. EPA maintains that glyphosate is "unlikely to be a human carcinogen," based on several studies, including a large study of agriculture workers published in 2017 in the Journal of the National Cancer Institute, which found no link between glyphosate and cancer.
A 2019 review published by independent researchers in the journal Mutation Research/Reviews in Mutation Research examined data from several studies on glyphosate's potential carcinogenic effects, including a large sample of farmworkers in the United States. The review found that workers exposed to the highest amounts of glyphosate herbicides had a 41% greater risk of developing NHL.
"I'm convinced that [this number] is still an underestimate," said the study's lead author Luoping Zhang, a toxicologist at the University of California, Berkeley. The data the researchers analyzed was collected through 2010, Zhang said, but glyphosate use has increased since then. Plus, many years could pass between a person's exposure to the chemical and resulting cancer, she said.
Additional studies on the health effects of glyphosate exposure have supported what Zhang and her colleagues discovered in their 2019 review. For example, a separate 2019 study published in the International Journal of Epidemiology pooled data on glyphosate exposure and the health of farmworkers in the U.S., France and Norway, and similarly found that exposure to the chemical was associated with some types of NHL.
Still, research on the subject remains sparse. Scientists would need to conduct many more studies with human subjects and get similar results before glyphosate could be definitively linked to NHL or any other cancer.
And key questions remain unanswered. For example, scientists don't yet have a handle on how, exactly, the chemical could trigger cancer to develop. And they don't know how much exposure to the chemical is needed to pose a risk.
It's unlikely that the amount of glyphosate that makes its way into food is enough to cause cancer, according to the WHO. Those at greatest risk are farmworkers who could be inhaling the chemical and absorbing relatively large amounts of it through their skin and eyes when they spray it, Zhang said. Some researchers suspect other diseases may also be linked to glyphosate exposure, such as celiac disease, Zhang added, but there's very little evidence to support this.
Activists take part in a protest against Monsanto's production and sale of glyphosate products in Brussels, Belgium on Jul. 19, 2017. (Image credit: Shutterstock)
What are people doing about it?
After the WHO called glyphosate "probably carcinogenic to humans" in 2016, people with NHL started filing lawsuits against Monsanto, and later Bayer, attributing their cancer to Roundup. Tens of thousands of people have since filed lawsuits against Bayer over Roundup, according to the company.
The first Roundup cancer case to make it to trial was brought by a California school district groundskeeper named Dewayne Johnson in 2018. Johnson was awarded $289 million in damages and the award was reduced to $20.4 million through appeals, according to Baum Hedlund Law, the law office that represented Johnson.
Two more similar cases were filed against Bayer in 2019. Edwin Hardeman developed NHL after he sprayed Roundup on his property for decades. He was awarded $80 million, which was later reduced to $25.2 million. The third case to go before a jury was brought by a couple, Alva and Alberta Pilliod, who began using Roundup in the 1970s. They were awarded more than $2 billion, which was reduced to $87 million. The plaintiffs in both cases were also represented by Baum Hedlund Law.
In June 2020, Bayer agreed to pay more than $10 billion to settle nearly all of the 125,000 cases currently filed or expected to be filed against them. The settlement does not include those of Johnson, Hardeman or the Pilliods, all of which are in the appeals process. In settling, the company hopes to prevent years of costly litigation and "return the conversation about the safety and utility of glyphosate-based herbicides to the scientific and regulatory arena and to the full body of science," said Bayer CEO Werner Baumann in a press release.
Additional resources:
Find answers to frequently asked questions about glyphosate from the U.S. FDA.
Here are a few general facts about glyphosate, from the National Pesticide Information Center.
Read more about the debate over the safety of glyphosate, from Frontiers in Public Health.
Editor's note: This article was updated on Sept. 21, 2020 to correctly state the final amount Dewayne Johnson was awarded in his lawsuit against Monsanto/Bayer.