scientificamerican--2020-08-26--COVID-19-Era Isolation Is Making Dangerous Eating Disorders Worse

Rosey has lived with bulimia for more than a decade .
The 31-year-old resident of Melbourne , Australia , started therapy for her eating disorder six years ago .
Although she says she had never considered herself “ cured , ” she had reached a point in her recovery that felt hopeful and manageable .
Then along came the novel coronavirus .
When mandatory COVID-19 lockdowns began in Australia in March , Rosey ’ s anxiety went into overdrive .
“ I ’ m single , I live alone , my family lives in another state , and I ’ @ @ @ @ @ @ @ ” she says , adding that her need for control—something she has now lost in almost every area of her life—has played a major role in the resurgence of symptoms : “ To have everything I knew and had control over , including how I managed my illness , ripped away has been one of the hardest things.
” Rosey is living an experience that may be familiar to anyone dealing with an eating disorder while weathering the unexpected storms of 2020 .
Recent research indicates that pandemic-related stay-at-home orders have ramped up @ @ @ @ @ @ @ .
A study published last month in the International Journal of Eating Disorders revealed that during the first few months of the pandemic , many individuals with anorexia reported restricting their eating more .
Meanwhile others with bulimia and binge-eating disorder reported more bingeing urges and episodes .
Respondents also noted increased anxiety and concern about COVID-19 ’ s impact on their mental health .
More than one third of the 1,021 participants ( 511 in the U.S. and 510 in the Netherlands ) said their eating disorder had worsened—and they attributed this @ @ @ @ @ @ @ of structure , a triggering environment , the absence of social support and an inability to obtain foods that fit their meal plans .
“ While no one knows for sure what causes eating disorders , a growing consensus suggests that [ they result from ] a range of biological , psychological and sociocultural factors , ” says Claire Mysko , CEO of the National Eating Disorders Association , who was not involved in the study .
She notes that many of those who struggle with these disorders have a co-occurring condition , @ @ @ @ @ @ @ paper ’ s senior author Cynthia M. Bulik of the University of North Carolina at Chapel Hill ( UNC ) notes that anxiety and depression are on the rise for many because of the pandemic—and this increase can present specific triggers to those with eating disorders .
Such triggers “ are almost custom-made to exacerbate their illness , ” says Bulik , who is the founding director of the UNC Center of Excellence for Eating Disorders .
One major provocation is social isolation .
“ Eating disorders are something individuals usually keep private @ @ @ @ @ @ @ of shame around behaviors , ” says Ellen E. Fitzsimmons-Craft , an assistant professor of psychiatry at Washington University School of Medicine , who specializes in eating disorder prevention and treatment research .
These disorders “ also thrive in isolation , so it ’ s not surprising we ’ re seeing an increase in disordered behaviors and even some relapse among those who were doing well prior to lockdown , ” says Fitzsimmons-Craft , who was not involved in the new study .
To fill the void left by physical distancing , many @ @ @ @ @ @ @ may actually be complicating matters for some with eating disorders .
“ Social media messages about being productive , effectively using time in quarantine and avoiding the ‘ COVID-19 weight gain ’ have led to increased negative self-talk , ” says Shiri Sadeh-Sharvit , associate director of training at the Center for m2Health at Palo Alto University .
Sadeh-Sharvit and her colleagues published a paper in July that examined risks and recommendations for people suffering from eating disorders in this unprecedented situation .
Lead study author Marita Cooper , a postdoctoral fellow at @ @ @ @ @ @ @ , says food-specific issues related to the pandemic also play a role .
“ Reduced food access , or food insecurity , [ has ] been rampant , ” she says .
“ The need to stock a ‘ quarantine pantry ’ can be a significant challenge , potentially triggering bingeing and compensatory episodes , ” such as self-induced vomiting , laxative misuse , fasting or excessive exercise .
Sarah Adler , a psychologist at Stanford University ’ s Eating Disorder and Weight Control Clinic , says food scarcity can create anxiety in @ @ @ @ @ @ @ “ the specific stress and anxiety associated with decisions about food and availability of food can dramatically increase anxiety in folks with eating disorders.
” Food is one part of the eating disorder equation ; exercise is often another .
“ For those whose disorder includes compulsive exercise , either they ’ re very anxious because they can ’ t go to the gym or find themselves exercising excessively at home because there are no barriers to doing so , ” Bulik says , adding that some people might even experience both of @ @ @ @ @ @ @ problem firsthand .
She says she has ramped up her home exercise routine since the pandemic began .
“ I knew I wouldn ’ t be able to stick to my very strict and regimented workout schedule with gyms closed , which sent my body dysmorphia into a downward spiral , ” she says .
“ I walk or jog every day to know how many calories I ’ ve burned.
” The pandemic has also highlighted the limitations of electronic means of accessing treatment .
In Bulik ’ s research , 47 @ @ @ @ @ @ @ seeking care over the phone or online ) is not cutting it , compared with in-person treatment .
And 45 percent of those surveyed in the U.S. say they are not receiving treatment at all .
“ Face-to-face therapy has largely been discontinued , so a primary source of support and accountability has been moved online , ” Bulik says .
“ Some things are just hard to do online , like weighing to make sure someone is not losing too much weight or [ to see ] whether they ’ re gaining @ @ @ @ @ @ @ much more complex with virtual care.
” Rosey says continuing therapy by phone has been helpful—to an extent .
“ Talking to someone who knows my history has lifted a bit of the weight off my shoulders , ” she says .
“ But I think taking away that face-to-face interaction removes a lot of the accountability.
” One possible upside is that providers can now glean more insights about what works online and what does not .
“ Clinicians can not assume that virtual therapy is the same as in-the-room therapy , @ @ @ @ @ @ @ to do a lot of experimenting to make sure patients have safe and private spaces and work together to figure out ways to make it function as close to a face-to-face session as possible.
” She also recommends augmenting sessions with digital resources such as Recovery Record , an eating-disorder-recovery app that uses cognitive behavioral therapy techniques to allow users to track progress and share data with their treatment team .
Fitzsimmons-Craft is conducting a study investigating the benefits of another mobile mental health app .
“ Digital mental health can bring treatment @ @ @ @ @ @ @ need it , ” she says .
“ I believe the delivery of treatment will change in the wake of COVID-19 , ” says Ruth Striegel Weissman , a professor of psychology at Wesleyan University .
“ We ’ ll see far more telehealth , and I think therapists will get better at it .
What ’ s unusual about the current situation is that the change was rapid , and therapists themselves are in a state of transition and stress.
” She says the sudden shift has left many experts scrambling .
@ @ @ @ @ @ @ forced to take client calls from their closet because of a lack of privacy at home .
Another potential bright side : although the majority of respondents to Bulik ’ s survey reported lockdown-related adversity , others said they noticed positive effects , including greater family connection , more self-care time and increased motivation for recovery .
“ I was fascinated that some [ people ] actually reported improvements , ” Weissman says .
“ A crisis such as COVID-19 may help ‘ reset ’ behavioral patterns and , for some people , @ @ @ @ @ @ @ personal growth.
” According to Cooper , the treatment industry needs to adapt and catch up .
“ Eating disorders are manageable and treatable—most people who receive evidence-based treatment will recover , ” she says .
“ We just need to improve accessibility and reduce stigma about accessing treatment.
” For Rosey , the struggle continues .
“ Every day I tell myself it will be better , ” she says .
“ I try to put some of the management methods I ’ ve used over the years into practice .
Some @ @ @ @ @ @ @ , I feel powerless.
” If you or someone you know is struggling with an eating disorder , you can contact the National Eating Disorders Association ’ s Helpline by calling ( 800 ) 931-2237 or clicking here to chat .
For crisis situations , you can text “ NEDA ” to 741741 to connect to a trained volunteer at the Crisis Text Line .
Read more about the coronavirus outbreak from Scientific American here .
And read coverage from our international network of magazines here .

Rosey has lived with bulimia for more than a decade. The 31-year-old resident of Melbourne, Australia, started therapy for her eating disorder six years ago. Although she says she had never considered herself “cured,” she had reached a point in her recovery that felt hopeful and manageable. Then along came the novel coronavirus.
When mandatory COVID-19 lockdowns began in Australia in March, Rosey’s anxiety went into overdrive. “I’m single, I live alone, my family lives in another state, and I’m not able to see friends,” she says, adding that her need for control—something she has now lost in almost every area of her life—has played a major role in the resurgence of symptoms: “To have everything I knew and had control over, including how I managed my illness, ripped away has been one of the hardest things.”
Rosey is living an experience that may be familiar to anyone dealing with an eating disorder while weathering the unexpected storms of 2020. Recent research indicates that pandemic-related stay-at-home orders have ramped up anorexia, bulimia and binge-eating disorder symptoms.
Isolation Hits Home
A study published last month in the International Journal of Eating Disorders revealed that during the first few months of the pandemic, many individuals with anorexia reported restricting their eating more. Meanwhile others with bulimia and binge-eating disorder reported more bingeing urges and episodes. Respondents also noted increased anxiety and concern about COVID-19’s impact on their mental health. More than one third of the 1,021 participants (511 in the U.S. and 510 in the Netherlands) said their eating disorder had worsened—and they attributed this change to issues such as a lack of structure, a triggering environment, the absence of social support and an inability to obtain foods that fit their meal plans.
“While no one knows for sure what causes eating disorders, a growing consensus suggests that [they result from] a range of biological, psychological and sociocultural factors,” says Claire Mysko, CEO of the National Eating Disorders Association, who was not involved in the study. She notes that many of those who struggle with these disorders have a co-occurring condition, such as anxiety or depression.
The paper’s senior author Cynthia M. Bulik of the University of North Carolina at Chapel Hill (UNC) notes that anxiety and depression are on the rise for many because of the pandemic—and this increase can present specific triggers to those with eating disorders. Such triggers “are almost custom-made to exacerbate their illness,” says Bulik, who is the founding director of the UNC Center of Excellence for Eating Disorders.
One major provocation is social isolation. “Eating disorders are something individuals usually keep private, and there can be a lot of shame around behaviors,” says Ellen E. Fitzsimmons-Craft, an assistant professor of psychiatry at Washington University School of Medicine, who specializes in eating disorder prevention and treatment research. These disorders “also thrive in isolation, so it’s not surprising we’re seeing an increase in disordered behaviors and even some relapse among those who were doing well prior to lockdown,” says Fitzsimmons-Craft, who was not involved in the new study.
To fill the void left by physical distancing, many people are logging hours online—a phenomenon that may actually be complicating matters for some with eating disorders. “Social media messages about being productive, effectively using time in quarantine and avoiding the ‘COVID-19 weight gain’ have led to increased negative self-talk,” says Shiri Sadeh-Sharvit, associate director of training at the Center for m2Health at Palo Alto University.
Sadeh-Sharvit and her colleagues published a paper in July that examined risks and recommendations for people suffering from eating disorders in this unprecedented situation. Lead study author Marita Cooper, a postdoctoral fellow at the Johns Hopkins University School of Medicine, says food-specific issues related to the pandemic also play a role. “Reduced food access, or food insecurity, [has] been rampant,” she says. “The need to stock a ‘quarantine pantry’ can be a significant challenge, potentially triggering bingeing and compensatory episodes,” such as self-induced vomiting, laxative misuse, fasting or excessive exercise.
Sarah Adler, a psychologist at Stanford University’s Eating Disorder and Weight Control Clinic, says food scarcity can create anxiety in anyone. But, she adds, “the specific stress and anxiety associated with decisions about food and availability of food can dramatically increase anxiety in folks with eating disorders.”
Food is one part of the eating disorder equation; exercise is often another. “For those whose disorder includes compulsive exercise, either they’re very anxious because they can’t go to the gym or find themselves exercising excessively at home because there are no barriers to doing so,” Bulik says, adding that some people might even experience both of these effects.
Rosey knows about this problem firsthand. She says she has ramped up her home exercise routine since the pandemic began. “I knew I wouldn’t be able to stick to my very strict and regimented workout schedule with gyms closed, which sent my body dysmorphia into a downward spiral,” she says. “I walk or jog every day to know how many calories I’ve burned.”
Treatment Challenges
The pandemic has also highlighted the limitations of electronic means of accessing treatment. In Bulik’s research, 47 percent of U.S. respondents say telehealth (seeking care over the phone or online) is not cutting it, compared with in-person treatment. And 45 percent of those surveyed in the U.S. say they are not receiving treatment at all.
“Face-to-face therapy has largely been discontinued, so a primary source of support and accountability has been moved online,” Bulik says. “Some things are just hard to do online, like weighing to make sure someone is not losing too much weight or [to see] whether they’re gaining according to plan. The logistics are much more complex with virtual care.”
Rosey says continuing therapy by phone has been helpful—to an extent. “Talking to someone who knows my history has lifted a bit of the weight off my shoulders,” she says. “But I think taking away that face-to-face interaction removes a lot of the accountability.”
One possible upside is that providers can now glean more insights about what works online and what does not. “Clinicians cannot assume that virtual therapy is the same as in-the-room therapy,” Bulik says. “You have to do a lot of experimenting to make sure patients have safe and private spaces and work together to figure out ways to make it function as close to a face-to-face session as possible.” She also recommends augmenting sessions with digital resources such as Recovery Record, an eating-disorder-recovery app that uses cognitive behavioral therapy techniques to allow users to track progress and share data with their treatment team. Fitzsimmons-Craft is conducting a study investigating the benefits of another mobile mental health app. “Digital mental health can bring treatment to people exactly when and where they need it,” she says.
“I believe the delivery of treatment will change in the wake of COVID-19,” says Ruth Striegel Weissman, a professor of psychology at Wesleyan University. “We’ll see far more telehealth, and I think therapists will get better at it. What’s unusual about the current situation is that the change was rapid, and therapists themselves are in a state of transition and stress.” She says the sudden shift has left many experts scrambling. And some of her colleagues have been forced to take client calls from their closet because of a lack of privacy at home.
Another potential bright side: although the majority of respondents to Bulik’s survey reported lockdown-related adversity, others said they noticed positive effects, including greater family connection, more self-care time and increased motivation for recovery. “I was fascinated that some [people] actually reported improvements,” Weissman says. “A crisis such as COVID-19 may help ‘reset’ behavioral patterns and, for some people, represent an opportunity for positive change or personal growth.”
According to Cooper, the treatment industry needs to adapt and catch up. “Eating disorders are manageable and treatable—most people who receive evidence-based treatment will recover,” she says. “We just need to improve accessibility and reduce stigma about accessing treatment.”
For Rosey, the struggle continues. “Every day I tell myself it will be better,” she says. “I try to put some of the management methods I’ve used over the years into practice. Some days, it works. But others, I feel powerless.”
If you or someone you know is struggling with an eating disorder, you can contact the National Eating Disorders Association’s Helpline by calling (800) 931-2237 or clicking here to chat. For crisis situations, you can text “NEDA” to 741741 to connect to a trained volunteer at the Crisis Text Line.
Read more about the coronavirus outbreak from Scientific American here. And read coverage from our international network of magazines here.


scientificamerican--2020-08-26--White Rhinos Eavesdrop to Know Who's Who

Rhinos have notoriously poor eyesight , so they mostly rely on their noses to understand the world around them .
But there ’ s one interaction in which sound plays a key role .
Southern white rhino males can either be dominant or subordinate .
And only the dominant males hold and defend territories .
New research finds that they eavesdrop on the calls of other males to know who is who .
“ We found that contact calls carry information about the dominance status of the males .
It means that only by listening to the calls , you @ @ @ @ @ @ @ or subordinate.
” Ivana Cinková , a zoologist at the University of KwaZulu-Natal in South Africa .
She and her team spent almost two years in South Africa ’ s Hluhluwe-iMfolozi Park recording the social contact and courtship calls of male rhinos .
Then they played those calls back to dominant territorial males and watched the responses .
[ Ivana Cinková and Adrian M. Shrader , Rival assessment by territorial southern white rhinoceros males via eavesdropping on the contact and courtship calls ] The researchers asked that the rhino calls not be included @ @ @ @ @ @ @ that poachers might use the calls to lure rhinos closer .
Back to the reactions of the rhinos : “ They started to search for the intruder the most quickly and spent the longest time searching around for the intruder after the playback of the subordinate call , which was quite surprising.
” Territorial male rhinos hold exclusive breeding opportunities with the female rhinos .
Subordinate males could thus be interested in challenging the territorial male for dominance .
But dominant males rarely lose their territories to subordinate males , at least while @ @ @ @ @ @ @ So responding to the challenge call quickly has little cost .
But other dominant rhinos theoretically pose a larger risk .
So when territorial rhinos heard other dominant males , they oriented toward the direction of the sound .
But they took their time responding .
The researchers think that the rhinos were being careful , waiting to acquire more information before reacting .
And most of them did eventually investigate the source of the sound .
Rhinos are always under a high risk of poaching , so parks and preserves usually keep @ @ @ @ @ @ @ for .
Cinková says that understanding their social dynamics could allow wildlife managers to more effectively manage their rhino herds , which ultimately enables them to better guard and protect the animals from poachers—so that rhinos can keep on calling for a long , long time .
[ The above text is a transcript of this podcast . ]

Full Transcript
Rhinos have notoriously poor eyesight, so they mostly rely on their noses to understand the world around them. But there’s one interaction in which sound plays a key role. Southern white rhino males can either be dominant or subordinate. And only the dominant males hold and defend territories. New research finds that they eavesdrop on the calls of other males to know who is who.
“We found that contact calls carry information about the dominance status of the males. It means that only by listening to the calls, you can say if the male is territorial or subordinate.”
Ivana Cinková, a zoologist at the University of KwaZulu-Natal in South Africa.
She and her team spent almost two years in South Africa’s Hluhluwe-iMfolozi Park recording the social contact and courtship calls of male rhinos. Then they played those calls back to dominant territorial males and watched the responses. [Ivana Cinková and Adrian M. Shrader, Rival assessment by territorial southern white rhinoceros males via eavesdropping on the contact and courtship calls]
The researchers asked that the rhino calls not be included in this podcast due to the concern that poachers might use the calls to lure rhinos closer. Back to the reactions of the rhinos:
“They started to search for the intruder the most quickly and spent the longest time searching around for the intruder after the playback of the subordinate call, which was quite surprising.”
Territorial male rhinos hold exclusive breeding opportunities with the female rhinos. Subordinate males could thus be interested in challenging the territorial male for dominance. But dominant males rarely lose their territories to subordinate males, at least while they’re in prime condition. So responding to the challenge call quickly has little cost.
But other dominant rhinos theoretically pose a larger risk. So when territorial rhinos heard other dominant males, they oriented toward the direction of the sound. But they took their time responding.
The researchers think that the rhinos were being careful, waiting to acquire more information before reacting. And most of them did eventually investigate the source of the sound.
Rhinos are always under a high risk of poaching, so parks and preserves usually keep tabs on every individual rhino they care for. Cinková says that understanding their social dynamics could allow wildlife managers to more effectively manage their rhino herds, which ultimately enables them to better guard and protect the animals from poachers—so that rhinos can keep on calling for a long, long time.
—Jason G. Goldman
[The above text is a transcript of this podcast.]


scientificamerican--2020-08-25--Storm Surge: The Science behind This Year's Unusual Hurricane Season

The peak of the Atlantic hurricane season has arrived and is living up to its name : Two storms , Laura and Marco , developed within the relatively small confines of the Gulf of Mexico and Caribbean Sea area late last week .
Their formation has already put the season halfway through the alphabetical list of available storm names—a clear sign that 2020 is meeting forecasts for a very active season amid a disastrous pandemic and major economic uncertainty .
The double punch of storms comes just before the 15th anniversary of Hurricane Katrina hitting Louisiana on August 29 , @ @ @ @ @ @ @ the worst storms ever to strike the U.S.—was also part of a blockbuster season .
The 2005 season holds the record for most named storms , using up all of its planned names and forcing forecasters to employ the Greek alphabet as a backup .
That situation could happen again this year if storms keep popping up at the current pace through the season ’ s official end on November 30 .
And those storms pose a threat to the U.S. because a high-pressure area called the Bermuda high has pushed farther west @ @ @ @ @ @ @ will hit the East or Gulf coast .
Tropical Storm Marco has already fizzled out but not before it brought some significant rains to the Gulf Coast .
Hurricane Laura looks to pose a greater threat , with its “ cone of uncertainty ” ( the range of possible tracks that meteorologists predict the hurricane might take ) showing it potentially hitting the coast of western Louisiana or eastern Texas as a major hurricane .
To break down how unusual it is to have two storms so close together—and where climate change fits @ @ @ @ @ @ @ spoke with J. Marshall Shepherd , a meteorologist and professor at the University of Georgia .
[ An edited transcript of the interview follows . ]
How unusual is it to see two storms in the same area of one ocean basin ?
I don ’ t think it ’ s unusual at all to have more than two storms in one basin ; we see that all the time in the Atlantic or Pacific basin .
Now it ’ s pretty unusual to see two in the Gulf of Mexico around the @ @ @ @ @ @ @ both storms had been a hurricane in the Gulf of Mexico—at one point , it looked like that was a possibility—I think that would have been unprecedented in the satellite era [ since about the mid-1960s ] .
But even now , to have a situation where we ’ re seeing , in the week building up to this , two cones of uncertainty essentially crossing each other within days—that ’ s bizarre .
What conditions have allowed these two systems to develop so close together in time and space ?
All along @ @ @ @ @ @ @ be an active Atlantic hurricane season .
The waters are very warm , and in the Gulf of Mexico right now , they ’ re some of the warmest on the planet .
And this time of year is also when we start to see more of a relaxation of wind shear [ when winds blow in different directions at different levels of the atmosphere ] .
So that ’ s why , typically , the peak of hurricane season tends to ramp up after about August 20 .
This is also the @ @ @ @ @ @ @ see less dust , [ which can impede storms ] , coming off of Africa .
There ’ s some other sorts of things that are going on in the background : There ’ s something called the Madden-Julian oscillation and Kelvin waves [ patterns that move through the atmosphere and impact the weather ] .
And we could kind of see that the activity was going to pick back up , because there was going to be a phasing of these [ phenomena ] that would lead to sort of a general @ @ @ @ @ @ @ get more uplift .
What can we say about the role of climate change in fueling a situation like this one ?
I think this sort of generation of earlier and warmer water is very consistent with what we would expect in a climate-changed environment .
We ’ re just in an era of high-octane hurricane fuel .
I think Hurricane Laura also has a reasonable chance of rapid intensification ( which is a certain amount of pressure drop over 24 hours ) in the Gulf of Mexico .
And again , that @ @ @ @ @ @ @ fueled by these superwarm waters that we have out there in the Gulf of Mexico .
One of the things that often gets missed in discussion about climate change is that most of the warming is in the ocean—90 percent or more .
And as I ’ ve often said in some of my lectures , all of that warming is going to find its way back to the atmosphere somehow .
Hurricanes are one way that it does that .
I think there ’ s some pretty compelling evidence that has been @ @ @ @ @ @ @ s not clear that either of these storms will do this—but I do think there ’ s pretty solid evidence that climate change is causing storms to slow down or linger more—in some cases , stall out , as we 've seen with [ Hurricane ] Harvey and Florence .
I think we ’ ve seen a more northward shift in intense storms .
We ’ ve seen that even earlier this season , when we had some tropical storms forming up in the mid-Atlantic and Northeast , on the very fringes of @ @ @ @ @ @ @ .
I think if we do get a Category 3 or greater storm , as some models indicate with Hurricane Laura , that would just be continuing the trend of these really intense storms—rapidly intensifying storms .
Finally , one more thing I ’ d say about climate change and hurricanes is something I ’ ve been convinced about for a while : I published a paper in the peer-reviewed literature , back in 2007 , looking at “ What are the contributions of hurricanes and tropical storms to coastal rainfall ?
” @ @ @ @ @ @ @ a baseline for a future study , because I wanted to know how much annual rainfall hurricanes or tropical storms contribute , on average , in coastal regions around the U.S .
I haven ’ t done the follow-up , but I suspect that hurricanes have probably become wetter .
I suspect that they ’ re just more prolific rain producers .
You often hear that climate change is a threat multiplier for national security , but it ’ s an impact multiplier for hurricanes .
What are the added risks with back-to-back @ @ @ @ @ @ @ might be the case with Laura and Marco ?
One is that we 're in a pandemic .
So that complicates evacuation plans if there are shelters that would normally be open that are closed because of COVID-19—or if you are in a shelter with a lot of people , and that elevates the risk because of COVID-19 .
Secondly—I was a little bit more worried about this over the weekend , when it looked like Marco was going to remain a hurricane—but can you imagine people just recovering even from just flooding @ @ @ @ @ @ @ then to turn around , 48 hours later , and have to deal with perhaps an even stronger storm ?
Logistically , it ’ s difficult enough to prepare for and recover from one storm .
One other thing that I saw talked about on Twitter—I really hadn ’ t thought about it , but actually it ’ s a great point—is : How are some of our storm surge models , and some of the other things that we use for warning of hazards , going to respond to back-to-back storms ?
@ @ @ @ @ @ @ the ocean is perhaps not doing what some of the assumptions and parameterizations of the models are saying it should do ?
As we ’ re approaching the 15th anniversary of Katrina , how has our understanding of hurricanes and the role of climate change altered since then ?
I think we have improved in our track forecasting in [ the past ] 15 years ; the cone continues to narrow , so to speak .
I think if you looked at the same cone for Katrina today versus 15 years ago , @ @ @ @ @ @ @ today .
Unfortunately , still , we ’ re struggling a little bit with intensity forecasts .
There ’ s some improvement , but as we ’ re seeing even with Marco and with Laura , the intensity forecast is still very tricky .
That ’ s just because some of the physics that we need for the models are happening at scales that we don ’ t often have measurements for in the same way we have for large atmospheric steering currents from soundings [ such as weather balloons ] .
I @ @ @ @ @ @ @ National Academies [ of Sciences , Engineering , and Medicine ’ s ] extreme-weather-attribution report back in 2016 , which looked at where we are on climate change attribution to extreme weather events .
We found that we were pretty conclusive and confident in the fact that heat waves , extreme rainfall events , perhaps some drought events and lack of cold events were highly attributable to climate change .
Hurricanes fell more into the middle .
And that ’ s simply because , in that report , we used a “ three @ @ @ @ @ @ @ climate models had to be able to reproduce the event , you had to have good physical understanding of the event , and you had to have a significantly robust enough record .
I think in 2005 we probably had even less ability to attribute some aspects of climate change to hurricanes .
In 2020 I think that the attribution signal—at least on the intensity and perhaps on the stalling and northward migration of stronger hurricanes—I think we have a bit more information on that .
I ’ d say today we have @ @ @ @ @ @ @ .
If we were to write that National Academies report now , I think the hurricane attribution signal probably would have moved up the scale some .

The peak of the Atlantic hurricane season has arrived and is living up to its name: Two storms, Laura and Marco, developed within the relatively small confines of the Gulf of Mexico and Caribbean Sea area late last week. Their formation has already put the season halfway through the alphabetical list of available storm names—a clear sign that 2020 is meeting forecasts for a very active season amid a disastrous pandemic and major economic uncertainty.
The double punch of storms comes just before the 15th anniversary of Hurricane Katrina hitting Louisiana on August 29, 2005. That destructive event—still one of the worst storms ever to strike the U.S.—was also part of a blockbuster season. The 2005 season holds the record for most named storms, using up all of its planned names and forcing forecasters to employ the Greek alphabet as a backup. That situation could happen again this year if storms keep popping up at the current pace through the season’s official end on November 30. And those storms pose a threat to the U.S. because a high-pressure area called the Bermuda high has pushed farther west, which makes it more likely they will hit the East or Gulf coast.
Tropical Storm Marco has already fizzled out but not before it brought some significant rains to the Gulf Coast. Hurricane Laura looks to pose a greater threat, with its “cone of uncertainty” (the range of possible tracks that meteorologists predict the hurricane might take) showing it potentially hitting the coast of western Louisiana or eastern Texas as a major hurricane.
To break down how unusual it is to have two storms so close together—and where climate change fits in with hurricane trends and risks—Scientific American spoke with J. Marshall Shepherd, a meteorologist and professor at the University of Georgia.
[An edited transcript of the interview follows.]
How unusual is it to see two storms in the same area of one ocean basin?
I don’t think it’s unusual at all to have more than two storms in one basin; we see that all the time in the Atlantic or Pacific basin. Now it’s pretty unusual to see two in the Gulf of Mexico around the same time. In fact, if both storms had been a hurricane in the Gulf of Mexico—at one point, it looked like that was a possibility—I think that would have been unprecedented in the satellite era [since about the mid-1960s]. But even now, to have a situation where we’re seeing, in the week building up to this, two cones of uncertainty essentially crossing each other within days—that’s bizarre.
What conditions have allowed these two systems to develop so close together in time and space?
All along, we knew this was going to be an active Atlantic hurricane season. The waters are very warm, and in the Gulf of Mexico right now, they’re some of the warmest on the planet. And this time of year is also when we start to see more of a relaxation of wind shear [when winds blow in different directions at different levels of the atmosphere]. So that’s why, typically, the peak of hurricane season tends to ramp up after about August 20. This is also the time of year when we start to see less dust, [which can impede storms], coming off of Africa. There’s some other sorts of things that are going on in the background: There’s something called the Madden-Julian oscillation and Kelvin waves [patterns that move through the atmosphere and impact the weather]. And we could kind of see that the activity was going to pick back up, because there was going to be a phasing of these [phenomena] that would lead to sort of a general push upward of the atmosphere. You get more uplift.
What can we say about the role of climate change in fueling a situation like this one?
I think this sort of generation of earlier and warmer water is very consistent with what we would expect in a climate-changed environment. We’re just in an era of high-octane hurricane fuel. I think Hurricane Laura also has a reasonable chance of rapid intensification (which is a certain amount of pressure drop over 24 hours) in the Gulf of Mexico. And again, that’s just, in part, fueled by these superwarm waters that we have out there in the Gulf of Mexico. One of the things that often gets missed in discussion about climate change is that most of the warming is in the ocean—90 percent or more. And as I’ve often said in some of my lectures, all of that warming is going to find its way back to the atmosphere somehow. Hurricanes are one way that it does that.
I think there’s some pretty compelling evidence that has been coming out in recent years—although it’s not clear that either of these storms will do this—but I do think there’s pretty solid evidence that climate change is causing storms to slow down or linger more—in some cases, stall out, as we've seen with [Hurricane] Harvey and Florence. I think we’ve seen a more northward shift in intense storms. We’ve seen that even earlier this season, when we had some tropical storms forming up in the mid-Atlantic and Northeast, on the very fringes of where we tend to see these things. I think if we do get a Category 3 or greater storm, as some models indicate with Hurricane Laura, that would just be continuing the trend of these really intense storms—rapidly intensifying storms.
Finally, one more thing I’d say about climate change and hurricanes is something I’ve been convinced about for a while: I published a paper in the peer-reviewed literature, back in 2007, looking at “What are the contributions of hurricanes and tropical storms to coastal rainfall?” I was actually trying to set up a baseline for a future study, because I wanted to know how much annual rainfall hurricanes or tropical storms contribute, on average, in coastal regions around the U.S. I haven’t done the follow-up, but I suspect that hurricanes have probably become wetter. I suspect that they’re just more prolific rain producers. You often hear that climate change is a threat multiplier for national security, but it’s an impact multiplier for hurricanes.
What are the added risks with back-to-back storms hitting the same area, as might be the case with Laura and Marco?
One is that we're in a pandemic. So that complicates evacuation plans if there are shelters that would normally be open that are closed because of COVID-19—or if you are in a shelter with a lot of people, and that elevates the risk because of COVID-19.
Secondly—I was a little bit more worried about this over the weekend, when it looked like Marco was going to remain a hurricane—but can you imagine people just recovering even from just flooding and maybe minor wind damage, only then to turn around, 48 hours later, and have to deal with perhaps an even stronger storm? Logistically, it’s difficult enough to prepare for and recover from one storm.
One other thing that I saw talked about on Twitter—I really hadn’t thought about it, but actually it’s a great point—is: How are some of our storm surge models, and some of the other things that we use for warning of hazards, going to respond to back-to-back storms? Can they reset and calibrate themselves when the ocean is perhaps not doing what some of the assumptions and parameterizations of the models are saying it should do?
As we’re approaching the 15th anniversary of Katrina, how has our understanding of hurricanes and the role of climate change altered since then?
I think we have improved in our track forecasting in [the past] 15 years; the cone continues to narrow, so to speak. I think if you looked at the same cone for Katrina today versus 15 years ago, it’d be a lot narrower today. Unfortunately, still, we’re struggling a little bit with intensity forecasts. There’s some improvement, but as we’re seeing even with Marco and with Laura, the intensity forecast is still very tricky. That’s just because some of the physics that we need for the models are happening at scales that we don’t often have measurements for in the same way we have for large atmospheric steering currents from soundings [such as weather balloons].
I was one of the authors on the National Academies [of Sciences, Engineering, and Medicine’s] extreme-weather-attribution report back in 2016, which looked at where we are on climate change attribution to extreme weather events. We found that we were pretty conclusive and confident in the fact that heat waves, extreme rainfall events, perhaps some drought events and lack of cold events were highly attributable to climate change. Hurricanes fell more into the middle. And that’s simply because, in that report, we used a “three legs of a stool” approach: climate models had to be able to reproduce the event, you had to have good physical understanding of the event, and you had to have a significantly robust enough record. I think in 2005 we probably had even less ability to attribute some aspects of climate change to hurricanes. In 2020 I think that the attribution signal—at least on the intensity and perhaps on the stalling and northward migration of stronger hurricanes—I think we have a bit more information on that. I’d say today we have much more sophisticated and better attribution studies. If we were to write that National Academies report now, I think the hurricane attribution signal probably would have moved up the scale some.


scientificamerican--2020-08-25--How Politics Muddied the Waters on a Promising COVID-19 Treatment

On Sunday afternoon , August 24 , President Trump announced an emergency use authorization ( EUA ) for what he described as a “ powerful therapy ” against COVID-19 .
Known as convalescent plasma , or CP , it ’ s donated by survivors of the disease , on the theory that the antibodies it carries can protect others from COVID ’ s worst ravages .
And a few weeks ago , the Mayo Clinic released a preliminary report saying CP showed promise in doing just that—but nevertheless , the New York Times reported that the FDA was not ready @ @ @ @ @ @ @ an emergency basis .
Now the president has forced the agency to reverse itself—and to make things even more confusing , FDA Commissioner Stephen Hahn described the efficacy of the treatment incorrectly .
So what ’ s going on ?
To be clear , we are not particularly supportive of EUAs , since they may give the public an urealistically rosy impression of how promising a treatment actually is—something critics have brought up in this case as well .
Another problem is that once an EUA has been issued , it can be @ @ @ @ @ @ @ control clinical trial , in which some subjects get a placebo and others get the actual treatment being studied .
In particular , we would never support overriding the judgement of FDA professionals .
As one of us ( Michael Kinch ) has consistently argued , the FDA must be guided by the independent and patient-focused approach exemplified by Frances Oldham Kelsey , who in the 1960s refused to approve thalidomide for distribution in the United States out of concern for patient safety .
Although we share concerns about the means by which @ @ @ @ @ @ @ and about the optics that clearly suggest that the decision was tainted by political considerations , an overly-strident reaction risks throwing out the baby with the bathwater .
In this spirit , we believe it is important to convey the rather remarkable story of how convalescent plasma arose for the treatment of COVID-19 .
To begin with , the Mayo Clinic study isn ’ t the only one that has shown promise .
Other researchers have generated rigorous , peer-reviewed outcomes from smaller trials—either randomized controlled trials that did not fully enroll , @ @ @ @ @ @ @ those from Mount Sinai and Houston Methodist Hospital .
In each case , these results showed consistent and encouraging results although they admittedly were not fully-enrolled and randomized controlled trials ( RCTs ) .
Over the last several months , a loose-knit group of physicians and academics , often funding and performing work themselves , have been exploring the potential of convalescent plasma .
The idea is hardly novel .
First developed in the 1890s by Nobel Prize–winning German physiologist Emil Behring , convalescent plasma is collected from the blood of patients who @ @ @ @ @ @ @ in that plasma can help treat current patients .
Over the last century , this type of therapy has saved countless lives .
In early February , as COVID-19 ravaged Wuhan , Arturo Casadevall at Johns Hopkins University floated the idea of using convalescent plasma to treat the coronavirus .
He did so on an informal LISTSERV—essentially an e-mail-based watercooler conversation—of physician-scientists and public health specialists .
Momentum began to build .
Michael Joyner of the Mayo Clinic started assembling a small response team .
New needs were identified , friends joined the @ @ @ @ @ @ @ .
Champions such as our colleague Brenda Grossman emerged to tackle critical challenges : the preparation and distribution of convalescent plasma , the complexities of blood banking and storage .
Volunteers raced to establish efficacy through RCTs .
( Historically , such trials were nearly nonexistent , since convalescent plasma was often pursued as a desperation measure , in the face of urgent need . )
Last spring , one of us ( Jeffrey Henderson ) reached out to the head infectious diseases researcher at Walter Reed ; the U.S. Navy ’ s @ @ @ @ @ @ @ head of the U.S. Army ’ s COVID-19 task force .
All three officials listened intently , acutely aware that the pandemic was now engulfing Italy and menacing American military bases there .
They recognized that the pandemic could impact military readiness and that infected warfighters might further serve their country by donating plasma ( the DoD has its own internal blood collection service ) .
They agreed to elevate the prospects for convalescent plasma within their commands .
The listserv volunteers continued their work , soon organizing into the National COVID-19 Convalescent @ @ @ @ @ @ @ , members raced down I-95 , from Baltimore to FDA headquarters outside Washington , to file paperwork for an investigational new drug application .
The FDA ’ s response , released March 24 , was more permissive than expected : it moved straight to compassionate use authorization .
Convalescent plasma could be given to the sickest patients in RCTs , as long as treating physicians agreed to provide post-transfusion safety data .
To facilitate convalescent plasma collection and evaluation , project members developed a dedicated communications network .
Problems were solved on the @ @ @ @ @ @ @ airplane while the craft was aloft .
Academic institutions , in accordance with FDA guidelines , began referring volunteers for plasma donation .
With assistance from Brenda Grossman and volunteer Chaim Lebovits , supply began to build in blood banks like the American Red Cross .
Philanthropic donors funded trials .
But the unexpected FDA authorization presented a potential problem .
Some worried that patients and physicians desperate to request compassionate use might hesitate to participate in randomized trials , where they may end up in a control group that does not receive @ @ @ @ @ @ @ .
Similarly , the much-needed adoption of social distancing measures in hospitals complicated the consent process necessary for trial enrollment .
These actions served to diminish the intended RCT design of the trials .
Such issues would later fuel criticism and were a factor in the FDA delaying emergency use authorization .
Nevertheless , the largest compassionate use trial , shepherded by Joyner and the Mayo Clinic , continued to grow and soon encompassed more than 60,000 patients .
Meanwhile , another LISTSERV leader , Liise-anne Pirofski at the Albert Einstein College of @ @ @ @ @ @ @ .
Other small ( and thus unfortunately statistically underpowered ) studies emerged from the Netherlands and China , the latter of which was halted with only about half of the patients enrolled .
On August 12 , the Mayo Clinic released findings based on a robust population of more than 35,000 patients , most of whom were hospitalized and very sick ( requiring intensive care ) .
Importantly , this study found , among other things , that treating patients with convalescent plasma results in a 27 percent improvement in seven-day survival—making this @ @ @ @ @ @ @ remdesivir , an experimental medicine that quickly became a household name a few months ago .
The August 12 study also revealed several important caveats to our larger COVID-19 response .
For example , it demonstrated that when treatment is administered within three days of diagnosis , mortality rates were substantially lower .
This was not unexpected , and mirrors the need for early intervention to succeed in combatting influenza , another infectious and deadly respiratory pathogen .
Intervention within three days has proven to be entirely feasible , especially as the turnaround @ @ @ @ @ @ @ time the CP study began .
Moreover , the conversion of the compassionate use trial to an EUA should increase the availability of CP and thus shorten time to treatment .
Indeed , the impressive strength of the American blood banking system allows the nation to move CP units around in an efficient way .
By informing providers of the usefulness of the therapy , as well as its limitations , physicians should also be able to deploy CS more optimally and to those patients most likely to benefit .
Yet these results @ @ @ @ @ @ @ and intervention—proposals that still generate considerable public debate .
Largely undiscussed is the relationship between the concentration of antibodies that recognize SARS-CoV-2 and how well patients respond to CP therapy .
In the Mayo study , researchers hypothesized that patients who received plasma with higher antibody concentrations would fare better than those who received plasma with lower concentrations .
Because physicians and patients had no prior knowledge of antibody concentrations at the time of treatment , this was effectively a randomized , blinded study with low-titer plasma serving as controls .
Long after @ @ @ @ @ @ @ randomized controlled study by measuring antibody content and comparing patient outcomes .
Among patients treated early , they found that mortality in those who received plasma with high SARS-CoV-2 antibodies decreased by more than a third compared to those who received plasma low antibodies .
In those treated late , mortality between groups was comparable .
This dose-dependence result was largely overlooked by the critics and would seem to further strengthen the argument for convalescent plasma in COVID-19 .
The dose-dependent outcome is crucial in light of evidence that the antibody levels in @ @ @ @ @ @ @ time .
Such outcomes may suggest an opportunity to pool and concentrate the antibody levels in plasma , interventions that are readily addressed by current technologies .
What initially set this study and the overall convalescent plasma project apart is that both were largely free from the hype and spin surrounding other investigational COVID-19 treatments .
At least this was the case before Sunday ’ s surprise announcement ; and the fact it occurred a day before the start of a political convention served merely to enrage political opponents .
We have already @ @ @ @ @ @ @ touted by politicians or companies seeking to profit from their notoriety .
In contrast , the nation ’ s academic and medical organizations , in concert with patients and primary physicians , have quietly pursued lifesaving medicine—and developed a powerful new tool—through an ethic of cooperation and transparency .
In the press conference where the policy reversal was announced , FDA Commissioner Stephen Hahn mistakenly claimed that , for example , an overall 35 percent efficacy meant that 35 of 100 people would be saved by the new treatment .
This is inaccurate @ @ @ @ @ @ @ measurement , meaning that subjects were over a third more likely to benefit from treatment than were control subjects in earlier experiments .
Despite the commotion , the EUA is largely a continuation of the status quo for CP , albeit with a relieved paperwork burden on medical providers and hospitals that use it , effectively expanding its availability to marginalized communities .
Notably , the EUA does not preclude future RCTs on plasma , and indeed , in issuing its authorization , the FDA stressed an intention that RCTs continue unabated Going @ @ @ @ @ @ @ private and public sectors to join forces .
We must assesss whether or how responses to convalescent plasma vary in patients with different degrees of disese severity and demographic diversity .
To do so , we must increase scale and facilitate early use of convalescent plasma treatments .
We must support the large-scale studies now underway , including RCTs , the results of which may become available within weeks .
We must resist baseless conspiracy theories that government scientists are holding back work .
We must avoid unscientific approaches such as “ right @ @ @ @ @ @ @ objective clinical trials .
We must complete randomized controlled trials to ensure that this therapy is both safe and efficacious .
Most importantly , we must allow the professionals in the FDA to make data-based , scientifically sound decisions , unbiased by political pressure .
The National Center for Advancing Translational Sciences ( NCATS ) is funding the expansion of two randomized placebo controlled trials of convalescent plasma in hospitalized patients led by the NYU Langone and Montefiore/Einstein health systems ( CONTAIN COVID-19 ) and Vanderbilt Medical Center ( PassItOn ) .
This @ @ @ @ @ @ @ physicians and for a public dreading what promises to be a brutal cold and flu season .
We still have much to do , as winter approaches , and we still have much to learn .
But thanks in part to a humble listserv , we can approach the coming months with considerably more hope .

On Sunday afternoon, August 24, President Trump announced an emergency use authorization (EUA) for what he described as a “powerful therapy” against COVID-19. Known as convalescent plasma, or CP, it’s donated by survivors of the disease, on the theory that the antibodies it carries can protect others from COVID’s worst ravages. And a few weeks ago, the Mayo Clinic released a preliminary report saying CP showed promise in doing just that—but nevertheless, the New York Times reported that the FDA was not ready to approve the treatment, even on an emergency basis.
Now the president has forced the agency to reverse itself—and to make things even more confusing, FDA Commissioner Stephen Hahn described the efficacy of the treatment incorrectly. So what’s going on?
To be clear, we are not particularly supportive of EUAs, since they may give the public an urealistically rosy impression of how promising a treatment actually is—something critics have brought up in this case as well. Another problem is that once an EUA has been issued, it can be harder to recruit subjects for a case control clinical trial, in which some subjects get a placebo and others get the actual treatment being studied. In particular, we would never support overriding the judgement of FDA professionals. As one of us (Michael Kinch) has consistently argued, the FDA must be guided by the independent and patient-focused approach exemplified by Frances Oldham Kelsey, who in the 1960s refused to approve thalidomide for distribution in the United States out of concern for patient safety.
Although we share concerns about the means by which the EUA was enacted, however, and about the optics that clearly suggest that the decision was tainted by political considerations, an overly-strident reaction risks throwing out the baby with the bathwater. In this spirit, we believe it is important to convey the rather remarkable story of how convalescent plasma arose for the treatment of COVID-19.
To begin with, the Mayo Clinic study isn’t the only one that has shown promise. Other researchers have generated rigorous, peer-reviewed outcomes from smaller trials—either randomized controlled trials that did not fully enroll, or case control studies, such as those from Mount Sinai and Houston Methodist Hospital. In each case, these results showed consistent and encouraging results although they admittedly were not fully-enrolled and randomized controlled trials (RCTs).
Over the last several months, a loose-knit group of physicians and academics, often funding and performing work themselves, have been exploring the potential of convalescent plasma. The idea is hardly novel. First developed in the 1890s by Nobel Prize–winning German physiologist Emil Behring, convalescent plasma is collected from the blood of patients who have recovered from a disease. Antibodies in that plasma can help treat current patients. Over the last century, this type of therapy has saved countless lives.
In early February, as COVID-19 ravaged Wuhan, Arturo Casadevall at Johns Hopkins University floated the idea of using convalescent plasma to treat the coronavirus. He did so on an informal LISTSERV—essentially an e-mail-based watercooler conversation—of physician-scientists and public health specialists. Momentum began to build. Michael Joyner of the Mayo Clinic started assembling a small response team. New needs were identified, friends joined the effort, and subgroups began to form.
Champions such as our colleague Brenda Grossman emerged to tackle critical challenges: the preparation and distribution of convalescent plasma, the complexities of blood banking and storage. Volunteers raced to establish efficacy through RCTs. (Historically, such trials were nearly nonexistent, since convalescent plasma was often pursued as a desperation measure, in the face of urgent need.)
Last spring, one of us (Jeffrey Henderson) reached out to the head infectious diseases researcher at Walter Reed; the U.S. Navy’s top infectious disease physician; and the head of the U.S. Army’s COVID-19 task force. All three officials listened intently, acutely aware that the pandemic was now engulfing Italy and menacing American military bases there. They recognized that the pandemic could impact military readiness and that infected warfighters might further serve their country by donating plasma (the DoD has its own internal blood collection service). They agreed to elevate the prospects for convalescent plasma within their commands.
The listserv volunteers continued their work, soon organizing into the National COVID-19 Convalescent Plasma Project. On a March afternoon, members raced down I-95, from Baltimore to FDA headquarters outside Washington, to file paperwork for an investigational new drug application. The FDA’s response, released March 24, was more permissive than expected: it moved straight to compassionate use authorization. Convalescent plasma could be given to the sickest patients in RCTs, as long as treating physicians agreed to provide post-transfusion safety data.
To facilitate convalescent plasma collection and evaluation, project members developed a dedicated communications network. Problems were solved on the fly; members joked about building an airplane while the craft was aloft. Academic institutions, in accordance with FDA guidelines, began referring volunteers for plasma donation. With assistance from Brenda Grossman and volunteer Chaim Lebovits, supply began to build in blood banks like the American Red Cross. Philanthropic donors funded trials.
But the unexpected FDA authorization presented a potential problem. Some worried that patients and physicians desperate to request compassionate use might hesitate to participate in randomized trials, where they may end up in a control group that does not receive CP, foreshadowing the controversies of today. Similarly, the much-needed adoption of social distancing measures in hospitals complicated the consent process necessary for trial enrollment. These actions served to diminish the intended RCT design of the trials. Such issues would later fuel criticism and were a factor in the FDA delaying emergency use authorization.
Nevertheless, the largest compassionate use trial, shepherded by Joyner and the Mayo Clinic, continued to grow and soon encompassed more than 60,000 patients. Meanwhile, another LISTSERV leader, Liise-anne Pirofski at the Albert Einstein College of Medicine, began a randomized clinical trial. Other small (and thus unfortunately statistically underpowered) studies emerged from the Netherlands and China, the latter of which was halted with only about half of the patients enrolled.
On August 12, the Mayo Clinic released findings based on a robust population of more than 35,000 patients, most of whom were hospitalized and very sick (requiring intensive care). Importantly, this study found, among other things, that treating patients with convalescent plasma results in a 27 percent improvement in seven-day survival—making this century-old method at least as useful as remdesivir, an experimental medicine that quickly became a household name a few months ago.
The August 12 study also revealed several important caveats to our larger COVID-19 response. For example, it demonstrated that when treatment is administered within three days of diagnosis, mortality rates were substantially lower. This was not unexpected, and mirrors the need for early intervention to succeed in combatting influenza, another infectious and deadly respiratory pathogen.
Intervention within three days has proven to be entirely feasible, especially as the turnaround time for diagnostics has improved since the time the CP study began. Moreover, the conversion of the compassionate use trial to an EUA should increase the availability of CP and thus shorten time to treatment. Indeed, the impressive strength of the American blood banking system allows the nation to move CP units around in an efficient way. By informing providers of the usefulness of the therapy, as well as its limitations, physicians should also be able to deploy CS more optimally and to those patients most likely to benefit. Yet these results also reinforce the importance of early testing and intervention—proposals that still generate considerable public debate.
Largely undiscussed is the relationship between the concentration of antibodies that recognize SARS-CoV-2 and how well patients respond to CP therapy. In the Mayo study, researchers hypothesized that patients who received plasma with higher antibody concentrations would fare better than those who received plasma with lower concentrations. Because physicians and patients had no prior knowledge of antibody concentrations at the time of treatment, this was effectively a randomized, blinded study with low-titer plasma serving as controls. Long after treatment, researchers unblinded this de facto randomized controlled study by measuring antibody content and comparing patient outcomes.
Among patients treated early, they found that mortality in those who received plasma with high SARS-CoV-2 antibodies decreased by more than a third compared to those who received plasma low antibodies. In those treated late, mortality between groups was comparable. This dose-dependence result was largely overlooked by the critics and would seem to further strengthen the argument for convalescent plasma in COVID-19.
The dose-dependent outcome is crucial in light of evidence that the antibody levels in infected patients tend to drop rapidly over time. Such outcomes may suggest an opportunity to pool and concentrate the antibody levels in plasma, interventions that are readily addressed by current technologies.
What initially set this study and the overall convalescent plasma project apart is that both were largely free from the hype and spin surrounding other investigational COVID-19 treatments. At least this was the case before Sunday’s surprise announcement; and the fact it occurred a day before the start of a political convention served merely to enrage political opponents. We have already seen too many drugs and vaccines loudly touted by politicians or companies seeking to profit from their notoriety. In contrast, the nation’s academic and medical organizations, in concert with patients and primary physicians, have quietly pursued lifesaving medicine—and developed a powerful new tool—through an ethic of cooperation and transparency.
In the press conference where the policy reversal was announced, FDA Commissioner Stephen Hahn mistakenly claimed that, for example, an overall 35 percent efficacy meant that 35 of 100 people would be saved by the new treatment. This is inaccurate. The 35 percent is a relative measurement, meaning that subjects were over a third more likely to benefit from treatment than were control subjects in earlier experiments.
Despite the commotion, the EUA is largely a continuation of the status quo for CP, albeit with a relieved paperwork burden on medical providers and hospitals that use it, effectively expanding its availability to marginalized communities. Notably, the EUA does not preclude future RCTs on plasma, and indeed, in issuing its authorization, the FDA stressed an intention that RCTs continue unabated
Going forward, it will be important for private and public sectors to join forces. We must assesss whether or how responses to convalescent plasma vary in patients with different degrees of disese severity and demographic diversity. To do so, we must increase scale and facilitate early use of convalescent plasma treatments. We must support the large-scale studies now underway, including RCTs, the results of which may become available within weeks. We must resist baseless conspiracy theories that government scientists are holding back work. We must avoid unscientific approaches such as “right to try,” which can undermine objective clinical trials. We must complete randomized controlled trials to ensure that this therapy is both safe and efficacious. Most importantly, we must allow the professionals in the FDA to make data-based, scientifically sound decisions, unbiased by political pressure.
The National Center for Advancing Translational Sciences (NCATS) is funding the expansion of two randomized placebo controlled trials of convalescent plasma in hospitalized patients led by the NYU Langone and Montefiore/Einstein health systems (CONTAIN COVID-19) and Vanderbilt Medical Center (PassItOn). This development provides much-needed good news for nervous physicians and for a public dreading what promises to be a brutal cold and flu season.
We still have much to do, as winter approaches, and we still have much to learn. But thanks in part to a humble listserv, we can approach the coming months with considerably more hope.


scientificamerican--2020-08-25--Australia Floats Plan to Better Protect Great Barrier Reef

Australian officials plan to redouble their efforts to save the Great Barrier Reef from the effects of global warming .
The world ’ s largest coral reef system is under threat from rising ocean temperatures , ocean acidification and violent tropical weather .
Scientists also have struggled to contain outbreaks of the crown-of-thorns starfish , a polyp-eating predator that can threaten the reef ’ s health .
In response to these dangers , Australia ’ s Department of Agriculture , Water and the Environment is floating a 30-year plan to protect the natural wonder .
The proposal calls for controlling @ @ @ @ @ @ @ can harm the reef , along with improved coastal infrastructure planning .
The draft also outlines rehabilitation efforts to be taken out to 2050 .
The Australian and Queensland governments are planning to spend up to $ 2 billion over the course of a decade as part of an initial phase of reef protection and recovery efforts .
The new draft plan was opened for public comments last week .
It ’ s a revision of a plan issued in 2015 .
The department said the updated strategy “ includes a greater focus @ @ @ @ @ @ @ the Reef ” and takes into account recent coral bleaching events that occurred after 2015 .
The Great Barrier Reef is a major tourist draw that creates more than 64,000 jobs for the state of Queensland and about $ 4.6 billion in annual economic benefit , according to the Australian government .
It is the world ’ s largest structure built by living organisms , and it ’ s among the most biodiverse regions of the world ’ s oceans .
The Great Barrier Reef is registered as a World Heritage Site by @ @ @ @ @ @ @ Long-Term Sustainability Plan ” points to climate change as the single greatest threat to the future of the Great Barrier Reef .
Getting greenhouse gas emissions under control will be critical to its future , the department argues .
“ Global warming and the climate change it drives is the most serious and pervasive threat to the Reef , ” says the draft .
“ The future long-term outlook is critically dependent on limiting global temperature rise to the maximum extent possible.
” And yet the draft plan acknowledges there is little Australia @ @ @ @ @ @ @ global warming or halt the rise in ocean temperatures—a prime factor in recent mass coral bleaching events .
Corals grow through a symbiotic relationship between animal coral polyps that build the hard calcium carbonate skeletons of the reefs and single-celled organisms that survive via photosynthesis and feed the polyps nutrients .
Higher water temperatures cause polyps to expel these single-celled zooxanthellae and turn corals white , thus the term “ bleaching.
” This increases coral mortality .
Harmful bleaching episodes at the Great Barrier Reef occurred in 2016 and 2017 .
The most @ @ @ @ @ @ @ during the Southern Hemisphere summer .
Its impact is still being assessed .
“ In 2020 , severe bleaching was more widespread than in previous bleaching events in 2016 and 2017 , ” the draft plan notes .
“ While major tourism areas of the Reef mostly had negligible or moderate bleaching in 2020 , areas in the southern part of the Reef that escaped much of the impact in 2016 and 2017 were severely affected by this third event.
” A new study by the Australian Institute of Marine Science ( AIMS @ @ @ @ @ @ @ has recovered slightly from the previous two coral bleaching events , but it cautioned that scientists won ’ t know the full impact of the 2020 bleaching until later this year .
The AIMS annual report , published Friday , found that two-thirds of 86 separate reef structures surveyed showed “ slightly increased coral cover , ” with coral cover in the southern portion of the Great Barrier Reef having recovered the most .
The institute noted that the corals of the Great Barrier Reef have largely bounced back from the 2016 and @ @ @ @ @ @ @ third mass coral bleaching event in five years will likely be a setback to their recovery.
” The government ’ s plan says Australia must accelerate domestic efforts to lower greenhouse gas emissions and do everything necessary to convince other governments to do the same .
It also proposes stricter regulation of land- and water-based activities in and around the reef .
And it recommends involving Aboriginal communities more in Great Barrier Reef management .
Stricter regulation of tourism may be forthcoming , as well .
Graeme Cumming , a professor and researcher @ @ @ @ @ @ @ Coral Reef Studies at James Cook University , says there ’ s been an exponential increase in government permits issued for Great Barrier Reef operations since 2000 .
The rise in permitting is revealed by data he uncovered during a study on conservation management .
The permitting spike reflects an increase in international tourism , but he said he doubts this has had major negative effects on the health of the reefs—as the permits were mostly for “ generally low-impact ” activities like tour boat access and moorings .
The management plan emphasizes @ @ @ @ @ @ @ surface runoff .
This means reducing fertilizer use for agriculture and ensuring the survival of coastal habitats that mitigate water quality issues , such as coastal wetlands and mangrove forests .
Runoff from coastal agriculture is “ the main source of water pollution in the Reef catchment and is therefore a major focus for action and funding under the Plan , ” says the draft .
The authors want new measures to control water pollution from urban runoff and more cleanup operations to remove marine litter around the reefs , in particular marine @ @ @ @ @ @ @ better manage and control coastal development , and for the national government to enact stricter enforcement against illegal fishing activity .
The population of towns and cities along Queensland ’ s coast is projected to steadily increase , “ which will intensify impacts from the associated use of the Reef if not managed appropriately , ” the draft says .
The plan also calls for greater protections for sea grass communities .
Sea grass is critical to the survival of endangered dugongs , a cousin species to Florida ’ s manatees .
Money @ @ @ @ @ @ @ crown-of-thorns starfish outbreaks and the spread of invasive species .
The plan promises future initiatives to replace or replenish corals that are damaged or destroyed by storms or other impacts , citing past coral experiments in reseeding and relocating corals that proved successful .
The Australian government aims to spend big on devising strategies to help the Great Barrier Reef adapt to higher ocean temperatures , including “ on-reef experimental trials of selected techniques ” launched within two years of the start of the recovery and protection plan .
Cumming called the new @ @ @ @ @ @ @ it wouldn ’ t resolve direct impacts from climate change .
He also expressed doubt about the government ’ s spending plan for water pollution .
“ I ’ m not convinced that the funding the government is committing to water quality is sufficient to achieve the necessary levels of catchment restoration , ” he said .
“ Recent research suggests that nutrients in seawater make bleaching worse.
” On Friday , scientists from the United States , Australia , New Zealand and Saudi Arabia published a study in the journal Science Advances @ @ @ @ @ @ @ exacerbated recent coral bleaching events in the Red Sea .
The public comment period for the new Great Barrier Reef protection plan closes Sept. 30 .
Reprinted from Climatewire with permission from E & E News .
E & E provides daily coverage of essential energy and environmental news at www.eenews.net .

Australian officials plan to redouble their efforts to save the Great Barrier Reef from the effects of global warming.
The world’s largest coral reef system is under threat from rising ocean temperatures, ocean acidification and violent tropical weather. Scientists also have struggled to contain outbreaks of the crown-of-thorns starfish, a polyp-eating predator that can threaten the reef’s health.
In response to these dangers, Australia’s Department of Agriculture, Water and the Environment is floating a 30-year plan to protect the natural wonder.
The proposal calls for controlling surface runoff and shore-based water pollution that can harm the reef, along with improved coastal infrastructure planning. The draft also outlines rehabilitation efforts to be taken out to 2050.
The Australian and Queensland governments are planning to spend up to $2 billion over the course of a decade as part of an initial phase of reef protection and recovery efforts. The new draft plan was opened for public comments last week.
It’s a revision of a plan issued in 2015. The department said the updated strategy “includes a greater focus on climate change and its impact on the Reef” and takes into account recent coral bleaching events that occurred after 2015.
The Great Barrier Reef is a major tourist draw that creates more than 64,000 jobs for the state of Queensland and about $4.6 billion in annual economic benefit, according to the Australian government. It is the world’s largest structure built by living organisms, and it’s among the most biodiverse regions of the world’s oceans. The Great Barrier Reef is registered as a World Heritage Site by UNESCO.
The draft “Reef 2050 Long-Term Sustainability Plan” points to climate change as the single greatest threat to the future of the Great Barrier Reef. Getting greenhouse gas emissions under control will be critical to its future, the department argues.
“Global warming and the climate change it drives is the most serious and pervasive threat to the Reef,” says the draft. “The future long-term outlook is critically dependent on limiting global temperature rise to the maximum extent possible.”
And yet the draft plan acknowledges there is little Australia itself can do to limit or reverse global warming or halt the rise in ocean temperatures—a prime factor in recent mass coral bleaching events.
Corals grow through a symbiotic relationship between animal coral polyps that build the hard calcium carbonate skeletons of the reefs and single-celled organisms that survive via photosynthesis and feed the polyps nutrients. Higher water temperatures cause polyps to expel these single-celled zooxanthellae and turn corals white, thus the term “bleaching.” This increases coral mortality.
Harmful bleaching episodes at the Great Barrier Reef occurred in 2016 and 2017. The most recent bleaching event happened earlier this year during the Southern Hemisphere summer. Its impact is still being assessed.
“In 2020, severe bleaching was more widespread than in previous bleaching events in 2016 and 2017,” the draft plan notes. “While major tourism areas of the Reef mostly had negligible or moderate bleaching in 2020, areas in the southern part of the Reef that escaped much of the impact in 2016 and 2017 were severely affected by this third event.”
A new study by the Australian Institute of Marine Science (AIMS) showed that the Great Barrier Reef has recovered slightly from the previous two coral bleaching events, but it cautioned that scientists won’t know the full impact of the 2020 bleaching until later this year.
The AIMS annual report, published Friday, found that two-thirds of 86 separate reef structures surveyed showed “slightly increased coral cover,” with coral cover in the southern portion of the Great Barrier Reef having recovered the most.
The institute noted that the corals of the Great Barrier Reef have largely bounced back from the 2016 and 2017 events; “however, the third mass coral bleaching event in five years will likely be a setback to their recovery.”
Reef tourism could change
The government’s plan says Australia must accelerate domestic efforts to lower greenhouse gas emissions and do everything necessary to convince other governments to do the same.
It also proposes stricter regulation of land- and water-based activities in and around the reef. And it recommends involving Aboriginal communities more in Great Barrier Reef management.
Stricter regulation of tourism may be forthcoming, as well.
Graeme Cumming, a professor and researcher at the ARC Centre of Excellence for Coral Reef Studies at James Cook University, says there’s been an exponential increase in government permits issued for Great Barrier Reef operations since 2000. The rise in permitting is revealed by data he uncovered during a study on conservation management.
The permitting spike reflects an increase in international tourism, but he said he doubts this has had major negative effects on the health of the reefs—as the permits were mostly for “generally low-impact” activities like tour boat access and moorings.
The management plan emphasizes the necessity of minimizing pollution from coastal surface runoff. This means reducing fertilizer use for agriculture and ensuring the survival of coastal habitats that mitigate water quality issues, such as coastal wetlands and mangrove forests.
Runoff from coastal agriculture is “the main source of water pollution in the Reef catchment and is therefore a major focus for action and funding under the Plan,” says the draft.
The authors want new measures to control water pollution from urban runoff and more cleanup operations to remove marine litter around the reefs, in particular marine plastic waste.
They want Queensland to better manage and control coastal development, and for the national government to enact stricter enforcement against illegal fishing activity.
The population of towns and cities along Queensland’s coast is projected to steadily increase, “which will intensify impacts from the associated use of the Reef if not managed appropriately,” the draft says.
The plan also calls for greater protections for sea grass communities. Sea grass is critical to the survival of endangered dugongs, a cousin species to Florida’s manatees.
Money also would be directed at controlling future crown-of-thorns starfish outbreaks and the spread of invasive species.
The plan promises future initiatives to replace or replenish corals that are damaged or destroyed by storms or other impacts, citing past coral experiments in reseeding and relocating corals that proved successful.
The Australian government aims to spend big on devising strategies to help the Great Barrier Reef adapt to higher ocean temperatures, including “on-reef experimental trials of selected techniques” launched within two years of the start of the recovery and protection plan.
Cumming called the new plan “useful” but warned that it wouldn’t resolve direct impacts from climate change. He also expressed doubt about the government’s spending plan for water pollution.
“I’m not convinced that the funding the government is committing to water quality is sufficient to achieve the necessary levels of catchment restoration,” he said. “Recent research suggests that nutrients in seawater make bleaching worse.”
On Friday, scientists from the United States, Australia, New Zealand and Saudi Arabia published a study in the journal Science Advances that points to proof that coastal runoff exacerbated recent coral bleaching events in the Red Sea.
The public comment period for the new Great Barrier Reef protection plan closes Sept. 30.
Reprinted from Climatewire with permission from E&E News. E&E provides daily coverage of essential energy and environmental news at www.eenews.net.