scientificamerican--2020-08-30--Do-it-Yourself Vaccines for COVID-19

Do-it-Yourself Vaccines for COVID-19

In response to the COVID-19 pandemic , members of the Rapid Deployment Vaccine Collaborative ( or RaDVaC ) —a group composed of scientists and their friends or colleagues—have been self-administering an untested vaccine for SARS-CoV-2 ( the virus that causes COVID-19 ) .
The RaDVaC scientists describe their project as aiming “ to reduce risk of harm from SARS-CoV-2 , minimally until there is at least one effective commercial vaccine widely available.
” Although the project ’ s white paper includes includes terms and conditions designed to shield the authors from liability , RaDVaC ’ s self-experimentation raises important legal @ @ @ @ @ @ @ fascinating history .
In the early 1900s , Walter Reed conducted experiments in Cuba deliberately exposing individuals to yellow fever that included members of the study team as participants ; these led to significant public health benefits in confirming that yellow fever was transmitted by mosquitoes , but also resulted in the deaths of several participants .
Some Nobel Prize–winning work by scientists was based on self-experimentation that initially was seen as crazy .
For instance , in 1984 , Barry Marshall swallowed bacteria to prove that they caused gastritis and peptic ulcers @ @ @ @ @ @ @ a 1929 experiment by a German doctor who inserted a catheter into his own heart .
Perhaps surprisingly , self-experimentation was once considered an ethical safeguard .
The Nuremberg Code , established in response to grossly unethical experiments during World War II , permitted higher risk research if investigators also volunteered to participate , as they had in the earlier yellow fever studies .
However , the idea that self-experimentation can justify higher research risks was abandoned in later codes of ethics .
Not only is self-experimentation legally and ethically complex , but @ @ @ @ @ @ @ , which are now required by research regulations , may be a better way to protect research participants .
Existing regulations for research were not designed to address self-experimentation .
Laws governing research typically define research as an activity designed to produce generalizable knowledge , which does not cover experimentation that is badly designed , unlikely to produce useful data , and merely aiming to protect a small group of people .
In addition , the U.S. Common Rule governs federally funded research , and RaDVaC is not using any federal funding .
@ @ @ @ @ @ @ “ federalwide assurance ” under which the institution has agreed that all research it conducts will abide by the regulations ( regardless of funding source ) .
If studies of immune responses involving self-experimentation are planned in George Church ’ s laboratory at Harvard , as has been reported , this undoubtedly requires approval by an Institutional Review Board , which would provide some oversight of this self-experimentation .
If results are to be published in a peer-reviewed journal , moreover , most , if not all , journals would require assurance of @ @ @ @ @ @ @ Food and Drug Administration has similar power to regulate research , and , perhaps more relevant for our purposes , “ drugs ” ( including human biological materials and biologics ) —even if they are not distributed for profit .
The RaDVaC project uses biological materials—more specifically , small chains of amino acids from key SARS-CoV-2 proteins—and therefore may fall under the FDA ’ s jurisdiction .
While the FDA has not traditionally exercised this authority to regulate the analogous practice of small scale , do-it-yourself biohacking , it retains the power to @ @ @ @ @ @ @ , if people were harmed by taking this vaccine , they could also sue RaDVaC , but the disclaimers in the white paper are carefully designed to avoid liability .
Even if the law doesn ’ t adequately address this behavior , it may be ethically problematic—including because it could be a waste of scientific expertise and research effort .
If RaDVaC intends to produce generalizable knowledge about this vaccine , unsystematic self-experimentation is unlikely to produce useful information .
For example , self-experimentation can lead to biased results if researchers overestimate the @ @ @ @ @ @ @ fail to report side effects .
Randomized controlled trials , by contrast , are typically designed with researchers being blinded to who receives the intervention or the placebo .
Beyond self-experimentation , friends , staff members , and family members of the scientists involved are taking this vaccine based on these expert ’ s recommendations , which could lead to two potential misconceptions .
First , people taking the vaccine might overestimate the likelihood that they are protected from SARS-CoV-2 and change their behavior .
If some individuals falsely believe they are protected @ @ @ @ @ @ @ that could cause harm to themselves and others .
A second misconception is the idea that this is research that could benefit others .
The same data analyst seemed to believe this when he added “ my continued existence through this pandemic will be a useful data set.
” Yet the RaDVaC project could not produce useful data in the same way as standard , well-designed vaccine trials , for example , because it is unclear whether individuals receiving the vaccine are thoroughly evaluated or monitored , and there does not appear to @ @ @ @ @ @ @ everyone involved with this project fully understands what they are getting into , however , there are also questions about expertise and privilege .
Senior scientists benefit from many layers of privilege : investment in their education , expertise in specialized areas , and access to information or materials .
Arguably , these privileges come with a responsibility to use expertise for the benefit of society .
If the RaDVaC vaccine is potentially beneficial , then it is tragic not to test it in a rigorously designed study .
Indeed , uncontrolled self-experimentation @ @ @ @ @ @ @ the COVID-19 pandemic .
Panic about the virus has led to the widespread use of interventions outside of well-designed clinical trials .
Without such trials , we remain in the dark about which interventions offer net benefits or net harms .
Insofar as the scientists involved have expertise in vaccine research , they should either reform the RaDVaC project or lend their expertise to serious projects .
On the other hand , if scientists don ’ t have relevant expertise , their overconfidence at their ability to work outside of their wheelhouse may @ @ @ @ @ @ @ Steven Salzberg , a computational biologist , called for experimental COVID-19 vaccines to be rolled out before the results of phase III testing .
An op-ed denouncing his misinformed view was published the next day , and Salzberg reversed his position immediately .
Similarly , some of the named members of the RaDVaC project have expertise in genetics , neuroscience , and anti-aging research .
Their time might be better spent on projects in these fields , which will still be important when this pandemic is finally over .
Rather than trying everything @ @ @ @ @ @ @ it would be wiser to focus our collective efforts on prioritizing the most promising interventions and testing them in rigorous research , as has been done for some treatments for COVID-19 .
RaDVaC ’ s scientists should be encouraged to collaborate on systematic COVID-19 vaccine testing if they have relevant expertise , and to do other valuable things with their time if not .

In response to the COVID-19 pandemic, members of the Rapid Deployment Vaccine Collaborative (or RaDVaC)—a group composed of scientists and their friends or colleagues—have been self-administering an untested vaccine for SARS-CoV-2 (the virus that causes COVID-19). The RaDVaC scientists describe their project as aiming “to reduce risk of harm from SARS-CoV-2, minimally until there is at least one effective commercial vaccine widely available.” Although the project’s white paper includes includes terms and conditions designed to shield the authors from liability, RaDVaC’s self-experimentation raises important legal and ethical questions.
Self-experimentation has a fascinating history. In the early 1900s, Walter Reed conducted experiments in Cuba deliberately exposing individuals to yellow fever that included members of the study team as participants; these led to significant public health benefits in confirming that yellow fever was transmitted by mosquitoes, but also resulted in the deaths of several participants. Some Nobel Prize–winning work by scientists was based on self-experimentation that initially was seen as crazy. For instance, in 1984, Barry Marshall swallowed bacteria to prove that they caused gastritis and peptic ulcers. Many cardiac procedures are based on a 1929 experiment by a German doctor who inserted a catheter into his own heart.
Perhaps surprisingly, self-experimentation was once considered an ethical safeguard. The Nuremberg Code, established in response to grossly unethical experiments during World War II, permitted higher risk research if investigators also volunteered to participate, as they had in the earlier yellow fever studies. However, the idea that self-experimentation can justify higher research risks was abandoned in later codes of ethics. Not only is self-experimentation legally and ethically complex, but protections like independent review and informed consent, which are now required by research regulations, may be a better way to protect research participants.
Existing regulations for research were not designed to address self-experimentation. Laws governing research typically define research as an activity designed to produce generalizable knowledge, which does not cover experimentation that is badly designed, unlikely to produce useful data, and merely aiming to protect a small group of people.
In addition, the U.S. Common Rule governs federally funded research, and RaDVaC is not using any federal funding. However, Harvard is covered by a “federalwide assurance” under which the institution has agreed that all research it conducts will abide by the regulations (regardless of funding source). If studies of immune responses involving self-experimentation are planned in George Church’s laboratory at Harvard, as has been reported, this undoubtedly requires approval by an Institutional Review Board, which would provide some oversight of this self-experimentation. If results are to be published in a peer-reviewed journal, moreover, most, if not all, journals would require assurance of regulatory review and oversight.
The U.S. Food and Drug Administration has similar power to regulate research, and, perhaps more relevant for our purposes, “drugs” (including human biological materials and biologics)—even if they are not distributed for profit. The RaDVaC project uses biological materials—more specifically, small chains of amino acids from key SARS-CoV-2 proteins—and therefore may fall under the FDA’s jurisdiction. While the FDA has not traditionally exercised this authority to regulate the analogous practice of small scale, do-it-yourself biohacking, it retains the power to do so in the future. Finally, if people were harmed by taking this vaccine, they could also sue RaDVaC, but the disclaimers in the white paper are carefully designed to avoid liability.
Even if the law doesn’t adequately address this behavior, it may be ethically problematic—including because it could be a waste of scientific expertise and research effort. If RaDVaC intends to produce generalizable knowledge about this vaccine, unsystematic self-experimentation is unlikely to produce useful information. For example, self-experimentation can lead to biased results if researchers overestimate the chance that the vaccine works, or fail to report side effects. Randomized controlled trials, by contrast, are typically designed with researchers being blinded to who receives the intervention or the placebo.
Beyond self-experimentation, friends, staff members, and family members of the scientists involved are taking this vaccine based on these expert’s recommendations, which could lead to two potential misconceptions. First, people taking the vaccine might overestimate the likelihood that they are protected from SARS-CoV-2 and change their behavior. If some individuals falsely believe they are protected, they might engage in riskier behavior that could cause harm to themselves and others.
A second misconception is the idea that this is research that could benefit others. One participant seemed to believe this when he added “my continued existence through this pandemic will be a useful data set.” Yet the RaDVaC project could not produce useful data in the same way as standard, well-designed vaccine trials, for example, because it is unclear whether individuals receiving the vaccine are thoroughly evaluated or monitored, and there does not appear to be a control group.
Even if everyone involved with this project fully understands what they are getting into, however, there are also questions about expertise and privilege. Senior scientists benefit from many layers of privilege: investment in their education, expertise in specialized areas, and access to information or materials. Arguably, these privileges come with a responsibility to use expertise for the benefit of society. If the RaDVaC vaccine is potentially beneficial, then it is tragic not to test it in a rigorously designed study.
Indeed, uncontrolled self-experimentation is part of a larger problem in the COVID-19 pandemic. Panic about the virus has led to the widespread use of interventions outside of well-designed clinical trials. Without such trials, we remain in the dark about which interventions offer net benefits or net harms. Insofar as the scientists involved have expertise in vaccine research, they should either reform the RaDVaC project or lend their expertise to serious projects.
On the other hand, if scientists don’t have relevant expertise, their overconfidence at their ability to work outside of their wheelhouse may be harmful. Earlier this week, Steven Salzberg, a computational biologist, called for experimental COVID-19 vaccines to be rolled out before the results of phase III testing. An op-ed denouncing his misinformed view was published the next day, and Salzberg reversed his position immediately. Similarly, some of the named members of the RaDVaC project have expertise in genetics, neuroscience, and anti-aging research. Their time might be better spent on projects in these fields, which will still be important when this pandemic is finally over.
Rather than trying everything but the kitchen sink against COVID-19, it would be wiser to focus our collective efforts on prioritizing the most promising interventions and testing them in rigorous research, as has been done for some treatments for COVID-19. RaDVaC’s scientists should be encouraged to collaborate on systematic COVID-19 vaccine testing if they have relevant expertise, and to do other valuable things with their time if not.


scientificamerican--2020-08-30--Red Stalagmites Reveal Glimpses of the Past

Not far from the famously multihued architecture of Bilbao in northern Spain , an underground world boasts its own vibrant @ @ @ @ @ stalagmites and stalactites of Goikoetxe Cave are not just the usual white ; many range @ @ @ @ @ .
New research shows that these formations , known generally as speleothems , get their @ @ @ @ @ leached from soil and transported by water .
Scientists suggest , in an article published @ @ @ @ @ International , that Goikoetxe Cave 's speleothems record environmental conditions such as rainfall .

Not far from the famously multihued architecture of Bilbao in northern Spain, an underground world boasts its own vibrant display of color. The stalagmites and stalactites of Goikoetxe Cave are not just the usual white; many range from honey to deep red. New research shows that these formations, known generally as speleothems, get their red color from organic compounds leached from soil and transported by water. Scientists suggest, in an article published online in April in Quaternary International, that Goikoetxe Cave's speleothems record environmental conditions such as rainfall.
Virginia Martínez-Pillado, a paleoclimatologist at the Atapuerca Research Group and the UCM-ISCIII Center for Human Evolution and Behavior in Madrid, hiked and crawled through Goikoetxe Cave to reach its sala roja (“red chamber”). “All around you is red,” Martínez-Pillado says of the cavernous room covered in stalagmites and stalactites. She and her colleagues collected four stalagmites rising from the cave floor and brought them back to the laboratory. The team analyzed trace elements in them and ruled out iron oxidation, which often causes red coloration. (Think Mars.)
A reddish hue can also derive from organic materials, so the scientists next checked the stalagmites' molecular makeup. By measuring how the speleothems scattered and absorbed light, the researchers found that they contained humic and fulvic acids. These complex molecules form from decomposed plant debris, and the team concluded they must have been picked up by water and deposited on the stalagmites as they grew over thousands of years.
The stalagmites could therefore point to past environmental conditions. Changes in rainfall, for instance, would affect the amount of organic matter flushed into the cave, says Alison Blyth, a geochemist at Curtin University in Perth, Australia, who was not involved in the study: “If we measure the chemical signals preserved in each layer, we can reconstruct how different environmental parameters have changed over time.” Martínez-Pillado and her colleagues are now analyzing the stalagmites to trace ancient variations in rainfall and vegetation above Goikoetxe Cave. This technique can also be applied to other caves with speleothems rich in organic matter, the researchers say.


scientificamerican--2020-08-31--The Dangers of Intellectual Territorialism

The Ancient Greek poet Archilochus wrote : “ The fox knows many things , but the hedgehog one big thing.
” When I started my career in astrophysics , the advice I received from my mentor , John Bahcall , was to use the hedgehog strategy in securing tenure : “ Focus on one area of research and aim to be the world expert in it.
” This was wise advice that accomplished its goal , as I received tenure a few years later .
Within two decades , I became the world expert on the first stars in the @ @ @ @ @ @ @ the hedgehog strategy , I began to develop doubts about it .
The doubts intensified when I and my former graduate student Steve Furlanetto wrote an extensive textbook on this emerging frontier that explored the earliest galaxies and the epoch of reionization .
Our purpose was to encourage young researchers to enter the field and make new discoveries .
Their findings would require us to make substantial updates to future editions of the book , but with the great benefit of learning something new .
Of course , as the field trended in @ @ @ @ @ @ @ developed expertise in it too .
At that point , I noticed that these so-called `` experts '' exhibited the unfortunate tendency to discourage younger scientists with fresh ideas from entering into their field .
The behavior appeared similar to the way animals protect their territory : they wish to remain dominant , minimize competition for available resources , and never expose their weaknesses—in the case of the experts , the important insights they might be missing .
The perspective of an outsider poses a threat to conventional thinking .
The consequences are @ @ @ @ @ @ @ questions to which there is no good answer .
The situation is similar outside academia .
When a few youngsters from a growing company called Microsoft entered the executive office of the Encyclopedia Britannica in the 1980s and offered to collaborate on an electronic CD-ROM version of the lucrative encyclopedia , their offer was declined by Britannica ’ s senior management .
At that time , the print version of the encyclopedia was a prominent luxury item with an unparalleled reputation .
As a result of the rejection , Microsoft released its own @ @ @ @ @ @ @ .
Two decades later , Britannica ceased production of its print version , recognizing that it was unable to compete with online resources like Wikipedia .
Ironically , the history of Britannica is now summarized on a Wikipedia page .
Is there any evidence that spreading your focus across multiple scientific disciplines necessarily leads to a superficial impact ?
To the contrary , history demonstrates that polymaths like Leonardo da Vinci , René Descartes , Gottfried Leibniz , Isaac Newton , Charles Darwin , Benjamin Franklin , Marie Curie and Nikola Tesla were @ @ @ @ @ @ @ .
Recognizing the added value of the fox strategy , I was motivated to bring together astronomers , physicists , mathematicians and philosophers under the interdisciplinary umbrella of the Black Hole Initiative at Harvard University .
That way , “ non-experts ” might help “ experts ” realize what they had been missing on unsolved puzzles about black holes .
Knowledge is an island in an ocean of ignorance , and a fresh perspective could identify distant unexplored lands .
A set of narrow experts , each focused on a single intellectual territory @ @ @ @ @ @ @ early maps of the world , which depicted a set of regions with unrealistic proportions and boundaries .
For example , Anaximander ’ s map from around 550 B.C.
, included only Europe , Asia and Libya , surrounded by a circular ocean .
The only way to obtain a proportional view of the complete intellectual world is to allow scientists to cross boundaries between separate intellectual continents and venture into uncharted oceans .
Such explorers might discover the Americas , those virgin continents of the new world beyond the imaginary circular ocean @ @ @ @ @ @ @ visited .
When on a few occasions I started to suggest out-of-the-box ideas to “ experts ” in other fields , most of my proposals were flatly rejected .
In retrospect , some of them turned out to be right on target .
After noticing the experience repeat , I decided to just follow my curiosity and not be swayed away by colleagues who warn , in effect , `` Stay out of this lane . ''
I realized that as long as I have tenure and my self-esteem does not depend on @ @ @ @ @ @ @ not sacrificing much by following my own compass .
Once an argument is validated beyond a reasonable doubt , the “ experts ” will agree with it , although they might also claim that they knew it all along .
My advice to young scientists is therefore different from the one I received—at least , after you have secured tenure .
Define your path not by looking at the surrounding geography and restricting your expertise to intellectual boundaries , but by following your internal compass .
Unwarranted resistance by experts might signal that @ @ @ @ @ @ @ breakthrough .
In the end , wearing early rejection as a badge of honor might give you more pride than any prize awarded to you afterwards by the same experts .

The Ancient Greek poet Archilochus wrote: “The fox knows many things, but the hedgehog one big thing.” When I started my career in astrophysics, the advice I received from my mentor, John Bahcall, was to use the hedgehog strategy in securing tenure: “Focus on one area of research and aim to be the world expert in it.”
This was wise advice that accomplished its goal, as I received tenure a few years later. Within two decades, I became the world expert on the first stars in the universe. But despite the success of the hedgehog strategy, I began to develop doubts about it. The doubts intensified when I and my former graduate student Steve Furlanetto wrote an extensive textbook on this emerging frontier that explored the earliest galaxies and the epoch of reionization. Our purpose was to encourage young researchers to enter the field and make new discoveries. Their findings would require us to make substantial updates to future editions of the book, but with the great benefit of learning something new.
Of course, as the field trended in popularity into the mainstream, established cosmologists developed expertise in it too. At that point, I noticed that these so-called "experts" exhibited the unfortunate tendency to discourage younger scientists with fresh ideas from entering into their field. The behavior appeared similar to the way animals protect their territory: they wish to remain dominant, minimize competition for available resources, and never expose their weaknesses—in the case of the experts, the important insights they might be missing. The perspective of an outsider poses a threat to conventional thinking. The consequences are particularly acute when the outsider raises foundational questions to which there is no good answer.
The situation is similar outside academia. When a few youngsters from a growing company called Microsoft entered the executive office of the Encyclopedia Britannica in the 1980s and offered to collaborate on an electronic CD-ROM version of the lucrative encyclopedia, their offer was declined by Britannica’s senior management. At that time, the print version of the encyclopedia was a prominent luxury item with an unparalleled reputation. As a result of the rejection, Microsoft released its own digital encyclopedia, Encarta, in 1993. Two decades later, Britannica ceased production of its print version, recognizing that it was unable to compete with online resources like Wikipedia. Ironically, the history of Britannica is now summarized on a Wikipedia page.
Is there any evidence that spreading your focus across multiple scientific disciplines necessarily leads to a superficial impact? To the contrary, history demonstrates that polymaths like Leonardo da Vinci, René Descartes, Gottfried Leibniz, Isaac Newton, Charles Darwin, Benjamin Franklin, Marie Curie and Nikola Tesla were all responsible for foundational breakthroughs in science. Recognizing the added value of the fox strategy, I was motivated to bring together astronomers, physicists, mathematicians and philosophers under the interdisciplinary umbrella of the Black Hole Initiative at Harvard University. That way, “non-experts” might help “experts” realize what they had been missing on unsolved puzzles about black holes. Knowledge is an island in an ocean of ignorance, and a fresh perspective could identify distant unexplored lands.
Anaximander's map of the world, circa 550 B.C. Credit: Wikimedia
A set of narrow experts, each focused on a single intellectual territory, provides a fragmented view similar to early maps of the world, which depicted a set of regions with unrealistic proportions and boundaries. For example, Anaximander’s map from around 550 B.C., included only Europe, Asia and Libya, surrounded by a circular ocean. The only way to obtain a proportional view of the complete intellectual world is to allow scientists to cross boundaries between separate intellectual continents and venture into uncharted oceans. Such explorers might discover the Americas, those virgin continents of the new world beyond the imaginary circular ocean, that previous map makers had never visited.
When on a few occasions I started to suggest out-of-the-box ideas to “experts” in other fields, most of my proposals were flatly rejected. In retrospect, some of them turned out to be right on target. After noticing the experience repeat, I decided to just follow my curiosity and not be swayed away by colleagues who warn, in effect, "Stay out of this lane." I realized that as long as I have tenure and my self-esteem does not depend on prizes or honor societies, I am not sacrificing much by following my own compass. Once an argument is validated beyond a reasonable doubt, the “experts” will agree with it, although they might also claim that they knew it all along.
My advice to young scientists is therefore different from the one I received—at least, after you have secured tenure. Define your path not by looking at the surrounding geography and restricting your expertise to intellectual boundaries, but by following your internal compass. Unwarranted resistance by experts might signal that you are on track for an important breakthrough. In the end, wearing early rejection as a badge of honor might give you more pride than any prize awarded to you afterwards by the same experts.


scientificamerican--2020-08-31--Deep-Sea Mining: How to Balance Need for Metals with Ecological Impacts

Slashing humanity ’ s reliance on fossil fuels will require billions of kilograms of metal : a single wind turbine can contain more than a metric ton of copper , and electric car batteries demand heaps of cobalt , nickel and manganese .
Most of these metals now come from terrestrial mines—often at the cost of deforestation , water pollution and human rights abuses .
But a vast trove of metals on the deep-sea floor could soon provide an alternative source .
Though companies have been eyeing this possibility for decades , engineering challenges and unfavorable economics have kept work @ @ @ @ @ @ @ also been a lack of international rules to govern the nascent industry .
But that is poised to change soon : The United Nations–chartered International Seabed Authority ( ISA ) has been finalizing regulations for commercially extracting deep-sea metals in international waters .
These rules could emerge within a year .
The inherent tension in setting them lies in balancing economic interests in metal production with another consideration : the potential for environmental damage .
Proponents say deep-sea mining can avoid a few of the ills of land-based extraction and cut the costs @ @ @ @ @ @ @ caution against jumping from exploration to exploitation too quickly , given how little we know about the deep-sea environment and the life it supports .
“ I generally don ’ t think it ’ s possible for us to objectively assess all the risks involved right now , ” says Jeff Drazen , a marine biologist at the University of Hawaii at Manoa .
“ This is the poorest-described ecosystem on the planet.
” Interest in deep-sea minerals focuses largely on one particular resource : polymetallic nodules .
These potato-sized deposits are rich @ @ @ @ @ @ @ nickel .
They form over millions of years as dissolved metals precipitate around the nuclei of organic materials—often ancient shark teeth , according to Antje Boetius , a marine biologist at the Max Planck Institute for Marine Microbiology in Bremen , Germany .
She says these nodules are scattered in many areas across the global seafloor .
They are especially plentiful in a vast swath of the ocean ’ s abyssal plain that stretches from Hawaii to Mexico and is called the Clarion-Clipperton Zone ( CCZ ) .
Nodules in the CCZ alone @ @ @ @ @ @ @ known land-based reserves of those metals .
Retrieving such nodules from their resting places—often more than three kilometers below the surface—is still a theoretical proposition , though most plans follow a similar blueprint : First , dump-truck-sized collection vehicles would scour the seafloor for nodule-bearing sediment .
A vertical “ riser ” pipe would then whisk the material up to ships equipped with sorting facilities , which would pluck out the valuable nodules and flush unwanted sediment back into the ocean .
But this mining method would necessarily disturb the marine environment , @ @ @ @ @ @ @ working to understand .
In a 2016 study in Nature , researchers found seven new species ( including four representing new genera ) living among the CCZ ’ s nodule beds .
“ There are millions of species out there that have yet to be described , ” says Lisa Levin , a marine biologist at the Scripps Institution of Oceanography , who was not involved in the study .
Even as researchers piece together the basics of these ecosystems , recent studies have sought to understand how mining might impact them .
@ @ @ @ @ @ @ published this past April in Science Advances , found that collection vehicles can have long-lasting physical and biological effects on the seafloor .
Her team revisited a site in the Peru Basin where , in 1989 , researchers had simulated effects of collection vehicles by cutting tracks into the seafloor with a blade-mounted plow towed by a ship .
The plow tracks were plainly visible decades later .
Initially , “ we were absolutely shocked , ” Boetius says .
But she explains that in the stable environment of the deep sea—with weak @ @ @ @ @ @ @ to the seafloor—it takes much longer for an area to recover than it would in shallower waters or on land .
In the old vehicle tracks , microbes were 30 percent less abundant than in a nearby unplowed region .
Animals such as worms and sea cucumbers were also less numerous .
“ You have such compacted sediments that no one can enter anymore , ” Boetius says .
“ Our experiment really shows that such physical processes will stop animals and microbes from returning to repopulate that habitat.
” Mining impacts could @ @ @ @ @ @ @ plumes of sediment that sorting vessels flush back into the water have been compared to inverted smokestacks sticking below the ocean ’ s sunlit surface layer .
Scientists estimate a single nodule-mining operation could release 50,000 cubic meters of sediment-laden water each day—enough to fill 10 Goodyear blimps .
But Thomas Peacock , a mechanical engineer at the Massachusetts Institute of Technology who studies plume behavior using computer models and field trials , has found that turbulence dilutes the plume , quickly bringing sediment concentrations close to background levels .
Still , even @ @ @ @ @ @ @ harm deep-sea dwellers such as plankton and jellyfish , which evolved in a habitat nearly devoid of sediment , Drazen says .
Many of these creatures feed by filtering tiny organic particles out of the water .
If caught in a sediment plume , “ they ’ re going to have a ton of mud to sift through , ” he says .
“ This may clog their filtering apparatus , or it may make it hard for them to choose the good stuff from the bad stuff.
” In a peer-reviewed opinion @ @ @ @ @ @ @ the National Academy of Sciences USA , Drazen and more than a dozen co-authors highlighted this and other risks mining poses to deep-sea waters .
The authors also warned that the practice could interrupt animal communication : noise pollution from sediment rattling up riser pipes could jam acoustic signals among whales and other cetaceans , while sediment plumes could cloud the bioluminescent signals that creatures such as squid and jellyfish use in the darkness of the deep ocean .
“ The animals are just blinking on and off , ” Drazen says .
@ @ @ @ @ @ @ like falling through the stars.
” While Drazen and others have identified some types of harm mining could inflict on deep-sea life , they can not yet pinpoint how much damage might be done : available information is still scant , and the industry is in its early stages .
This uncertainty has led many scientists to adopt a precautionary approach .
The ills of terrestrial mining do not justify a headlong rush to dig up the ocean floor , says Diva Amon , a marine biologist at the Natural History Museum in @ @ @ @ @ @ @ creating damage in an ecosystem we don ’ t yet understand , ” she says .
Groups such as the nonprofit Conservation International have called for a 10-year moratorium on deep-sea mining to give scientists and policy makers more time to examine the potential environmental harms .
But others see the emerging industry as a moral imperative , given metals ’ crucial role in the renewable-energy technologies needed to curtail global warming—and the environmental and social costs often linked to existing mining practices .
“ I started looking at the footprint of terrestrial @ @ @ @ @ @ @ ” says Gregory Stone , chief ocean scientist at DeepGreen , a mining company with exploration agreements in the CCZ .
He points to sometimes deadly health impacts on workers and to child-labor violations , both of which are often associated with terrestrial mining of minerals such as cobalt .
With deep-sea mining , “ the disruption to the planetary system will be a lot less , ” Stone contends .
He adds that a multiyear environmental assessment prior to commercial extraction—which the ISA could require in its final regulations—could help minimize damage @ @ @ @ @ @ @ so by placing the most environmentally sensitive areas off-limits to mining .
The ISA is using the growing body of scientific research in the CCZ “ to identify the best measures required to protect the marine environment ” as the group creates the first ever deep-sea-mining-exploitation code , according to a written statement from its secretary-general Michael Lodge .
These regulations will be adopted if all 168 ISA members ( 167 countries plus the European Union ) agree on them , he said .
This summer , the organization ’ s annual assembly @ @ @ @ @ @ @ regulations could be adopted next year .
Lodge did not comment on the possibility of regulating the specific potential environmental harms identified by researchers so far .
Scientists from all sectors—industry , academia and conservation—are closely following the ISA ’ s efforts .
Boetius says that in recent years , the ISA has convened discussions about protecting organisms ranging from bacteria to octopuses .
“ The [ regulatory ] system has gotten more ecologically friendly and concerned than it was 20 years ago , ” she says .
Boetius and others , including @ @ @ @ @ @ @ Initiative , have provided expert input to help ensure sufficient environmental precautions .
“ There have been huge strides made during this process of drafting regulations , ” says Amon , who works with the network .
“ But there ’ s still much more to be done.
” Levin agrees and raises the question of how much of the finalized ISA rule book will consist of enforceable mandates—versus mere suggestions .
“ A lot of the environmental components are just guidance right now , ” she says .
Levin stops short of @ @ @ @ @ @ @ is not fully convinced of the need for deep-sea mining ; she does not think it will simply replace terrestrial operations .
“ It would almost certainly add to [ them ] , ” Levin says .
She also notes that future improvements to metal recycling and product life spans could reduce demand for a new source of virgin metals .
“ My number-one question is ‘ Do we really need minerals from the bottom of the ocean ?
’ ” Levin says .

Slashing humanity’s reliance on fossil fuels will require billions of kilograms of metal: a single wind turbine can contain more than a metric ton of copper, and electric car batteries demand heaps of cobalt, nickel and manganese. Most of these metals now come from terrestrial mines—often at the cost of deforestation, water pollution and human rights abuses. But a vast trove of metals on the deep-sea floor could soon provide an alternative source.
Though companies have been eyeing this possibility for decades, engineering challenges and unfavorable economics have kept work in the exploration phase. There has also been a lack of international rules to govern the nascent industry. But that is poised to change soon: The United Nations–chartered International Seabed Authority (ISA) has been finalizing regulations for commercially extracting deep-sea metals in international waters. These rules could emerge within a year. The inherent tension in setting them lies in balancing economic interests in metal production with another consideration: the potential for environmental damage.
Proponents say deep-sea mining can avoid a few of the ills of land-based extraction and cut the costs of renewable technology. But some scientists caution against jumping from exploration to exploitation too quickly, given how little we know about the deep-sea environment and the life it supports. “I generally don’t think it’s possible for us to objectively assess all the risks involved right now,” says Jeff Drazen, a marine biologist at the University of Hawaii at Manoa. “This is the poorest-described ecosystem on the planet.”
Enticing Prize at a Vast Depth
Interest in deep-sea minerals focuses largely on one particular resource: polymetallic nodules. These potato-sized deposits are rich in manganese, copper, cobalt and nickel. They form over millions of years as dissolved metals precipitate around the nuclei of organic materials—often ancient shark teeth, according to Antje Boetius, a marine biologist at the Max Planck Institute for Marine Microbiology in Bremen, Germany. She says these nodules are scattered in many areas across the global seafloor. They are especially plentiful in a vast swath of the ocean’s abyssal plain that stretches from Hawaii to Mexico and is called the Clarion-Clipperton Zone (CCZ). Nodules in the CCZ alone contain more nickel and cobalt than all known land-based reserves of those metals.
Retrieving such nodules from their resting places—often more than three kilometers below the surface—is still a theoretical proposition, though most plans follow a similar blueprint: First, dump-truck-sized collection vehicles would scour the seafloor for nodule-bearing sediment. A vertical “riser” pipe would then whisk the material up to ships equipped with sorting facilities, which would pluck out the valuable nodules and flush unwanted sediment back into the ocean.
But this mining method would necessarily disturb the marine environment, altering deep-sea ecosystems that scientists are still working to understand. In a 2016 study in Nature, researchers found seven new species (including four representing new genera) living among the CCZ’s nodule beds. “There are millions of species out there that have yet to be described,” says Lisa Levin, a marine biologist at the Scripps Institution of Oceanography, who was not involved in the study.
An Unknown Cost
Even as researchers piece together the basics of these ecosystems, recent studies have sought to understand how mining might impact them. Work by Boetius and her colleagues, published this past April in Science Advances, found that collection vehicles can have long-lasting physical and biological effects on the seafloor. Her team revisited a site in the Peru Basin where, in 1989, researchers had simulated effects of collection vehicles by cutting tracks into the seafloor with a blade-mounted plow towed by a ship. The plow tracks were plainly visible decades later. Initially, “we were absolutely shocked,” Boetius says. But she explains that in the stable environment of the deep sea—with weak currents and low rates of sediment dropping to the seafloor—it takes much longer for an area to recover than it would in shallower waters or on land. In the old vehicle tracks, microbes were 30 percent less abundant than in a nearby unplowed region. Animals such as worms and sea cucumbers were also less numerous. “You have such compacted sediments that no one can enter anymore,” Boetius says. “Our experiment really shows that such physical processes will stop animals and microbes from returning to repopulate that habitat.”
Mining impacts could reach well beyond the seafloor. The plumes of sediment that sorting vessels flush back into the water have been compared to inverted smokestacks sticking below the ocean’s sunlit surface layer. Scientists estimate a single nodule-mining operation could release 50,000 cubic meters of sediment-laden water each day—enough to fill 10 Goodyear blimps. But Thomas Peacock, a mechanical engineer at the Massachusetts Institute of Technology who studies plume behavior using computer models and field trials, has found that turbulence dilutes the plume, quickly bringing sediment concentrations close to background levels.
Still, even a small bump in sediment concentration could harm deep-sea dwellers such as plankton and jellyfish, which evolved in a habitat nearly devoid of sediment, Drazen says. Many of these creatures feed by filtering tiny organic particles out of the water. If caught in a sediment plume, “they’re going to have a ton of mud to sift through,” he says. “This may clog their filtering apparatus, or it may make it hard for them to choose the good stuff from the bad stuff.”
In a peer-reviewed opinion paper published in June in Proceedings of the National Academy of Sciences USA, Drazen and more than a dozen co-authors highlighted this and other risks mining poses to deep-sea waters. The authors also warned that the practice could interrupt animal communication: noise pollution from sediment rattling up riser pipes could jam acoustic signals among whales and other cetaceans, while sediment plumes could cloud the bioluminescent signals that creatures such as squid and jellyfish use in the darkness of the deep ocean. “The animals are just blinking on and off,” Drazen says. Piloting a submarine through them is “like falling through the stars.”
How to Proceed
While Drazen and others have identified some types of harm mining could inflict on deep-sea life, they cannot yet pinpoint how much damage might be done: available information is still scant, and the industry is in its early stages. This uncertainty has led many scientists to adopt a precautionary approach. The ills of terrestrial mining do not justify a headlong rush to dig up the ocean floor, says Diva Amon, a marine biologist at the Natural History Museum in London. “We would essentially be creating damage in an ecosystem we don’t yet understand,” she says. Groups such as the nonprofit Conservation International have called for a 10-year moratorium on deep-sea mining to give scientists and policy makers more time to examine the potential environmental harms.
But others see the emerging industry as a moral imperative, given metals’ crucial role in the renewable-energy technologies needed to curtail global warming—and the environmental and social costs often linked to existing mining practices. “I started looking at the footprint of terrestrial mining, and it is horrific,” says Gregory Stone, chief ocean scientist at DeepGreen, a mining company with exploration agreements in the CCZ. He points to sometimes deadly health impacts on workers and to child-labor violations, both of which are often associated with terrestrial mining of minerals such as cobalt. With deep-sea mining, “the disruption to the planetary system will be a lot less,” Stone contends. He adds that a multiyear environmental assessment prior to commercial extraction—which the ISA could require in its final regulations—could help minimize damage. For example, it could do so by placing the most environmentally sensitive areas off-limits to mining.
The ISA is using the growing body of scientific research in the CCZ “to identify the best measures required to protect the marine environment” as the group creates the first ever deep-sea-mining-exploitation code, according to a written statement from its secretary-general Michael Lodge. These regulations will be adopted if all 168 ISA members (167 countries plus the European Union) agree on them, he said. This summer, the organization’s annual assembly was postponed because of COVID-19, yet regulations could be adopted next year. Lodge did not detail possible regulatory approaches to each of the potential environmental harms that researchers have identified so far. But he said the mining code “will incorporate specific provisions to ensure the effective protection of the marine environment and conservation of marine biodiversity, human health and safety and equitable sharing of financial and other economic benefits.”*
Scientists from all sectors—industry, academia and conservation—are closely following the ISA’s efforts. Boetius says that in recent years, the ISA has convened discussions about protecting organisms ranging from bacteria to octopuses. “The [regulatory] system has gotten more ecologically friendly and concerned than it was 20 years ago,” she says. Boetius and others, including an international network called the Deep-Ocean Stewardship Initiative, have provided expert input to help ensure sufficient environmental precautions. “There have been huge strides made during this process of drafting regulations,” says Amon, who works with the network. “But there’s still much more to be done.”
Levin agrees and raises the question of how much of the finalized ISA rule book will consist of enforceable mandates—versus mere suggestions. “A lot of the environmental components are just guidance right now,” she says. Levin stops short of calling for a moratorium but says she is not fully convinced of the need for deep-sea mining; she does not think it will simply replace terrestrial operations. “It would almost certainly add to [them],” Levin says. She also notes that future improvements to metal recycling and product life spans could reduce demand for a new source of virgin metals. “My number-one question is ‘Do we really need minerals from the bottom of the ocean?’” Levin says.
*Editor’s Note (9/1/20): This paragraph was revised after posting to add an update about the ISA’s mining code being expected to address specific potential environmental harms.


scientificamerican--2020-08-31--Stressed Out: Causes, Effects and Keeping Calm

1.3 The Trauma after the Storm by Anna Harwood 2.1 The Danger of Stress by Melinda Wenner 2.2 Fact or @ @ @ @ @ Hair by Coco Ballantyne 2.4 Fight or Flight May Be in Our Bones by Diana @ @ @ @ @ Brain in Meltdown by Amy Arnsten , Carolyn M. Mazure & Rajita Sinha 3.2 Strain @ @ @ @ @ Mossop 3.3 Why Ca n't Christine Blasey Ford Remember How She Got Home ?
by @ @ @ @ @ ’ t We Talking About Burnout ?
by Krystal D'Costa 5.2 How I Broke the @ @ @ @ @ Duncan 5.3 The Essence of Optimism by Elaine Fox 5.4 Changing Our DNA through Mind @ @ @ @ @ 5.5 Mind of the Meditator by Matthieu Ricard , Antoine Lutz & Richard J. Davidson @ @ @ @ @ Grit by Gary Stix 6.3 The Coronavirus and Post-Traumatic Growth by Steve Taylor

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scientificamerican--2020-08-31--COVID-19 Can Wreck Your Heart, Even if You Haven't Had Any Symptoms

Beyond its scientific backing , the notion that a COVID-19 patient might wind up with long-term lung scarring or breathing issues has the ring of truth .
After all , we hear the stories , right ?
The virus can leave survivors explaining how they struggled to breathe , or how it can feel , in the words of actress Alyssa Milano , “ like an elephant is sitting on my chest.
” We ’ ve also known for a while that some COVID-19 patients ’ hearts are taking a beating , too—but over the past few weeks , the @ @ @ @ @ @ @ happen even among people who have never displayed symptoms of coronavirus infection .
And these frightening findings help explain why college and professional sports leagues are proceeding with special caution as they make decisions about whether or not to play .
From an offensive lineman at Indiana University dealing with possible heart issues to a University of Houston player opting out of the season because of “ complications with my heart , ” the news has been coming fast and furiously .
More than a dozen athletes at Power Five conference schools have @ @ @ @ @ @ @ coronavirus infection , according to ESPN ; two of the conferences—the Big Ten and the Pac-12—already have announced they are postponing all competitive sports until 2021 .
And in Major League Baseball , Boston Red Sox ace pitcher Eduardo Rodriguez told reporters that he felt “ 100 years old ” as a result of his bout with COVID , and of MLB ’ s shortened season because of myocarditis—an inflammation of the heart muscle , often triggered by a virus .
Said Rodriguez : “ That ’ s [ the heart is ] @ @ @ @ @ @ @ , so when you hear that … I was kind of scared a little .
Now that I know what it is , it ’ s still scary.
” Why are these athletes ( and their leagues and conferences ) taking such extreme precautions ?
It ’ s because of the stakes .
Though it often resolves without incident , myocarditis can lead to severe complications such as abnormal heart rhythms , chronic heart failure and even sudden death .
Just a few weeks ago , a former Florida State basketball player , @ @ @ @ @ @ @ complications just after recovering from a bout of COVID-19 in Serbia , where he was playing pro ball .
Here ’ s the background : Myocarditis appears to result from the direct infection of the virus attacking the heart , or possibly as a consequence of the inflammation triggered by the body ’ s overly aggressive immune response .
And it is not age-specific : In The Lancet , doctors recently reported on an 11-year-old child with multisystem inflammatory syndrome ( MIS-C ) —a rare illness—who died of myocarditis and heart failure .
@ @ @ @ @ @ @ identify coronavirus particles present in the child ’ s cardiac tissue , helping to explain the virus ’ direct involvement in her death .
In fact , researchers are reporting the presence of viral protein in the actual heart muscle , of six deceased patients .
Of note is the fact that these patients were documented to have died of lung failure , having had neither clinical signs of heart involvement , nor a prior history of cardiac disease .
Ossama Samuel , associate chief of cardiology at Mount Sinai Beth Israel in @ @ @ @ @ @ @ cluster of younger adults developing myocarditis , some of them a month or so after they had recovered from COVID-19 .
One patient , who developed myocarditis four weeks after believing he had recovered from the virus , responded to a course of steroid treatment only to develop a recurrence in the form of pericarditis ( an inflammation of the sac surrounding the heart ) .
A second patient , in her 40s , now has reduced heart function from myocarditis , and a third—an athletic man in his 40s—is experiencing recurring and @ @ @ @ @ @ @ he wear a LifeVest defibrillator for protection .
His MRI also demonstrates fibrosis and scarring of his heart muscle , which may be permanent , and he may ultimately require placement of a permanent defibrillator .
This is an incredibly tricky diagnosis .
Patients with myocarditis often experience symptoms like shortness of breath , chest pain , fever and fatigue—while some have no symptoms at all .
J.N.
, a health care provider who asked that his full name not be used , told me that COVID-19 symptoms first appeared in his case @ @ @ @ @ @ @ hospitalized at Mount Sinai Medical Center after developing unrelenting fevers spiking to 104 degrees , chest tightness , nausea , vomiting and diarrhea .
“ Even the Advil and acetaminophen wouldn ’ t help my fevers , ” said J.N .
Just 34 years old , he was diagnosed with COVID-induced myocarditis and severe heart failure .
Doctors admitted him to the intensive care unit and placed him on a lifesaving intra-aortic balloon pump due to the very poor function of his heart .
He spent two weeks in the hospital , has @ @ @ @ @ @ @ now says , “ I ’ m very careful .
I ’ m very concerned about the length of time I ’ ve been feeling sick , and if these symptoms are lifelong or will go away anytime soon.
” J.N .
said that everyday activities , like carrying his one-year-old daughter up a flight of stairs , leave him feeling winded and fatigued .
He has been unable to work since March .
According to some reports , as many as 7 percent of deaths from COVID-19 may result from myocarditis .
@ @ @ @ @ @ @ high . )
The arrhythmia that sometimes accompanies it is also worrisome , and researchers have found that to be fairly common among COVID-19 patients .
In J.N.
’ s case , he noticed his heart racing on several occasions into the 130 beats per minute range .
And while the prevalence of this in virus patients is not known exactly , a study found that ventricular arrhythmias occurred in 78 percent of patients without COVID-19 , with up to 30 percent of them experiencing serious arrhythmias 27 months later .
Experts estimate @ @ @ @ @ @ @ a chronic complication , but several studies suggest that COVID-19 patients show signs of the condition months after contracting the virus .
One non–peer reviewed study , involving 139 health care workers who developed coronavirus infection and recovered , found that about 10 weeks after their initial symptoms , 37 percent of them were diagnosed with myocarditis or myopericarditis—and fewer than half of those had showed symptoms at the time of their scans .
Any such cardiac sequelae lingering weeks to months after the fact is clearly concerning , and we ’ re @ @ @ @ @ @ @ German study found that 78 percent of recovered COVID-19 patients , the majority of whom had only mild to moderate symptoms , demonstrated cardiac involvement more than two months after their initial diagnoses .
Six in 10 were found to have persistent myocardial inflammation .
While emphasizing that individual patients need not be nervous , lead investigator Elike Nagel added in an e-mail , “ My personal take is that COVID will increase the incidence of heart failure over the next decades.
” Taking on myocarditis is a chore .
Thankfully , some @ @ @ @ @ @ @ requiring only hospital monitoring and possibly some heart medications .
We ’ ve learned that steroids and immunoglobulins—useful elsewhere—aren ’ t effective in acute viral myocarditis , although Samuel said there may be a role for steroids in younger COVID-19 patients who seem to present with more of an autoimmune type of the condition .
And , of course , an effective vaccine could help prevent cases in the first place .
Samuel called it “ extremely dangerous ” for athletes diagnosed with myocarditis to play competitive sports for at least three to @ @ @ @ @ @ @ of serious arrhythmia or sudden death , and several athletes already have made the decision to heed those dire warnings .
We ’ ll likely see more such decisions in the very near future , as each sport enters its peak season .
And for the rest of us ?
Wear a mask , social distance , avoid large gatherings , and spend more time in the great outdoors .
I would echo the advice of J.N .
: “ Be careful .
Just don ’ t get the virus in the beginning.
@ @ @ @ @ @ @ s still the best defense we ’ ve got .

Beyond its scientific backing, the notion that a COVID-19 patient might wind up with long-term lung scarring or breathing issues has the ring of truth. After all, we hear the stories, right? The virus can leave survivors explaining how they struggled to breathe, or how it can feel, in the words of actress Alyssa Milano, “like an elephant is sitting on my chest.”
We’ve also known for a while that some COVID-19 patients’ hearts are taking a beating, too—but over the past few weeks, the evidence has strengthened that cardiac damage can happen even among people who have never displayed symptoms of coronavirus infection. And these frightening findings help explain why college and professional sports leagues are proceeding with special caution as they make decisions about whether or not to play.
From an offensive lineman at Indiana University dealing with possible heart issues to a University of Houston player opting out of the season because of “complications with my heart,” the news has been coming fast and furiously. More than a dozen athletes at Power Five conference schools have been identified as having myocardial injury following coronavirus infection, according to ESPN; two of the conferences—the Big Ten and the Pac-12—already have announced they are postponing all competitive sports until 2021. And in Major League Baseball, Boston Red Sox ace pitcher Eduardo Rodriguez told reporters that he felt “100 years old” as a result of his bout with COVID, and of MLB’s shortened season because of myocarditis—an inflammation of the heart muscle, often triggered by a virus. Said Rodriguez: “That’s [the heart is] the most important part of your body, so when you hear that … I was kind of scared a little. Now that I know what it is, it’s still scary.”
Why are these athletes (and their leagues and conferences) taking such extreme precautions? It’s because of the stakes. Though it often resolves without incident, myocarditis can lead to severe complications such as abnormal heart rhythms, chronic heart failure and even sudden death. Just a few weeks ago, a former Florida State basketball player, Michael Ojo, died of suspected heart complications just after recovering from a bout of COVID-19 in Serbia, where he was playing pro ball.
Here’s the background: Myocarditis appears to result from the direct infection of the virus attacking the heart, or possibly as a consequence of the inflammation triggered by the body’s overly aggressive immune response. And it is not age-specific: In The Lancet, doctors recently reported on an 11-year-old child with multisystem inflammatory syndrome (MIS-C)—a rare illness—who died of myocarditis and heart failure. At autopsy, pathologists were able to identify coronavirus particles present in the child’s cardiac tissue, helping to explain the virus’ direct involvement in her death. In fact, researchers are reporting the presence of viral protein in the actual heart muscle, of six deceased patients. Of note is the fact that these patients were documented to have died of lung failure, having had neither clinical signs of heart involvement, nor a prior history of cardiac disease.
Ossama Samuel, associate chief of cardiology at Mount Sinai Beth Israel in New York, told me about a cluster of younger adults developing myocarditis, some of them a month or so after they had recovered from COVID-19. One patient, who developed myocarditis four weeks after believing he had recovered from the virus, responded to a course of steroid treatment only to develop a recurrence in the form of pericarditis (an inflammation of the sac surrounding the heart). A second patient, in her 40s, now has reduced heart function from myocarditis, and a third—an athletic man in his 40s—is experiencing recurring and dangerous ventricular heart rhythms, necessitating that he wear a LifeVest defibrillator for protection. His MRI also demonstrates fibrosis and scarring of his heart muscle, which may be permanent, and he may ultimately require placement of a permanent defibrillator.
This is an incredibly tricky diagnosis. Patients with myocarditis often experience symptoms like shortness of breath, chest pain, fever and fatigue—while some have no symptoms at all. J.N., a health care provider who asked that his full name not be used, told me that COVID-19 symptoms first appeared in his case in late March. He ultimately was hospitalized at Mount Sinai Medical Center after developing unrelenting fevers spiking to 104 degrees, chest tightness, nausea, vomiting and diarrhea.
“Even the Advil and acetaminophen wouldn’t help my fevers,” said J.N. Just 34 years old, he was diagnosed with COVID-induced myocarditis and severe heart failure. Doctors admitted him to the intensive care unit and placed him on a lifesaving intra-aortic balloon pump due to the very poor function of his heart. He spent two weeks in the hospital, has suffered recurrences since his discharge, and now says, “I’m very careful. I’m very concerned about the length of time I’ve been feeling sick, and if these symptoms are lifelong or will go away anytime soon.” J.N. said that everyday activities, like carrying his one-year-old daughter up a flight of stairs, leave him feeling winded and fatigued. He has been unable to work since March.
According to some reports, as many as 7 percent of deaths from COVID-19 may result from myocarditis. (Others feel that estimate is too high.) The arrhythmia that sometimes accompanies it is also worrisome, and researchers have found that to be fairly common among COVID-19 patients. In J.N.’s case, he noticed his heart racing on several occasions into the 130 beats per minute range. And while the prevalence of this in virus patients is not known exactly, a study published recently in the Journal of the American College of Cardiology found that some type of ventricular arrhythmias occurred in 78 percent of patients without COVID. Up to 30 percent of the full study group, meanwhile, experienced serious arrhythmias 27 months later.
Experts estimate that half of myocarditis cases resolve without a chronic complication, but several studies suggest that COVID-19 patients show signs of the condition months after contracting the virus. One non–peer reviewed study, involving 139 health care workers who developed coronavirus infection and recovered, found that about 10 weeks after their initial symptoms, 37 percent of them were diagnosed with myocarditis or myopericarditis—and fewer than half of those had showed symptoms at the time of their scans.
Any such cardiac sequelae lingering weeks to months after the fact is clearly concerning, and we’re seeing more evidence of it. A German study found that 78 percent of recovered COVID-19 patients, the majority of whom had only mild to moderate symptoms, demonstrated cardiac involvement more than two months after their initial diagnoses. Six in 10 were found to have persistent myocardial inflammation. While emphasizing that individual patients need not be nervous, lead investigator Elike Nagel added in an e-mail, “My personal take is that COVID will increase the incidence of heart failure over the next decades.”
Taking on myocarditis is a chore. Thankfully, some acute cases resolve on their own, requiring only hospital monitoring and possibly some heart medications. We’ve learned that steroids and immunoglobulins—useful elsewhere—aren’t effective in acute viral myocarditis, although Samuel said there may be a role for steroids in younger COVID-19 patients who seem to present with more of an autoimmune type of the condition. And, of course, an effective vaccine could help prevent cases in the first place.
Samuel called it “extremely dangerous” for athletes diagnosed with myocarditis to play competitive sports for at least three to six months, because of the risk of serious arrhythmia or sudden death, and several athletes already have made the decision to heed those dire warnings. We’ll likely see more such decisions in the very near future, as each sport enters its peak season.
And for the rest of us? Wear a mask, social distance, avoid large gatherings, and spend more time in the great outdoors. I would echo the advice of J.N.: “Be careful. Just don’t get the virus in the beginning.” As of today, it’s still the best defense we’ve got.


scientificamerican--2020-08-30--Do-It-Yourself Vaccines for COVID-19

Do-It-Yourself Vaccines for COVID-19