NPR

“……Only one in 27 people with depression in developing countries receives adequate treatment, according to the report. Developed countries do a bit better – one in five people with depression get treatment. But overall, wealthier countries have a poor enough record of providing adequate services…..”

CDC

Acute flaccid myelitis (AFM) is a rare condition. It affects a person’s nervous system, specifically the spinal cord, causing weakness in one or more limbs. AFM or neurologic conditions like it have a variety of causes such as viruses, environmental toxins, and genetic disorders.

Since August 2014, CDC has seen an increased number of people across the United States with AFM. We have not confirmed the cause for the majority of these cases. CDC has been actively investigating these AFM cases, and we continue to receive information about suspected AFM cases.

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What This Graph Shows

The graph shows the number of AFM cases confirmed by CDC as of October 16, 2018, with onset of the condition through September 30, 2018.

• So far in 2018, there are 62 confirmed cases of AFM. (Note: The cases occurred in 22 states across the U.S.)
  Note: These 62 confirmed cases are among the total of 127 reports that CDC received of patients under investigation (PUIs). CDC recently received increased reports for PUIs with onset of symptoms in August and September. CDC and state and local health departments are still investigating some of these PUIs. With enhanced efforts working with local and state health departments and hospitals, we were able to confirm a number these cases faster. CDC is now providing the number of patients still under investigation so people can better anticipate increases in confirmed cases over the coming months.
• In 2017, CDC received information for 33 confirmed cases of AFM. (Note: The cases occurred in 16 states across the U.S.)
• In 2016, 149 people were confirmed to have AFM. (Note: The cases occurred in 39 states across the U.S. and DC)
• In 2015, 22 people were confirmed to have AFM. (Note: The cases occurred in 17 states across the U.S.)
• From August to December 2014, 120 people were confirmed to have AFM. (Note: The cases occurred in 34 states across the U.S.)
• The case counts represent only those cases for which information has been sent to and confirmed by CDC.

It is currently difficult to interpret trends of the AFM data. Collecting information about suspected AFM cases is relatively new, and it is voluntary for most states to send this information to CDC. There may initially be more variability in the AFM data from year to year making it difficult to interpret or compare case counts between years.

We defer to the states to release additional information on cases as they choose.

What We Know

Since 2014, CDC has learned the following about the AFM cases:

• Most patients are children.
• The patients’ symptoms have been most similar to complications of infection with certain viruses, including poliovirus, non-polio enteroviruses, adenoviruses, and West Nile virus.
  • All of the AFM cases have tested negative for poliovirus.
  • Enteroviruses most commonly cause mild illness. They can also cause neurologic illness, such as meningitis, encephalitis, and AFM, but these are rare.
• CDC has tested many different specimens from AFM patients for a wide range of pathogens (germs) that can cause AFM. To date, no pathogen (germ) has been consistently detected in the patients’ spinal fluid; a pathogen detected in the spinal fluid would be good evidence to indicate the cause of AFM since this condition affects the spinal cord.

• The increase in AFM cases in 2014 coincided with a national outbreak of severe respiratory illness among people caused by enterovirus D68 (EV-D68). Among the people confirmed with AFM, CDC did not consistently detect EV-D68 in every patient. During 2015, CDC did not receive information about large EV-D68 outbreaks in the United States, and laboratories reported only limited EV-D68 detections to CDC’s National Enterovirus Surveillance System (NESS). During 2016, CDC was informed of a few localized clusters in the United States. Learn more about EV-D68.

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What We Don’t Know

Among the people who were diagnosed with AFM since August 2014:

• The cause of most of the AFM cases remains unknown.
• We don’t know what caused the increase in AFM cases starting in 2014.
• We have not yet determined who is at higher risk for developing AFM, or the reasons why they may be at higher risk.
• We do not yet know the long-term effects of AFM. We know that some patients diagnosed with AFM have recovered quickly, and some continue to have paralysis and require ongoing care.

See prevention for information about how to protect your family from viruses that may cause AFM.

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What CDC Is Doing

CDC is actively investigating AFM cases and monitoring disease activity. We are working closely with healthcare providers and state and local health departments to increase awareness for AFM. We are encouraging healthcare providers to recognize and report suspected cases of AFM to their health departments, and for health departments to send this information to CDC to help us understand the nationwide burden of AFM. CDC is also actively looking for risk factors and possible causes of this condition.

CDC activities include:

• urging healthcare providers to be vigilant for AFM among their patients, and to send information about suspected cases to their health departments
• verifying clinical information of suspected AFM cases submitted by health departments, and working with health departments and neurologists to classify cases using a case definition adopted by the Council of State and Territorial Epidemiologists (CSTE)
• testing specimens, including stool, blood, and cerebrospinal fluid, from suspected AFM cases
• working with healthcare providers, experts, and state and local health departments to investigate and better understand the AFM cases, including potential causes and how often the condition occurs
• providing new and updated information to healthcare providers, health departments, policymakers, the public, and partners in various formats, such as scientific journals and meetings, and CDC’s AFM website and social media
• using multiple research methods to further explore the potential association of AFM with possible causes as well as risk factors for AFM. This includes collaborating with experts to review MRI scans of people from the past 10 years to determine how many AFM cases occurred before 2014, updating treatment and management protocols, and engaging with several academic centers to conduct active surveillance simultaneously for both AFM and respiratory viruses.

For more information, see

• CSTE Standardized Case Definition for Acute Flaccid Myelitis
• Resources and References

History Channel

History Channel

NYT

“……Members of the Myanmar military were the prime operatives behind a systematic campaign on Facebook that stretched back half a decade and that targeted the country’s mostly Muslim Rohingya minority group, the people said. The military exploited Facebook’s wide reach in Myanmar, where it is so broadly used that many of the country’s 18 million internet users confuse the Silicon Valley social media platform with the internet. Human rights groups blame the anti-Rohingya propaganda for inciting murders, rapes and the largest forced human migration in recent history...…”

NYT

Snakes kill or cripple 500,000 people a year

“……Dr. Shea’s lab is creating hydrogel nanoparticles coated with polymers — the building blocks of plastics — small enough to attach to proteins.

While screening them against common venoms, he isolated some nanoparticles that bind with and neutralize two poisons produced by snakes like cobras, kraits, coral snakes, sea snakes and mambas.

José María Gutiérrez, a venom specialist at the University of Costa Rica, injected dozens of mice with the venom of the black-necked spitting cobra. He found that Dr. Shea’s nanoparticles significantly reduced tissue damage in the mice. Importantly, the nanoparticles did not appear to interfere with normal proteins or to trigger dangerous allergic reactions……”

NYT

Document:  Global Warming of 1.5 Degrees Centigrade

IPCC PRESS RELEASE

8 October 2018

Summary for Policymakers of IPCC Special Report on Global Warming of 1.5ºC approved by governments

INCHEON, Republic of Korea, 8 Oct – Limiting global warming to 1.5ºC would require rapid, farreaching and unprecedented changes in all aspects of society, the IPCC said in a new assessment. With clear benefits to people and natural ecosystems, limiting global warming to 1.5ºC compared to 2ºC could go hand in hand with ensuring a more sustainable and equitable society, the Intergovernmental Panel on Climate Change (IPCC) said on Monday.

The Special Report on Global Warming of 1.5ºC was approved by the IPCC on Saturday in Incheon, Republic of Korea. It will be a key scientific input into the Katowice Climate Change Conference in Poland in December, when governments review the Paris Agreement to tackle climate change.

“With more than 6,000 scientific references cited and the dedicated contribution of thousands of expert and government reviewers worldwide, this important report testifies to the breadth and policy relevance of the IPCC,” said Hoesung Lee, Chair of the IPCC.

Ninety-one authors and review editors from 40 countries prepared the IPCC report in response to an invitation from the United Nations Framework Convention on Climate Change (UNFCCC) when it adopted the Paris Agreement in 2015.

The report’s full name is Global Warming of 1.5°C, an IPCC special report on the impacts of global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways, in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty.

“One of the key messages that comes out very strongly from this report is that we are already seeing the consequences of 1°C of global warming through more extreme weather, rising sea levels and diminishing Arctic sea ice, among other changes,” said Panmao Zhai, Co-Chair of IPCC Working Group I.

The report highlights a number of climate change impacts that could be avoided by limiting global warming to 1.5ºC compared to 2ºC, or more. For instance, by 2100, global sea level rise would be 10 cm lower with global warming of 1.5°C compared with 2°C. The likelihood of an Arctic Ocean free of sea ice in summer would be once per century with global warming of 1.5°C, compared with at least once per decade with 2°C. Coral reefs would decline by 70-90 percent with global warming of 1.5°C, whereas virtually all (> 99 percent) would be lost with 2ºC.

“Every extra bit of warming matters, especially since warming of 1.5ºC or higher increases the risk associated with long-lasting or irreversible changes, such as the loss of some ecosystems,” said Hans-Otto Pörtner, Co-Chair of IPCC Working Group II.

Limiting global warming would also give people and ecosystems more room to adapt and remain below relevant risk thresholds, added Pörtner. The report also examines pathways available to limit warming to 1.5ºC, what it would take to achieve them and what the consequences could be.

“The good news is that some of the kinds of actions that would be needed to limit global warming to 1.5ºC are already underway around the world, but they would need to accelerate,” said Valerie Masson-Delmotte, Co-Chair of Working Group I.

The report finds that limiting global warming to 1.5°C would require “rapid and far-reaching” transitions in land, energy, industry, buildings, transport, and cities. Global net human-caused emissions of carbon dioxide (CO2) would need to fall by about 45 percent from 2010 levels by 2030, reaching ‘net zero’ around 2050. This means that any remaining emissions would need to be balanced by removing CO2 from the air.

“Limiting warming to 1.5ºC is possible within the laws of chemistry and physics but doing so would require unprecedented changes,” said Jim Skea, Co-Chair of IPCC Working Group III.

Allowing the global temperature to temporarily exceed or ‘overshoot’ 1.5ºC would mean a greater reliance on techniques that remove CO2 from the air to return global temperature to below 1.5ºC by 2100. The effectiveness of such techniques are unproven at large scale and some may carry significant risks for sustainable development, the report notes.

“Limiting global warming to 1.5°C compared with 2°C would reduce challenging impacts on ecosystems, human health and well-being, making it easier to achieve the United Nations Sustainable Development Goals,” said Priyardarshi Shukla, Co-Chair of IPCC Working Group III.

The decisions we make today are critical in ensuring a safe and sustainable world for everyone, both now and in the future, said Debra Roberts, Co-Chair of IPCC Working Group II.

“This report gives policymakers and practitioners the information they need to make decisions that tackle climate change while considering local context and people’s needs. The next few years are probably the most important in our history,” she said.

The IPCC is the leading world body for assessing the science related to climate change, its impacts and potential future risks, and possible response options.

The report was prepared under the scientific leadership of all three IPCC working groups. Working Group I assesses the physical science basis of climate change; Working Group II addresses impacts, adaptation and vulnerability; and Working Group III deals with the mitigation of climate change.

The Paris Agreement adopted by 195 nations at the 21st Conference of the Parties to the UNFCCC in December 2015 included the aim of strengthening the global response to the threat of climate change by “holding the increase in the global average temperature to well below 2°C above preindustrial levels and pursuing efforts to limit the temperature increase to 1.5°C above pre-industrial levels.”

As part of the decision to adopt the Paris Agreement, the IPCC was invited to produce, in 2018, a Special Report on global warming of 1.5°C above pre-industrial levels and related global greenhouse gas emission pathways. The IPCC accepted the invitation, adding that the Special Report would look at these issues in the context of strengthening the global response to the threat of climate change, sustainable development, and efforts to eradicate poverty.

Global Warming of 1.5ºC is the first in a series of Special Reports to be produced in the IPCC’s Sixth Assessment Cycle. Next year the IPCC will release the Special Report on the Ocean and Cryosphere in a Changing Climate, and Climate Change and Land, which looks at how climate change affects land use.
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The Summary for Policymakers (SPM) presents the key findings of the Special Report, based on the assessment of the available scientific, technical and socio-economic literature relevant to global warming of 1.5°C.

The Summary for Policymakers of the Special Report on Global Warming of 1.5ºC (SR15) is available at http://www.ipcc.ch/report/sr15/ or www.ipcc.ch.

Key statistics of the Special Report on Global Warming of 1.5ºC

91 authors from 44 citizenships and 40 countries of residence – 14 Coordinating Lead Authors (CLAs) – 60 Lead authors (LAs) – 17 Review Editors (REs) 133 Contributing authors (CAs) Over 6,000 cited references A total of 42,001 expert and government review comments (First Order Draft 12,895; Second Order Draft 25,476; Final Government Draft: 3,630)

For more information, contact: IPCC Press Office, Email: ipcc-media@wmo.int Werani Zabula +41 79 108 3157 or Nina Peeva +41 79 516 7068

GA: 2 (-5) hospitals on generator power, 1 (+1) no power; 1 nursing home no power, 9 (-13) on generator power; 10 (-11) sheltering-in-place •

FL: 3 hospitals closed; 8 dialysis centers closed; Nursing Homes/ Assisted Living Facilities: 18 sheltering in place, 2 with no power, 17 (-1) on generator power, 1(-1) closed/evacuating, and 7 (-1) closed/evacuated •

HHS DMATS: FL: 6; AL 1 (and 1 DMORT); 1 cache staged in Atlanta, GA

AL EOC at Partial Activation:

o Governor declared a statewide State of Emergency

o Emergency Declaration FEMA-3407-EM approved on October 12th

• FL EOC at Full Activation:

o Governor declared a State of Emergency for 35 counties

o Emergency Declaration FEMA-3405-EM-FL approved October 9th

o Major Disaster Declaration FEMA-4399-DR-FL approved October 11th

• GA EOC at Full Activation:

o Governor declared State of Emergency for 108 counties

o Emergency Declaration FEMA-3406-EM-GA approved on October 10th

o Governor requested an Major Disaster Declaration on October 12th

• NC EOC at Monitoring; Governor declared a State of Emergency

• SC EOC at Normal Operations; Governor declared a State of Emergency

• TN EOC at Monitoring (EMAC support)

• VA EOC at Monitoring; Governor declared a State of Emergency

FEMA Region IV

• RRCC at Level I (24/7), all ESFs, DCO/DCE and DHS NPPD

• LNOs deployed to FL and GA

• IMAT-2 deployed to FL EOC

FEMA HQ/Federal Response

• NRCC at Level II with select ESFs

• National IMAT East deployed to FL EOC

• Region II IMAT deployed to AL EOC

• Region V IMAT deployed to GA EOC

• ISB Team deployed to Montgomery, AL

• Staging areas: Montgomery, AL (Maxwell AFB); Fayetteville, NC (Ft Bragg); North AF AUX, SC

FEMA Daily Operations Briefing for October 13, 2018

Health and Medical

• GA: 7 hospitals & 20 nursing homes/assisted living facilities on generator power, 6 dialysis centers closed

• FL: 4 hospitals closed; 8 dialysis centers closed; 23 nursing homes/assisted living facilities closed, 20 on generator power, 2 without power

• HHS DMATS: FL: 6; AL 1 (and 1 DMORT); 1 cache staged in Atlanta, GA