Japan PM Abe seeks citizens’ help in coronavirus fight as Olympics to go ahead

TOKYO (Reuters) – Japanese Prime Minister Shinzo Abe on Saturday called on the public to cooperate in a “tough battle” to contain the coronavirus outbreak in coming weeks as the country prepares to hold the Olympic Games in Tokyo as planned.

Japan’s Prime Minister Shinzo Abe attends a news conference on coronavirus at his official residence in Tokyo, Japan February 29, 2020. REUTERS/Issei Kato

“To be frank, we cannot win this battle through the efforts of the government alone,” Abe told a news conference two days after calling for all schools nationwide to be closed for more than a month. The abrupt decision caught teachers, parents and their employers off guard, sparking a fresh wave of criticism.

Abe had already come under fire for his handling of the coronavirus, and Saturday’s news conference was his first since the outbreak.

“I have decided we must make all efforts in the next one or two weeks to prevent the spread” of the virus, he said, while expressing confidence this was possible.

Abe said Japan would go ahead with both the Summer Olympics and a spring visit by Chinese President Xi Jinping, but added he would not hesitate to expand immigration curbs if needed.

Abe, who returned to office in 2012 and is now Japan’s longest-serving premier, has made hosting the Tokyo Olympics a top priority of his tenure. Officials have repeatedly denied that they are considering postponing or canceling the Games.

Japan has seen more than 940 cases of infection of the virus, including 705 from the British-registered Diamond Princess cruise liner, which was quarantined near Tokyo this month, according to the public broadcaster, NHK. There have been 11 fatalities, including six from the cruise ship, Japan’s handling of which drew harsh criticism overseas and at home.

Abe acknowledged the burden that parents would face due to the school closures and said the government would create a fund to subsidize workers who had to take time off work to care for their children.

He said measures, using 270 billion yen ($2.50 billion) in budget reserves, including steps for smaller firms, would be coming in the next 10 days.

The government was also closely watching the global economy and would take fiscal steps as necessary to counter the economic impact of the spreading virus.

Abe also urged consumers to avoid rushing to buy up toilet paper, dismissing rumors of a shortage that have emptied store shelves of the product in recent days.

He promised to boost Japan’s capacity to test for the coronavirus, following reports some people were turned away despite doctors’ recommendations and suspicions that authorities were under-testing to keep contagion numbers low.

Hokkaido, a popular destination for foreign tourists, on Friday declared a state of emergency and urged its population of about 5 million people, including the capital Sapporo – the venue for the Olympics marathon – to stay home this weekend.

“The impact of the state of emergency could be big,” said Yukihiro Watanabe, 57, owner of a wine bar in Otaru city, north of Sapporo, who decided to close his shop at the weekend.

Despite Abe’s appeal – broadcast nationwide on TV – #Abeyamero, meaning “Abe, quit!”, was still trending on Twitter. “We need new leadership,” said one tweet.

Reporting by Junko Fujita, Chang-Ran Kim, Elaine Lies; Writing by William Mallard and Linda Sieg; Editing by Ed Davies and Louise Heavens

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Global downturn looms as countries struggle to contain coronavirus outbreak

GENEVA/BEIJING (Reuters) – The coronavirus spread further on Friday, with cases reported for the first time in at least six countries across four continents, battering markets and leading the World Health Organization (WHO) to raise its impact risk alert to “very high.”

Hopes that the epidemic that started in China late last year would be over in months, and that economic activity would quickly return to normal, have been shattered.

World shares were on course for their largest weekly fall since the 2008 financial crisis, bringing the global wipeout to $5 trillion as supply chains were disrupted, travel plans postponed and major events canceled. [MKTS/GLOB]

The WHO said it was raising its assessment of the global risk to ‘very high’ from ‘high’, which its head of emergencies Dr Mike Ryan said was intended to put national authorities on full alert.

“I think this is a reality check for every government on the planet – wake up, get ready, this virus may be on its way and you need to be ready,” Ryan said.

The latest WHO figures indicate over 82,000 people have been infected, with over 2,700 deaths in China and 57 deaths in 46 other countries.

Mexico, Nigeria, New Zealand, Lithuania, Belarus and Azerbaijan reported their first cases, all with travel history connected to epicenters in Italy and Iran. Mexico is the second Latin American country to register the virus, after Brazil.

The Nigerian case, an Italian man, is the first in sub-Saharan Africa. The man traveled through the capital and other parts of Nigeria for almost two days before he was isolated and quarantined, authorities said, underlining the difficulties already overstretched health services will have in containing the disease.

Potentially making it even harder to eradicate, a growing number of discharged coronavirus patients in China and elsewhere are testing positive again, sometimes weeks after being allowed to leave the hospital.

In addition to stockpiling medical supplies, some governments ordered schools shut and canceled big gatherings to try to halt the flu-like disease. Switzerland canceled next week’s Geneva international car show, one of the industry’s most important gatherings.

The New York Stock Exchange said it had “robust contingency plans” to allow it to continue operating if its floor had to close.

SURGING OUTSIDE CHINA

The outbreak appears to be easing in China, where it first emerged late last year in an market illegally trading wildlife.

Mainland China reported 327 new cases in the last 24 hours, the lowest in the country in more than a month, and China’s three biggest airlines restored some flights.

A volunteer keeps watch near an entrance blocked by barricades and shared bicycles at a residential area in Wuhan, the epicentre of the novel coronavirus outbreak, Hubei province, China February 28, 2020. REUTERS/Stringer CHINA OUT.

But the virus is surging elsewhere. Countries other than China now account for about three-quarters of new infections.

South Korea, with the most cases outside China, reported 571 new infections on Friday, bringing the total to 2,337, with 13 people dead.

The death toll in Italy rose to 21, with nearly 900 testing positive. Cafes and schools have been closed as daily life has ground to a halt.

The WHO’s Ryan said Iran’s outbreak may be worse than realized. Its toll of 34 dead is the highest outside China, although there are reports of much higher numbers. A WHO team is expected to be in Iran by Sunday or Monday.

In the United States, the outbreak of the new coronavirus and efforts to prepare for its possible spread have become political in a presidential election year.

Federal government health officials told lawmakers the country had insufficient testing resources, a source said, and Democratic presidential candidates slammed the government’s response. But the White House played down the coronavirus crisis and called the high level of news coverage a ploy to hurt U.S. President Donald Trump.

The Trump administration plans to use defense legislation to boost production of protective gear like masks and gloves, the health secretary said.

Online retailer Amazon.com joined other companies in implementing travel restrictions for its employees.

Slideshow (29 Images)

Japan is scheduled to host the 2020 Olympics in July but Ryan said discussions were being held about whether to go ahead. Organizers will decide next week on the ceremonial torch relay, due to arrive on March 20 for a 121-day journey.

Confirmed cases in Japan have risen above 200, with four deaths, excluding more than 700 cases on a quarantined cruise liner, Diamond Princess. Six people from the ship have died, including a man who was reported on Friday as the first British person to die from the disease.

[Interactive graphic tracking global spread of coronavirus: open tmsnrt.rs/3aIRuz7 in an external browser.]

Reporting by Stephanie Nebehay in Geneva, Ryan Woo, Yingzhi Yang in Beijing, Lisa Lambert and Mark Hosenball in Washington, Sangmi Chai in Seoul, Leika Kihara in Tokyo, Kate Kelland in London, Tsvetelia Tsolova in Sofia, Michael Shields and Brenna Hughes Neghaiwi in Zurich, Daina Beth Solomon in Mexico City; Writing by Nick Macfie and Rosalba O’Brien; Editing by Timothy Heritage and Grant McCool

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Mixed messages, test delays hamper U.S. coronavirus response

(Reuters) – Even as U.S. officials warn of an inevitable outbreak of coronavirus in the United States, and are alerting Americans to take precautions, some health agencies charged with protecting the public appear unprepared to deal with the threat.

FILE PHOTO: A standard dust & particle mask, and an N95 medical respirator mask (bottom), that are part of personal protection and survival equipment kits ordered by customers preparing against novel coronavirus, are seen at Nitro-Pak in Midway, Utah, U.S. February 27, 2020. REUTERS/George Frey

Barely more than a handful of public health departments across the country are able to test for the novel virus, which began in China and has spread to at least 44 countries. The federal government has less than 10% of the protective masks required to protect healthcare workers and the public. And Washington still does not have adequate funding in place to support health departments’ efforts, though more money is on the way.

Conflicting messaging from the White House and top U.S. officials regarding the severity of the threat has only added to the uncertainty.

The U.S. Centers for Disease Control and Prevention (CDC) this week for the first time advised American businesses, schools, hospitals and families to prepare for domestic acceleration of the virus, which has infected more than 80,000 people worldwide and killed nearly 3,000.

President Donald Trump on Wednesday assured Americans that the risk of coronavirus transmission in the United States was “very low.” Despite an explosion of cases in China over the past two months, the Trump administration only this week put in a request for $2.5 billion to aid in the response, an amount both Republicans and Democrats have said is too small.

Critics of the federal response say the United States squandered precious weeks by focusing too narrowly on keeping the coronavirus from crossing U.S. borders rather than marshalling resources to prepare American communities for a widespread domestic outbreak that officials now say was inevitable.

“This has been a realistic risk for a month, and the signal to trigger that kind of preparedness has only been going out in the last few days in an explicit way,” said Jeremy Konyndyk, a senior policy fellow at the Center for Global Development in Washington. “That’s a huge problem.”

FEW BEING TESTED

There are 60 confirmed U.S. cases of the novel coronavirus, which causes the disease known as Covid-19, U.S. health officials said on Wednesday. But experts admit they have no way of knowing the true figure because access to testing at present is severely limited.

So far, the U.S. strategy has focused almost exclusively on testing infected travelers, using a test that looks for genetic material from the virus in saliva or mucus. As of February 23, fewer than 500 people from 43 states had been or are being tested for the virus.

Currently, just seven state and local health departments have the ability to screen for the virus, the Association of Public Health Laboratories (APHL) said on Wednesday. CDC-developed tests issued three weeks ago were producing inaccurate results in some labs, so new tests had to be made and cleared by the U.S. Food and Drug Administration (FDA), leaving many labs with no local testing capability, the group said.

The CDC and FDA have worked out a fix that will allow 40 more public health labs to do testing by the end of next week, the APHL’s Chief Executive Scott Becker told Reuters.

In the meantime, the burden has fallen largely on the CDC, which does testing for most of the country on its campus in Atlanta.

“Unfortunately, we are now in the bottom tier in countries capable of doing population-based testing,” said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

U.S. patients typically wait 24 to 48 hours to find out whether they have tested positive and need to be quarantined, health officials said, during which time those who are infected can spread the virus to others

The CDC’s test is restricted solely for use by public health labs, but if the virus begins spreading widely in the United States, hospitals will need to be able to do the tests themselves, public health experts say. Such testing is typically done using kits produced by commercial companies. Several privately developed tests are in the works, but none have yet won approval from the FDA.

Some health experts also fault the narrow testing criteria that the United States is using to screen for potential infections. Currently, individuals with flu-like symptoms are only tested for the coronavirus if they have traveled to a country where the virus is spreading. This has raised concerns that there are far more cases in the United States than are currently recorded.

“If the majority of testing is all around airports or travelers, we won’t know whether it’s circulating in communities,” said Dr. Tom Inglesby, director of the Center for Health Security of the Johns Hopkins Bloomberg School of Public Health.

Those worries were reinforced on Wednesday when the CDC confirmed the first U.S. case of coronavirus in a California patient with no apparent travel history. The University of California Davis said in a statement the patient was transferred to the hospital with severe pneumonia and the hospital requested testing. But since the patient didn’t fit the CDC’s criteria, those tests were delayed by several days.

On Thursday, CDC said it is broadening those criteria to allow testing when the virus is suspected.

MASKS IN SHORT SUPPLY

Around 15 state health departments contacted by Reuters raised concerns about challenges they would face in the event of community spread, including worries about not having enough personal protective gear to safeguard frontline medical workers.

The U.S. Department of Health and Human Services on Tuesday estimated that the United States would need 300 million face masks to protect healthcare workers and the public from people infected with the virus. The country has fewer than 20 million of the kind of masks needed to protect healthcare workers in the Strategic National Stockpile, a government repository of medical supplies needed to address public health emergencies.

“There is a real concern the availability of this equipment may be limited, in part because of the public buying it in a panic when they don’t need it,” said Matt Zavadsky, head of the National Association of Emergency Medical Technicians.

President Donald Trump’s administration is considering invoking special powers through a law called the Defense Production Act to quickly expand domestic manufacturing of protective masks and clothing to combat the coronavirus in the United States, two U.S. officials told Reuters.

With no Covid-19 vaccine or proven anti-viral medicine available, states are planning to isolate sick people in their homes, both to slow community spread and reduce pressure on hospitals, according to the CDC.

Their ability to track a rapidly expanding web of patients who test positive, and all the people with whom they have had contact, is of major concern, according to chief epidemiologists in several states.

Health departments in some states have purchased disease surveillance software to help them with that task. The state of Washington’s system, for instance, tracks patients and people they have had contact with, and asks them about their condition. If someone reports symptoms that merit hospitalization, the patient and doctors are informed of that.

The CDC said in a news conference on Tuesday that transmission of the virus could be slowed by the closure of schools and businesses and the cancellations of concerts and other mass gatherings.

But exactly who would make those decisions or how they would be enforced isn’t clear and could vary widely throughout the nation.

In Texas, for example, such decisions may be made by local officials, said Chris Van Deus, a spokesman with the Texas health department.

“Texas is a home rule state so the buck really stops with county judges and mayors,” Van Deus said.

Another concern is a flood of patients into health systems that are already overburdened in many parts of the country, particularly during winter flu season.

Slideshow (13 Images)

Washington state is considering temporary drive-through care facilities to stop potential coronavirus carriers entering healthcare facilities, mindful that hospitals can amplify outbreaks, as was the case with the viruses that cause MERS and SARS.

New Mexico is working with healthcare systems to turn outpatient facilities into care units if needed, said State Epidemiologist Michael Landen.

“The biggest challenge is getting a consistent message to the public with respect to their options with dealing with this virus,” Landen said.

Reporting by Julie Steenhuysen in Chicago, Andrew Hay in Taos, New Mexico and Brad Brooks in Austin, Texas; Editing by Marla Dickerson

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A small Delhi hospital overwhelmed by wave of violence

NEW DELHI (Reuters) – As deadly violence erupted in the northeast of New Delhi this week, with armed mobs rampaging the streets, a small hospital located in a densely packed Muslim neighborhood found itself at the epicenter of the unrest.

A Muslim man is treated at Al-Hind hospital after he was injured in a clash between people demonstrating for and against a new citizenship law in a riot affected area in New Delhi, India February 27, 2020. REUTERS/Anushree Fadnavis

Al-Hind Hospital, in the riot-torn Mustafabad neighborhood, was flooded with patients this week, and it has also become a place of refuge for people whose homes were burned or destroyed.

At least 38 people were killed and hundreds more injured in the worst sectarian violence in Delhi in decades, as groups of Hindus and Muslims clashed.

The violence began after weeks of protests over a citizenship law that Prime Minister Narendra Modi’s government introduced in December, which eases the path to Indian citizenship for minority groups from neighboring Muslim-majority countries.

Critics say the law is biased against Muslims and undermines India’s secular constitution. Modi’s Bharatiya Janata Party has denied having any bias against India’s 180 million Muslims.

On Thursday people were still trickling in, saying they had suffered acid attacks and beatings with rods.

Doctors described being overwhelmed on Monday and Tuesday when dozens of wounded streamed into the 15-bed, two-storey building. Some were carried on people’s shoulders and others on wooden carts, stretching the hospital’s resources to the limit.

Many medicines ran out, as did oxygen supplies. But the flow of patients didn’t stop, said doctor Mehraj Ekram.

“We were all crying as we treated them. For the rest of my life, I will not be able to shake those days from my mind,” he said. “The brutality with which people had been beaten, it’ll never leave me.”

“At one point, we had to pull the shutters down, because we could not take in more people,” he said, tears welling up in his eyes.

AMBULANCES BLOCKED

M.A. Anwar, a local doctor who set up the hospital two years ago to make up for the lack of good primary care in the area, said the facility was only built to give patients basic initial treatment.

But, as thousands gathered around the hospital on Tuesday, ambulances could not enter to take patients to bigger hospitals, said Anwar.

Amid the cries of worried families, Anwar contacted lawyers who secured a midnight hearing from a High Court bench in Delhi that eventually ordered the police to escort ambulances to the entrance.

Al-Hind had no mortuary. As they got into an ambulance to take the dead bodies away, Anwar said the vehicle was chased by men wielding swords.

“I hope in my life I never have to witness such inhumanity again,” he said.

On Thursday, traumatized families sat at the hospital. Some had lost their homes and livelihoods.

Irshaad, a tailor who uses only one name, sat with his four young children and wife with a small pile of clothes – his house had been burned down.

“Everything is gone,” he said, breaking down. “What will my kids’ future be? I have no documents, nothing to show anymore.”

Slideshow (9 Images)

On the floor below lay 26-year-old Muslim Shabana Parveen, who had given birth after being beaten while heavily pregnant at her home on Tuesday.

She went into labor that day, and a Hindu neighbor took her to safety, she said.

“A mob came into my home and hit me with rods on my stomach. I didn’t think my baby would survive,” she said, as her rosy-cheeked infant yawned beside her. “I don’t know where I’ll go. We’ve lost everything.”

Editing by Euan Rocha and Mike Collett-White

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Losing a Spouse Could Speed Brain’s Decline

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News Picture: Losing a Spouse Could Speed Brain's DeclineBy Steven Reinberg
HealthDay Reporter

WEDNESDAY, Feb. 26, 2020 (HealthDay News) — Losing a spouse can be a heartbreaker, and new research suggests it’s also tough on the brain.

The study found that when a husband or wife dies, the surviving mate’s mental acuity could start to decline.

In fact, people who are widowed and have high levels of beta-amyloid plaque, a hallmark of Alzheimer’s disease, appear to experience cognitive decline three times faster than similar people who have not lost a spouse, the researchers added.

“The associations of widowhood and amyloid were compounded, not simply additive, indicating that widowhood is a specific risk factor for cognitive decline due to Alzheimer’s disease,” explained lead researcher Dr. Nancy Donovan, chief of the Division of Geriatric Psychiatry at Brigham and Women’s Hospital in Boston.

Rebecca Edelmayer, director of scientific engagement at Alzheimer’s Association, reviewed the findings and said this small study can’t prove that being widowed causes cognitive decline, but it may well be a factor.

Donovan said the specific mechanisms by which widowhood increases the risk of cognitive decline isn’t known.

“Some studies suggest that having close relationships, such as a close sibling or adult child, helps to protect against cognitive decline among widows, though we didn’t find this in our study,” Donovan said.

It is likely that being married has beneficial effects by providing daily emotional support, stimulating companionship, better health behaviors and larger social networks, she said.

For people who lose a spouse, Donovan recommends “what we know to be beneficial overall for older adults: exercise, social engagement, cognitively stimulating activities, a healthy diet, manage stress levels and reduce cardiovascular risk factors.”

Dr. Marzena Gieniusz, a geriatrician and internist at Northwell Health in Manhasset, N.Y., said she often sees cognitive decline in surviving spouses in her practice.

“I think being married is likely a protective factor, which is lost when the spouse passes away,” she said.

It’s possible that the beginnings of thinking declines were already present in the surviving spouse, but hidden, said Gieniusz, who wasn’t involved with the study.

“Passing of a spouse likely leads to an unmasking of mild cognitive impairment, which went previously unnoticed,” she said.

Having a spouse seems to be an extra layer of support throughout life in general, “which makes sense,” Gieniusz said. “Two people tackling life together is easier than one doing it alone and also likely functions to help slow cognitive decline.”

Also, people become more isolated when a spouse passes away. “I’m sure that contributes to cognitive decline,” Gieniusz said.

For the study, Donovan and her colleagues collected data on nearly 260 seniors who took part in the Harvard Aging Brain Study. All the participants had their levels of brain beta-amyloid determined at the start of the study.

The researchers monitored the participants’ cognitive performance each year for four years.

They found that cognitive performance declined among those who were widowed, while no difference was seen among those who were married or single.

Also, cognitive decline among people with the highest beta-amyloid levels was three times faster among those widowed as those married. This finding remained significant after the researchers took age, sex, socioeconomic status and depression into account.

The report was published online Feb. 26 in the journal JAMA Network Open.

This study highlights one factor that can affect cognitive decline, Edelmayer said.

“It is important that we continue to study Alzheimer’s disease and all dementia, from all angles, because that’s the only way that we will be able to provide the right type of care and support structures that are going to be necessary for these populations. And it’s also going to be important for us to truly understand the types of risk factors that are driving the disease process,” Edelmayer said.

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QUESTION

One of the first symptoms of Alzheimer’s disease is __________________.
See Answer

References

SOURCES: Nancy Donovan, M.D.,chief, Division of Geriatric Psychiatry, Brigham and Women’s Hospital, Boston; Rebecca Edelmayer, Ph.D., director, scientific engagement, Alzheimer’s Association; Marzena Gieniusz, M.D., geriatrician and internist, Northwell Health, Manhasset, N.Y.; Feb. 26, 2020, JAMA Network Open, online

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New immune cell with ‘Jekyll and Hyde properties’ identified

Scientists at Trinity College Dublin have identified a rare, new cell in the immune system with “Jekyll and Hyde properties”. These cells play a key protective role in immunity to infection but – if unregulated – also mediate tissue damage in autoimmune disorders.

The findings should help us design more effective vaccines to prevent infections such as MRSA, and may also assist help us develop of new therapies for autoimmune diseases, such as multiple sclerosis or rheumatoid arthritis.

The research was funded by Science Foundation Ireland and led by Kingston Mills, Professor of Experimental Immunology, and Dr. Sarah Edwards and Dr. Caroline Sutton, Postdoctoral Fellows in the School of Biochemistry and Immunology in the Trinity Biomedical Sciences Institute. Their findings were published today [Thursday 27th February 2020] in The Journal of Experimental Medicine.

The immune system functions to control infection, utilizing various immune cells, such as T cells to respond to and control invading microbes. However, if these immune cells are not highly regulated, they can attack and damage body tissues, leading to the development of autoimmune diseases.

Molecules called T cell receptors (TCRs) allow T cells to recognize components of infectious agents with exquisite specificity. The TCRs enable T cells to respond to and eventually eliminate the infectious agent.

Professor Kingston Mills said:

Until now scientists thought that there were two discrete populations of T cells, expressing either ‘αβ’ or ‘γδ’ TCRs. The αβs are the most common T cells in the body. They play a key role in remembering prior infection or immunization and thereby help protect us against re-infection and mediate vaccine-induced protective immunity. The γδs are more prevalent at mucosal surfaces, such as the lung or gut, and provide an immediate first line of defense against pathogens that invade through these routes.”

We have discovered a new cell type that expresses both αβ and γδ TCRs. This rare population of chimeric or hybrid αβ-γδ T cells has properties of both αβ and γδ T cells. Importantly, they are normally highly activated and poised to act as first responders to control bacterial infection. However, given this high level of activation, they are effectively ‘Jekyll and Hyde cells’ because in certain contexts they can also precipitate autoimmune responses.”

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Using a model of Staphylococcus aureus infection, Professor Mills and his team found that these cells are rapidly mobilized during infection and play a key role in quickly eliminating the microbes from the body.

The induction of these hybrid αβ-γδ T cells may thus represent a novel approach in the design of more effective vaccines against Staph aureus and other infectious diseases, while advancing our ability to control their response may yield additional therapeutic options.

Professor Mills added:

In a model of autoimmune disease, we found that the hybrid T cells can also trigger the inflammatory cascade that mediates tissue damage in autoimmunity. Therefore, approaches for inhibiting these highly activated immune cells in susceptible individuals may open up new approaches for the treatment of autoimmune diseases such as psoriasis and multiple sclerosis.”

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Source: Trinity College Dublin

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Your School Assignment For The Day: Spelling And Specs

DELANO, Calif. — Daisy Leon struggles to sit still and read the letters on the eye chart. Her responses tumble out in a quiet, confused garble.

“You know your letters?” asks optometrist Jolly Mamauag-Camat. “Umm, ya,” says Daisy, almost inaudibly.

The 6-year-old kindergartner had her eyes examined for the first time on a recent Thursday morning. Although she hadn’t complained about headaches or blurry vision, her grandmother noticed she’d been inching closer to watch television.

After Daisy’s failed attempts at reading the eye chart, Mamauag-Camat inspects the little girl’s eyes through a phoropter and writes her a prescription for glasses.

At least 20% of school-age children in the U.S. have vision problems. But according to the Centers for Disease Control and Prevention, fewer than 15% of children get an eye exam before entering kindergarten. Because vision problems tend to worsen the longer they go undetected, many children suffer even though there are often simple, relatively inexpensive solutions such as prescription glasses.

Half of the states plus the District of Columbia require screenings or exams for preschoolers, according to the National Center for Children’s Vision & Eye Health. But California has no such requirement, said Xuejuan Jiang, an assistant professor of research ophthalmology at Keck School of Medicine of USC. California does require them for older children.

“The system in California is not as good as it can be,” Jiang said.

In much of California’s Central Valley, where roughly 1 in 5 people live in poverty, two school districts are working with two nonprofits, the Advanced Center for Eyecare and OneSight, to provide vision care to Kern County’s underserved and uninsured children.

Many of the neediest are the children of farmworkers.

“We are an agriculture-based community,” said Linda Hinojosa, coordinator of health services for the Delano Union School District. “Most of our families harvest table grapes 12 hours a day, with very limited time to take their children in for an eye exam.”

The program, funded by the nonprofits and the school districts, operates five school-based clinics in Bakersfield and Delano. Students receive comprehensive eye exams and glasses, along with free transportation. And breakfast.

Most of the children who visit the clinics have coverage through Medi-Cal, California’s Medicaid program for low-income people. There is no out-of-pocket cost for the eye exams and glasses for them, or for children who are uninsured, said Alexander Zahn, chief business development officer for the Advanced Center for Eyecare.

Almost half of the students examined need glasses.

“The need was very apparent” in the Central Valley, Zahn said. “Sixty dollars for an eye exam and $80 for glasses might be the difference between eating dinner a couple days a week.”

Daisy was among 12 students who were bused to the Delano Union School District Vision Center, adjacent to Pioneer School, an elementary school with about 1,000 students. Almost all the students at Pioneer are Hispanic and about three-quarters qualify for free or reduced-price lunches.

Students from throughout the Delano Union School District visit the clinic. Since it opened in 2018, the clinic has performed 961 eye exams and prescribed 517 pairs of glasses.

For Daisy, whose parents are farmworkers, the clinic has been a tremendous help.

“They prune out in the fields,” said Guadalupe Leon, Daisy’s grandmother. “They can’t afford to take days off.”

The Delano Union School District Vision Center is funded by multiple sources: OneSight, a nonprofit organization dedicated to increasing access to vision care in underserved communities around the world, donated the ophthalmic equipment and provided grant funding for the first year of operation. The Advanced Center for Eyecare provides staff and supplies. And the school district provides the facility, furnishings and transportation. (Heidi de Marco/KHN)

Twelve students from Nueva Vista Language Academy and Fremont Elementary School arrive by bus for their eye exams and follow-ups. Linda Hinojosa, a registered nurse for 20 years, says lack of transportation is a major barrier to vision care. “Parents a lot of times don’t have a car, or it can be a one-vehicle family,” she says. (Heidi de Marco/KHN)

Students are offered breakfast before their appointments with optometrist Jolly Mamauag-Camat. About three-quarters of students in the district are eligible for free/reduced-price meals. (Heidi de Marco/KHN)

Daisy Leon, a kindergartner at Nueva Vista Language Academy, takes a test to check for color blindness. Before beginning, the optical technician asks Daisy if she understands English. Because of the region’s large Spanish-speaking population, clinic staff members often act as interpreters. (Heidi de Marco/KHN)

Daisy looks into an auto refractor as part of her eye exam. (Heidi de Marco/KHN)

Daisy and Jonathon Castro watch a movie as they wait for their eyes to dilate. This is the first eye exam for both of them. (Heidi de Marco/KHN)

Daisy sits on her knees to see through a phoropter, a device to help determine eyeglass prescriptions. Mamauag-Camat says children often can’t tell if they have vision problems because they don’t know any differently. “They can fall through the cracks,” she says. “They don’t know the difference between what’s clear and not clear.” (Heidi de Marco/KHN)

About 45% of Kern County’s population is on Medi-Cal. Medi-Cal covers vision care, including an eye exam and glasses every two years, but in communities like Delano, access is a problem. “We live in an area with a big shortage of providers, particularly specialty care providers like optometrists and ophthalmologists,” says Alexander Zahn, of the Advanced Center for Eyecare. (Heidi de Marco/KHN)

Daisy picks out glasses right after her exam, a pink pair that she had been admiring all morning. “We need to go where students are,” says Hinojosa. “Vision is absolutely vital.” (Heidi de Marco/KHN)

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WHO warns against ‘fatal’ complacency in global coronavirus fight

GENEVA/DUBAI (Reuters) – No country should make the “fatal mistake” of assuming it will be spared the coronavirus, the World Health Organization said on Thursday, as governments from Iran to Australia raced to contain the epidemic’s rapid global spread.

With new infections reported around the world now surpassing those in mainland China, WHO Director General Tedros Adhanom Ghebreyesus said even rich nations should prepare for surprises.

“No country should assume it won’t get cases, that would be a fatal mistake, quite literally,” Tedros said, pointing to Italy, where authorities said three more people had died, bringing the toll from Europe’s worst outbreak of the illness to 17. Confirmed cases there rose to 650.

As well as stockpiling medical supplies, governments ordered schools shut and canceled big gatherings, including sports events, to try to halt the flu-like disease that emerged in China more than two months ago from an illegal wildlife market.

It is on the decline there after an aggressive containment campaign, but rising elsewhere.

In Japan, where cases rose to 200, there was particular concern after a female tour bus guide tested positive for a second time – one of very few worldwide to do so.

The head of the WHO’s emergency program, Dr. Mike Ryan, said discussions were being held with organizers about the fate of the 2020 Olympics, scheduled for July in Tokyo, although no decision was expected soon.

Their cancellation or relocation would be a massive blow for Japan.

The coronavirus has mainly battered China, causing more than 78,000 infections and around 2,750 deaths. It has spread to another 44 countries, where around 3,250 cases and 51 deaths have been reported.

Though the outbreak meets the definition of a pandemic – widespread contagion across a large region – the WHO has so far held back from using that term.

“This virus has pandemic potential,” WHO chief Tedros told reporters in Geneva.

He said Iran, Italy and South Korea were at a “decisive point”, still short of sustained community transmission, and that U.S. President Donald Trump was right to recommend preventive hygiene measures such as frequent hand-washing.

MARKET SELLOFF

In Australia, Prime Minister Scott Morrison ordered hospitals to ensure sufficient medical and protective supplies and staff. Trump put Vice President Mike Pence in charge of America’s response, while France’s President Emmanuel Macron rallied the nation.

“We have a crisis before us. An epidemic is on its way,” Macron said at a Paris hospital where a 60-year-old man this week became France’s second coronavirus fatality.

Germany, too, has warned of an impending epidemic. And Greece, a gateway for refugees from the Middle East and beyond, announced tighter border controls.

Spooked by the impact on China, the heart of corporate supply chains, and the increasing effect on other countries, stocks sank deeper into the red and oil prices fell. [MKTS/GLOB]

Global equity markets have dropped for six straight days, wiping out more than $3.6 trillion in value. .MIWD00000PUS

Employees from a disinfection service company sanitize a shopping district in Seoul, South Korea, February 27, 2020. REUTERS/Kim Hong-Ji

European Central Bank policymakers Isabel Schnabel and Klaas Knot expressed concern about the virus’s spread, although Knot, a policy hawk, noted that China’s economy had rebounded strongly after the 2002/03 SARS epidemic that also originated there.

There is no cure for the coronavirus, which can lead to pneumonia, and a vaccine may take up to 18 months to develop.

MISINFORMATION ‘EPIDEMIC’

Iran, urging people to avoid unnecessary travel, extended closures of cinemas, cultural events and conferences for another week and called off Friday prayers in some cities.

The WHO’s Ryan said Iran’s outbreak may be worse than yet realized. Twenty-six people have died there, the highest toll outside China, with 245 infected, including some senior officials, adding to the isolation of a nation already under U.S. sanctions.

New cases in South Korea took its total to 1,261 with 12 deaths.

Italy, desperate to stave off a probable recession, warned that the “epidemic of misleading information” could do worse harm than the virus itself.

The coronavirus has played havoc with global aviation and tourism as airlines cancel flights, countries ban visitors from hot spots and nervous passengers put off travel.

In Spain’s Canary Islands, 130 of 700-plus guests locked down in a hotel were cleared to leave.

The United States is managing 59 cases – most Americans repatriated from a cruise ship quarantined in Japan where almost 700 cases developed. But Trump said the risk was “very low” in the United States which was “very, very ready”.

Slideshow (19 Images)

Chinese authorities said the number of new deaths stood at 29 on Thursday, its lowest daily tally since Jan. 28. There were just 433 new cases in mainland China over the previous day, compared to 586 in nations and territories elsewhere.

[Interactive graphic tracking global spread of coronavirus: open tmsnrt.rs/3aIRuz7 in an external browser.]

Reporting by Ryan Woo, Yilei Sun and Lusha Zhang in Beijing, Daniel Leussink in Tokyo, Aradhana Aravindan in Singapore, Parisa Hafez in Dubai, Stephanie Nebehay in Geneva, Sudip Kar-Gupta and Michel Rose in Paris, Crispian Balmer and Gavin Jones in Rome; Writing by Andrew Cawthorne and Catherine Evans; Editing by Nick Macfie and John Stonestreet

Our Standards:The Thomson Reuters Trust Principles.

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Kuwait has 43 confirmed cases of coronavirus: health ministry

FILE PHOTO: A Kuwaiti boy wears a protective face mask, following the outbreak of the new coronavirus, as he throws water at passing cars, during celebrations for the 29th Kuwait Liberation Day from the Iraqi occupation, in Kuwait City, February 26, 2020. REUTERS/Stephanie McGehee

DUBAI (Reuters) – Kuwait now has 43 confirmed cases of coronavirus, according to a health ministry official on Thursday, who added all cases involved people who had been to Iran.

Iran, which lies east of Kuwait, has experienced the largest death toll from coronavirus outside China, with 26 deaths and 245 cases.

Kuwait announced a raft of measures on Thursday, according to state news agency KUNA, including forcing all flight passengers to sign an avowal that would make them subject to quarantine for a minimum of two weeks at the Kuwaiti authorities’ discretion.

Those who do not comply could face “punishments and legal accountability”, KUNA added.

A number of educational institutes will also close for two weeks. The Kuwaiti army will suspend studies at military colleges and schools for two weeks from March 1 due to concerns about the coronavirus outbreak, and studies at Saad Al-Abdullah Academy For Security Sciences will also be halted for two weeks from March 1.

Classes have also been halted at the Institute of Banking Studies until further notice.

The state-owned Kuwait Oil Company said on Twitter it has suspended all domestic and foreign official missions and training programs for its employees until further notice, including training at international companies and participation at conferences.

It made no explicit reference to coronavirus, but said it was “a precautionary measure to ensure the safety of workers.”

Reporting by Alaa Swilam and Ahmed Tolba; Writing by Yousef Saba; Editing by Hugh Lawson and Alexandra Hudson

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Cellular metabolism plays key role in dictating the fate decision between pathogenic and regulatory T cells

Patients with autoimmune diseases like multiple sclerosis, inflammatory bowel disease and rheumatoid arthritis have an imbalance between two types of immune system T cells. Destructive Th17 cells that mediate chronic inflammation are elevated, and regulatory T cells, or Treg cells, which suppress inflammatory responses and play a protective role in autoimmune disorders, are diminished.

Both cells differentiate from the same precursors — naïve CD4 T cells — and the beginning of their change to either Th17 or Treg cells starts with the same signal. Subsequently, a fate decision occurs, like a fork in the road, steering the changing CD4 cells to become either inflammatory T cells or regulatory T cells.

New, preclinical research, led by Laurie Harrington, Ph.D., associate professor in the UAB Department of Cell, Developmental and Integrative Biology at the University of Alabama at Birmingham, shows a pivotal role for cellular metabolism to regulate that fate decision, a decision that occurs very early in the activation of CD4 T cells. This opens a possibility that manipulating the cellular metabolism of T cells may provide a new, promising therapeutic intervention to modulate the balance between pathogenic Th17 and Treg cells in chronic autoimmune disorders. The research is published in the journal Cell Reports.

Upon activation, T cells were known to rapidly increase metabolism, including glycolysis and mitochondrial oxidative phosphorylation, or OXPHOS, to meet the energetic demands of differentiation. But the precise contribution of OXPHOS to that Th17 differentiation was not defined.

The UAB researchers, and one colleague at New York University, found that ATP-linked mitochondrial respiration during Th17 differentiation was essential to upregulate glycolysis and the TCA cycle metabolism. Strikingly, it also was essential to promote inflammation of the central nervous system by Th17, as shown in a mouse model for multiple sclerosis.

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In the mouse model, experimental autoimmune encephalitis, Th17 cells cause the disease progression. For the experiment, harvested CD4 T cells were differentiated using a combination of Th17-polarizing cytokines. One group was the polarized control, and one group was polarized in the presence of oligomycin, an inhibitor of mitochondrial OXPHOS. Then the T cells were transferred into experimental mice. Mice receiving the T cells treated with oligomycin during polarizing conditions showed a significantly delayed onset of disease and reduced disease severity. Both groups of T cells proliferated robustly after transfer.

In mechanistic experiments, the researchers detailed the early molecular events that differ between cells polarized in the presence or absence of oligomycin. These included gene sets that are upregulated or downregulated, presence or absence of Th17 or Treg cell markers, expression of signature transcription factors needed for Th17 differentiation, and expression of gene products that play a role in T cell receptor signaling.

A surprise was found in the timing of the fate decision. In an experiment, CD4 T cells were exposed to Th17-polarizing conditions with oligomycin present only during the first 24 hours. They were then washed and allowed to continue differentiation in the polarizing conditions. The effects of this brief exposure to oligomycin were T cells that lacked Th17 markers and instead showed hallmarks of Treg cells, including expression of Foxp3. Thus, the brief early exposure to oligomycin imprinted the Foxp3 fate decision.

Overall, Harrington said:

Inhibition of mitochondrial OXPHOS ablates Th17 pathogenicity in a mouse model of multiple sclerosis and results in generation of functionally suppressive Treg cells under Th17 conditions.”

Source:

University of Alabama at Birmingham

Journal reference:

Shin, B., et al. (2020) Mitochondrial Oxidative Phosphorylation Regulates the Fate Decision between Pathogenic Th17 and Regulatory T Cells. Cell Reports. doi.org/10.1016/j.celrep.2020.01.022.

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