Climate Change and Global Health

Storm Surge Flooding, Westport, Washington, November 2009

Climate Change and Global Health

Climate change poses a number of risks to global health.  These risks draw our attention to the fact that health issues operate on a scale that transcends our own individual concerns, extending well beyond local communities, state and national boundaries.  

I attended a lecture in February, 2011, by Dr Howard Frumkin, Dean of the University of Washington School of Public Health on the health risks of climate change.  It was an interesting talk, covering many areas where climate change impacts global health. These impacts may be associated with the increased frequency of extreme weather events. 

Extreme weather events discussed included increased heat, cold, melting, freezing, flooding and droughts.  Increased atmospheric instability may give rise to more frequent hurricanes and tornadoes. Extreme weather events can be viewed on various time scales, from 50 to 100 year storms, to events on a more geological time scale.

Heat stress is of particular concern to the elderly, the young and the immune-compromised. Extreme heat, especially in non or inadequately air-conditioned spaces may result in premature mortality during heat waves, in the vulnerable, especially in the city where paved areas draw heat.  Dr Frumkin was concerned about the "harvesting" effect of heat waves on elderly, urban, populations.

Cold, snow, ice and freezing also may become survivability issues, involving issues of heating and interruption of water and electrical service.  Storms may impact travel and thus food supply, transportation of vital supplies to population centers and medical facilities.  

Public health challenges may emerge with air or water quality issues, impacting respiratory, cardiovascular, and other associated systems.  Infectious diseases may spread via the air or water through vectors  such as tic or mosquitoes, or via zoonotic means through human to animal or animal to human spread).  Allergies may develop in response to climate changes, and new pathogens may emerge or spread to different areas.

Air pollution is a problem which affects more than just urban areas.  With experience working in the regulatory air quality sector, I realize the widespread impacts that pollutants such as ozone and other pollutants have.  Photochemical reactions involving products of combustion (e.g. auto exhaust) take place in the atmosphere resulting in ozone levels downwind of major urban areas. As the reactions involve sunlight and heat, the levels on sunny and hot days increase in the summer. In the fall and spring periods of extended air stagnation resulting from stalled high pressure weather systems may increase the respiratory and cardiovascular burden on the vulnerable patient group. Air pollution does not know boundaries, thus residential and industrial pollution from other countries may impact us, as ours impacts theirs.  Forest fires add to the impact.  Extreme weather may impact all these issues.

The impact of climate change, extreme weather events and public health challenges may impact food production, may result in civil conflict, dislocation of impacted people and may increase the expression of mental health issues .

The discussion of climate science drives the discussion on public health impacts as projections are made regarding the manner in which changes will take place in Earth's climate systems.  Modeling climate systems drives downstream weather and public health challenges. These challenges are studied in a variety of settings, including federal government institutions such as NOAA, NASA and the CDC, and at a variety of state and local governmental and, at private institutions.  The Intergovernmental Panel of Climate Change and the National Climate Assessment have comprehensive plans reflecting policy in this area.

Extreme weather events can result in significant mortality and morbidity, as well as impacts to property.  Tornadoes and Hurricanes and wind storms may result in death and injuries from flying objects, falling trees and power lines as well as medical emergencies secondary to the event.  Fires may result from damaged gas lines. 

Increased flooding and storm surge may result in drownings and damage to property. Flooding may increased the spread of infectious diseases, problems with sewage systems and interruptions in drinking supplies

Drought may bring about reductions in food supply.  This is a serious issue as crops may be challenged to grow in areas where they were previously able to.  Vegetation, vectors and pathogens may spread into other areas as a result of warming.  This impacts the latitude at which such impacts occur as well as the altitude above sea level, moving to cooler latitudes and elevations.

More weeds may develop in urban areas in response to climate change and global warming as vegetation adjusts to the changing environment.

Extreme weather events thus may have public health impacts relating to many systems, resulting in dislocation of people and mental health issues as citizens adjust to the events.

The challenge is how to address climate change issues in the context of these public health issues.

Ferguson

What started presumably as a simple theft and an encounter with a marked police car and a uniformed police officer has turned into racial rioting in Ferguson, Missouri and elsewhere around the country.  It is a tragedy that an 18 year old African-American young man was shot and killed by a white police officer.  This young man had a potential future ahead of him, and whether or not he stole some cigarillos from a store, and whatever his encounter may have been with the officer, it is a tragedy that his life had to end so soon.

At the same time we consider the actions and state of mind of the police officer in question, who was not indicted, but who will live with his actions for the rest of his life, and who must have gone through his own private and public hell, taking a life in the course of duty.  This was a life, going through that tenuous period in early adulthood. But there probably was more to it than that.

The riots that have followed the incident in Ferguson and the decision by the Grand Jury are an unfortunate commentary on the manner in which society acts to resolve its problems.  The issues in this case are complex.  The issue goes to the core of what it means to be a police officer in a society where the officer is empowered to use lethal force and must, in some cases, at a moment's notice act to preserve the law and/or to protect his own life and well being.

How can society understand the lessons of the Michael Brown and apply them better?  I will focus on  a few broad areas that I feel led to the situation escalating quickly and then  spiraling out of control into a series of demonstrations.

Cognitive Dissonance

One principle is the principle of cognitive dissonance that the police officer has to deal with in his position, whether it be as a beat cop, a patrol officer in a vehicle, or an undercover officer placed in an extraoardinarily difficult position.  Cognitive Dissonance  according to Wikipedia, is the "mental stress or discomfort discomfort experienced by an individual who holds two or more contradictory beliefs, ideas, or values at the same time, or is confronted by new information that conflicts with existing beliefs, ideas, or values." The officer has to deal with threats to his life, health and well being,  as he balances his actions in enforcing the law and in maintaining a civil society.  When these issues conflict, it creates cognitive dissonance.

Bayesian Thought Processes

Another principle the officer has to deal with is "Bayesian Thought Processes", which refer to a manner in which the brain processes information in order to perceive situations.  The brain tends to be programmed in a fashion in order to do forward thinking threat and risk assessment based on prior probabilities, which are conditional.  These conditional experiences represent the statistical evaluation of past experience in the brain.  If the officer has come to associate the evolution of threats with certain populations, then when a threat situation arises, he will be more likely to act on the basis of that threat when those populations are involved.  The associations may relate to personal experience, exposure to media, training or other exposures.  The key to solving the problem, is to address these underlying associations.  This is a difficult task and it is one that reflect's society's views and prejudices.

The Marijuana Symbol

Laws are getting more and more complex and this leads by itself to occasions of increased cognitive dissonance for the police officer.  An example of this is that the officer noticed a marijuana symbol on the socks of one of the men and that impacted perception.  Marijuana laws have become more complex, with some states (Washington and Colorado) legalizing it, while other states and the Federal government consider it illegal.  Medical marijuana is allowed in some cases.  For example, Missouri allows it for use for intractable epilepsy.  These laws by themselves add considerable cognitive dissonance to a police officer who may consider marijuana a 'gateway' drug to other more harmful drugs (and it still may be).  It is possible that the marijuana could be used for a medical purpose, a different association entirely.  Did Michael Brown have epilepsy?  I don't know.

An Officer's Sense of Space and Safety

The subjects approached the patrol officer's vehicle from behind, endangering the officer's feeling of control over his own space.  This was probably the key element in the confrontation.

The race and age of the subjects in question, and the perception that they may be subjects in a robbery the officer had heard about probably also contributed to the officer's sense of personal safety. The issue in question, with the demonstrations, however, is the extent to which the officer's perception of risk to his personal safety was based on preconceptions based on race, which may have influenced the outcome.

The Subject's Behavior and the Officer's Behavior

The officer missed one vital point, the subject's behavior.  If Michael Brown had committed a theft, as it appeared, then why did he challenge the police officer?   Was he guided by outside forces to act in a manner inimical to his own feelings of safety? Was his intent to be caught?  He challenged the police officer when his safest approach would have been to simply avoid the situation. Is it possible that the police officer's reaction, when threatened (by being surprised in his vehicle), triggered past memories of racial harassment in Michael Brown?  Did an emotional memory of a past event trigger an action to challenge rather than avoid conflict (fight or flight?).  At the age of eighteen, a number of issues could have been involved, including unknown existential issues.

Did Michael Brown attempt to surrender and the officer fail to recognize it for some reason?  Why?

Perception of Police and Justice System

The issue in the community becomes the perception of the public towards the police and the justice system as they examine the various roles in a tragedy of a life that ended too soon and the feelings of the police themselves.

How to fix this?  It is a good idea for people to have some understanding of police thought processes, especially understanding their concern about protecting their firearms and their physical space.

Police responses are to a certain extent wired into them by training, as in many fields.  Police need to be trained to act very quickly in risky situations, something not necessarily true of all professions.   In fact many of these hardwired thought processes are what have kept them safe in their jobs, so that seeking to change perceptions of police officers is fraught with many challenges, some of which involve the issues of cognitive dissonance alluded to above.

So the mystery of Michael Brown remains, how do you solve the problem?  You can educate the public, but the public is such a large body to educate.  This is a challenge.  Police training needs to continue to incorporate the importance of psychological factors, perceptions, including  the types of issues discussed above.

It is very possible that the subjects anomalous behavior led to a situation of cognitive dissonance in the officer where it generated a 'fight or flight' situation that the officer reacted to and resolved with his training and his capability to protect himself from potential harm.  It's possible the officer resolved the anomalous situation as only a challenge to his authority when there were other factors as well.  Time will tell as analysis of the situation proceeds.

One thing we do know, and that is suppressing a vulnerable, poor and disadvantaged population can have impacts that reverberate beyond the immediate situation in question.

It is difficult to comment on the legal tactics employed with the grand jury proceeding. The results speak for themselves.

A community mourns and it is time to heal and try to fix the problems.

Ebola

Raudfjorden Beach, Svalbard, Norway

The Ebola outbreak has proven to a challenge for worldwide heatlh leaders.  The CDC has information about Ebola on its website, as does the World Health Organization (WHO).  The CDC information is delineated into a number of topical areas of interest to subject audiences.  I'm interested in the etiology of Ebola, its transmission, and issues surrounding its current outbreak.

My interest in Ebola began during my actuarial career, reading the "Hot Zone" , a 1994 non-fiction book about incidents involving viral hemorrhagic fevers, including ebolaviruses and marbug viruses. The memory of the book stayed with me since I was reading it while sailing down the west coast of Vancouver Island in 15 foot swells in a sailing vessel.  I can recall eating copious amounts of ginger cookies to ward off seasickness as I read of hemorrhagic fevers killing off people very quickly, in a very bloody and gory fashion, as all the while I was lurching back and forth in the sea and swell on the Pacific Ocean.  The ginger cookies did their job and the memory is etched in my experience, gone but not forgotten, as Ebola emerges again, this time, expressed  in the news of an outbreak.

These hemorrhagic diseases killed off people before they had a chance to spread extensively, and, were confined to certain areas in Africa and mostly away from major population centers.

According to the CDC, the virus can be spread through direct contact with blood and body fluids of a person infected with Ebola, with objects such as syringes infected with Ebola and infected fruit bats or primates.  The question remains as to factors impacting the geographical distribution of Ebola, how it independently arises, factors of etiology and its potential spread elsewhere.

The recent upswing in the Ebola virus prompted me to question its etiology, transmission and other issues.  For example, because of the increase in number of cases, I wondered if the virus had recombined with another virus to increase its transmission and decrease its mortality, or if there were other factors.   In this blog article I consider a number of issues, and raise some questions relating to the virus.


Etiology

• Does Ebola predate the AIDs/SIV/HIV viruses and does it provide some idea of the origin of these viruses? The CDC expresses that it does not know the origin of the original host of the Ebola Virus;  It is interesting to study the context of the Ebola virus regarding its emergence out of the Kinshasha Highway  across the Congo into Uganda as discussed in "The Hot Zone".  Did the virus have origins in bat habitats such as caves, rock, lava tubes, environments exposed to varying bacteria and archaea?
• The Ebola virus is a negative sense RNA virus. The production of proteins from a negative sense RNA virus require first the production of Messenger RNA (mRNA) and then proteins from mRNA. Ebola does not have reverse transcriptase, which would ordinarily be needed to enable insertion of its genetic contents into the DNA.   Is its 'purpose' then to directly produce mRNA (messenger RNA), and why? Research has shown that the filoviruses behind Ebola are very old and that there is direct insertion of genetic content with indications of evolutionary divergence a long time ago.  - The Lin Edwards article, "Ebola and Marburg viruses may be much older than thought" discusses this subject.
• Does the Ebola virus relate to issues concerning New World Monkeys and Old World Monkeys and the divergence of the two species?  If so, would this tend to indicate the same type of environmental conditions that may have existed at the time of that divergence?
• What is the distribution of the virus?  Does the virus act with regards to specific populations, affecting certain populations in a negative or positive way, and leaving others untouched.  What factors in these populations would account for the outbreak?  Are other populations at risk?

Transmission

• Did the Ebola virus recombine with another virus (for example the Corona Mers Virus  , Seasonal Flu Virus or enteroviruses) to allow it to decrease its mortality rate and increase its transmission?  Is it continuing to do so and would further recombination with the current seasonal flu change it further along these lines? 
• A subject of interest to is transmission of Ebola from the natural host to a target population.  Is Ebola being expressed, sustained within the target population or being sequestered?  Does this imply sequestration in a host for transmission or expression later under circumstances that may enable it to be used as a regulatory operator or a mediator of group identity or expression of  immunity systems?  Is it developing a symbiotic relationship with the host or another virus in a toxin/anti-toxin sort of manner (discussed by my blog article on Dr Luis Villarreal and his work on group identity systems)? How does this concept explain the existence of this virus in a reservoir species?
• What is the risk for the spread of Ebola?  To what extent is the risk environmental and to what extent can it be transmitted from person to person? 
• Is Ebola being transmitted in a less than lethal form under our eyes without our knowledge?
• Can Ebola be spread by more species of animals than listed under the CDC website?  
• How might Ebola change to become more transmissible to a greater variety of populations impacted by different environmental factors?  How would this risk change if the Ebola virus were to combine with the seasonal flu in a variety of different ways?

Geological Factors

• What factors in Africa are most significant in the etiology of Ebola?  Heat, humidity, coeexistence with and diversity of animal species, alkaline environments, carbon dioxide sequestration and outgassing (e.g. Lake Nyos), the Archaean basement substrate of the West African bedrock, granite, uranium, endospores such as bacillus anthracis, and  natural nuclear fission reactors from underground uranium (Gabon)? 
• What is the impact of the African mining fields?  Iron, gold, lead, silver, arsenic, mercury , uranium and nickel are among products of mining.  Nickel has a positive feedback impact on inflammatory markers. 
• How do endospores such as bacillus anthracis  fit into the story of Ebola, set in the mining context of West Africa, with its iron, gold, silver, arsenic, uranium, nickel and mercury, and the expression of inflammatory markers and feedback indicators?
• Are these various environmental issues constrained to Africa or are they present in other environments, and where do other similar environmental conditions exist?  Do these conditions have to exist in the same place or can an individual experience them by exposure to a variety of locations? For example, Archaean basement layers of rock exist in the Arctic, in Svalbard, which I visited in 2005. How would exposure to Archaea and other factors present in West Africa differ from the situation in Svalbard where it is much colder! Where else can we find archaea and chiral substances?
• How do increases in solar radiation  and changes in the Earth's magnetic field impact the expression of Ebola in Africa? To what extent would these factors affect the expression of Ebola in other areas of the planet?

Environment and Physiology

•  Does the emergence of a disease that promotes bleeding have significance as it relates to climate change or other planetary or environmental factors?    Is some environmental change occurring that would result in blood clotting more easily, something that would need to be countered by less viscous blood and changes in the coagulation cascade?
• How might the environmental factors in Africa affect blood coagulation?  Through mitochondrial regulation as it is impacted by environment, haplogroups and uncoupling in oxidative phosphorylation?  Through the impacts of oxygen reactive species?  Through solar radiation, geomagnetic storms and cycles?  Through the Warburg effect  (which replaces aerobic respiration with glycolysis)? Through arsenic mining?  Through positive feedback mechanisms involving hypoxemia  and inflammatory responses?  
• Is it possible that the Archaean basement layer of rock in West Africa impacts the blood coagulation cascade  and the blood vasculature through chirality?  Would concepts of fractal dimension  and tortuosity explain concepts of blood coagulation and vascular inflammation and other disorders, including stroke and cancers, including those of the blood and lymphatic systems?  
• What impact does the water people drink (and breathe through water vapor) impact people, including the impact on group identity systems and physiological parameters?
• Does the outgassing  of carbon dioxide  as a result of global warming, the release of iron from iron sequestered in the rock, and the release of endospores from sequestration, explain any of the natural events happening today, as regards vascular and coagulation issues?
• Is it possible that Ebola, as a disorder that promotes bleeding, developed as a feedback mechanism to counter the impact of increased blood coagulation due to the environmental impacts raised above? 
•  Bleeding may increase as blood coagulation factors are used up; does Ebola act to promote such bleeding to counter increases in clotting factors secondary to these environmental issues?  Is it possible that Ebola thus impacts the regulatory mechanisms of the coagulation cascade?

Detection

• Could an easy detection test be done for Ebola using, for example, saliva? This might prove less expensive and easier to measure for initial testing prior to full blood workups if it was sufficiently sensitive and specific.
• Could the d-dimer test and PPT tests be used as early indicators of Ebola.
• Can a series of early indicators, including markers of respiratory and coagulation system function and exposure to certain environmental factors, be developed to ascertain risk patterns for specific populations?  
• Where might the solution to Ebola be found?  Only time will tell.  Are lamprey VLR's a potential solution for isolating, detecting, and finding a cure for Ebola, considering their ability to detect bacillus anthracis and their affinity for carbohydrate glycoproteins?  Considering the age of the filoviruses and the characteristics of Ebola itself, is this a potential area to investigate?

Summary

Does the emergence of Ebola reflect the re-emergence of ancient historical patterns?  Have these patterns been carried by reservoir species from the depths of time to the particular victims of Ebola? Will Ebola adapt and spread elsewhere or re-emerge in other parts of the planet, independently?

Are the issues happening in West Africa an early indicator ('Canary in a Coal Mine')  of planetary changes?  These changes include changes in Earth's magnetic field, climate change, global warming and solar radiation, and downstream effects including release of sequestered minerals and gases such as carbon dioxide and methane from rock and oceans.  These are all areas of concern.  Historical examples of changes in Earth's magnetic field are shown over longer periods of time and more recent geologic time periods in this Wikipedia article on the Earth's Magnetic Field.

Finally, I am reminded of the childhood game, "Animal, vegetable or mineral" and associations with the "Tree of Life" (and probably, by extension, "The Tree of Good and Evil").  Ebola is a disease with a past, reflecting deep phylogeny and the rivers of time as embedded in the history of our rocks.

Sources:

marilyndunstan.blogspot.com
Evolution of Adaptive Immunity

Wikipedia:
Ebola virus disease
"The Hot Zone"
Kinshasha Highway
Archaea
Sense (molecular biology)
Messenger RNA
Reverse Transcriptase
Filoviridae
New World Monkey
Lake Nyos
Endospore
Bacillus Anthracis
Natural nuclear fission reactor
Nickel
Chirality
Sunlight
Earth's Magnetic Field
Oxidative Phosphorylation
Reactive Oxygen Species
Geomagnetic Storm
Warburg Effect
Glycolysis
Coagulation Cascade
Fractal Dimension
Tortuosity
Outgassing
Carbon Sequestion
Animal Sentinel
Earth's Magnetic Field-Geomagnetic Polarity
Earth's Magnetic Field-Brunhes Geomagnetism
Earth's Magnetic Field

World Health Organization:
Ebola Virus Disease

CDC:
CDC
Ebola (Ebola Virus Disease
2014 Ebola Outbreak in West Africa (Outbreak Distribution Map)

Phys Org: 
Ebola and Marburg Viruses May be Much Older Than Thought

JoVE Visualize: Anthrax lethal toxin inhibits translation of hypoxia inducible factor 1? and causes decreased tolerance to hypoxic stress

Geology and Mineral Resources of West Africa - The Archaean Basement

National Academy of Sciences: High-affinity lamprey VLRA and VLRB monoclonal antibodies

Berkeley Lab: Structure of the Ebola Virus Glycoprotein Bound to an Antibody from a Human Survivor

NASA Science News - Earth's Inconsistent Magnetic Field

Evolution of Adaptive Immunity

Two Trees (creative digital image)

I attended a "Weiser Endowed Lecture in Immunology" featuring Dr Max Cooper of the Emory University School of Medicine, speaking on "Evolution of adaptive immunity" at the University of Washington in 2012.  Dr Cooper's work is foundational in this subject area.

It is interesting that immunity systems follow a phylogenetic pathway much as the phylogeny of species themselves do. The evolutionary pathway of jawless vertebrates (of whom hagfish and lampreys are surviving members), possess differences in comparison to the common evolutionary pathway followed by other vertebrates.

Lampreys and hagfish do not possess a thymus , nor do they possess a spleen.    Lampreys and hagfish do not possess Major Histocompatibility Complex (MHC) 1 or 2, T-cell receptors or recombination activating genes (RAG 1 and 2) which play an active role in the recombination of T-cell and immunoglobulin  receptors. Lampreys and hagfish posses hematopoietic tissue, the former in the intestine and the latter in the portal vein.  With these changes, the lampreys and hagfish diverged off the common immune system evolutionary pathway prior to the development of certain MHC class immunity in other species.  This is an important benchmark due to the major role that the MHC class plays in vertebrates.  It is a vital aspect which makes the concept of a separate phylogenetic pathway earmarked for the immune system so interesting.  If lampreys do not possess a thymus, then what substitutes in its place?

Lampreys and hagfish utilize a system of leucine-rich repeats )(LRR's) to mediate immune system responses using Variable Lymphocyte Receptor (VLRs), (VLRA's, VLRB's and VLRC's).  The interesting aspect of the jawless vertebrate immune system function is comparing its action in structure and function to the immune systems we are familiar with.  VLRB's have structures similar to toll like receptors (proteins that play a key role in the innate immune system), while their functions are similar to those of antibodies,  and they possess humoral characteristics (using macromolecules in extracellular fluids in immunity systems). They act using discrete populations of lymphocytes (types of white blood cells) .

VLRBs act as an adaptive immune system and can differentiate foreign from self in recognizing lymphocytes.

Lampreys posses a diverse variety of leucine-rich repeats which code for germline and mature genes. They possess a specificity for carbohydrate and protein receptors on bacterial and mammalian cells. They bind antigens with high avidity and affinity, describing the binding capacity of multiple versus single interactions of antibodies with antigenic epitopes.

 In "Evolutionary implications of a third lymphocyte lineage in lamprey", the authors find a thymoid source for VLRA and VLRC assembly in the lamprey gill tips, while VLRB assembly occurs in hematopoietic typhosole and kidney tissues.  VLRC appeared more numerous than VLRA, and predominated in the skin.  They conclude that a similar body plan of two T-cell type lymphocytes in a thymoid type structure and one B-cell type lymphocyte in the blood and kidneys shows some similarity in basic structure to the immune system for jawed vertebrate, while achieving adaptive immunity through different means.

Monclonal VLRB antibodies  from immunized lamprey larvae can recognize plasma cells from myeloma patients.  VLR4, a monoclonal VLRB specific for BclA, the bacillus collagen-like protein, has shown to be specific for B. Anthracis spores.  Information on B. Anthracis can be obtained from the US Centers for Disease Control (CDC) CDC - Anthrax and the World Health Organization (WHO) WHO - Anthrax.

Research indicates a number of applications where VLR's can recognize certain immumogens  An immunogen is any antigen that is capable of inducing humoral and/or cell-mediated immune response rather than immunological tolerance.  These applications include diagnosis, research and bioterrorism investigations.