Science
California hospitals scramble on earthquake retrofits as state limits extensions
More than half of the 410 hospitals in California have at least one building that probably wouldn’t be able to operate after a major earthquake hit their region, and with many institutions claiming that they don’t have the money to meet a 2030 legal deadline for earthquake retrofits, the state is now granting relief to some while ramping up pressure on others to get the work done.
Gov. Gavin Newsom in September vetoed legislation championed by the California Hospital Assn. that would have allowed all hospitals to apply for an extension of the deadline for up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural or “distressed” hospitals to get an extension of up to three years.
“It’s an expensive thing and a complicated thing for hospitals — independent hospitals in particular,” said Elizabeth Mahler, an associate chief medical officer for Alameda Health System, which serves Northern California’s East Bay and is undertaking a$25-million retrofit of its hospital in Alameda, on an island beside Oakland.
The debate over how seismically safe California hospitals should be dates to the 1971 Sylmar quake near Los Angeles, which prompted a law requiring new hospitals to be built to withstand an earthquake and continue operating. In 1994, after the magnitude 6.7 Northridge quake killed at least 57 people, lawmakers required existing facilities to be upgraded.
The two laws have left California hospitals with two sets of standards to meet. The first — which originally had a deadline of 2008 but was pushed to 2020 — required hospital buildings to stay standing after an earthquake. About 20 facilities have yet to meet that requirement for at least one of their buildings, although some have received extensions from the state.
Many more — 674 buildings, spread across 251 licensed hospitals — do not meet the second set of standards, which require hospital facilities to remain functional in the event of a major earthquake. That work is supposed to be done by 2030.
“The importance of it is hard to argue with,” said Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, citing a 2023 earthquake in Turkey that damaged or destroyed multiple hospitals. “There were a number of hospitals that were intact but not usable. That’s better than a collapsed structure. But still not what you need at a time of emergency like that.”
The influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline, though the state has granted various extensions to specific facilities. Newsom’s signature on one of the three bills addressing the issue this year represents a partial victory for the industry.
Hospital administrators have long complained about the steep cost of seismic retrofits.
“While hospitals are working to meet these requirements, many will simply not make the 2030 deadline and be forced by state law to close,” Carmela Coyle, president and chief executive of the California Hospital Assn., wrote in a letter to Newsom before he vetoed the CHA bill. A 2019 Rand Corp. study paid for by the CHA pinned the price of meeting the 2030 standards at $34 billion to $143 billion statewide.
Labor unions representing nurses and other medical workers, however, say that hospitals have had plenty of time to get their buildings into compliance, and that most have the money to do so.
“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Assn., said in an interview prior to the governor’s action. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”
In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension wasn’t justified, and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”
He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.
But he signed a third bill, which allows small, rural and “critical access” hospitals, and some others, to apply for a three-year extension, and directs the Department of Health Care Access and Information to offer them “technical assistance” in meeting the deadline.
The state designates 37 hospitals as providing “critical access.” An additional 56 are considered “small,” meaning they have fewer than 50 beds, 59 are considered “rural,” and 32 are “district” hospitals, meaning they are funded by special government entities called “health care districts.” They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones for implementing it.
Debi Stebbins, executive director of the Alameda Health Care District, which owns the Alameda Hospital buildings, said small hospitals face a big challenge. Even though Alameda is close to San Francisco and Oakland, the tunnels, bridges, and ferries that connect it to the mainland could easily be shut in an emergency, making the island’s hospital a lifeline.
“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.
The Rand study estimated the average cost of a retrofit at more than $92 million per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.
Small and rural hospitals can get some aid from the state through grants financed by the California Electronic Cigarette Excise Tax, but Andrew DiLuccia, spokesperson for the Department of Health Care Access and Information, said that would yield just $2 million to $3 million total annually. He added that the Small and Rural Hospital Relief Program also has received a one-time infusion of $50 million from a tax on health insurers to help with the seismic work.
Labor unions and critics of the extensions often point to the large profits that some hospitals reap: A California Health Care Foundation report published in August found that California’s hospitals made $3.2 billion in profit during the first quarter of 2024. The study notes that there “continues to be wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”
Stebbins has had to help her district figure out a plan.
After Newsom vetoed a bill in 2022 that would have granted an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help back a loan.
The cost to retrofit will be about $25 million, and the system is also investing millions more into other projects, such as a new skilled-nursing facility. The construction work is set to be completed in 2027.
“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler of Alameda Health System said. “How do we make sure that they get what they need to stay open?”
This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues.
Science
Panama Canal’s Expansion Opened Routes for Fish to Relocate
Night fell as the two scientists got to work, unfurling long nets off the end of their boat. The jungle struck up its evening symphony: the sweet chittering of insects, the distant bellowing of monkeys, the occasional screech of a kite. Crocodiles lounged in the shallows, their eyes glinting when headlamps were shined their way.
Across the water, cargo ships made dark shapes as they slid between the seas.
The Panama Canal has for more than a century connected far-flung peoples and economies, making it an essential artery for global trade — and, in recent weeks, a target of President-elect Donald J. Trump’s expansionist designs.
But of late the canal has been linking something else, too: the immense ecosystems of the Atlantic and the Pacific.
The two oceans have been separated for some three million years, ever since the isthmus of Panama rose out of the water and split them. The canal cut a path through the continent, yet for decades only a handful of marine fish species managed to migrate through the waterway and the freshwater reservoir, Lake Gatún, that feeds its locks.
Then, in 2016, Panama expanded the canal to allow supersize ships, and all that started to change.
In less than a decade, fish from both oceans — snooks, jacks, snappers and more — have almost entirely displaced the freshwater species that were in the canal system before, scientists with the Smithsonian Tropical Research Institute in Panama have found. Fishermen around Lake Gatún who rely on those species, chiefly peacock bass and tilapia, say their catches are growing scarce.
Researchers now worry that more fish could start making their way through from one ocean to the other. And no potential invader causes more concern than the venomous, candy-striped lionfish. They are known to inhabit Panama’s Caribbean coast, but not the eastern Pacific. If they made it there through the canal, they could ravage the defenseless local fish, just as they’ve done in the Gulf of Mexico and the Caribbean.
Already, marine species are more than occasional visitors in Lake Gatún, said Phillip Sanchez, a fisheries ecologist with the Smithsonian. They’re “becoming the dominant community,” he said. They’re “pushing everything else out.”
Science
Sitting hurts. Train for your desk job with these 5 easy exercises for your head and neck
It’s Monday morning, the start of your work week. You’ve put the finishing touches on that big report, prepared for that imminent presentation. But it’s likely that there’s one aspect of the job you’re not ready for: the marathon of sitting at your desk all day.
Time to start training. Because while it might not be earthshaking news, it bears repeating: Prolonged desk work can lead to a host of musculoskeletal issues, from annoying aches and pains to injuries.
Even if your work space is ergonomically correct — and even if you exercise regularly in your free time — excessive desk work (considered three or four continuous hours) can lead to weakened, tight muscles, joint stiffness, inflammation in the muscles and tendons and tight fascia (connective tissue). Add it all up, and the result is typically some level of discomfort.
Left untreated, muscles that are stressed and deconditioned can lead to painful soft tissue problems, such as tendonitis and carpal tunnel syndrome, as well as chronic lower back pain. You can also become at risk for bulging or herniated discs, pinched nerves and other issues.
Desk work can also lead to biomechanical imbalances. Weakened glutes from sitting, for example, can lead to stress on the knees and lower back; tired hip flexors can alter pelvic movement, leading to lower back pain.
Which is concerning seeing as sitting for work is both on the rise and can put us at risk for other serious health issues, says Stella Volpe, president of the American College of Sports Medicine.
“We know that there are more Americans now that have sedentary jobs than ever in the past,” Volpe says. “The more we sit, the greater risk we have of diabetes, obesity and cardiovascular disease.”
Blame our sitting-related woes on the advent of furniture, says David Raichlen, a USC evolutionary biologist who studies sedentary behavior and exercise.
Before chairs with a back and arm rests debuted as a status symbol among ancient Egyptians about 5,000 years ago, he says that humans mostly kneeled or squatted for about 2 million years. Those resting postures require light muscle activity, but when the body is fully supported by a chair or a couch, it turns off that activity in the body parts being supported by the furniture, Raichlen says. Prolonged inactivity can then lead to muscle atrophy and other problems.
“From an evolutionary standpoint, the human body hasn’t yet adapted to furniture,” Raichlen says. “It never had to deal with completely inactive muscles for long periods of time until very recently.”
But the good news is you can train for long-distance sessions at your desk by working out your neck, your wrists, your lower back, even your feet and toes. These “exercise snacks,” as trainers call them, don’t require a trip to the gym, or equipment, or even much time.
They’re not meant to replace regular exercise, but they will — if done regularly — prepare your body for the challenge that is desk work by stretching and strengthening your muscles, taking pressure off your joints and reducing stiffness and inflammation in the area — all of which may alleviate pain and prevent new injuries.
“We’re designed to be hunter-gatherers, not to wiggle our fingers on a keyboard for eight hours straight,” says Dr. Joshua T. Goldman, a UCLA sports medicine physician. “We need to build up strength, for endurance purposes, to help those body parts tolerate that activity.”
“The human body hasn’t yet adapted to furniture. It never had to deal with completely inactive muscles for long periods of time until very recently.”
— David Raichlen, USC evolutionary biologist
We spoke to exercise physiologists, sports medicine physicians, personal trainers, physical therapists and others to devise a short, five-minute exercise routine for six key regions of the body. We’ll roll out one routine a week — starting with the head and neck area — for six weeks, until you have a complete full-body workout.
Each exercise is purposefully simple, meant to take 30-60 seconds. And each routine lasts about five minutes or less in total. They’re ideally done throughout the day, so as to promote mobility and circulation, bringing blood flow and nutrients to the muscles and tendons, and increasing lubrication in the joints. Set a timer. Take a five-minute break to execute one routine. Then get back to work.
Still too busy? Do just one exercise, for 30-60 seconds, then continue working. If you get through one routine by day’s end, consider it a win. Focus on a different routine the next day.
“It all adds up,” Volpe says. “Our society often thinks that if you’re not running a marathon, you’re not doing enough. But the additive effect is still good for you.”
A routine for your head and neck
The neck is a common area in which to develop pain from desk work. Looking at a computer monitor, we often jut our neck forward rather than tucking in our chin, as we should. That pushes our cervical column out of alignment and creates excess stress on the bones and discs of the cervical spine. It shortens and tightens muscles in the neck, which can lead to pain and cause tension headaches.
Do these exercises to help stretch and strengthen the muscles that support your head and neck. They’re demonstrated by trainer Melissa Gunn, of Pure Strength LA, whose team trains desk workers on how to protect their bodies through exercise.
- Clasp your hands behind your head and gently tuck your chin down toward your chest. Hold 10 seconds. Do five times.
- Slowly tilt your head to the left, bringing your ear toward your shoulder. Hold for 10 seconds, then raise it slowly back up to the starting point. Switch sides. Do three times on each side. To increase the stretch, after bringing your ear to your shoulder and holding, turn your head and look down toward your armpit on the same side, then return to starting position.
- Place your back flat against a wall and stand with your feet about eight inches from the wall, with knees slightly bent. Your arms should be flush against the wall, with palms facing outward. Tuck your chin slightly and push your head gently against the wall. Slide your arms up the wall, as if doing a snow angel. Go as far as you can with your arms and hands flush against wall. Stop when they begin to pull away from the wall — typically when palms are between shoulder height and head height. Do 10 times.
- Stand up straight and align your head, shoulders, hips and ankles — most people jut their neck forward without knowing it, creating static tension there, so consciously move your head back so it’s above your shoulders. Slowly roll your head in a circle, first to the left, clockwise, all the way around; then to the right, counter-clockwise. Do 3 times on each side.
- Stand up straight and align your head, shoulders, hips and ankles. Your arms should be beside you and your palms facing outward. Then pull your arms back but no further than the back pockets of your pants — without lifting your shoulders — and draw your shoulder blades together. Hold for 2-5 seconds. Do 5-10 times.
(Exercises came from Dr. Joshua T. Goldman, UCLA sports medicine; Melissa Gunn, Pure Strength LA; Tom Hendrickx, Pivot Physical Therapy; Vanessa Martinez Kercher, Indiana University-Bloomington, School of Public Health; Nico Pronk, Health Partners Institute; Niki Saccareccia, Light Inside Yoga.)
Science
Lead Poisoning May Have Made Ancient Romans a Bit Less Intelligent
Roughly 2,000 years ago, the Roman Empire was flourishing. But something sinister was in the air. Literally.
Widespread pollution in the form of airborne lead was taking a toll on health and intelligence, researchers reported on Monday in the journal Proceedings of the National Academy of Sciences.
During the roughly two centuries starting in 27 B.C., a period of relative stability and prosperity known as the Pax Romana, the empire extended throughout Europe, the Middle East and North Africa. Its economy relied on silver coinage, which required huge mining operations.
But extracting silver from the Earth creates a whole lot of lead, said Joseph McConnell, an environmental scientist at the Desert Research Institute, a nonprofit group based in Nevada, and the lead author of the new research. “If you produce an ounce of silver, you’d have produced something like 10,000 ounces of lead.”
And lead has a host of negative effects on the human body. “There is no such thing as any safe level of lead exposure,” said Deborah Cory-Slechta, a neurotoxicologist at the University of Rochester Medical Center who was not involved in the research.
Dr. McConnell and his colleagues have now detected lead in layers of ice collected in Russia and Greenland that date to the time of the Roman Empire. Lead entered the atmosphere from Roman mining operations, hitched a ride on air currents and eventually fell out of the atmosphere as snow in the Arctic, the team surmised.
The levels of lead that Dr. McConnell and his collaborators measured were extremely low, roughly one lead-containing molecule per trillion molecules of water. But the ice samples were collected thousands of miles from southern Europe, and lead concentrations would have been highly dispersed after such a long journey.
In order to estimate the amount of lead originally emitted by Roman mining operations, the researchers worked backward: Using powerful computer models of the planet’s atmosphere and making assumptions about the location of the mining sites, the team varied the amount of lead emitted to match the concentrations they measured in the ice. In one case, they assumed that all silver production took place at a historically important mining site in southwestern Spain known as Rio Tinto. In another case, they presumed that silver mining was equally spread out across dozens of sites.
The team calculated that anywhere from 3,300 to 4,600 tons of lead were being emitted into the atmosphere each year by Roman silver-mining operations. The researchers then estimated how all that lead would be scattered across the Roman Empire.
“We ran the model in the forward direction to see how those emissions would be distributed,” Dr. McConnell said.
With those atmospheric-lead concentrations in hand, the researchers next used modern-day data to estimate how much lead would have entered the bloodstreams of people in ancient Rome.
Dr. McConnell and his colleagues focused on infants and children. Young people are particularly susceptible to taking up lead from their environment via ingestion and inhalation, said Dr. Bruce Lanphear, a public heath physician at Simon Fraser University in British Columbia who was not involved in the research. “Pound for pound, children, particularly infants, eat more and breathe more.”
In recent decades, lead levels in children’s blood have been correlated with a slew of physical and mental health metrics, including I.Q., Dr. Cory-Slechta said. “We have actual data on I.Q. scores in kids with different blood-lead concentrations.”
Using those modern-day relationships, Dr. McConnell and his team estimated that children across much of the Roman Empire would have had around 2 to 5 additional micrograms of lead, per deciliter of blood. Such levels correspond to I.Q. declines of roughly 2 or 3 points.
For comparison, American children in the 1970s had average blood-lead-level enhancements of around 15 micrograms more lead per deciliter of blood before the phasing out of leaded gasoline and leaded paints. Their corresponding average I.Q. decline was about 9 points.
But lead exposure would have had other negative effects on Romans as well. Higher levels of lead in the blood have also been linked to higher incidences of preterm births and reduced cognitive functioning in old age. “It follows you throughout life,” Dr. Lanphear said.
Some scholars have hypothesized that lead poisoning played an important role in the decline of the Roman Empire. But that idea has been called into question, at least when it comes to water contaminated by lead pipes. A 2014 study showed that, while the pipes used to distribute water in Rome increased lead levels, the water was unlikely to be truly harmful.
These new findings make sense, said Hugo Delile, a geoarchaeologist at the French National Centre for Scientific Research, who was not involved in the research. “They confirm the extent of lead pollution resulting from Roman mining and metallurgical activities.”
According to Dr. McConnell, the research also confers a dubious honor on Roman mining. “To my knowledge, it’s the earliest example of widespread industrial pollution,” he said.
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