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California workers died of a preventable disease. The threat was known years earlier



California workers died of a preventable disease. The threat was known years earlier

When Wendy Solano first heard the word “silicosis,” her husband Jose Raul Garcia Leon was already suffering from the incurable disease that would kill him.

After immigrating from Mexico, the father of three had provided for his family by cutting countertops. His illness began as a dry cough — something the couple had chalked up to allergies or the changing weather — and rapidly became so debilitating that he grew exhausted trying to speak, Solano said.

Leon died months after joining the waitlist for a lung transplant. Near the end, he could no longer speak, his lungs irreparably damaged by the pale dust that coated his clothes and head when he returned from work.

Wendy Solano stands in front of an altar for her late husband Jose Raul Garcia Leon, who died in February from silicosis.

(Dania Maxwell / Los Angeles Times)


He was 46 years old.

The deaths of workers like Leon, some barely at middle age, have alarmed California lawmakers and regulators as dozens of cases of the suffocating illness have emerged among people who cut and grind countertops. Physicians have linked the silicosis outbreak to the booming demand for engineered stone, a synthetic material much higher in lung-scarring silica than natural granite or marble.

Yet the threat of silicosis is far from a new one, known for centuries as a hazard to workers breathing in tiny particles of crystalline silica. And more than a decade before Leon died, researchers had already raised alarms about the renewed threat of silicosis specifically among workers cutting engineered stone, which has surged in popularity since the turn of the century.

Many experts said the risks should have been anticipated and averted long before young men like Leon started dying.


“It still astounds me as to how glacial the pace has been” to tackle the problem, said Dr. Ryan Hoy, who leads an occupational respiratory disease clinic at Alfred Hospital in Melbourne, Australia.

“This is an epidemic of silicosis — a completely preventable lung disease — in this industry all for the sake of having a fashionable kitchen countertop,” Hoy said. Regulators should be looking at the risks of any new material, he said, not “waiting until patients and workers are dying and then doing something.”

But California physicians and scientists trying to raise alarms have faced a host of obstacles. Silicosis takes years to become apparent after workers are exposed, and the disease has often been mistaken for other ailments by physicians unaware of its modern resurgence. Immigrant workers may hesitate to seek medical care, preventing their illnesses from being detected promptly by health officials.

Dozens of California cases have been tallied so far, but that’s “just the tip of the iceberg,” said Dr. Amy Heinzerling, chief of the emerging workplace hazards unit at the California Department of Public Health. Regulators estimate the state is home to more than 800 shops where engineered stone is readied for installation in kitchens and bathrooms — and believe the bulk are out of compliance with silica rules. “There are almost certainly more cases out there that we don’t know about.”



Silicosis is one of the oldest occupational diseases on the globe. The deadly toll of dust on miners and stonecutters was detailed by European scholars in the 1500s and 1700s. During the Great Depression, silicosis killed hundreds of workers — most of them Black men — who drilled a West Virginia tunnel, a disaster that spurred a national campaign by labor officials to “Stop Silicosis.”

Deaths from silicosis plummeted in the U.S. between 1968 and 2002, with a 93% decline in the rate of silicosis deaths in that time, according to the Centers for Disease Control and Prevention. The International Labour Organization and the World Health Organization launched a program to eliminate silicosis worldwide by 2030.

But the threat never disappeared, afflicting workers who were sandblasting denim and tombstones and toiling in mines. And as new forms of silica exposure arose, that goal of eliminating silicosis by 2030 has become an unlikely one, said Dr. Francisco Santos-O’Connor, senior specialist in occupational safety and health at the ILO.

A stylish kitchen featuring white Caesarstone countertops.

A stylish kitchen featuring white Caesarstone countertops.

(Mariah Tauger / Los Angeles Times)


Physicians have linked many recent cases to the rise of engineered stone in the international market. In the 1970s, an Italian entrepreneur developed the technology to bind crushed stone together with resin and produce slabs of artificial stone. Among the first companies to manufacture it was Caesarstone, which set up a factory in 1987 at an Israeli kibbutz.

Doctors in Israel began to spot silicosis cases among such workers between 1997 and 2001, but “these were scattered events,” they wrote in the medical journal Chest, and “we did not appreciate the nature of the outbreak” at first. By the time they published their findings in 2012, they had found more than two dozen cases among stonecutters working with a “relatively new, artificial, decorative stone product.”

At that point, silicosis cases had also been detected in Spain, where engineered stone had gone into production. More cases arose in Italy and Australia as well.

Hoy said that long before stonecutters started struggling to breathe, the sheer amount of silica in many kinds of engineered stone — upwards of 90% — should have made it obvious that the material was risky to cut and grind, especially in workplaces without sophisticated measures to control dust.

“Silica is an occupational hazard that’s been known about for well over a century … longer than asbestos, longer than tobacco smoking,” Hoy said. But as engineered stone grew into a global industry worth more than $20 billion, “all our worst fears have kept coming true.”


Physicians have been alarmed to see young men sickened after a decade or less of workplace exposure. In the U.S. and elsewhere, laborers cut the high-silica material in the same shops where they had toiled over marble or granite — and using the same methods, including “dry cutting” without any water to suppress dust.

The fabrication shops where workers cut and polish slabs are typically divorced from the engineered stone manufacturers that supply the material. That complicates information sharing and enforcement, said Dr. Robert Harrison, a public health medical officer with the California Department of Public Health.

The U.S. has tightened limits for how much silica workers should be exposed to, but “the real problem is that OSHA” — the federal Occupational Safety and Health Administration — “is incredibly underresourced,” said Dr. Cecile Rose, a pulmonologist at National Jewish Health in Denver. “They do not have enough funding to be able to go to all the workplaces” where silica could put people at risk.

Industry groups have placed the blame on unsafe practices by fabrication shops rather than the material itself. Facilities where regulations are not enforced have endangered workers by neglecting “fundamental safety precautions,” said Eric Rose, a spokesperson for the Stone Coalition, which includes manufacturers, fabricators and distributors across the country.

“Silicosis is almost entirely preventable,” he said. “Any contractor who adheres to Cal/OSHA guidelines can ensure the safe cutting of all types of stone, be it engineered or natural, with minimal risk to their workers.”


But scientists and regulators have grown concerned about whether recommended strategies such as wet cutting, proper ventilation and wearing respirator masks can do enough to protect workers from dust so high in silica. Cal/OSHA officials have generally described silicosis as preventable, but also caution that with 93% silica content, “safe use of engineered stone may not be possible” even with proper workplace practices.

In Australia, workplace safety officials recently recommended a total ban on engineered stone, calling it “the only way to ensure that another generation of Australian workers do not contract silicosis from such work.”


More than a decade ago, U.S. physicians began seeing reports from abroad about the risks of cutting engineered stone and realized that silicosis could soon afflict workers here.

Just a few months after a CDC blog post in 2014 warned of the possible threat, health officials in Texas learned that a 37-year-old worker was suffering from the disease — the first reported case tied to high-silica countertop cutting in North America, according to researchers.


Five years later, U.S. researchers had tallied 18 such cases in four states. Among them were six men from California, all working for the same company. Public health investigators found the first one using state data about hospital discharges, identifying a young man who had cut countertops for nearly a decade.

But researchers often do not get information about hospital discharges until a year or more later, Heinzerling said. By the time the researchers learned about that first patient, he had already died at the age of 38.

Leobardo Segura Meza, who suffers from silicosis, is photographed in his Pacoima home.

Leobardo Segura Meza suffers from silicosis, an incurable lung disease that has been afflicting workers who cut and polish engineered stone high in silica.

(Mel Melcon / Los Angeles Times)

This is an epidemic of silicosis — a completely preventable lung disease — in this industry all for the sake of having a fashionable kitchen countertop.

— Dr. Ryan Hoy, who leads a respiratory disease clinic in Melbourne, Australia


Scores of silicosis cases among California countertop workers have been reported since 2019, the bulk of them in Los Angeles County, where small workshops are tucked into industrial stretches of the San Fernando Valley. The numbers have rapidly escalated, with roughly half of the 93 known cases identified this year alone. At least 10 countertop workers across California have died of the disease.

Physicians fear many more cases have gone undetected. A study by researchers at UCLA and UC San Francisco found that among dozens of California countertop workers with silicosis, more than half were initially misdiagnosed with other ailments.

“They kept working. They kept being exposed. They were getting medical care that wasn’t the right medical care and it was delaying their actual diagnosis — and they were getting worse,” said Dr. Sheiphali Gandhi, a pulmonologist at UCSF. Part of the problem is many physicians “just don’t think that this can happen anymore.”


Many doctors do not routinely ask patients about the work they do. Even when cases of silicosis are recognized, California physicians haven’t been required to report them to health officials — something the public health department is now working to change.

Then there is the question of whether suffering workers see a doctor at all. Gandhi said California has more expansive health coverage for undocumented immigrants than many other states, where such workers might have more difficulty accessing medical care.

Countertop fabricators cut stone in a workshop in Sun Valley.

Countertop fabricators cut stone in a workshop in Sun Valley.

(Brian van der Brug / Los Angeles Times)

The National Institute for Occupational Safety and Health said it cannot track the number of silicosis cases tied to countertop cutting across the U.S. because health records don’t typically include the work done by patients. Nor is there a global system for tracking such threats, experts said. Cecile Rose and her colleague Dr. Jeremy T. Hua are building an international registry of silicosis cases to better understand the scope of the problem.


In Australia, which is now weighing a national ban on engineered stone, government leaders took action after workers began telling their stories. Among them was Anthony White, a Queensland stonecutter whose illness and death at age 36 were widely covered there.

But in the U.S., many immigrants suffering from silicosis were initially reluctant to speak publicly, Gandhi said. The tiny shops where countertop cutters work are not generally unionized, leaving employees fearful of losing their jobs and unlikely to complain to government agencies, Cal/OSHA officials said in a report.

Changes are now in the works in California: After finding widespread violations of a state standard meant to protect workers from silica, Cal/OSHA is hustling to draft emergency rules. If employers don’t follow them, the agency says it could consider a ban on engineered stone.

State lawmakers are vowing to take action. Los Angeles County is also backing stronger standards to protect workers and considering a possible ban.

Some families are going after the makers of engineered stone in court. Solano is among the plaintiffs in dozens of California lawsuits that argue the slabs are “inherently hazardous.”


Manufacturers have fought such cases: Caesarstone denied that Solano and her children were damaged by “any act or omission” by the company. Cosentino said California courts lacked jurisdiction because the company “has never conducted any business in California.”

In Spain, however, a Cosentino executive admitted in court that its failure to disclose risks caused serious injury to five workers and agreed to pay them and their families more than $1 million. Cosentino said in a statement that it was found liable only for providing “insufficient technical information” to a particular fabrication shop.

A woman shows a tattoo on the inside of her forearm.

Wendy Solano shows a tattoo she got after her husband, Jose Raul Garcia Leon, died of silicosis.

(Dania Maxwell / Los Angeles Times)

Leon died in February after being disconnected from a ventilator at a Los Angeles hospital, his wife said. The couple, who had met when Solano was a teenager, were together for two and a half decades and married in a church. Leon had been a devoted father who showed up at school dances and games and loved dogs and cars and soccer, she said. For a long time, he loved his job too.


Before he died, he knew that Solano was going to pursue the lawsuit against engineered stone manufacturers. She has pressed forward, she said, because her husband was not alone.

“There are many other people whose lives are in danger, because this is not going to stop,” she said.

It’s long been known that “if you inhale high levels of silica dust, you’re going to get silicosis,” said Dr. Paul Blanc, an occupational lung disease specialist at UCSF. But “there is a kind of cyclical amnesia in occupational health where we’re aware of a problem and we give some attention to it, and then there’s a forgetting.”

And, he said, “the economic interests are certainly in favor of forgetting.”

Times staff writer Kate Linthicum contributed to this report.

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Column: A bogus new attack on COVID vaccines from Texas’ least credible politician



Column: A bogus new attack on COVID vaccines from Texas’ least credible politician

In recent times, whenever a government lawsuit swears at common sense, at the facts and at the public interest, it has been a safe bet that Texas Atty. Gen. Ken Paxton has his fingerprints on it.

Sure enough, here comes Paxton with a lawsuit charging Pfizer Inc. with systematically misrepresenting the efficacy of its COVID-19 vaccine and attempting to censor public discussion about it.

“The COVID vaccines are the miracle that wasn’t,” Paxton states in the very first line of the lawsuit, filed Nov. 30 in state court in Lubbock. “Placing their trust in Pfizer, hundreds of millions of Americans lined up to receive the vaccine…. However, the pandemic did not end; it got worse.”

There’s a lot of misinformation and disinformation packed into the 54 pages of Paxton’s legal complaint, some of it so nonsensical as to evoke laughter, starting with the fact that the reasons the pandemic got worse after the introduction of COVID vaccines had more to do with policies promoted by Paxton and his political cronies than with Pfizer.

But let’s quickly dispose with the underlying theme of Paxton’s lawsuit, which is that the vaccines don’t work.


The COVID vaccines are the miracle that wasn’t.

— Texas Atty. Gen. Ken Paxton

The Health and Human Services Department of the State of Texas itself refutes that assertion. Its website documents that at every stage of the pandemic and among every age group, vaccinated Texans experienced massively lower death rates from COVID than the unvaccinated.

In late January 2022, during the devastating Omicron wave, for instance, the COVID death rate in Texas was nearly 805 per 100,000 residents among the unvaccinated. Among those who had received the recently released bivalent booster vaccine, it was zero. In late April, the latest period surveyed, the death rate among the unvaccinated was 23 per 100,000; among the fully vaccinated it was 1.83.

Those figures match the findings of countless other studies of the vaccines’ effectiveness. A year ago, after the vaccines had been available for two years, the Commonwealth Fund calculated that they had prevented more than 18.5 million hospitalizations and more than 3 million deaths in the U.S. That saved the U.S. about $1.15 trillion in healthcare costs that would otherwise have been incurred, the fund estimated.


What’s Paxton’s purpose in challenging this reality? It would take a triumph of metaphysics to pry into his soul, but it’s fair to conjecture that he’s trying to maintain his extreme right-wing cred after his near-career-death experience in September. That’s when his Republican colleagues in the state Senate narrowly acquitted him of the corruption and bribery charges on which he had been impeached by the Republican-controlled Texas house in May.

You can’t say that Paxton doesn’t know his audience. Polls show that Republicans, self-identified conservatives and the less educated have all been overrepresented among vaccine resisters, in part because of campaigns against vaccines and vaccine mandates promoted by politicians such as Paxton.

In July 2021, when the Biden administration was trying to impose a vaccine mandate on employees of the federal government and of federal contractors, Paxton was quoted responding, “Not on my watch!” That October, he sued to block the mandates.

Official Texas statistics showing higher COVID death rates among the unvaccinated refute Texas A.G. Paxton’s claim that the COVID vaccines don’t work.

(Texas Health and Human Services Dept.)


In general terms, Paxton’s claim that the vaccines are ineffective, even dangerous, dovetails neatly with themes parroted falsely by such luminaries of the extreme right as Arizona’s Kari Lake, Sen. Ron Johnson (R-Wis.) and Florida Surgeon General Joseph Ladapo — all of which have been conclusively refuted.

These claims are no laughing matter, however. They undermine confidence in vaccines against all vaccine-preventable diseases — measles and polio, among others — threatening the health of tens of millions of children and adults.

Paxton’s immediate target is Pfizer, but his broader targets are the mRNA vaccines developed by Pfizer and Moderna, which are the leading COVID vaccines in the U.S. and much of the rest of the developed world.

He also takes shots at the Food and Drug Administration, suggesting that the FDA improperly approved the vaccines for distribution. It should be remembered that the FDA, America’s premier regulator of drugs and medical devices, has long been a target of anti-regulation conservatives, including Johnson.


So let’s take a closer look at Paxton’s case.

At its heart is a ginned-up controversy over Pfizer’s claim that its COVID vaccine is 95% effective against COVID. Paxton complains that that’s a measure of the vaccine’s reduction of “relative risk,” when it should be citing “absolute risk.”

These are abstruse notions for laypersons, so here’s an explanation. (Beth Mole of Ars Technica, a microbiologist, is very good on this topic.) Put simply, when risk is fairly low, absolute risk calculations yield low numbers. Anti-vaxxers like that, because it minimizes the perception of a vaccine’s efficacy. Relative risk, however, arguably provides a better window into a treatment’s effectiveness.

For its key clinical trial of its COVID vaccine in November 2020, Pfizer divided test subjects into two groups of about 17,500 people each. One group got the vaccine, the other got a placebo. None had shown evidence of a prior COVID infection.

Of the placebo group, 162 of the 17,511 subjects got COVID. Only eight of the 17,411 members of the vaccinated group got COVID. The relative risk calculation is 162 minus eight, divided by 162 and expressed as a percentage. That answers the question of how much less is a vaccinated person likely to contract COVID than an unvaccinated subject, and the answer is 95% less.


Absolute risk is much lower, because the original risk is fairly low — of the vaccinated group, 0.046% got COVID; of the unvaccinated group, about 0.9% did.

Paxton’s argument is that Pfizer should have claimed only a 0.86% risk reduction rate. But that’s absurd. As Mole points out, the absolute risk of an infectious disease can vary widely based on circumstance. “A person’s absolute risk of flu drops significantly when it’s not flu season,” she writes. The absolute risk of COVID declined precipitately during lockdowns, and rose when people went out into the world again.

The question relevant for vaccines is how they worked for different people in the same situation — and that’s relative risk. Pfizer’s figures suggested that for everyone in a lockdown, the vaccine would reduce the severity of infection by 95%; the same for everyone out in the world.

Paxton asserts that Pfizer’s 95% claim “created the false impression that 95% of vaccine recipients would never obtain COVID-19, full stop.”

If that’s so, it’s a flaw in our system of scientific reporting, perhaps because journalists writing about these results didn’t know the significance of relative versus absolute risk reduction. But it was certainly well understood in the scientific community and at the FDA, which had all the data at hand and knows how to do the math.


Paxton also advances a long-debunked claim that the COVID vaccines actually increase the likelihood of contracting the disease. His argument here rises from a combination of sheer ignorance — if not deliberate misrepresentation — and flagrant cherry-picking.

One of his sources is a post that appeared on an online contrarian website last year and was widely reprinted, but that grossly misinterpreted an article in the New England Journal of Medicine about the effect of vaccination on children.

The post claimed that the NEJM article showed that vaccination increased children’s susceptibility to COVID, but that was wrong, as the author of the NEJM article made clear. In fact, the article showed only that the immunity conferred by the vaccine waned over time, which pointed to the conclusion not that vaccines are a health hazard for children, but just the opposite — that they should receive booster vaccines.

Paxton’s second source is a study of COVID death rates in Scotland that, he says, “demonstrate negative vaccine efficacy.” For example, the data show that the age-adjusted death rate from COVID in the third week of December 2021 was 1.69 per 100,000 among the unvaccinated, but 6.55 per 100,00 among those with two doses of vaccine.

That’s true, but incomplete. In that week, the age-adjusted death rate among those with a booster or three doses was 0.33. And by the second week of January 2022, the rate among the unvaccinated was 10.4 per 100,000, but for those with booster shots or three doses it was only 1.5. In other words, Scotland’s survey irrefutably demonstrated that the vaccines worked, not the opposite.


The danger in Paxton’s campaign against Pfizer is that it only amplifies anti-vaccination sentiment that is spreading alarmingly around the country, especially in red states and conservative communities.

Vaccination is the quintessential medical intervention that benefits not only the vaccinated individuals but all those around them — family, friends, co-workers and employees of the services that can’t avoid contact with others. It’s the sine qua non of public-spirited medical options, and it’s our shame and misfortune that it has been redefined by the Paxtons of this world as a strictly personal choice.

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Could a monthly treatment prevent fentanyl overdoses? Scientists are working on it



Could a monthly treatment prevent fentanyl overdoses? Scientists are working on it

Scientists have developed an antibody treatment that shows promise in blocking the potentially deadly effects of fentanyl for nearly a month, raising hopes for a new tool to combat overdoses.

Tests in animals found that the treatment could effectively block the effects of fentanyl, laying the groundwork for assessing whether the medication will prove effective in humans, according to a study published Tuesday in the journal Nature Communications.

The antibodies are too big to cross the blood-brain barrier, so when they bind to fentanyl in the bloodstream, they stop the powerful opioid from reaching receptors in the brain, researchers explained. The experimental treatment, dubbed CSX-1004, was administered to animals via an intravenous infusion.

Andrew Barrett, chief scientific officer for Cessation Therapeutics, the company that developed the treatment, likened the way it works to “Pac-Man” snapping up fentanyl in the blood, which “prevents fentanyl from ever getting to the brain where it produces its effects,” both pleasurable and dangerous.


Among its possible uses: The infusion could be given as a preventive measure to patients who complete an inpatient detoxification program “to try to prevent a death in the event of a relapse,” Barrett said.

Finding such a tool has been especially urgent as the number of American lives lost to drug overdoses has climbed to more than 100,000 a year, according to federal data. The bulk of those deaths have been linked to synthetic opioids such as fentanyl, a potent drug that has also been found in counterfeit pills and is often mingled with other drugs such as methamphetamine.

Scientists at Cessation Therapeutics in San Diego, teaming up with researchers from Harvard Medical School and McLean Hospital in Massachusetts, performed a series of tests in rodents and squirrel monkeys to gauge CSX-1004’s effects and found that a single infusion protected the primates from fentanyl for more than three weeks.

One set of experiments included eight monkeys who were given fentanyl multiple times over 28 days. The animals first received a placebo to see how they responded to the opioid without treatment. Later, they received either a low or high dose of CSX-1004 at the outset of the cycle and were given fentanyl six times.

Breathing measurements showed the medicine was most protective for the first week and waned steadily after that, with the higher dose showing significant effects for as long as 28 days.


The experimental treatment reversed slowed or shallow breathing, an overdose symptom that can lead to death, researchers reported. And it worked on other dangerous fentanyl analogs like carfentanil —a synthetic opioid intended for sedating large animals — without affecting oxycodone or other opioids prescribed by doctors for pain management, the study authors found.

Cessation Therapeutics has started assessing the safety of the treatment in human volunteers and plans to next gauge its effects in people with opioid dependency, Barrett said. If CSX-1004 proves effective in clinical trials, the researchers said, it could protect people who are at high risk of overdose and become a bridge to other treatments that address craving and withdrawal symptoms, researchers wrote.

“We’re in that crisis situation where we need all hands on deck to help prevent people from dying,” said Kelly E. Dunn, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine who advised the company on the design for human trials of the medication but was not involved in data collection for the new study.

“These transformative approaches are exactly what we need,” because with existing tools, “we’re just not making the headway that we would hope.”

Arming people with antibodies has long been explored by researchers as a potential way to protect people from a range of addictive drugs.


With fentanyl deaths up sharply since the start of the COVID-19 pandemic, the research on antibody treatments “really opens a door for a tool that will help us address very high-risk populations,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which funded the new research. Among them are people exiting jails or prisons, who face an alarmingly high risk of overdose in the weeks after they are released, she said.

Volkow added that the treatment could help protect people who use cocaine or methamphetamine, who are in danger of overdosing when their drugs are contaminated with fentanyl. For those people, she said, “you will dramatically reduce the risk for dying.”

The antibodies could have advantages over extended-release naltrexone, a medication that blocks the effects of opioids, Barrett said. Monthly injections of naltrexone require people to abstain from opioids for a while before beginning the medication.

“Your tolerance goes down very quickly” in that time, said Dr. Melissa B. Weimer, an associate professor of medicine and public health at Yale who was not involved in the study. As they undergo withdrawal, “most people who have severe opioid use disorder will be quite uncomfortable during that period of time. That places them at risk to not start treatment,” leaving them unprotected and at higher risk of opioid overdose.

In addition, people taking naltrexone cannot use other common medications to reduce opioid cravings such as methadone. And because naltrexone blocks all opioids, it can complicate pain management in emergencies. Based on the findings so far, CSX-1004 doesn’t share those drawbacks, Barrett said.


The research team is still studying whether CSX-1004 causes “precipitated withdrawal” — an abrupt and sickening experience that people have suffered with some treatments for opioid use disorder. “We don’t know the answer yet, but we don’t think it will be a profound withdrawal” because of the way it works, Barrett said.

Weimer said that another important question is what happens if people use more fentanyl to try to override the effects of the medication. Physicians will need to know if people could be at higher risk of overdose as the effects of the medication wear off, she said.

And then there is the practical question of “what proportion of individuals would opt for this treatment,” said Dr. Larissa Mooney, an addiction psychiatrist at UCLA. “People who choose this therapy option would have to be motivated to receive a treatment that will reduce the effects of fentanyl.”

Scientists have also tried to develop vaccines that prompt the body to produce antibodies that can protect against fentanyl and other illicit drugs. Dr. Thomas Kosten, a psychiatrist at Baylor College of Medicine who has been working on a fentanyl vaccine, said antibody-based therapies might have some practical drawbacks.

The cost of making monoclonal antibodies like CSX-1004 is “rather high,” Kosten said, and “you can’t just store a monoclonal in your closet, you have to refrigerate it. … So in some ways, it’s not a practical solution to what’s a huge problem.” He also questioned whether health insurers would cover the costs of an infusion treatment for substance use disorder.


Volkow said that if a treatment like CSX-1004 proves effective in humans, “there is a lot of room for innovation” to address practical issues. “It would make sense to do that innovation if it does look like it’s going to work.”

Cessation Therapeutics said it is already developing an injectable version of the antibody treatment that could be more convenient. In the new paper, the authors wrote that monoclonal antibodies could be priced around the same level as some existing treatments for opioid use disorder.

Dunn of Johns Hopkins University urged more investment in new medications and approaches to thwart overdoses. There is “very little general investment in this area,” she said, despite the alarming number of lives lost. “We need that investment to be able to really make big changes.”

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COVID, flu, RSV on the rise in California. Is another ‘tripledemic’ coming?



COVID, flu, RSV on the rise in California. Is another ‘tripledemic’ coming?

Respiratory virus season is ramping up in California, prompting health officials to renew their calls for residents to get vaccinated in hopes of reducing potential pressure on health systems across the state.

While conditions so far are nowhere near as daunting as last autumn — when hospitals labored under the strain of a “tripledemic” spawned by wide simultaneous circulation of COVID-19, flu and respiratory syncytial virus — the transmittable trio is on the rise.

Data show new COVID and flu hospital admissions are increasing in California, and Fresno County was forced to take steps last month to stem a tide of patients arriving in its emergency rooms, instructing ambulances to not transport patients to hospitals if they are stable and not suffering from an emergency.

Nationally, “RSV season is in full swing. The flu season is just beginning across most of the country, though accelerating fast. And while we’re seeing relatively low levels of COVID, COVID is still the primary cause of new respiratory hospitalizations and deaths, with about 15,000 hospitalizations and about 1,000 deaths every single week,” Dr. Mandy Cohen, director of the U.S. Centers for Disease Control and Prevention, told a House of Representatives subcommittee last week.

Of the three viruses, RSV is the most concerning in California in terms of community transmission, said Dr. Peter Chin-Hong, an infectious diseases expert at UC San Francisco. In Los Angeles County, for data released on Thursday, 13% of specimens tested for RSV came back positive, up from 9% two weeks prior.


“It is pretty high [and] hasn’t started to go down yet,” Chin-Hong said.

But despite recent increases, health officials say they have yet to see the sort of widespread issues that made the previous respiratory virus season so challenging. Last year at this time, children’s hospitals across California were under stress, with exceptionally high hospitalization rates related to RSV — including in Orange County, which declared a health emergency related to the virus.

“The interesting thing with RSV is that the levels of hospitalization isn’t the same crisis levels in pediatric hospitals as one year ago, when it peaked in November,” Chin-Hong said.

One possible reason is that since RSV was pretty severe last autumn, there might be some carryover immunity. Chin-Hong said that UC San Francisco’s pediatric hospitals are now about 90% full — “average for this time of year” — as opposed to being beyond capacity last year.

The availability of RSV vaccines for babies and young children, the elderly and those who are pregnant may also be helping, he added.


As of Nov. 18, coronavirus levels in L.A. County wastewater were at 24% of last winter’s peak, up from 13% the prior week.

That level, though still considered relatively low, is the highest seen since the end of September, when the county was recovering from a late summer COVID-19 uptick.

And for the week that ended Nov. 25, about 8% of specimens tested for flu at L.A. County labs were positive for the virus, up from about 7% the prior week.

“We believe flu season has begun,” the county Department of Public Health said in a statement to The Times. “Influenza is circulating in the community and on the rise.”

Doctors are also closely watching the latest upstart coronavirus subvariant — nicknamed “Pirola” but officially designated BA.2.86.


The CDC estimates that BA.2.86 constituted 8.8% of coronavirus cases over the two-week period that ended Nov. 25, up from 3% for the prior two-week period.

The CDC has been concerned that the strain’s unusually high number of mutations might empower it to more easily infect those who had previously caught the coronavirus or received an older vaccine formulation. However, emerging evidence indicates that the latest COVID-19 vaccine formula appears to provide strong protection against Pirola.

The rise of BA.2.86 should further encourage people, especially older individuals, to get the new vaccine this autumn, doctors say, as relying on old booster shots or natural immunity from a past infection may not be protective enough.

“If somebody’s at risk for getting seriously ill, particularly those who are older than 65, you can’t really rely on getting the old shot last year to really carry you through this winter,” Chin-Hong said. “You really need some replenishing of the antibodies, and that’s what the new vaccine will do.”

In L.A. County, just 21% of seniors have received the updated COVID-19 vaccination this autumn. Orange County reports that about 25% of its seniors have received the updated shot, as have 27% of seniors in San Diego and Ventura counties. In Riverside County, about 20% of seniors have received the latest shot, as have 17% of seniors in San Bernardino County.


Senior vaccination rates are much higher in the San Francisco Bay Area. Santa Clara County, the region’s most populous, has a senior vaccination rate of 36%; while San Francisco and Alameda County report a rate of 38%. Contra Costa and San Mateo counties report a rate of 40%, while Sonoma, Marin and Napa counties report even higher figures.

Statewide, 27% of California’s seniors have received the newest COVID-19 vaccination.

Meanwhile, global health officials are monitoring a significant rise in respiratory illness among children in northern China. Chin-Hong characterized the situation there as an “unprecedented number of kids and adolescents who are getting sick; a proportion of those are going to the hospital in very large numbers” — serious enough to prompt the World Health Organization to inquire what was going on.

Cohen, the CDC director, told House lawmakers last week that “we do not believe this is a new or novel pathogen,” but a combination of illnesses such as COVID-19, flu, RSV, as well as a bacterium called mycoplasma pneumoniae that can infect the respiratory system and trigger bronchitis or pneumonia.

“Chinese authorities advised that there has been no detection of any unusual or novel pathogens or unusual clinical presentations, including in Beijing and Liaoning, but only the aforementioned general increase in respiratory illnesses due to multiple known pathogens,” the WHO said in a statement last month. “They further stated that the rise in respiratory illness has not resulted in patient loads exceeding hospital capacities.”


Other areas of the world noting reports of mycoplasma or a rise in pneumonia affecting children include Denmark and the Netherlands, Chin-Hong said.

Stateside, Warren County, Ohio, has also reported what local officials called “an extremely high number of pediatric pneumonia cases being reported this fall season.” No deaths have been reported, however, and most of the ill children recover at home and have been given antibiotics.

“The increase in reported pneumonia cases is not suspected of being a new/novel respiratory virus but rather a large uptick in the number of typical pediatric pneumonia cases,” the Warren County Health District said in a statement. “There has been zero evidence of this outbreak being connected to other outbreaks, either statewide, nationally or internationally.”

Some health officials have taken notice of reports from China. A statement posted to a Taiwanese government website Sunday said that officials there have not seen “a rapid surge in respiratory infections similar to China,” but rather a drop in flu-like cases in recent weeks.

Taiwan’s premier, Chen Chien-jen, who is also an epidemiologist, was quoted in the government statement as saying the surge in respiratory illness in China is mostly related to flu, but also rhinoviruses — the most frequent cause of the common cold — mycoplasma pneumoniae, adenoviruses and coronaviruses. Still, “the government has increased surveillance measures for related infectious pathogens,” the statement said.


There are several possible, competing explanations as to why China is seeing such a rise in respiratory illness among children. One is that this is the first autumn-and-winter season after the end of COVID-era lockdowns there, and children are going to see a surge in illness after years of not being exposed to viruses, Chin-Hong said.

Mycoplasma is a possible culprit, as the bacterium surges every few years or so, but it can be treated with antibiotics.

The third explanation, Chin-Hong said, is there’s “something that we don’t know about yet that’s causing this illness. And I guess some of that rationale is that we’re also seeing ‘kid pneumonias’ in other parts of the world at the same time, [places that] reopened much earlier than China.”

One reassuring data point is there haven’t been reports of more kids dying from this wave of pediatric pneumonia, or overly taxing hospitals. “But again, it’s something to watch as the season progresses,” Chin-Hong said.

For children who do get a respiratory illness, a warning sign to take them to the hospital is if they are struggling to breathe, Chin-Hong said. A warning sign for young children is if they have difficulty feeding or become lethargic.

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