Science
Children's Hospital keeps limits on transgender care amid challenges to Trump order
Children’s Hospital Los Angeles is keeping its recent restrictions on gender-affirming care in place as hospital officials review decisions by federal judges to pause parts of President Trump’s executive order targeting the use of puberty blockers, hormones and other procedures for transgender youths.
In separate rulings, U.S. District Court judges in Baltimore and Seattle issued temporary restraining orders to put parts of Trump’s executive order on hold, including a section that directs federal agencies to ensure that hospitals receiving federal research or education grants “end the chemical and surgical mutilation of children.”
In an email to staff last week, hospital chief executive Paul Viviano and chief operating officer Lara Khouri said they welcomed the temporary restraining orders issued by the federal judges, but were still reviewing them to understand their implications.
One of them “disappointingly appears to apply only to the three states that filed the lawsuit” and the other only blocked the section of the executive order “pertaining to certain federal agencies withholding or conditioning funds” based on whether gender-affirming care is provided for youth, the CHLA leaders said.
CHLA said earlier this month that it had paused the initiation of hormonal therapy for “gender affirming care patients” under the age of 19 as it assessed Trump’s executive order. In addition, the L.A. hospital also said it had already halted gender-affirming surgeries for minors
Restricting hormonal therapy “was a difficult decision and one that was taken quickly,” Viviano and Khouri said in their email to hospital staff. The decision “was communicated poorly and for this, we apologize.”
A CHLA spokesperson said Wednesday that there were no updates to its policy on gender-affirming care.
LGBTQ+ advocates and L.A. City Councilmembers Ysabel Jurado and Hugo Soto-Martinez joined hundreds of people who protested outside the L.A. hospital this month, saying that the move jeopardized the health of transgender youth and defied the guidance of major medical organizations like the American Academy of Pediatrics, which recommends transgender youth have access to gender-affirming care.
The move by CHLA to restrict such care was celebrated by groups such as the California Family Council, which has decried medical care involved in gender transition as harmful for youth and urged other hospitals to follow suit as facilities in New York, Virginia and elsewhere paused services.
In a letter sent two weeks ago, California Atty. Gen. Rob Bonta’s office cautioned the L.A. hospital that withholding gender-affirming care from transgender youth could run afoul of California law. LGBTQ advocates have also stressed that many of the changes outlined in the executive order hinge on federal rulemaking that has yet to be carried out.
In their message to staff, CHLA’s Viviano and Khouri stressed that the hospital relies heavily on funding from the federal government. “In all our combined decades in hospital administration, we can’t think of a time when there was more at risk for CHLA,” they wrote. “We want to be clear that every decision we make is with all our patients and team members top of mind.”
Parent Jesse Thorn, whose children receive care at CHLA, said he sympathizes with its fears, but “I also would ask them to search their hearts and say, ‘What other groups of people would we stop providing care for?’ Where do they draw the line here?”
Families of transgender youth and others have sued to try to stop Trump’s executive order, saying it violates the rights of transgender youth. In Baltimore, U.S. District Court Judge Brendan Hurson granted their request for a temporary restraining order last week, saying that the executive order “seems to deny that this population even exists, or deserves to exist” and that disrupting their care could cause “irreparable harm.”
The restraining order in that case lasts 14 days but could be extended. Another federal judge in Seattle also granted a temporary restraining order pausing the executive order on Friday, in response to a lawsuit by Democratic attorneys general from Washington state, Oregon and Minnesota. The order issued Friday says it applies “within the Plaintiff states,” which don’t include California.
Dannie Ceseña, director of the California LGBTQ Health and Human Services Network, said that as of last week, he didn’t know of any California healthcare providers besides CHLA that had continued to suspend care for transgender youth after Bonta had spoken out publicly about the issue.
The Associated Press contributed to this report.
Science
Lithuania’s Peat Bogs Could Help the Climate and Defend the Border, Too
In a scrubby forest an hour outside the Lithuanian capital on a recent day this spring, excavators were digging ditches and tree harvesters were whirring in an effort to restore a waterlogged, mosquito-infested ecosystem that was drained in the Soviet era.
The reason is twofold: to help the climate and to defend the country from invasion.
The area was once a vast peat bog, and peat bogs are highly efficient at storing planet-warming carbon dioxide. They also happen to be very good at stopping tanks, because the spongy soil can’t support the weight of armored vehicles. The tanks get stuck and sink, often permanently.
Tomas Godliauskas, the Lithuanian vice minister of defense, said the bogs would form “an integral defensive line” when combined with other military tactics. The project also has the advantage of being relatively cheap compared with other measures like tank ditches and minefields, he added.
Lithuania isn’t the only European Union country using bogs to deter a Russian invasion. Latvia and Finland, for example, are also seeking to restore bogs for both environmental and defense purposes. And Ukrainian bogs helped to delay Russian troops in a failed push toward Kyiv in 2022.
Richard Hooker, a former director at the National Security Council who’s now a senior fellow at the Atlantic Council, a research organization based in Washington that focuses on international security, said peatland restoration could play an important role in Lithuania’s defense against an invasion from the east.
He noted that only one major highway runs from Minsk, in Byelorussia, to the Lithuanian capital, Vilnius, and that the Russian Army is heavily mechanized, without the kind of light infantry units that the U.S. Army has. That means restored, impassible peat bogs would force invading troops onto roads and trails, where they would be more vulnerable.
“The idea that you can use natural obstacles to tie in with man-made obstacles to slow down an attacker is an excellent one,” Mr. Hooker said. “A lot more could be done than has been done, but the early signs anyway are promising.”
The hazards of the bogs were illustrated in March last year, when a 70-ton M88 armored recovery vehicle from the U.S. Army sank during a training exercise near Pabrade, a city in eastern Lithuania near the border with Belarus. Four crew members died.
The bog restoration project is part of Lithuania’s total defense doctrine, a security strategy mobilizing the military, civilian and private sectors to be prepared in case of Russian aggression. The country is looking to restore 6,000 hectares of peatlands, Mr. Godliauskas said.
But it’s about more than just defending the border. It’s also about carbon capture.
Peat bogs form when oxygen-poor conditions in wetlands prevent bacteria and fungi from fully breaking down organic matter like plants and dead animals. In Lithuania, some of the resulting peat was extracted by the Soviet authorities to burn in power plants and to expand agriculture.
The restoration effort is a priority across multiple agencies in the government, said Aira Paliukenaite, Lithuania’s vice minister of the environment. The ministry is planning for restoration to continue for the next 30 years as a part of its policy of aligning with the European Union’s Nature Restoration Law.
That measure requires every country in the bloc to implement a plan, with targets, to mitigate carbon emissions and restore biodiversity and habitats in the coming decades.
Lithuania appears to be in a good starting position. The country still has large quantities of undisturbed peat underground. By rewetting it, officials said they could transform the land back into a what’s known as a carbon sink, or storage system, because peat can lock away carbon for much longer than forests can.
It’s not a simple process, though. The technical planning and site preparation can take years. The projects are still in the early stages, especially those along the border, but they are starting to work with nongovernmental groups like the Foundation for Peatland Restoration and Conservation.
While some in the country are skeptical about the restoration process and its efficacy, others are welcoming the plan.
Albertas Lakstauskas, 52, a teacher and politician, has lived his whole life in Zasliai, a small town near one of the foundation’s projects, the restoration of about 150 acres of drained land where peat was extracted to supply energy to the Soviet Union.
Mr. Lakstauskas said he, like some others in the town, was doubtful that peat bogs alone could stop a Russian invasion, but he said he thought supporting the environment was a matter of national pride.
“If we can do some things to do better, I think that’s a good opportunity,” he said. “And I choose to participate.”
Science
Hantavirus strikes a cruise ship, Californians at risk: Is this the start of something much worse?
The voyage was marketed for explorers eager to venture to “the edges of the map,” from Antarctica to some of the most remote islands in the world.
It would be a tantalizing trip for tourists with an appetite for adventure — less about trips to the spa and lounging by the pool than a chance to see landscapes few humans have ever laid eyes upon.
But this call of the wild was ultimately among the factors that turned the MV Hondius into the epicenter of the first-ever deadly outbreak of hantavirus aboard a modern cruise ship. Eleven cases have been linked to the outbreak so far. Three people are dead, and two others are in intensive care.
The incident — with a few uncomfortable echoes of the onset of the COVID-19 pandemic — has sparked concerns and questions. Chief among them: Was this a freak occurrence, or a sign of things to come?
“I think it’s both,” said Dr. Peter Chin-Hong, an infectious diseases expert at UC San Francisco.
Hantavirus had previously been an obscure illness. Typically spread through exposure to infected rodents’ urine and droppings, it’s notoriously difficult to diagnose and has no specified antiviral treatment. It was definitively identified relatively recently, in a field rodent near the Hantan River in South Korea in 1978, and finally explained the mystery cause of the “Korean hemorrhagic fever” that infected thousands of United Nations troops during the Korean War.
Though rare, the disease has drawn attention in the U.S. over the decades due to its incredibly high case-fatality rate: up to 50% among the strains that circulate in the Americas.
Western Hemisphere hantavirus strains are so deadly because they can attack the lungs and make them leak. The strains that circulate in Asia and Europe — where hantavirus is more common, and generally less deadly — attack the kidneys.
Those who are severely ill can only be treated by putting them on life-support machines that directly add oxygen to their blood.
Despite its severity, the overall impact of the disease in the Americas has remained muted for two main reasons. First, most strains of hantavirus do not spread directly from person to person. And second, many people will not come into contact with rodents carrying the virus during their daily lives.
Excursions that attract people like those aboard the MV Hondius, however, blur the second line. Launched in 2019, the ice-strengthened vessel offered passengers opportunities for “maximum contact with the nature and wildlife you traveled so far to see,” according to its operator, Oceanwide Expeditions.
“The broader pattern is definitely not random,” Chin-Hong said, “which is more expedition tourism visiting remote areas.” Climate change, he added, is also increasing the range of certain infectious diseases.
“The hantavirus in the cruise ship is unprecedented, and reflects kind of like a perfect storm of the expedition cruise through a remote area, environmental exposure potentially during a short excursion, and the hantavirus — this particular Andes virus — being capable of going from person to person,” he said.
The Andes virus, which circulates in Argentina and Chile and is mainly spread among the long-tailed pygmy rice rat, is the only hantavirus strain known to be able to transmit from human to human.
Such inter-person spread occurred previously in a deadly outbreak in Argentina. From November 2018 through February 2019, the Andes virus infected 34 people there, killing 11, according to a study in the New England Journal of Medicine.
There were 149 passengers and staff aboard the MV Hondius when the ship publicly disclosed that three of its passengers had died. Of the 18 U.S. citizens on the ship, one passenger initially tested positive for hantavirus overseas but also got a negative test result; a follow-up test is now being done in the U.S., and results are expected in a day or so, Dr. David Fitter, incident manager for the Centers for Disease Control and Prevention’s hantavirus response, told reporters in a briefing Wednesday.
That patient, who is not ill, is being monitored at a biocontainment unit at the University of Nebraska Medical Center.
Five California residents have been potentially exposed to the virus — four aboard the cruise ship, and the fifth while on a plane with an infected person in South Africa. All five are asymptomatic and appear healthy, the California Department of Public Health said Wednesday.
Most infected people actually don’t seem to spread the Andes virus, Chin-Hong said. But some do end up being “superspreaders,” infecting others at exceptional rates.
That’s what happened in 2018-19. A single person got the Andes virus from a rodent, and the outbreak was spread mainly by three sick people who attended crowded social events, the medical journal study said — including a birthday party and a wake for one of the hantavirus victims.
In the case of the MV Hondius, the first person believed to have contracted the hantavirus was a man from the Netherlands who was possibly exposed to rodents while bird-watching prior to boarding the ship before it left for its transatlantic journey, according to authorities. He had spent the prior three months traveling through Argentina, Chile and Uruguay, the World Health Organization said. The man boarded the ship on April 1, developed symptoms on April 6 and died on board on April 11.
“At present, the thought is that it was an ornithologist who was visiting a dump, where many rare birds congregate, and was exposed to a rodent that was in the garbage dump,” said Dr. Elizabeth Hudson, regional physician chief of infectious diseases for Kaiser Permanente Southern California.
From there, she said, the realities of cruising at sea set the stage.
“Cruise ships are a perfect environment for the spread of infectious diseases, unfortunately,” Hudson said. “You have a population of people who are living together in a relatively small and confined space, with most folks spending a good part of their time indoors eating and socializing. This means that if there’s an infection that can spread easily from person to person, the very nature of the cruise ship allows this to happen more readily.”
It can also be difficult to isolate sick people aboard a cruise ship. The MV Hondius’ doctor fell ill with hantavirus, as did another crew member who was working as a guide. Among the symptoms people reported were gastrointestinal illness, fever, general malaise, pneumonia, fatigue, aches and respiratory symptoms.
Extensive spread of the hantavirus outbreak is not expected, health experts say. Unlike COVID-19, the Andes virus is much harder to transmit from person to person.
In past outbreaks of the Andes virus, taking steps like isolating people who are sick — and asking those who aren’t sick but have been exposed to stay away from others — have brought outbreaks to an end.
It can take up to six weeks from the time a person has been exposed to the virus to the onset of illness. That “takes us to the 21st of June,” WHO Director-General Tedros Adhanom Ghebreyesus said at a news briefing Tuesday. “WHO’s recommendation is that they should be monitored actively at a specified quarantine facility or at home for 42 days from the last exposure.”
One Californian who was on the MV Hondius, but left the ship before the hantavirus outbreak was discovered, is back home in Santa Clara County and remains healthy. That person is being asked to limit trips outside the home during the 42-day period to see if they become ill, according to Dr. Erica Pan, director of the California Department of Public Health.
Another Californian, from Sacramento County, is also back at home after sitting within a couple of seats of a hantavirus-infected passenger who was briefly on a flight from South Africa to the Netherlands before being asked to deplane due to her illness. The Californian remains healthy, but is also being asked to limit activities with others.
“They’re not to share a bed with someone else. … They shouldn’t attend social events, and they should not visit any crowded venues,” Pan said.
Two other Californians who were on board the MV Hondius are healthy and are being observed at the University of Nebraska Medical Center’s National Quarantine Unit, the only federally funded quarantine unit in the U.S. Thirteen others are also being observed there, while two are at Emory University in Atlanta.
The California Department of Public Health said it didn’t know when the Californians in Nebraska would return home.
California health officials Wednesday said that there was a fifth state resident who was potentially exposed to the hantavirus. That person left the cruise ship, returned briefly to California, then left for additional travel, all before the outbreak was announced.
That person, who remains healthy, is now in the remote Pitcairn Islands in the south Pacific Ocean — halfway between Peru and New Zealand.
Despite concerns surrounding this latest outbreak, the Andes virus is considered a poor candidate to become the next pandemic. One thing that makes COVID spread so easily is that people can infect others even if they’re not personally experiencing symptoms.
With COVID, people could get sick just by breathing in aerosolized viral particles floating around and pushed across an entire room by an air conditioning vent.
With the Andes virus, by contrast, people probably need to be symptomatic to spread illness.
The 2018-19 Andes virus outbreak in Argentina also showed that close contact is needed for transmission, including “being seated very close” to the sick person, Chin-Hong said.
Those at highest risk of getting hantavirus from another human have “some direct exposure to bodily fluids,” Pan said.
The first U.S. case of Andes virus actually occurred in January 2018, in a woman who had stayed in cabins and youth hostels in the Andes region of Argentina and Chile. She did not infect anyone else after her return despite taking two commercial flights in the U.S. when sick and before she was hospitalized in Delaware. She eventually recovered at home.
More morbidly, health experts note, the Andes virus is also too deadly for it to spread rapidly in a pandemic situation.
So why are we seeing this outbreak now?
Hantavirus appears to be expanding its range in Argentina. A report published in December noted that hantavirus’ range in that country was moving southward.
“This redistribution indicates either ecological shifts affecting rodent reservoir populations, increased human encroachment into previously untouched habitats, or improved surveillance detecting cases in areas with lower historical awareness,” said the report, published by the Biothreats Emergence, Analysis and Communications Network, or BEACON, based at Boston University’s Center on Emerging Infectious Diseases.
From mid-June through early November, there were 23 confirmed cases in the country, with nine deaths. No human-to-human transmission was reported during that time period.
Another report suggested changing temperatures and rainfall also affected hantavirus transmission in Argentina.
Another well-documented example of that phenomenon is the rise of dengue viruses in Argentina, which are spread by mosquitoes. Rising temperatures are making the climate more suitable for transmission, one study suggested.
“Climate change has definitely had an impact on Argentina,” Chin-Hong said. “As it gets warmer, you potentially have more rats.”
Science
5 Great Stargazing Trains
Stargazing, it turns out, doesn’t have to be a stationary activity.
On railway lines around the world, from the Arctic Circle to New Zealand, a select set of evening train excursions take riders deep into dark-sky territory — some en route to remote station stops decked out with telescopes, others featuring onboard astronomers.
These five rail journeys (all of which are accessible) range from two- to three-hour desert outings to a hunt for the northern lights. One route even has a planetarium on rails. All promise a renewed appreciation of train travel — and of our pale blue dot’s improbable place in the cosmos.
Nevada
The Great Basin Star Train
Any stargazing train worth its salt requires one thing: a dark sky. The Star Train resoundingly checks that box, traveling through a part of eastern Nevada that is one of the least-populated places in the lower 48.
Run by the Nevada Northern Railway in partnership with nearby Great Basin National Park, the train departs the historic East Ely Depot, in Ely, Nev., early enough in the evening to catch the sunset over the Steptoe Valley, and then cruises through darkening skies to its destination: a remote corner of the desert appropriately called Star Flat, where a stargazing platform outfitted with telescopes awaits. There, riders disembark (equipped with red-light necklaces to help preserve their night vision) and take turns viewing the cosmos, guided by professional astronomers. (Last year’s onboard stargazing guides came from Caltech; in previous seasons, the National Park Service’s Dark Rangers, who specialize in night-sky activities, accompanied trips.)
The Star Train makes its two-and-a-half-hour round-trip journey most Friday evenings between mid-May and mid-September, and tickets ($65 for adults) can sell out almost a year in advance — though members of the Nevada Northern Railway Museum get early access. Alternatively, the railroad’s more frequent Sunset, Stars and Champagne excursions trade telescopes for desert sundowners but feature the same expert stargazers and the same Nevada night sky, which is often dark enough to see the Milky Way with the naked eye.
New Mexico
The Stargazer
While plenty of heritage railroads across the United States offer twilight rides and nighttime excursions, at the moment there’s only one other dedicated, regularly scheduled stargazing train in North America besides the Star Train: the Stargazer, operated by Sky Railway, in Santa Fe, N.M.
Much like its Nevada counterpart, the Stargazer makes a two-and-a-half-hour round trip through dark-sky country, though in this case, the journey really is the destination, because it doesn’t make any stops. More of a rolling night-sky revue, the Stargazer features live music and professional astronomers who share their celestial knowledge and stories as the train rumbles into the vast Galisteo Basin south of Santa Fe. Sky Railway’s colorfully painted trains feature heated, enclosed passenger cars to stave off the evening chill and flatbed cars open to the night sky.
Departing from the Santa Fe Depot downtown, the train normally runs once a month (adult tickets from $139, including a champagne welcome toast). Sky Railway also occasionally schedules excursions for special celestial events.
New Zealand
Matariki Rail Experience
With its alpine landscapes and rugged coastline, New Zealand’s South Island is practically tailor-made for scenic daytime train journeys. But when night falls, the sparsely populated island — home to the Southern Hemisphere’s largest International Dark Sky Reserve — is heaven for stargazers, too.
This year, Great Journeys New Zealand, which operates the country’s tourist-centric long-distance trains, is offering a special nighttime run of the Coastal Pacific, whose route skirts the South Island’s northeastern coast. Timed to Matariki, the Maori new year, which is heralded by the first rising of the Pleiades star cluster, the eight-hour round trip from Christchurch is a cultural and astronomical celebration.
After the first half of a four-course onboard dinner, the train arrives in Kaikoura, in dark-sky country, for a guided stargazing stop with a range of telescopes — and fire pits and a night market. (The rain plan involves a virtual stargazing session at the local museum using virtual reality headsets.) Dinner resumes back on the train as it returns to Christchurch. This is a strictly limited engagement, on the rails for one night only: July 11, for 499 New Zealand dollars, about $295, per person.
In the far northern reaches of Norway, inside the Arctic Circle, you can ride a train that chases another wonder of the night sky: the aurora borealis. Twice a week from October to March, the Northern Lights Train takes its riders into the dark polar night in pursuit of the aurora’s celestial light show.
From the remote town of Narvik, the train travels along the Ofoten Railway, the northernmost passenger rail line in Western Europe. The destination on this three-hour round-trip excursion (1,495 kroner, or about $160) is Katterat, a mountain village accessible only by rail and free of light pollution, making it an ideal place to spot the aurora. At the Katterat station, local guides and a campfire cookout await, as does a lavvu, the traditional tent used by the Sami people of northern Scandinavia, offering a respite from the cold (as well as hot drinks and an open fire for roasting sausages).
And aboard the train, the lights stay off, which means that on a clear night, you might even catch the northern lights on the way there and back.
Leave it to Japan to take the stargazing train to another level.
The High Rail 1375 train — so named because it runs along Japan’s highest-elevation railway line (the high point is 1,375 meters, or roughly 4,500 feet, above sea level) — is one of JR East’s deliberately unhurried Joyful Trains, which the railway company describes as “not only a means of transportation, but also a package of various pleasures.” This astronomy-themed train certainly packs plenty of joy into its two cars, with seat upholstery inspired by constellations, a snack bar, a souvenir shop and a planetarium car with a library of astronomy books and images of the night sky projected onto its domed ceiling.
The train makes two daytime runs along the mountainous Koumi Line, taking a little over two hours to travel between Kobuchizawa (accessible by express train from Tokyo) and Komoro. But the main event is the High Rail Hoshizora (“Starry Sky”) evening trip, which includes an extended stop at Nobeyama Station (the highest in the country) for a guided stargazing session. A one-way ride on High Rail 1375, which runs on weekends and occasional weekdays, requires a seat reservation if you’re traveling on a Japan Rail pass, or a stand-alone ticket plus seat reservation (2,440 yen, or about $15). And remember to preorder a special “Starry Sky” bento box.
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