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Opinion: How measles reemerged as a threat in California and elsewhere

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Opinion: How measles reemerged as a threat in California and elsewhere

The measles virus is resurging in the U.S. despite the long-standing availability of a vaccine that provides nearly life-long immunity. In the past few weeks, hundreds of people were exposed to a child with the virus in a Northern California healthcare facility; our state is one of 17 jurisdictions with reported measles cases in 2024, higher than seen in recent years.

Measles is an extremely transmissible pathogen: On average, one infected person infects 12 to 18 unvaccinated people. The airborne virus can linger in floating aerosols long after someone has left a room, and the common symptoms, which include rash, a high fever, watery eyes, cough and a runny nose, typically take a week or two to appear.

Infections can also cause immune amnesia, in which your immune system becomes better at fighting measles and worse at fighting other infections you were previously protected against. In rare cases it also leads to death, more often in children than adults, from respiratory or neurological complications, including a type of brain swelling in young children that can appear years after the initial measles infection.

Before the measles vaccine was introduced and licensed in 1963, the Centers for Disease Control and Prevention cites an annual average of 549,000 cases (with likely millions more going unreported), 48,000 hospitalizations, nearly 500 deaths and 1,000 people with chronic disability. By 2000, thanks to vaccination, measles was declared eliminated in the U.S. But because of cases from people arriving here from other countries, combined with pockets of low vaccination, we are seeing outbreaks among unvaccinated people.

Policy can worsen the issue. Last month in Florida, following an outbreak at an elementary school, the state’s surgeon general left the decision to parents whether to send their children to school, citing high levels of community immunity as the rationale for not following the usual protocols. That cavalier response risked a much worse outbreak. A more standard response would have called for unvaccinated students and staff to be vaccinated and quarantine for 21 days (the time frame in which the disease could develop).

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It might be tempting to Californians to dismiss this as a Florida problem. But our state has a measles time bomb on our hands. Ideally communities should hit at least 95% vaccination to achieve herd immunity. But a recent nationwide survey found that Southern California alone has 350 schools falling short of the desired vaccination threshold, meaning a single measles case in these schools could easily become an outbreak among the unvaccinated.

Misinformation around the measles vaccine has been an issue for years. A debunked but influential 1998 research paper in the Lancet, a British medical journal, suggested a link between the vaccine, which babies can receive starting at the age of 12 months, and autism. The paper was retracted in 2010 (and the authors were later reported to have committed fraud). But measles vaccine rates dropped in England throughout the early 2000s.

In California, a 2014 outbreak at Disneyland was connected to more than 140 cases in North America, with declining vaccination rates one contributing factor. A recent systematic review of the reasons why parents reject measles vaccination for their children found fear of autism the most cited concern. Those who were hesitant more frequently cited the internet and social media as information sources on vaccines than those who were not hesitant.

In recent years hesitancy has grown as misinformation about the COVID vaccine has made some parents doubtful of routine inoculations. Vaccination exemptions during the 2022-23 school year reached the highest level ever reported in the U.S., increasing in 40 states and Washington, D.C., and 10 states reaching exemption rates of above 5%. According to the CDC, the 93.1% vaccination rate among eligible children puts about 250,000 kindergarten students at risk for measles.

Encouragingly, we’ve seen in our own state that vaccine hesitancy can be reversed. Marin County had among the lowest measles vaccination rates in the state in 2011 and now has coverage close to 99% among children entering school. State contact tracing efforts that were strengthened during COVID-19, including the California Connected program, have been useful to track the contacts of measles cases.

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But as the recent scares remind us, we still aren’t where we need to be with vaccination. Following the Disneyland outbreak, in 2015 California passed a law to remove the “personal belief” exemption from required childhood vaccines, meaning people must provide a medical reason to decline it. The law broadened the criteria for medical exemptions, which increased the year after it passed. Although the state tightened up medical exemptions with a new law in 2019, with the pandemic disrupting routine vaccinations and increasing homeschooling, the percentage of kindergarteners not up to date on vaccinations went up by 2021.

Vaccine exemption laws vary widely across the U.S., with some states allowing only medical exemptions, some also allowing religious exemptions and others permitting philosophical exemptions too. And outbreaks from one state can spill over across borders quickly.

That means decisions by Florida’s public health department, and vaccine hesitancy anywhere, can affect us all. California has to close the gap for communities that are not well-protected against measles.

Abraar Karan is an infectious disease doctor and researcher at Stanford University, where Julie Parsonnet is a professor of infectious diseases and of epidemiology and population health.

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Q&A: Learn how Olympians keep their cool from Team USA's chief sports psychologist

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Q&A: Learn how Olympians keep their cool from Team USA's chief sports psychologist

Your morning jog or weekly basketball game may not take place on an Olympic stage, but you can use Team USA’s techniques to get the most out of your exercise routine.

It’s not all about strength and speed. Mental fitness can be just as important as physical fitness.

That’s why the U.S. Olympic & Paralympic Committee created a psychological services squad to support the mental health and mental performance of athletes representing the Stars and Stripes.

“I think happy, healthy athletes are going to perform at their best, so that’s what we’re striving for,” said Jessica Bartley, senior director of the 15-member unit.

Bartley studied sports psychology and mental health after an injury ended her soccer career. She joined the USOPC in 2020 and is now in Paris with Team USA’s 592 competitors, who range in age from 16 to 59.

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Bartley spoke with The Times about how her crew keeps Olympic athletes in top psychological shape, and what the rest of us can learn from them. Her comments have been edited for length and clarity.

Why is exercise good for mental health?

It gets you moving. It gets the endorphins going. And there’s often a lot of social aspects that are really helpful.

There are a number of sports that stretch your brain in ways that can be really, really valuable. You’re thinking about hand-eye coordination, or you’re thinking about strategy. It can improve memory, concentration, even critical thinking.

What’s the best way to get in the zone when it’s time to compete?

When I work with athletes, I like to understand what their zone is. If a 0 or a 1 is you’re totally chilled out and a 10 is you’re jumping around, where do you need to be? What’s your number?

People will say, “I’m at a 10 and I need to be at an 8 or a 7.” So we’ll talk about ways of bringing it down, whether it’s taking a deep breath, listening to relaxing music, or talking to your coach. Or there’s times when people say they need to be more amped up. That’s when you see somebody hitting their chest, or jumping up and down.

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If you make a mistake in the middle of a competition, how do you move on instead of dwelling on it?

I often teach athletes a reset routine. I played goalie, so I had a lot of time to think after getting scored on. I would undo my goalie gloves and put them back on, which to me was a reset. I would also wear an extra hairband on my wrist, and when I would snap it, that meant I needed to get out of my head.

It’s not just a physical reset — it helps with a mental reset. If you do the same thing every single time, it goes through the same neural pathway to where it’s going to reset the brain. That can be really impactful.

Do Olympic athletes have to deal with burnout?

Oh, yeah. Everybody has a day where they don’t want to do whatever it is. That’s when you have to ask, “What’s in my best interests? Do I need a recovery day, or do I really need to get in the pool, or get in the gym?”

Sometimes you really do need what we like to refer to as a mental health day.

How can you psych yourself up for a workout when you just aren’t feeling it?

It’s really helpful to think about why you’re doing this and why you’re pushing yourself. Do you have goals related to an activity or sport? Is there something tied to values around hard work or discipline, loyalty or dependability?

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When you don’t want to get in the gym, when you don’t want to go for a run, think about something bigger. Tie it back to values.

Is sleep important for maintaining mental health?

Yes! We started doing mental health screens with athletes before the Tokyo Games. We asked about depression, anxiety, disordered eating and body image, drugs and alcohol, and sleep. Sleep was actually our No. 1 issue. It’s been a huge initiative for us.

How much sleep should we be getting?

It’s different for everyone, but generally we know seven to nine hours of sleep is good. Sometimes some of these athletes need 10 hours.

I highly recommend as much sleep as you need. If you didn’t get enough sleep, napping can be really valuable.

Is napping just for Olympic athletes or is it good for everybody?

Everybody! Naps are amazing.

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What if there’s no time for a nap?

There are different ways of recharging. Naps could be one of them, but maybe you just need to get off your feet for 20 minutes. Maybe you need to do a meditation or mindfulness exercise and just close your eyes for five minutes.

How do you minimize the effects of jet lag?

We try to shift one hour per day. That’s the standard way of doing it. If you can, it’s super helpful. But it’s not always possible.

The thing we tell athletes is that our bodies are incredible, and you will even things out if you can get back on schedule. One or two nights of crummy sleep is not going to impact your overall performance.

What advice do you give athletes who have trouble falling asleep the night before a competition?

You don’t want to change much right before a competition, so I usually direct athletes to do what they would normally do.

Do you need to unwind by reading a book? Do you need to talk on the phone with somebody and get your mind off things? Can you put your mind in a really restful place and think about things that are really relaxing?

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Are there any mindfulness or meditation exercises that you find helpful?

There are some athletes who benefit greatly from an hourlong meditation. I love something quick, something to reset my brain, maybe close my eyes for a minute.

If I’m feeling like I need to take a moment, I love mindful eating. You savor a bite and go, “Oh, my gosh, I have not been fully engaged with my senses today.” Or you could take a mindful walk and take in the sights, the smells, all of the things that are around you.

What do you eat when you need a quick nutrition boost?

Cashews. I tend to carry those with me. They’ve got enough energy to make sure I keep going, physically.

I’ve always got gummy bears on me too. There’s no nutritional value but they keep me going mentally. I’m a big proponent of both.

Is it OK to be superstitious in sports?

It depends how flexible you are. Maybe you put on your socks or shoes a certain way, or listen to certain music. Routines are really soothing. They set your brain up for success in a particular performance. It can be really, really helpful.

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But I’ve also seen an athlete forget their lucky underwear or their lucky socks, and they’re all out of sorts. So your routine has to be flexible enough that you’re not going to completely fall apart if you don’t do it exactly.

Are Olympians made of stronger psychological stuff than the rest of us?

Not necessarily. There are some who don’t get feathers ruffled and have a high tolerance for the fanfare. There’s also a lot of regular human beings who just happen to be fantastic at a particular activity.

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‘Ready, Steady, Slow’: Championship Snail Racing at 0.006 M.P.H.

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‘Ready, Steady, Slow’: Championship Snail Racing at 0.006 M.P.H.
For the next few weeks, Paris will be home to many of the world’s impressive athletes, including some of the fastest human beings on the planet. Among the competitors gathering for the Olympic Games are runners who can knock out a marathon in just over two hours, a mile in under four minutes and 100 meters in less than 10 seconds.

Earlier this month, the rural village of Congham, England, played host to a less likely group of athletes: dozens of garden snails. They had gathered to compete in the World Snail Racing Championships, where the world record time for completing the 13.5 inch course stands at 2 minutes flat. At that speed — roughly 0.006 miles per hour — it would take the snails more than six days to travel a mile.

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Caring for condor triplets! Record 17 chicks thrive at L.A. Zoo under surrogacy method

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Caring for condor triplets! Record 17 chicks thrive at L.A. Zoo under surrogacy method

A new method of rearing California condors at the Los Angeles Zoo has resulted in a record-breaking 17 chicks hatched this year, the zoo announced Wednesday.

All of the newborn birds will eventually be considered for release into the wild under the U.S. Fish and Wildlife Service’s California Condor Recovery Program, a zoo spokesperson said.

“What we are seeing now are the benefits of new breeding and rearing techniques developed and implemented by our team,” zoo bird curator Rose Legato said in a statement. “The result is more condor chicks in the program and ultimately more condors in the wild.”

Breeding pairs of California condors live at the zoo in structures the staff “affectionately calls condor-miniums,” spokesperson Carl Myers said. When a female produces a fertilized egg, the egg is moved to an incubator. As its hatching approaches, the egg is placed with a surrogate parent capable of rearing the chick.

California condor eggs are cared for at L.A. Zoo. The animal is critically endangered.

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(Jamie Pham / L.A. Zoo)

This bumper year of condor babies is the result of a modification to a rearing technique pioneered at the L.A. Zoo.

Previously, when the zoo found itself with more fertilized eggs than surrogate adults available, staff raised the young birds by hand. But condors raised by human caretakers have a lower chance of survival in the wild (hence the condor puppets that zookeepers used in the 1980s to prevent young birds from imprinting on human caregivers).

In 2017, the L.A. Zoo experimented with giving an adult bird named Anyapa two eggs instead of one. The gamble was a success. Both birds were successfully released into the wild.

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Faced with a large number of eggs this year, “the keepers thought, ‘Let’s try three,’” Myers said. “And it worked.”

The zoo’s condor mentors this season ultimately were able to rear three single chicks, eight chicks in double broods and six chicks in triple broods. The previous record number of 15 chicks was set in 1997.

Condor experts applauded the new strategy.

“Condors are social animals and we are learning more every year about their social dynamics. So I’m not surprised that these chick-rearing techniques are paying off,” said Jonathan C. Hall, a wildlife ecologist at Eastern Michigan University. “I would expect chicks raised this way to do well in the wild.”

The largest land bird in North America with an impressive wingspan up to 9½ feet, the California condor could once be found across the continent. Its numbers began to decline in the 19th century as human settlers with modern weapons moved into the birds’ territory. The scavenger species was both hunted by humans and inadvertently poisoned by lead bullet fragments embedded in carcasses it ate. The federal government listed the birds as an endangered species in 1967.

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A condor, one of a record-breaking 17 at the zoo, makes its way out of its shell.

A condor, one of a record-breaking 17 at the zoo, makes its way out of its shell.

(Jamie Pham / L.A. Zoo)

When the California Condor Recovery Program began four decades ago, there were only 22 California condors left on Earth. As of December, there were 561 living individuals, with 344 of those in the wild. Despite the program’s success in raising the population’s numbers, the species remains critically endangered.

In addition to the ongoing threat of lead poisoning, the large birds are also at risk from other toxins. One 2022 study found more than 40 DDT-related compounds in the blood of wild California condors — chemicals that had made their way from contaminated marine life to the top of the food chain.

“Despite our success in returning condors to the wild, free-flying condors continue to face many obstacles with lead poisoning being the No. 1 cause of mortality,” said Joanna Gilkeson, spokesperson for Fish and Wildlife’s Pacific Southwest Region. “Innovative strategies, like those the L.A. Zoo is implementing, help us to produce more healthy chicks and continue releasing condors into the wild.”

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The chicks will remain in the zoo’s care for the next year and a half before they are evaluated for potential release to the wild. Thus far, the zoo has contributed 250 condor chicks to Fish and Wildlife’s program, some of which the agency has redeployed to other zoos as part of its conservation efforts.

In a paper published earlier this year, a team of researchers found that birds born in captivity have slightly lower survival rates for their first year or two but then have equally successful outcomes to wild-hatched birds.

“Because condors reproduce slowly, releases of captive-bred birds are essential to the recovery of the species, especially in light of ongoing losses due to lead-related mortality,” said Victoria Bakker, a quantitative ecologist at Montana State University and lead author of the paper. “The team at the L.A. Zoo should be recognized for their innovative and important contributions to condor recovery.”

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