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Polio Was Almost Eradicated. This Year It Staged a Comeback.

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Polio Was Almost Eradicated. This Year It Staged a Comeback.

Firstly of this 12 months, there was a thrum of pleasure amongst world well being specialists: Eradication of polio, a centuries-old foe that has paralyzed legions of kids across the globe, appeared tantalizingly shut.

Pakistan, certainly one of solely two nations the place wild poliovirus nonetheless circulates, had not recorded circumstances in additional than a 12 months. Afghanistan had reported solely 4.

However eradication is an uncompromising objective. The virus should disappear from each a part of the world and keep gone, no matter wars, political disinterest, funding gaps or conspiracy theories. New indicators of the virus in a single nation can derail the hassle.

In polio’s case, there have been a number of ominous setbacks.

Malawi in February introduced its first case in 30 years, a 3-year-old lady who grew to become paralyzed following an infection with a virus that gave the impression to be from Pakistan. Pakistan itself went on to report 14 circumstances, eight of them in a single month this spring.

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In March, Israel reported its first case since 1988. Then, in June, British authorities declared an “incident of nationwide concern” once they found the virus in sewage. By the point New York Metropolis detected the virus in wastewater final week, polio eradication appeared as elusive as ever.

“It’s a poignant and stark reminder that polio-free nations should not actually polio-risk free,” stated Dr. Ananda Bandyopadhyay, deputy director for polio on the Invoice & Melinda Gates Basis, the biggest supporter of polio eradication efforts.

The virus is at all times “a aircraft journey away,” he added.

Polio is a extremely contagious and generally lethal enemy, able to ravaging the nervous system and inflicting paralysis inside hours. Those that get well might relapse and turn out to be critically unwell years later.

The virus multiplies within the gut for weeks and will unfold by means of feces or contaminated meals or water — for instance, when an contaminated little one makes use of the bathroom, neglects washing fingers after which touches meals.

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For many years the virus terrorized households, inflicting paralysis amongst greater than 15,000 American kids every year and lots of of 1000’s extra worldwide. Its retreat is a triumph of vaccination. After the primary vaccine arrived in 1955, the variety of circumstances dropped precipitously, and by 1979 the USA was declared polio-free.

Though the USA and Britain have excessive immunization charges, additionally they have pockets of low immunity that permit the virus to flourish. In these communities, all unvaccinated folks — not simply kids — are in danger. If polio continues to unfold in the USA for a 12 months, the nation could lose its polio-free standing beneath W.H.O. tips.

The Covid-19 pandemic left many different nations weak to a resurgence of polio: It disrupted vaccination drives for months and diverted employees and assets away from prevention packages, ensuing within the worst backslide in immunization charges in 30 years.

“The second you’re taking your eye off the ball, you realize that the virus will merely reappear,” stated Aidan O’Leary, director for polio eradication on the World Well being Group. “We now have to actually face down each single chain of transmission that we will determine.”

Support organizations first aspired to eradicate polio in 1988 and poured billions of {dollars} into the World Polio Eradication Initiative, a consortium of six companions, together with the Gates Basis, the W.H.O. and the Facilities for Illness Management and Prevention.

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Regardless of the latest circumstances, the progress is unmistakable: World circumstances of polio have fallen by 99 % — from 350,000 circumstances of paralysis in 1988 to about 240 thus far this 12 months.

That success “is each a miraculous factor and a factor that’s taken approach, approach longer than folks anticipated,” stated Invoice Gates, who has taken a pointed curiosity in polio, in an interview in February. “Eradications are tremendous arduous, they usually hardly ever must be undertaken.”

Ending polio has been significantly difficult.

There are three strains of the wild poliovirus. Sort 2 was declared eradicated in 2015, and Sort 3 in 2019. Solely Sort 1 poliovirus stays at giant, and solely in Pakistan and Afghanistan.

Till not too long ago, there was good purpose to be optimistic about Sort 1’s demise. India and Nigeria had been each thought-about inconceivable targets for polio elimination, however each achieved that objective.

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“There have been so many individuals who saved telling us you’ll by no means achieve India,” stated Dr. Hamid Jafari, W.H.O.’s director of polio eradication for the jap Mediterranean area.

Afghanistan and Pakistan have confirmed harder due to their nomadic populations, tough terrain and the baseless notion that the vaccine is a Western device for sterilizing the inhabitants, Dr. Jafari stated.

In Afghanistan, polio thrived in areas the place immunization bans had been imposed by the Taliban. In late March, the Taliban allowed vaccinations to renew, however the doses are administered in door-to-door campaigns, typically by feminine well being care employees. Some have been assaulted and killed.

Just one human viral illness, smallpox, has ever been eradicated. For all its deadliness, smallpox was comparatively easy to dispatch as a result of each an infection resulted in dramatic, unmistakable signs.

Polio is way more sly: It could unfold silently, inflicting delicate flulike signs or none in any respect, and but the illness paralyzes certainly one of each 200 contaminated kids. Even one case of paralysis is a sign that there could also be lots of and even 1000’s of undetected infections.

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“Paralysis is the tip of the iceberg,” stated Dr. Walter Orenstein, affiliate director of the Emory Vaccine Heart and a former director of the USA’ Immunization Program.

However in some nations, polio has turn out to be such a dim and distant risk that well being officers have stopped searching for it. Whereas Britain and Israel monitor sewage for the virus — splendid as a result of polio spreads by means of fecal matter — many others, together with these in the USA, have ceased energetic surveillance.

“There’s little doubt that there are locations the place it must be strengthened,” stated Dr. Matshidiso Moeti, W.H.O.’s regional director for Africa.

The one case imported into Malawi from Pakistan resulted in mass immunizations of practically 28 million kids in Malawi and its neighbors. However well being care employees had turn out to be unaccustomed to door-to-door campaigns.

Within the Chikwawa district in southern Malawi in March, Charles Bizimaki woke at 5 a.m., took the lunch his spouse had packed for him and walked a number of kilometers to a close-by village. Mr. Bizimaki has been the vaccine supervisor for six villages since 2007.

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However he had not carried out a door-to-door vaccination marketing campaign since a tetanus outbreak in 2013 and had by no means led one for polio.

The marketing campaign was bodily exhausting and irritating as a result of it generally took a number of visits earlier than he might discover a little one at residence. “It was not a straightforward job,” Mr. Bizimaki stated. It took him six days to vaccinate each little one beneath 5 within the close by villages.

Immunization for polio will be completed in certainly one of two methods. The injected vaccine utilized in the USA and most wealthy nations accommodates killed virus, is powerfully protecting in opposition to sickness however doesn’t stop the vaccinated from spreading the virus to others.

Mass vaccination campaigns depend on the oral polio vaccine, which delivers weakened virus in just some drops on the tongue. The oral vaccine is cheap, simple to manage and might stop contaminated folks from spreading the virus to others, a way higher suited to extinguishing outbreaks.

However it has one paradoxical flaw: Vaccinated kids can shed the weakened virus in feces, and from there it may possibly generally discover its approach again into folks, often setting off a series of infections in communities with low immunization charges.

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If the weakened virus circulates for lengthy sufficient, it may possibly slowly mutate again right into a extra virulent kind that may trigger paralysis.

Whilst wild poliovirus has been on the decline, so-called vaccine-derived polio has been on the upswing. Instances tripled between 2018 and 2019, and once more between 2019 and 2020. Between January 2020 and April 2022, 33 nations reported a complete of practically 1,900 circumstances of paralysis from vaccine-derived polio.

The samples present in London sewage, in Israel and in New York are all vaccine-derived virus. They carry the identical genetic fingerprint, suggesting that the virus could have been circulating undetected for a few 12 months someplace on the earth.

Eradicating polio would require wiping out the vaccine-derived sort, not simply the few remaining scorching spots of untamed virus. “We undoubtedly have to cease all polio transmission, whether or not wild poliovirus or whether or not circulating vaccine-derived poliovirus,” stated John Vertefeuille, who heads polio eradication on the C.D.C.

Vaccine-derived polio has turn out to be extra prevalent as a result of the oral vaccine in use now protects in opposition to solely Varieties 1 and three of the virus. In 2016, buoyed by the seeming eradication of Sort 2 virus, the W.H.O. withdrew it from the oral vaccine. That transfer left the world more and more weak to outbreaks of residual Sort 2 virus.

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On the identical time, world well being organizations shifted away from sustaining nimble groups that may swiftly stamp out outbreaks to strengthening well being care methods total. Areas that wrestle to include polio are likely to produce other public well being issues, equivalent to poor diet, entry to secure consuming water and different infectious illness outbreaks.

However the response to an outbreak of polio — or to different infectious ailments like Covid-19 or monkeypox — requires devoted groups and packages, stated Kimberly M. Thompson, a well being care economist whose work focuses on polio eradication.

The W.H.O. has not delivered on that objective for many years, “however there is no such thing as a accountability for efficiency,” Dr. Thompson stated. Likewise, nations that obtain funding for polio are hardly ever held liable for diverting the cash to different packages, she added.

Because of the dismantling of outbreak groups, the response to vaccine-derived polio has typically been sluggish and inefficient.

“The velocity and the standard of the responses must go up to ensure that us to cease these outbreaks,” Dr. Vertefeuille stated.

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In November 2019, the W.H.O. granted an emergency use authorization for a novel oral vaccine that’s particular to the Sort 2 virus. The vaccine, which took a decade to develop, is extra genetically secure than the extensively used oral vaccine and fewer prone to revert to a kind that may trigger paralysis.

The eventual objective for polio eradication is to immunize kids in each nation with the injected vaccine utilized in the USA, stated Jalaa’ Abdelwahab, director of vaccine packages at Gavi, which helps improve immunizations in poor nations. Provides of oral vaccine could be stockpiled solely to reply to surprising outbreaks, Mr. Abdelwahab stated.

The latest circumstances have compelled a reassessment of the methods getting used to detect and include polio. The C.D.C. is planning to introduce wastewater surveillance at strategic websites within the nation, in keeping with an announcement from the company.

Pakistan has among the many largest wastewater surveillance methods for polio, however vaccine hesitancy is rampant. One workforce of scientists, led by Dr. Jai Das at Aga Khan College in Karachi, has discovered that providing communities an incentive — putting in water pumps, for instance — in the event that they elevate vaccination charges could also be more practical than unconditional money prizes for people.

Eradicating polio by 2026, the present objective, would require modern methods, persistence and persistence — and an estimated $4.8 billion.

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“That final mile, these final circumstances, are at all times the toughest,” stated Simon Bland, chief government officer of the World Institute for Illness Elimination.

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How a water scientist hopes to save California habitats that could be pumped dry

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How a water scientist hopes to save California habitats that could be pumped dry

California is recognized as one of the world’s hotspots of biodiversity, with more species of plants and animals than any other state. And a significant number of the state’s species, from frogs to birds, live in habitats that depend on groundwater.

These rich ecosystems — including spring-fed streams, wetlands, riparian forests and oak woodlands — are vulnerable to declines in groundwater levels. In areas where unchecked pumping from wells severely depletes aquifers, once-thriving wetlands and forests can dry up and die.

Spotting threats to vulnerable natural areas has become a mission for Melissa Rohde, a hydrologist who has spent years analyzing satellite data and water levels in wells to come up with strategies for preventing ecosystems from being left high and dry.

“Nature has been getting the short end of the stick. It basically gets whatever is left behind, which oftentimes is not enough,” Rohde said. “How do we ensure that these ecosystems are protected?”

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More than 300 species of birds have been seen at Kern River Preserve.

(Robert Gauthier / Los Angeles Times)

California is the only state with a groundwater law that includes provisions intended to protect groundwater-dependent ecosystems. But the law, adopted in 2014, gives considerable leeway to local agencies in developing water management plans that prevent “significant and unreasonable adverse impacts.”

When Rohde and other scientists examined the local plans for parts of the state that fall under regulation, they found only about 9% of groundwater-dependent ecosystems are adequately protected, while the remaining 91% are vulnerable.

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When they looked at the entire state, they determined only 1% of the ecosystems are sufficiently protected under measures adopted to date.

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Rohde has been focusing on finding ways to change that, in California and around the world.

Often working at home, she has pored over satellite data to spot decreases in vegetation greenness during drought, a telltale sign of die-off caused by declining aquifer levels. And she has analyzed how different types of trees, including willows, cottonwoods and oaks, fare when water levels fall depending on the depth of their roots.

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Rohde and other researchers recently published a study outlining how California can set targets for maintaining groundwater levels — based on a formula including the type of vegetation, local water data and satellite imagery — to ensure the plants that anchor each ecosystem will be able to reach water and survive during dry times.

Cattle graze at the Kern River Preserve.

Cattle graze at the Kern River Preserve.

(Robert Gauthier / Los Angeles Times)

“If we don’t have groundwater levels that are able to support these diverse native vegetation ecosystems, then basically we run the risk of losing that important habitat for a lot of our threatened and endangered species,” Rohde said. “When you play around with keeping groundwater levels too deep to support the habitat, then you could lose species, and then that’s irreversible. The consequences can be severe.”

In California’s Mediterranean climate, trees, shrubs and the species they support are naturally adapted to drought. But excessive pumping from wells can push habitats beyond ecological limits by depleting the sources that sustain them.

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With humanity’s heating of the planet intensifying droughts, the strains affecting these ecosystems continue to grow.

Already, California has lost the vast majority of its original wetlands to development, water diversions and agriculture. To avoid losing what remains, Rohde said, the state needs “a precautionary and preventative approach that can ensure that these ecosystems can withstand the intensification of droughts in climate change.”

During a recent visit to Kern County, Rohde and several conservation specialists walked in the shade through a lush forest of cottonwood trees near the south fork of the Kern River, visiting a nature preserve she had previously seen only in satellite images.

Scientist Melissa Rohde stands in a riparian forest.

Scientist Melissa Rohde visits a riparian forest at the Kern River Preserve.

(Robert Gauthier / Los Angeles Times)

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At the edge of a clearing, she came upon the bare, sunbleached skeletons of dead trees.

She said satellite data had revealed that parts of the forest died along this part of the Kern River during the drought between 2012 and 2016.

“That’s because the groundwater levels rapidly declined,” Rohde said.

After that die-off, she said, groundwater levels rebounded in the area, and the native vegetation has been growing back.

A sign reads "Kern River Preserve" on a gate, with trees in the background.

The Kern River Preserve protects the riparian ecosystem along the south fork of the Kern River.

(Robert Gauthier / Los Angeles Times)

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It helps that this forest is protected as part of the Kern River Preserve, which is managed by the National Audubon Society, and that some nearby farmlands have been retired and converted to conservation lands over the years.

The preserve’s managers, working with the organization Ducks Unlimited, have also restored an expanded wetland by diverting water from the river and flooding a section of pastureland where cattle used to graze.

The wetland attracts birds, such as coots and tricolored blackbirds, and also recharges the aquifer that the roots of cottonwoods and willows tap into.

Scientists and conservation specialists stand on a rock formation overlooking a wetland.

Scientist Melissa Rohde, left, and conservation specialists from Ducks Unlimited and the Audubon Society, including Reed Tollefson, right, stand on rocks overlooking a wetland at the Kern River Preserve.

(Robert Gauthier / Los Angeles Times)

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The 3,300-acre preserve has expanded as adjacent alfalfa fields have been purchased and agricultural wells have been shut down, said Reed Tollefson, the preserve’s manager. These efforts have helped protect a refuge for birds including willow flycatchers and yellow-billed cuckoos.

As he pointed to several dead trees poking from the living cottonwoods, he said protecting the forest from groundwater pumping and climate change will require additional effort.

“I think it’s tenuous,” he said. “We’ve got more work to do to try and really sustain this.”

The dead trees that have appeared here and elsewhere in California over the past decade represent the sort of die-off that water managers need to focus on preventing, Rohde said.

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“It has to be an intentional practice of setting thresholds, monitoring, using satellite data or other scalable means to measure the impacts, in order to make sure that we are not allowing this to happen on a wider scale,” she said. “From a biodiversity perspective, it’s absolutely critical.”

Rohde said she felt hopeful seeing the forest rebounding and much greener than it was several years ago, with many young trees coming up.

Some other parts of California haven’t fared nearly as well.

One rainy day last month, Rohde visited an area along the Santa Clara River in Ventura County where several hundred acres of willows and cottonwoods dried up and died during the drought in the mid-2010s.

When groundwater pumping by farms and communities caused aquifer levels to fall, many trees died along the river near the city of Fillmore.

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“We saw this catastrophic drop in groundwater at this site,” Rohde said.

She visited the area with a research colleague and two managers from The Nature Conservancy. They stood on a gravel road next to a lemon grove, checking on what remained of the forest.

Scientist Melissa Rohde stands beside tall reeds.

Scientist Melissa Rohde stands in a thicket of arundo, an invasive reed that has proliferated along parts of the Santa Clara River in Ventura County. There are ongoing efforts to remove the nonnative reeds in the area.

(Brian van der Brug / Los Angeles Times)

Where native trees died, an explosion of invasive reeds has taken over. The nonnative reeds, called arundo, have grown into thickets more than 20 feet tall. And unlike willows, Rohde said, arundo offers little value as habitat for birds.

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“When we had that massive die-off, and the groundwater levels remained deep, there was no way for the native vegetation to regenerate,” she said. “But arundo is extremely efficient at extracting soil moisture. And so it was able to outcompete the native vegetation.”

She said efforts to prevent this sort of habitat degradation should be prioritized.

When managers of local agencies set goals for maintaining groundwater levels, she said, they can tailor targets to the type of vegetation — whether there are cottonwood trees, with roots averaging about 9 feet long, or oaks, with roots that average nearly 30 feet but can grow much deeper.

Her colleague Michael Bliss Singer said when native trees are ravaged by multiple years of low water levels, they will start losing leaves and then dropping branches.

In one study, Singer and others documented a “brown wave” of trees drying along the Santa Clara River between 2012 and 2016 — a loss they saw in satellite images.

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A man looks out on a muddy river.

Scientist Michael Bliss Singer looks out over the Santa Clara River in Ventura County.

(Brian van der Brug / Los Angeles Times)

“It’s completely transformed the ecosystem here,” said Singer, a professor at Cardiff University in Wales who is also a researcher at UC Santa Barbara.

When plants die off like this and don’t recover, it’s a symptom of an ecosystem in decline. To prevent more of these losses in an era when climate change is driving more severe droughts, Singer said, it’s crucial to “come up with creative solutions for the worst-case scenario.”

Rohde has found in her research, however, that most local groundwater plans in California haven’t adequately accounted for climate projections.

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Previously, Rohde did other types of climate research, including a stint in Antarctica in 2010, where she was part of a drilling team collecting ice cores. From that experience, Rohde said she realized that “I didn’t want to spend my career convincing people that climate change was an issue; I wanted to do something about it.”

She wore a faded cap with an Antarctica map, a memento of that trip. Rohde said her recent work is motivated by concerns about the climate crisis and biodiversity, as well as a conviction that proactive steps to protect ecosystems can make a difference.

“I have two young kids. I really want to make sure that I’m doing the best thing that I can to ensure a sustainable future for them, where they can access nature,” Rohde said.

A man holds binoculars as he observes a wetland.

E.J. Remson, a senior project director for The Nature Conservancy, surveys a wetland along the Santa Clara River in Ventura County.

(Brian van der Brug / Los Angeles Times)

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“Often groundwater is out of sight, out of mind,” she said. “We don’t measure it, we don’t understand it and we misuse it. And we need to make sure that we are managing groundwater so that it is supporting us, and making sure that we have a sustainable future.”

Rohde now works as an independent scientist. Previously, as a researcher for The Nature Conservancy, she helped write an atlas of threatened and endangered species that rely on groundwater.

California’s groundwater-dependent ecosystems lie not only along streams, but also in habitats such as mountain meadows, coastal redwood forests and mesquite bushes among desert sand dunes. The species they support range from tiger salamanders to desert pupfish, and from songbirds to mammals such as ground squirrels and bighorn sheep.

“The risks are high when species are on the verge of extinction,” Rohde said.

Rohde and other scientists have found that ecosystems sustained by groundwater are under threat worldwide. Some of the few regions that have measures intended to protect them, she said, include Australia, the European Union and California.

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Still, even with California’s groundwater regulations and endangered species laws, Rohde said, “we continue to miss the mark in actually protecting them.”

Rohde said state officials should give local water agencies clear direction to ensure they’re using science-based methods to safeguard ecosystems in their state-mandated plans. She said agencies can now use the approaches scientists have outlined to map strongholds of biodiversity and set targets for maintaining aquifer levels.

“It’s very attainable,” she said. “Now, it’s just basically up to political will, or enforcement by the Department of Water Resources, to ensure that that happens.”

Walking in the rain at the Santa Clara River Preserve, Rohde followed her former Nature Conservancy colleagues Peter Dixon and E.J. Remson on a trail through a stand of healthy trees.

A man in a hooded rain jacket hikes along a soaked trail.

Peter Dixon, a project manager with The Nature Conservancy, walks on a trail through the riparian forest at the Santa Clara River Preserve.

(Brian van der Brug / Los Angeles Times)

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They stood on the banks of the fast-flowing river, watching the muddy water churn past.

In the summer and fall, this part of the river usually dwindles to a trickle.

And during the next drought, when the river dries up, the forest will depend on the same groundwater that nearby communities and farms also use.

If the water needs of this and other ecosystems aren’t prioritized, Rohde said, vital habitats will suffer.

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“We need to be deliberate about the planning, and ensuring that they get their fair share,” she said. “Their existence is potentially imperiled if we don’t act.”

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Opinion: Most older Americans who need hearing aids don't use them. Here's how to change that

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Opinion: Most older Americans who need hearing aids don't use them. Here's how to change that

Having depended on hearing aids for nearly three decades, I’m astounded by the lack of Medicare coverage for devices that can solve a problem afflicting tens of millions of older Americans.

Nearly two-thirds of Americans over age 70 have some degree of hearing loss, and over half of those 75 and older experience impairment serious enough to be considered disabling. But most don’t wear hearing aids.

Because the legislation that created Medicare nearly 60 years ago specifically excluded hearing aids, those who rely on the program’s traditional coverage must pay for them out of pocket. That expense is among the chief barriers to wider use of the devices.

Age-related hearing loss impedes basic communication and the relationships that depend on it. Expanded access to hearing aids could therefore do no less than enable more older Americans to establish and maintain the social connections that are essential to a meaningful life.

Hearing loss is like an invisible, muffling curtain that falls in front of anyone speaking. Asking people to repeat themselves can yield irritated and hurtful responses. And it’s hopeless to ask a soft-spoken person to speak up. Sometimes it’s easier just to nod and smile.

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Many older people I know choose to avoid social gatherings altogether because they can’t hear well. Without hearing aids, I’d stay home too.

Hearing loss can harm one’s health in other ways. For example, I’ve written about the need for a comprehensive approach to reducing cancer risk at older ages, including preventive services such as colorectal cancer screening. But these services rely on conversations between patients and their healthcare providers. An older patient’s ability to hear and understand such conversations shouldn’t be taken for granted or ignored.

The Food and Drug Administration did improve access to hearing aids by making some of them available without a prescription in 2022, but the over-the-counter devices are inadequate for serious hearing loss like mine. My private health insurance, meanwhile, started covering hearing aids a few years ago, providing up to $2,500 for them every five years. One hearing aid alone can cost that much or more, however.

Despite its limitations, my private coverage for hearing aids is better than nothing, which is what traditional Medicare provides.

Hearing loss is more common among lower-income people and those without advanced education. The toll from noisy workplaces compounds age-related hearing loss for some. One analysis found that most Americans with a serious hearing disability can’t afford the typical price of hearing aids.

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Many of the older adults who can’t come up with these significant out-of-pocket expenses spent their working years in low-wage jobs that our country depends on. Denying them treatment for their hearing loss is a lousy way to treat people who gave years of service to our society.

Although some older adults with hearing loss won’t benefit from hearing aids, Medicare coverage for the devices might encourage more beneficiaries to get their hearing tested so they can get the treatment that’s right for them. And while Medicare coverage alone won’t address the stigma some people associate with hearing aids, the availability of newer, more comfortable and less obvious technology might win over some refuseniks.

Legislation reintroduced with bipartisan support last year would finally correct this glaring gap in Medicare coverage by removing the hearing aid exclusion from the law. There’s no reason to delay action on this any longer. Are our representatives listening?

Mary C. White is an adjunct professor of environmental health at Emory University’s Rollins School of Public Health, a Public Voices fellow at AcademyHealth in partnership with the OpEd Project and a former federal epidemiologist.

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Second human case of bird flu detected in Michigan dairy worker

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Second human case of bird flu detected in Michigan dairy worker

A second human case of bird flu in a diary worker has been confirmed in Michigan, state and federal health officials announced Wednesday.

The symptoms were mild, consisting of conjunctivitis. The Texas dairy worker who contracted the virus in March also came down with pink eye.

At a press call on Wednesday, Nirav Shah, principal deputy director of the U.S. Centers for Disease Control and Prevention, said the finding was “not unexpected” and that it was a scenario “that we had been preparing for.”

He said that since the discovery of H5N1 in dairy cattle, state and federal health officials have been closely monitoring farmworkers and slaughterhouse workers and urging farmers and farmworker organizations to “be alert, not alarmed.”

Federal officials say they still believe the human health risk of bird flu is low; however, it underscores the need for people who are interacting with infected or potentially infected farm animals or birds to take precautions, including avoiding dead animals and wearing personal protective equipment (PPE) if there’s a need to be in close contact.

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Though a nasal swab from the person in Michigan tested negative for influenza, an eye swab from the patient was shipped to the CDC and tested positive for influenza A(H5N1) virus.

This is the third case of H5N1 reported in the United States. A poultry worker in Colorado was identified in 2022.

Although the symptoms in the three farmworkers in the U.S. have been mild, people elsewhere in the world have suffered more severe illness, including death. According to the World Health Organization, between Jan. 1, 2003, and March 28, 2024, there have been 888 cases of human infection from 23 countries; 463 were fatal.

In preparation for a more widespread outbreak, the CDC updated its guidance for PPE in dairies and issued a nationwide order for healthcare providers to be on the lookout for novel influenza.

On Tuesday, the CDC asked clinical laboratories and health departments to increase the number of influenza samples being analyzed “to maximize the likelihood of catching a case of H5N1 in the community,” Shah said.

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The US Department of Agriculture is also expanding its surveillance and support by providing $1500 to non-infected farms to beef up biosecurity, and $100 to producers who want to buy inline samplers to test their milk. The agency will also provide $2000 per farm to cover veterinary fees for testing, as well as shipping costs to send those tests to laboratories for analysis.

There have been no cases of H5N1 detected in California’s dairy herds.

Officials said ongoing analysis of the nation’s dairy supply suggests it is safe to consume, Despite the risk to human health being low, an official with the Administration for Strategic Preparedness and Response said it will make Tamiflu available upon request “to jurisdictions that do not have their own stockpile and are responding to pre-symptomatic persons with exposure to confirmed or suspected infected birds, cattle or other animal exposures.”

Dawn O’Connell, assistant secretary of the preparedness agency, said it started the “fill and finish” process for approximately 4.8 million doses of vaccine “that is well matched to the currently circulating strain of H5N1 through the national pre-pandemic influenza vaccine stockpile program.”

She said the decision to get started on H5N1 vaccines was not a response to any heightened concern, but since it takes several months to fill and finish vaccine doses, the agency “thought it made sense given what we were seeing.”

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