Science
Wastewater testing, vital in COVID-19 tracking, could help identify monkeypox spread

As wastewater testing continues to show helpful in estimating the unfold of the coronavirus, scientists once more are utilizing sewage to trace the newest public well being emergency: monkeypox.
In late June — a few month after the primary California case was confirmed — monkeypox DNA was detected in wastewater in San Francisco, in accordance with the WastewaterSCAN coalition, a gaggle of scientists who’ve been testing sewage for the presence of the coronavirus since 2020.
The group just lately confirmed the presence of the monkeypox virus in Los Angeles County waste.
“It helps perceive how widespread that is,” mentioned Stanford civil and environmental engineering professor Alexandria Boehm, one of many lead researchers on the WastewaterSCAN staff.
She mentioned COVID-19 sewage testing has been notably helpful throughout “the onset section,” or instantly after a brand new variant has been recognized nevertheless it’s unclear the extent of its presence. Public well being officers can use the data to theorize how nice the unfold might turn into.
“We’re kind of in that [phase] for monkeypox now,” Boehm mentioned.
Monkeypox DNA was first detected in Los Angeles County wastewater July 31, about 20 days after the WastewaterSCAN group expanded its monkeypox testing past the Bay Space to nearly 40 different amenities nationwide — together with in L.A. — in accordance with information from the group.
Samples from L.A.’s Joint Water Air pollution Plant in Carson, which serves about 4 million residents and companies, confirmed a small presence of the monkeypox virus July 31 and for 3 days throughout the first week in August, in accordance with WastewaterSCAN information. The virus since has not been detected there, regardless of rising monkeypox circumstances in Los Angeles County.
By comparability, monkeypox DNA has been detected nearly day-after-day since June 27 at two wastewater amenities in San Francisco — and at a lot larger ranges than in L.A. County.
Nonetheless, Boehm mentioned that doesn’t imply there’s no more monkeypox in Los Angeles County; it’s simply troublesome to detect among the many huge pattern dimension.
As a result of the L.A. wastewater facility serves such a large variety of individuals “it’s important to take into consideration the sensitivity of detecting monkeypox relative to the incident fee within the inhabitants,” Boehm mentioned. “Simply since you don’t detect monkeypox, doesn’t imply there’s no one [in that waste watershed] with monkeypox.”
The 2 amenities in San Francisco serve a a lot smaller inhabitants, about 100,000 residents every.
Whereas each Los Angeles and San Francisco have seen a fast rise in monkeypox circumstances in latest weeks, the totals are nonetheless solely a fraction of every county’s inhabitants: about 600 in San Francisco amongst fewer than 1 million residents and roughly 1,000 in L.A. County amongst 10 million residents, in accordance with every county’s public well being departments.
“We’re doing [wastewater] surveillance for monkeypox, and it was solely simply recognized,” the Los Angeles Division of Public Well being mentioned in a press release. “It took longer to establish right here than in some locations most definitely as a result of we have now a big inhabitants relative to the variety of circumstances. Wastewater surveillance is comparatively new and considerably investigational.”
It was not instantly clear whether or not the L.A. County well being division plans to develop monkeypox testing in wastewater or how it will use the information. The county has been monitoring wastewater for the coronavirus for months, together with on the Joint Water Air pollution Plant, in addition to on the Hyperion Water Reclamation Plant in Playa Del Rey and amenities close to Lancaster and Malibu.
When at-home COVID-19 testing started to restrict the flexibility to watch case counts, L.A. County public well being officers usually used wastewater information to trace transmission tendencies — one issue that performed a job in a choice to not implement one other indoor masks mandate.
“It’s useful to have this extra lens into the epidemiology and dynamics of illness as a result of it doesn’t depend on behaviors of individuals or testing,” Boehm mentioned. “There’s sort of a health-equity part.”
She mentioned wastewater information can assist inform public well being selections, corresponding to the place to focus on data, clinics or therapy.
The scientists behind WastewaterSCAN name the information on viruses “invaluable,” having already discovered monkeypox in 22 California wastewater amenities, from San Diego to Sacramento, in addition to at 9 amenities in seven different states.
There’s not but a nationwide database to trace monkeypox in waste, such because the CDC does for COVID-19, however Boehm mentioned she’d wish to see the testing develop. Her staff is also working to check sewage for influenza A and respiratory syncytial virus (RSV), which she hopes can proceed to assist reply questions on viral transmission.
She mentioned she’d just like the wastewater testing, which has been discovered to be extraordinarily correct, for use to tell care, therapy and even vaccine growth of present viral outbreaks — in addition to future ones.
“I’m a scientist, so I’m simply curious how far we will take this,” Boehm mentioned. “Its’ turning out to be a very attention-grabbing and kind of superb useful resource for understanding public well being.”

Science
Strangers in the middle of a city: The John and Jane Does of L.A. General Medical Center

He had a buzz cut and brown eyes, a stubbly beard and a wrestler’s build.
He did not have a wallet or phone; he could not state his name. He arrived at Los Angeles General Medical Center one cloudy day this winter just as thousands of people do every year: alone and unknown.
Some 130,000 people are brought each year to L.A. General’s emergency room. Many are unconscious, incapacitated or too unwell to tell staff who they are.
Nearly all these Jane and John Does are identified within 48 hours or so of admission. But every year, a few dozen elude social workers’ determined efforts to figure out who they are.
Too sick to be discharged yet lacking the identification they need to be transferred to a more appropriate facility, they stay at L.A.’s busiest trauma hospital for weeks. Sometimes months. Occasionally years.
That’s an outcome no one wants. And so hospital staff did for the buzz cut man what they do once every other possibility is exhausted.
Social workers cobbled together the tiny bit of information they could legally share: his height and weight, his estimated age, his date of admission, the place where he was found. They stood over his hospital bed and took his photograph.
Then they asked the 10 million people of Los Angeles County: Does anyone know who this is?
This unidentified patient arrived at L.A. General on Feb. 6 after being found unconscious in East Hollywood.
(Los Angeles General Medical Center)
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Just before 8 a.m. on Feb. 16, paramedics responded to a medical emergency at 1037 N. Vermont Ave.
The man was face-down on a stretch of sidewalk lined with chain-link fences and sandbags, near a public restroom and the entrance to the Vermont/Santa Monica subway stop. Pink scrape marks blossomed above and below his right eye.
Paramedics estimated he was about 30 years old. Hospital staff guessed 35 to 40.
He had no possessions that might offer clues: no phone, no wallet, no tickets or receipts crumpled in his pockets.
He could not state his name or answer any questions. The hospital admitted him under a name the English-speaking world has used for centuries when a legal name can’t be verified: John Doe.
The vast majority of patients admitted as John Does leave as themselves. The unconscious wake up. The intoxicated sober up. Frantic relatives call the hospital looking for a missing loved one, or police arrive seeking their suspect.
None of these things happened for the man from North Vermont. When he finally opened his eyes, his language was minimal: a few indistinct words — possibly English, possibly Spanish — and nothing that sounded like a name.
Social workers wrote down everything they knew for sure about their patient: his height (4 feet, 10 inches), his weight (181 pounds), the color of his eyes (dark brown).
Then they started following the trail that typically leads to identification.
The ambulance crew didn’t recognize him, and the run sheet — the document paramedics use to record patients’ condition and care — had no revelatory details.
They checked Google Maps. Any nearby shelter whose manager they could call to ask about a missing resident? Nope. Was there an apartment building whose residents might recognize his photo? Nothing.

A second photo L.A. General released to the public in search of a name or next of kin for this unidentified patient found in East Hollywood.
(Los Angeles General Medical Center)
They clicked through county databases. His details didn’t align with any previously admitted hospital patient, or anyone in the mental health system. No missing-persons report matched his description; social workers couldn’t find a mention of someone like him in any social media posts.
An anonymous patient is an administrative problem. It’s also a safety concern. If a patient can’t state their name, they probably also can’t say if they have life-threatening allergies or are taking any medications, said Dr. Chase Coffey, who oversees the hospital’s social work team.
“We do our darndest to deliver safe, effective, high-quality care in these scenarios, but we run into limits there,” he said.
Federal law requires hospitals to guard patient privacy zealously, and L.A. General is no exception. But given that virtually every hospital deals with unnamed patients, California carves out an exception for unidentified people who can’t make their own healthcare decisions. In such instances, hospitals can go public with information that could locate their patient’s next of kin.
On March 3, nearly two weeks after the man’s arrival, a press release went live on the county’s website and pinged in the inboxes of reporters across the region.
“Los Angeles General Medical Center, a public hospital run by the L.A. County Department of Health Services, is seeking the media and public’s help in identifying a patient,” the flier said. In the photograph the man gazed up from his hospital bed, eyes fixed somewhere past the camera, looking as lost as could be.
The buzz cut man from North Vermont was not the only Doe in the hospital’s care.
On the same March 3 morning, the county asked for help identifying a wisp-thin elderly man with a grizzled beard and swollen black eye who’d been found in Monterey Park’s Edison Trails Park.
Three days later, it sent out a bulletin for a gray-haired Jane Doe picked up near Echo Park Lake. In her photo she was unconscious and intubated, a bruise forming on her forehead, wires curling around her.

L.A. General seeks identification for a female patient who arrived in late May.
(Los Angeles General Medical Center)
By the end of the month, L.A. General would ask the public to identify four more men and women found alone in parks and on streets across the county, people whose cognitive state or medical condition left them unable to speak for themselves.
All of the hospital’s Does are found in L.A. County. That doesn’t mean they live here.
L.A. General is 2 miles from Union Station, where buses and trains deposit people traveling from all over North America. A few years ago, Coffey and social work supervisor Jose Hernandez found themselves trying to place an elderly couple from Nevada, both suffering from cognitive decline, who arrived at the station and couldn’t recall who they were or where they meant to go.
Fingerprinting is rarely an option. The federal fingerprint database can be accessed only for patients who are dying or are the subject of a police investigation, hospital staff said.
Even if those criteria are met, the database will only yield a name if the person’s fingerprints are already in the system. And even that’s not always enough.
Late last year, law enforcement ran the prints of an unidentified female patient who had been involved in a police incident. The system returned a name — one the patient adamantly insisted was not hers.
“Now the question is, is she confused? Do we have the wrong fingerprints-to-name match? Is there a mismatch? Is there a person using a different identity?” said Coffey. “Now what do we do?”
In end-of-the-rope scenarios such as this, the hospital turns to the public.
The press releases are carefully phrased. The hospital can disclose just enough information to make the patient recognizable to those who know them, but not a word more. Federal laws forbid references to the patient’s mental health, substance use, developmental disability or HIV status.

The hospital is trying to find next of kin for a 26-year-old man admitted in March.
(Los Angeles General Medical Center)
The releases are posted on the county’s website and social media channels. Local media outlets often publicize them further.
In “the best outcome that we get, we send [the notice] out and we get a hit within a couple of days. We start getting calls from the community saying, ‘Oh, we know who this patient is,’” Hernandez said.
About 50% of releases lead to such positive outcomes. For the other half of patients, the chance of being named gets a little smaller with every day that the phone doesn’t ring.
“If we don’t know who you are after a month, that’s when it becomes decreasingly likely that we’re going to figure it out,” said Dr. Brad Spellberg, the hospital’s chief medical officer.
On April 9, nearly two months after the buzz cut man’s arrival at L.A. General, the hospital sent out a second release about him. His scrapes had healed. His black hair was longer. His stubble had grown into a wispy beard.
“Patient occasionally mentions that he lives on 41st Street and Walton Avenue,” the release said. “Primarily Spanish speaking.” But he still had no name.
It is possible for a person in this situation to be stuck at L.A. General for the rest of their lives.
One man hit by a car on Santa Monica Boulevard in January 2017 lived for nearly two years with a traumatic brain injury before dying unidentified in the hospital. As of late 2024, a few Does had been there for more than a year.
1. This woman, believed to be 55, was found outside Los Angeles General Medical Center. 2. This patient, who was found in Pasadena, has a tattoo of a small cross on his left forearm and small star tattoo on his left bicep. 3. This patient, believed to be about 50 years old, was found on East 5th Street in downtown Los Angeles. (Los Angeles General Medical Center)
If a patient has no identity, L.A. General can’t figure out who insures them. And in the U.S. healthcare system, not having a guarantee of payment is almost worse than not having a name.
Skilled nursing facilities, group homes and rehabilitation centers won’t take people who don’t have anyone to pay for them, Spellberg said. The county Public Guardian serves as a conservator for vulnerable disabled residents, but can’t accept nameless cases.
Unless a patient recovers sufficiently to check themselves out, they are stuck in a lose-lose scenario. They can’t be discharged from L.A. General, whose 600 beds are desperately needed by the county’s most critically ill and injured, but also can’t move on to a facility that provides the care they need.
“We’re the busiest trauma center west of Texas in the United States,” Spellberg said. “If our bed is taken up by someone who really doesn’t need to be in the [trauma] hospital but can’t leave … that’s a bed that’s not available for other patients who need it.”
L.A. General is staffed to handle crises, not long-term care of people with dementia or traumatic brain injuries.
Bedbound patients could get pressure sores if they aren’t turned frequently enough. Mobile patients could wander the hospital’s corridors, or fall and injure themselves.
“You’re trapping the patient in the wrong care environment,” Spellberg said. “They literally become a hostage in the hospital, for months to years.”
The man found in Edison Trails Park eventually left the hospital. So did the gray-haired woman, whose name was at last confirmed.
The man from North Vermont is still at L.A. General, his identity as much a mystery as the day he arrived four months ago.
The Does keep coming: An elderly man found near Seventh and Flower streets. A young man found near railroad tracks. A man with burn injuries and a graying beard; another unconscious and badly bruised.
All sick or injured, all separated from their names, all their futures riding on a single question: Does anyone know who this is?
If you have information about an individual pictured here, contact L.A. General’s Social Work Department from 8 a.m. to 5 p.m. Monday through Friday at (323) 409-5253. Outside of those hours, call the Department of Emergency Medicine’s Social Work Department at (323) 409-6883.
Science
Pressure is mounting for soil testing post-fire cleanup. The Newsom administration is downplaying the concerns

Elected officials in California are calling on the Federal Emergency Management Agency and the Newsom administration to pay for soil testing on properties destroyed in the Eaton and Palisades wildfires, underscoring the public health risk and financial burdens that could be faced by survivors seeking to rebuild in Altadena and Pacific Palisades.
FEMA, the agency leading the wildfire recovery efforts, has come under heavy criticism for its decision not to test properties for contaminants after removing wreckage and up to 6 inches of top soil. That policy differs from how California has handled virtually all wildfire recoveries in the recent past.
After every major wildfire since 2007, federal and state disaster agencies have conducted soil sampling to ensure that debris-cleared properties do not contain unhealthy levels of lead and other toxic metals. In these cases, at properties where agencies detected high levels of contaminants, they typically deployed cleanup crews to remove another layer of soil, and then would perform another round of soil testing. This would be repeated until testing showed that the soil met state standards.
Following the 2025 L.A. wildfires, however, FEMA has repeatedly refused to pay for soil testing, contending that removing wildfire debris and up to 6 inches of topsoil from portions of destroyed homes is sufficient to eliminate any immediate health threats.
This month, U.S. Rep. Judy Chu (D-Pasadena) led a contingent of 28 federal legislators in writing a letter demanding that FEMA reassess its decision. The letter, sent June 3, calls for federal funding for soil testing and for further remediation at properties with soil contamination above California’s standards.
In a separate letter, sent Thursday, state Sen. Ben Allen (D-Santa Barbara) and three other state legislators urged California environmental regulators to step in and conduct soil sampling if federal disaster agencies continue to resist soil testing protocols. The letter recommends that state officials tap a $2.5-billion emergency relief package signed by Gov. Gavin Newsom in January, which includes funding for debris cleanup and post-fire assessments.
Allen’s letter said the state’s decision to leave burned-down homes untested “will reverse precedent and lower standards for future disasters.” Without comprehensive government-led soil testing, the letter argued, homeowners would be left to pay for soil sampling themselves or risk returning to a property with unsafe levels of contamination.
“It is deeply unjust that this responsibility has fallen to fire survivors — already burdened by the challenges of total loss recovery — simply because federal partners like FEMA and the U.S. Army Corps of Engineers have failed to lead,” write Allen and his co-signatories in the letter. “The State of California now has the opportunity to fill that gap with leadership that centers science, transparency, and community needs.”
In February, the Newsom administration asked FEMA to reconsider its decision not to conduct post-cleanup soil testing, stressing that fire-related contamination can remain undetected and pose public health risks, even after cleanup crews finish their first pass at a property. But federal officials swiftly rejected the request, and instead suggested that state and local officials should perform this work.
Since then, the pressure has continued for California officials to step up.
Last month, a coalition of environmental researchers wrote a letter to the Newsom administration, urging state agencies pay for soil testing.
The Newsom administration appears to be walking back its concerns about lingering fire-related contamination. In a June 6 letter replying to those researchers, CalEPA Secretary Yana Garcia downplayed the risks of lingering contamination from the Eaton and Palisades wildfires.
Although air quality and soil testing have found high levels of lead downwind of the Eaton fire, Garcia said that some of this soil contamination could have resulted from the historical use of leaded gasoline in cars and heavy industry.
“It is in this environment, not a clean slate, that the Palisades and Eaton Fires occurred,” she wrote in her letter.
Soil testing carried out by Los Angeles Times journalists in March provided the first evidence that homes cleaned by federal cleanup crews still contained elevated levels of lead and arsenic. Soon after, the Los Angeles County Department of Public Health also published preliminary data finding 27% of soil samples collected at already-cleaned homes still had lead above state standards for residential properties.
Despite these soil sampling results, Garcia signaled she is satisfied with the federal cleanup.
“Sampling results so far are demonstrating the effectiveness of the existing clean-up approach,” Garcia wrote in the letter.
(The health department denied an L.A. Times public records request seeking the raw data showing the extent of the soil contamination detected, saying the results had yet to be finalized. The department also declined requests for a copy of its contract with Roux Associates, including how much the county had paid the consultant to perform the soil sampling.)
Garcia stressed that blood testing around the wildfire-affected communities showed overall exposure was low. She did not directly respond to the researchers’ request to pay for soil testing for the L.A. wildfires.
Sen. Allen and the three state legislators who cosigned his public letter are seeking more answers from state environmental agencies. The letter calls for state environmental agencies to convene a public meeting by the end of June to discuss post-wildfire soil testing protocols and plans for the L.A. wildfires.
CalEPA officials did not immediately respond to a request for comment.
Science
Former Cedars-Sinai OB-GYN surrenders license after sexual abuse complaints

Former Cedars-Sinai Medical Center obstetrician-gynecologist Barry J. Brock has surrendered his medical license following an accusation of negligent care from the state medical board.
Brock, 75, signed an agreement late last month to give up the license he has held since 1978, rather than contest an accusation the Medical Board of California filed in September regarding a former patient’s treatment. The surrender took effect on Wednesday.
While Brock “doesn’t admit any factual allegations,” his attorney Tracy Green said, he elected to surrender his license rather than invest time and money into a hearing.
Under the terms of the agreement, Brock is barred from legally practicing medicine in California for the rest of his life.
Brock retired from medicine in August. Since then, at least 176 women have filed lawsuits alleging that Cedars-Sinai and other facilities where Brock worked knowingly concealed his sexual abuses and misconduct, including medically unjustifiable procedures that at times resulted in lasting physical complications.
Brock has denied all allegations of impropriety. The OB-GYN was a member of the Cedars-Sinai physician network until 2018 and retained his clinical privileges there until mid-2024.
Cedars-Sinai confirmed in July that it suspended Brock’s hospital privileges after receiving “concerning complaints” from former patients. His privileges were terminated a few months later.
“The type of behavior alleged about Dr. Barry Brock is counter to Cedars-Sinai’s core values and the trust we strive to earn every day with our patients,” the medical center said in a statement. “We recognize the legal process must now take its course, and we remain committed to Cedars-Sinai’s sacred healing mission.”
The accusation that led to the surrender of his license focused on a patient who sought treatment in 2018 for a blighted ovum, a form of miscarriage in which the fertilized egg fails to develop into an embryo.
According to the complaint, the patient reported to Brock’s office in September 2018 for a dilation and curettage to remove remaining tissues from her uterus.
Brock ordered the patient to undress in front of him, the complaint stated, and didn’t wear gloves during the procedure, which was done without a chaperone present.
The patient experienced severe pain during the visit and bled for two months afterward, the complaint said, and no follow-up care was provided. When she visited a physician’s assistant in November 2018, the complaint said, she learned that Brock had failed to complete the dilation and curettage successfully, and she had to undergo the process a second time to remove the remaining tissue.
The complaint alleged that Brock didn’t administer sufficient pain medication and failed to properly complete the procedure or follow up with pathology findings.
While Brock’s license surrender resolves this accusation, he still faces the civil lawsuits.
Suits were filed on behalf of 167 women last year, and nine more women sued the former physician earlier this month, alleging that Brock groped their breasts and genitals inappropriately during appointments, often with bare hands, and made sexually harassing comments.
“This is why these civil lawsuits and these women coming forward … are so, so important. He can’t avoid this,” said Lisa Esser, an attorney representing the nine plaintiffs. “He’s going to be held accountable.”
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