This week, the news cycle has been awash with speeches and sound bites from the 26th United Nations Climate Change Conference, also known as COP26, being held in Glasgow, Scotland.
The summit has regularly been cited as our last hope of tackling the climate emergency that threatens our very survival.
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It sounds dramatic, and it is, but it also reflects a truth that is staring us in the face: we depend on a healthy planet for food, water, shelter and the air we breathe. But as we plunder its resources and emit pollutants into the atmosphere, we are not only killing the wildlife and plants, we share the earth with, we are directly harming our own health. Attempts to secure more energy, food and infrastructure leave a trail of environmental contamination and human health hazards.
It is no secret that humans are inherently selfish creatures; the warning signs of climate change have been present for decades, but it is only since seeing the direct effects it has had on our safety and wellbeing that most of us have been spurred into action.
One of the main items on the COP26 agenda is aiming for a global reduction in fossil fuel burning. Fossil fuels are formed from the fossilised remains of dead plants and animals that humans extract and burn for their carbon-containing energy content. They include coal, crude oil and natural gas. Burning fossil fuels has been shown to have direct adverse effects on our health. Air pollution continues to be a serious public health concern affecting nine out of 10 individuals living in urban areas worldwide. Exposure to air pollution is the ninth biggest risk factor for lung and heart damage.
Burning coal is a leading cause of greenhouse gas emissions as well as an array of toxic chemicals. China, India and the United States are the world’s main coal mining regions. However, Indonesia, Australia, Russia, South Africa and Colombia also produce large amounts. Coal-burning not only releases carbon dioxide and methane, two of the worst greenhouse gases, but also sulphur dioxide, nitrogen oxide and mercury – all of which are harmful to human health.
Crude oil combustion also releases harmful gases such as carbon dioxide and sulphur into the atmosphere, whereas burning natural gas can release the powerful greenhouse gas methane when it is heated and compressed to release energy into the air.
The lungs are the primary organ affected by gases and chemicals released by fossil fuel burning. People who work in coal mines are far more likely to suffer from lung diseases like emphysema and bronchitis; both conditions obstruct airways and make it difficult to breathe. Those who live near coal stations and breathe in air that contains the harmful components that coal-burning releases are also at higher risk of suffering from these conditions.
It is time for change; we must demand better from our leaders and no longer sleepwalk alongside them into climate catastrophe.
Nitrogen oxide, in particular, can affect the protein component in the lungs and reduce their ability to inflate and deflate as well as they should, meaning airflow is reduced, leaving people with chronic lung conditions that can leave them short of breath. Inhalation of these same chemicals has also been shown to have an adverse effect on the heart muscle in some people, causing it to become bigger and weaker, a condition known as cardiac muscle hypertrophy.
It stands to reason that if these harmful chemicals can affect adults in such ways, children must also be at increased risk. Studies have shown that children exposed to higher levels of carbon in the air have an increased risk of cognitive impairment and even memory issues. There is also evidence showing that an association between high levels of nitrogen oxide and pollution from traffic on roads can affect fertility as well as the menstrual cycle in some women and increase the risk of miscarriage during pregnancy. And it is not just women being affected; there has been a steady decline in overall sperm count in men over the last 50 years, with poor air quality thought to play a factor. Air pollution has also been linked to lower birthweights in newborn babies as well as an increased risk of premature delivery, which in itself carries a high risk of health complications for babies.
Health authorities and governments have been aware of the evidence linking adverse health outcomes to poor air quality, but many have been slow to act, putting profit and the drive for a growing economy over the health of their populations.
It is time for change; we must demand better from our leaders and no longer sleepwalk alongside them into climate catastrophe. We are constantly being told that the current infrastructures are too complex to change, that it would cost too much. But what is the cost of doing nothing? Surely there is no price too high to pay for the future of our planet and the health of our children.
We need firm answers and pledges from COP26, no more excuses. Our lives depend on it.
Progress report: What is the AY.4.2 coronavirus subvariant?
Many of us are now used to hearing about new variants of the coronavirus. The Delta variant has become dominant due to mutations on its spike protein that allow it to more quickly and effectively bind to human host cells, making it more infectious than previous variants.
Now a new subvariant of the Delta variant has been identified. Known as AY.4.2, it was first identified in the United Kingdom in July and has now spread to at least 42 countries, including the United States, according to the latest World Health Organization (WHO) weekly epidemiological update on COVID-19.
The AY.4.2 subvariant is known to contain two additional mutations on its spike protein, which is the part of the virus that sticks out and allows it to bind to human host cells thereby infecting them. The mutations – Y145H and A222V – are currently under investigation by scientists. The questions they will be asking are whether the mutations make this new subvariant more transmissible, more dangerous and more evasive to the immune response triggered by the vaccines.
The AY.4.2. subvariant has only been increasing at a modest rate in the UK, making up approximately 6 percent of new COVID cases during the week commencing October 20. It has officially been designated a Variant Under Investigation by the UK Health Security Agency.
So far, there is little evidence that we need to be overly concerned about this new subvariant; it has yet to show itself as being more infectious than the original Delta variant and there is nothing to suggest it will take over its parent as the dominant variant of the coronavirus. There is also no real evidence of it causing a severer illness or being any more evasive to the immune reaction stimulated by the vaccines.
The advice around protecting ourselves from COVID remains the same: get vaccinated when offered, keep indoor spaces ventilated, wear a mask in crowded spaces and maintain good hand hygiene.
Good news: US approves vaccines for 5 to 11-year-olds
On October 29, 2021, the US Food and Drug Administration (FDA) released a statement approving the emergency use of the Pfizer-BioNTech COVID-19 vaccine to include children aged five to 11 years old.
An Emergency Use Authorization (EUA) is a mechanism to facilitate the availability and use of medical countermeasures – including vaccines – during public health emergencies, such as the current COVID pandemic.
The decision came after a panel reviewed the data from a study looking at the effectiveness and safety of a low dose version of the Pfizer vaccine in this age group; the panel came to the conclusion (PDF) that the benefits of getting the vaccine outweighed any potential risks.
In the US, children aged five to 11 make up 39 percent of COVID cases in under-18s.
The ongoing study, conducted with approximately 3,100 children in the US, Finland, Poland and Spain, showed that five- to 11-year-olds had a similar immune response to the vaccine as those aged 16 to 25, and that the vaccine was 90.7 percent effective in preventing COVID-19 in this younger age group.
While no serious side effects have been detected, commonly reported side effects in the clinical trial included injection site pain (sore arm), redness and swelling, fatigue, headache, muscle and/or joint pain, chills, fever, swollen lymph nodes, nausea and decreased appetite. More children reported side effects after the second dose than after the first. These were generally mild to moderate in severity and occurred within two days of the vaccination. Most went away within one to two days.
The Pfizer vaccine has been linked to inflammation of the heart muscle and its lining in young men, but the study showed no such side effect in five- to 11-year-olds, although the study was relatively small and is ongoing.
Although COVID is generally not as serious a condition in children as it is in adults, there have been 440 deaths of children and teens aged five to 18 from the virus in the US since the start of the pandemic. This may seem like a relatively small number but it is worth pointing out that we do not see high numbers of deaths in this age group in developed countries from any infectious disease. In the US, children aged five to 11 make up 39 percent of COVID cases in those below 18. According to the Centers for Disease Control and Prevention (CDC), approximately 8,300 COVID-19 cases in children aged five to 11 resulted in hospitalisation.
Combined with the higher risk of infection posed by the Delta variant and the danger of Long COVID in children, the FDA has concluded that vaccinating this age group is in their best interests.
Personal account: Should the UK be removing countries from its red list?
On the morning of November 1, 2021, the UK officially removed any remaining countries from its “red list”. This meant travellers returning from Ecuador, the Dominican Republic, Colombia, Peru, Panama, Haiti and Venezuela will no longer have to quarantine in hotels. Those arriving – fully vaccinated or below 18 years of age – do not need to complete a predeparture COVID test, a test on the eighth day after arriving, or isolate for 10 days at home.
With COVID cases in the UK so high in comparison to many of our neighbouring countries, we are likely to be exporting more coronavirus than we are importing, but I remain concerned about our lax borders.
I fully empathise with the hardships the travel industry has had to endure during this pandemic. It has been affected more than most – but speaking as a doctor, I remain concerned about the lack of reverse transcription-polymerase chain reaction (RT-PCR) testing for people returning to the UK. Those who return from trips abroad or visit us here – provided they are fully vaccinated – need only do a lateral flow test on the second day after arrival. This then means they have to self-report the result to a government website. The onus is on the individual to report the correct result; there are no checks in place to see if tests are actually being done or if the result being reported is indeed the true reading.
I would like to think that most people will report their results honestly and book a RT-PCR test and isolate should their lateral flow test come back positive, but I know this will not be the case for everyone. My other concern is that the lack of routine RT-PCR testing for people arriving from overseas means we have less of a handle on any new variants that might inadvertently be imported in. We saw what happened when the Delta variant was allowed in through open borders earlier this year.
My advice would have been to have kept the Day 2 RT-PCR testing in place rather than replace it with a self-reported lateral flow test. That way we could support the travel industry while keeping a closer eye on what was coming in through our borders.
Only time will tell if the UK government’s current policy is the correct one.
Reader’s question: What is the Valneva COVID vaccine?
The Valneva vaccine, made by French company Valneva, is a proposed COVID-19 vaccine that is yet to complete trials. The vaccine technology is more traditional in that it uses a similar technique to polio and flu vaccines, relying on an inactivated whole version of the coronavirus, which cannot replicate or cause disease. After being inactivated, the virus is purified and combined with an adjuvant that helps stimulate an immune response.
The reason why there is such interest in this vaccine is that instead of just relying on the spike protein part of the virus – as the Pfizer, Moderna and AstraZeneca vaccines do – this one presents the whole virus to the immune system, meaning that, in theory, you get an immune response to the whole virus and not just part of it.
This means that if a part of the actual coronavirus mutates in the future – as we have seen with emerging variants – your immune system will still recognise the unmutated parts and neutralise it. The hope is that vaccines using this technology will be able to provide protection for longer, rather than needing to be reformulated to get ahead of new variants.
The results from trials so far have been promising, with good immune responses reported as well as no serious adverse effects. Phase three trials are ongoing, but the UK has already ordered 100 million doses and countries like Australia have also expressed an interest.
If we have a vaccine that gets us ahead of any future variants that may emerge, it will indeed be a game-changer.