WORCESTER MEDICINE
Climate Change
Climate Change, Health, and the Marine Environment Continued 18. Hare, J.A., Morrison, W.E., Nelson, M.W., Stachura, M.M., Teeters, E.J., Griffis, R.B., Alexander, M.A., Scott, J.D., Alade, L., Bell, R.J., Chute, A.S., Curti, K.L., Curtis, T.H., Kircheis, D., Kocik, J.F., Lucey, S.M., McCandless, C.T., Milke, L.M., Richardson, D.E., Robillard, E., Walsh, H.J., McManus, M.C., Marancik, K.E., Griswold, C.A. 2016. A vulnerability assessment of fish and invertebrates to climate change on the northeast US continental shelf. PLoS ONE 11: 1–30. 19. Tanaka, K.R., Torre, M.P., Saba, V.S., Stock, C.A., Chen, Y., 2020. An ensemble high-resolution projection of changes in the future habitat of American lobster and sea scallop in the Northeast US continental shelf. Diversity and Distributions 26: 987–1001. 20. Wahle, R.A., Dellinger, L., Olszewski, S., Jekielek, P. 2015. American lobster nurseries of southern New England receding in the face of climate change. ICES Journal of Marine Science (2015), 72(Suppl. 1). i69–i78. 21. Glenn, R.P., Pugh, T.L. 2006. Epizootic shell disease in American lobster (Homarus americanus) in Massachusetts coastal waters: interactions of temperature, maturity, and intermolt duration. Journal of Crustacean Biology 26: 639–645. 22. Groner, M.L., Shields, J.D., Jr, D.F.L., Swenarton, J., Hoenig, J.M. 2018. Rising Temperatures, Molting Phenology, and Epizootic Shell Disease in the American Lobster 192: E163-E177. 23. Cooley, S.R., Rheuban, J.E., Hart, D.R., Luu, V., 2015. An Integrated Assessment Model for Helping the United States Sea Scallop (Placopecten magellanicus) Fishery Plan Ahead for Ocean Acidification and Warming. PLoS ONE 10: e0124145. 24. Cisneros-Mata, M.A., Mangin, T., Bone, J., Rodriguez, L., Smith, S.L., Gaines, S.D. 2019. Fisheries governance in the face of climate change: Assessment of policy reform implications for Mexican fisheries. PloS one 14: e0222317.
Inflammation of the Climate: The Impact on Gastrointestinal Infections Parul Sarwal, M.D. George M. Abraham, M.D., M.P.H., F.A.C.P., F.I.D.S.A.
T
he united states ventured to return to the paris climate
Agreement this January, a month that saw warmer-thanaverage temperatures in most parts of the country. The average global temperature today is 1 degree Celsius higher than before the industrial revolution of the last century. While this statistic beguiles the gravity of the climate crisis, extreme weather events certainly do not - as demonstrated by the increasing frequency of heat waves and floods, among other natural disasters. The 2020 Atlantic hurricane season witnessed the greatest number of storms in recorded history in the shortest duration of time; so much so, that the National Hurricane Center ran out of human names for the storms, needing to turn to the Greek alphabet for Tropical Storm Beta, the cyclone that affected the southeastern US this past September. One of the myriad corollaries of harsh weather is an upsurge in infectious diseases, primarily gastrointestinal (GI) and hepatic. Studies have consistently demonstrated an association between temperature variations and GI infections. A recent review by Australian researchers confirmed that temperatures warmer than the usual baseline are associated with more frequent bacterial GI infections, which is compounded by an increase in humidity and precipitation. Campylobacter and Salmonella infections peaked in Scotland in July according to one study. This brings to mind the “gastroenteritis season” in July and August every year during my medical school training in India — rows of extra hospital beds in the hallways festooned with bags of IV fluids. A heat wave is defined by the World Meteorological Organization as five or more consecutive days of prolonged heat wherein the daily maximum temperature is at least 9 degrees Fahrenheit (5 degrees Celsius) higher than the average maximum temperature. Scientists in Switzerland reported a nearly 5% increase in GI infections and resultant hospitalizations for every additional hot day during heat waves – an effect not observed during spells of cold weather. The year 2018 saw one of the longest heat waves in the United Kingdom. This prompted water treatment agencies to offer Legionella risk assessments to prevent potential outbreaks. While not primarily a GI infection, Legionnaires’ disease can often cause diarrhea, and its outbreaks have been partly ascribed to climate variations by the scientific community. This is perhaps due to its propensity for spread via internal climate control systems. Thus, it is important to note that external climate change can cause increased disease spread via internal climate change machinery. In the same vein, we are presented with uncharted challenges with respect to sanitation and clean water. There has been a resurgence of hepatitis E virus in endemic areas due to increasing population densities as well as the increased frequency of flooding and drought, impacting access to safe drinking water. Further, variations in temperature and carbon dioxide
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