#epidemiologists warning numbers

[covid-safer-hotties]

Also preserved on our archive (Thousands of reports, sources, and resources! Daily updates!)

By Robert Stevens

A COVID wave fuelled by the XEC variant is leading to hospitalisations throughout Britain.

According to the UK Health Security Agency (UKHSA), the admission rate for patients testing positive for XEC stood at 4.5 per 100,000 people in the week to October 6—up significantly from 3.7 a week earlier. UKHSA described the spread as “alarming”.

Last week, Dr. Jamie Lopez Bernal, consultant epidemiologist at the UKHSA, noted of the spread of the new variant in Britain: “Our surveillance shows that where Covid cases are sequenced, around one in 10 are the ‘XEC’ lineage.”

The XEC variant, a combination of the KS.1.1 and KP.3.3 variants, was detected and recorded in Germany in June and has been found in at least 29 countries—including in at least 13 European nations and the 24 states within United States. According to a New Scientist article published last month, “The earliest cases of the variant occurred in Italy in May. However, these samples weren’t uploaded to an international database that tracks SARS-CoV-2 variants, called the Global Initiative on Sharing All Influenza Data (GISAID), until September.”

The number of confirmed cases of XEC internationally exceeds 600 according to GISAID. This is likely an underestimation. Bhanu Bhatnagar at the World Health Organization Regional Office for Europe noted that “not all countries consistently report data to GISAID, so the XEC variant is likely to be present in more countries”.

Another source, containing data up to September 28—the Outbreak.info genomic reports: scalable and dynamic surveillance of SARS-CoV-2 variants and mutations—reports that there have been 1,115 XEC cases detected worldwide.

Within Europe, XEC was initially most widespread in France, accounting for around 21 percent of confirmed COVID samples. In Germany, it accounted for 15 percent of samples and 8 percent of sequenced samples, according to an assessment from Professor Francois Balloux at the University College London, cited in the New Scientist.

Within weeks of those comments the spread of XEC has been rapid. Just in Germany, it currently accounts for 43 percent of infections and is therefore predominant. Virologists estimate that XEC has around twice the growth advantage of KP.3.1.1 and will be the dominant variant in winter.

A number of articles have cited the comments made to the LA Times by Eric Topol, the Director of the Scripps Research Translational Institute in California. Topol warns that XEC is “just getting started”, “and that’s going to take many weeks, a couple months, before it really takes hold and starts to cause a wave. XEC is definitely taking charge. That does appear to be the next variant.”

A report in the Independent published Tuesday noted of the make-up of XEC, and its two parent subvariants: “KS.1.1 is a type of what’s commonly called a FLiRT variant. It is characterised by mutations in the building block molecules phenylalanine (F) altered to leucine (L), and arginine (R) to threonine (T) on the spike protein that the virus uses to attach to human cells.

“The second omicron subvariant KP.3.3 belongs to the category FLuQE where the amino acid glutamine (Q) is mutated to glutamic acid (E) on the spike protein, making its binding to human cells more effective.”

Covid cases are on the rise across the UK, with recent data from the UK Health Security Agency (UKHSA) indicating a 21.6 percent increase in cases in England within a week.

There is no doubt that the spread of XEC virus contributed to an increase in COVID cases and deaths in Britain. In the week to September 25, there were 2,797 reported cases—an increase of 530 from the previous week. In the week to September 20 there was a 50 percent increase in COVID-related deaths in England, with 134 fatalities reported.

According to the latest data, the North East of England is witnessing the highest rate of people being hospitalised, with 8.12 people per 100,000 requiring treatment.

Virologist Dr. Stephen Griffin of the University of Leeds has been an active communicator of the science and statistics of the virus on various public platforms and social media since the start of the pandemic. He was active in various UK government committees during the height of the COVID-19. In March 2022, he gave an interview to the World Socialist Web Site.

This week Griffin spoke to the i newspaper on the continuing danger of allowing the untrammelled spread of XEC and COVID in general. “The problem with COVID is that it evolves so quickly,” he said.

He warned, “We can either increase our immunity by making better vaccines or increasing our vaccine coverage, or we can slow the virus down with interventions, such as improving indoor air quality. But we’re not doing those things.”

“Its evolutionary rate is something like three or four times faster than that of the fastest seasonal flu. So you’ve got this constant change in the virus, which accelerates the number of susceptible people.

“It’s creating its own new pool of susceptibles every time it changes to something that’s ‘immune evasive’. Every one of these subvariants is distinct enough that a whole swathe of people are no longer immune to it and it can infect them. That’s why you see this constant undulatory pattern which doesn’t look seasonal at all.”

There are no mitigations in place in Britain, as is the case internationally, to stop the spread of this virus. Advice for those with COVID symptoms is to stay at home and limit contact with others for just five days. The National Health Service advises, “You can go back to your normal activities when you feel better or do not have a high temperature”, despite the fact that the person may well still be infectious. Families are advised that children with symptoms such as a runny nose, sore throat, or mild cough can still “go to school or childcare' if they feel well enough.

The detection and rapid spread of new variants disproves the lies of governments that the pandemic is long over and COVID-19 should be treated no differently to influenza.

Deaths due to COVID in the UK rose above 244,000 by the end of September. It is only a matter of time before an even deadlier variant emerges. Last month, Sir Chris Whitty, England’s chief medical officer, told the ongoing public inquiry into COVID-19 “We have to assume a future pandemic on this scale [the global pandemic which began in 2020] will occur… That’s a certainty.”

[collapsedsquid]

In the U.K., the Health Security Agency recently raised its threat level to 4 out of 6, the stage immediately before large-scale human outbreaks. In Europe, countries are proactively vaccinating dairy and poultry workers against infection, with 15 nations already securing a total of 40 million doses through the European Commission. In the United States, despite having a stockpile of those vaccines, we are not distributing them, instead focusing on standing up voluntary supplies of seasonal flu vaccines to frontline workers. (The hope is that this will prevent animal infections of human flu that might aid in the further mutation of H5N1.) The Centers for Disease Control and Prevention has cited the low number of cases to justify its inaction, but it has also moved remarkably slowly to promote the kind of widespread surveillance testing that could actually identify cases. Only recently has the agency begun to mobilize real funding for a testing push, after a period of months in which various federal groups batted around responsibility and ultimate authority like a hot potato. And as was the case early in the Covid-19 pandemic, the C.D.C.’s preferred test for bird flu “has issues.” Three months into the outbreak, only 45 people had even been tested; six weeks later, the total number of people tested had grown only to “230+.” [...] Most farms aren’t supplying N95 masks, goggles or aprons to protect workers, either, and when Amy Maxmen of KFF News surveyed farm workers to ask why they weren’t getting tested, “no one had heard of bird flu, never mind gotten P.P.E. or offers of tests,” she reported. “One said they don’t get much from their employers, not even water. If they call in sick, they worry about getting fired.” Last month, a crew was deployed to slow the spread of the disease by killing every last chicken of 1.78 million on a large Colorado farm where H5N1 had broken out and six of the workers contracted the virus, partly because the gear they’d been provided was hard to use in the punishing 104-degree heat. In June, Robert Redfield, former director of the C.D.C., echoed many epidemiologists in predicting that “it’s not a question of if, it’s more of a question of when we will have a bird flu pandemic.” In July, Brown’s Jennifer Nuzzo warned that the steady beat of new cases “screams at us that this virus is not going away.” Tulio de Oliveira, a bioinformatician who studies global disease surveillance, marveled that the American effort to track the spread of the disease was absolutely amateurish and the country’s apparent indifference “unbelievable.”

[mindblowingscience]

The risk of suffering a stroke is significantly higher with high overnight temperatures, posing a potential health concern around the globe as the world gets warmer. Mapping night-time temperatures against the number of stroke cases recorded in the German city of Augsburg across the course of 15 years, a research team led by the Helmholtz Munich research center in Germany found a statistically significant increase in stroke risk on days where extremely warm night-time temperatures were recorded, with older people and women particularly vulnerable. "We wanted to understand the extent to which high night-time temperatures pose a health risk," says Alexandra Schneider, an epidemiologist at the Helmholtz Munich. "This is important because climate change is causing night-time temperatures to rise much faster than daytime temperatures."

Continue Reading.

[readingsquotes]

"The Integrated Phase Classification (IPC) system, set up 20 years ago, provides the most authoritative assessments of humanitarian crises. Its figures for Gaza are the worst ever by any metric. It estimates that 677,000 people, or 32% of all Gazans, are in “catastrophic” conditions today and a further 41% are in “emergency” conditions. It expects fully half of Gazans, more than 1 million people, to be in “catastrophe” or “famine” within weeks."

...

We are about to witness most intense famine since the second world war. It won’t be the biggest, because starvation is confined to the 2.2 million residents of the Gaza Strip.

...

Epidemiologists in London and Baltimore have generated projections for the likely death toll in Gaza from all causes over the months to August. If epidemics are included, their “status quo” scenario projects a range of 48,210 to 193,180 deaths, while under the “with escalation” scenario those figures range even higher.

Gaza’s health crisis has its own dreadful momentum. Even if the shooting ends today and the aid trucks begin to roll, the dying will carry on for some time.

And even when the numbers of people needlessly dying dwindle, the scars of famine will endure.

....

And in Gaza there is no margin of doubt.

In most famines, there’s a margin of uncertainty in predictions, because people may be able to find unexpected sources of food or money. In parts of rural Africa, grandmothers may know about edible wild roots and berries or migrant workers may find creative ways of sending cash to their families. In Gaza, Israel knows every calorie that’s available. In 2008, the coordinator of government activities in the territories calculated every aspect of Gaza’s food production and consumption, in minute detail, and extracted the “red lines” needed to keep Palestinians on what it called a “diet”, just short of starvation.

Until 7 October 2023, Israel was, according to its own analysis, just on the right side of the international laws prohibiting starvation. About 500 truckloads of essentials entered every day to complement local farms, fisheries and livestock. In recent months, less than one-third of that number has been allowed to enter, while local food production has been reduced to almost zero.

Israel has had ample warning of what will happen if it continues its campaign of destroying everything necessary to sustain life. The IPC’s Famine Review Committee report on 21 December authoritatively warned of starvation if Israel did not cease destruction and failed to allow humanitarian aid at scale. Israel’s own judge nominated to sit at the international court of justice, Aharon Barak, voted with the court’s majority in favour of “immediate and effective measures to enable the provision of urgently needed basic services and humanitarian assistance”.

Israel has not changed course. The supplies entering Gaza are woefully short of the minimum calories Israel specified before the war. American airdrops of supplies and an emergency port are a pitiful pretence of a substitute.

Famine is unfolding in Gaza today. We should not have to wait until we count the graves of children to speak its name.

[mariacallous]

Chrissy Kinsella was looking for a more personalized approach to her health. “You know, what is good for you as an individual may not necessarily be good for the next person,” she says. So she reached for a subscription to Zoe—a personalized nutrition service cofounded by Tim Spector, a celebrity scientist and a genetic epidemiologist at King’s College London. Kinsella paid the £299 ($365) for a testing kit and later received a bright yellow package in the mail: a bundle of vials, patches, and muffins.

By testing, scoring, and monitoring how you respond to different foods, Zoe says, it can help with a whole host of problems. Its personalized recommendations can help you “reach a healthy weight,” “feel less bloated,” and “avoid chronic health issues,” claims its website. The program can even help with menopause, Zoe says.

But doctors are more ambivalent. Sure, getting people to think critically about what they eat can be beneficial, but scoring and monitoring someone’s diet could lead to unnecessary health concerns or even disordered eating. British doctors say they have seen perfectly healthy patients with concerns about their blood sugar control prompted by readings in their Zoe app.

A Zoe starter pack includes a fecal sampling kit, a finger-prick blood test, and a continuous glucose monitor (CGM). Participants are asked to take a blood sample before and after they eat a muffin precisely engineered by the startup to contain specific levels of fat, sugar, and proteins. Zoe then runs a blood-fat test to see how each person responds to fat in their diet (prolonged high levels of fat in the blood are a health risk). Combined with blood glucose data (from the CGM) and an analysis of the quality of their microbiome (via the fecal sample), these measurements are used to create personalized diet recommendations, where each item of food is scored on a scale up to 100.

A sugary food, for example, would have a low score for someone whose data shows their body doesn’t control blood sugar levels well; for someone with good sugar control, the same food would be scored a bit higher. Meals, too, are scored out of 100—based on the personalized scores of their ingredients, as well as how those ingredients interact.

Kinsella, who used the program for a year, says she values the insights it gave on what foods were more suited to her body—now she knows that she tolerates fat well, sugar not so much, and that dairy milk sits better with her than oat milk. Kinsella loved inspecting data about her body, but she admits she became obsessed with checking the app to see what her blood sugar was doing in response to what she ate, courtesy of the CGM. Small, coin-shaped, and usually affixed to the upper arm, CGMs have been a regular appendage of people with diabetes for years now, allowing them to track dips and hikes in blood sugar without needing to prick their finger every time. There’s been a growing trend of companies selling the monitors to people without diabetes for them to track how their body responds to certain foods. Levels and Veri, two other personalized nutrition plans, also use CGMs.

Getting a score of at least 75 every day is the ultimate aim of the Zoe program. This figure is calculated based on what you’ve eaten. But Kinsella found herself ruling out a lot of foods because they wouldn’t get her to that magic number, and she thinks the app encourages this kind of obsessive behavior. “You’re giving people an app that is kind of almost gamified, in that when you hit this magical 75, you get a big green circle. And everybody wants to get 10 big green circles in a row,” she says.

Shivani Misra, a consultant doctor specializing in diabetes in London, has seen an influx of patients at her non-NHS practice who have either purchased a CGM themselves or through the Zoe program, and who’ve become worried they are at risk for developing diabetes—due to seeing either continuously high blood sugar levels or sharp rises and falls.

When Misra formally tests them for diabetes, the results always come back normal. “We shouldn’t be using CGM to diagnose diabetes; it’s absolutely not validated for that,” she says. What concerns Misra is the people she’s seen who are restricting calorie intake and have become extremely anxious about eating carbohydrates. “I really worry about that group, because they’ve just become overwhelmed with the data that they’re seeing, which is completely normal.”

“It’s set up to derive those kinds of behaviors in exactly the people that would be susceptible to it, in my opinion,” she says. The patients who came to her were seeking professional guidance because they felt their anxiety about what the data was telling them had become problematic—in the case of one patient, they felt they couldn’t eat fruit anymore. “I personally think there is some corporate responsibility to make sure that there is adequate safety in place for people,” says Misra.

Federica Amati, a medical scientist and nutritionist and a science communications strategist at Zoe, says that the company has “lots of systems in place for customer service, and for our coaching team to be able to flag if they feel that somebody is not interacting with the app in a healthy way,” she says. “Of course, the fact that there’s a score associated with food is still problematic if you have disordered eating.”

On the potential for programs like Zoe to burden health systems with concerned users, Amati says that the company is putting a task force together to investigate how medical professionals are experiencing Zoe’s influence. “We feel very responsible about it,” she says.

Nicola Guess, a dietitian and researcher at the University of Oxford, says that she has also been approached by patients concerned about their health after seeing their blood glucose spike while wearing a CGM offered as part of a personalized nutrition plan. When she tested these patients to assess their blood glucose control, their results were completely normal. “It’s just making them quite weird about food, and it takes a lot of the enjoyment out of food for no reason whatsoever,” says Guess.

But, says Amati, Zoe didn’t create the worried well, noting that the problem has been an issue for the public health service for a very long time. “For sure, we’ve probably now created a new stream for the worried well to feed into, but I think that that’s a bigger problem than just Zoe.”

There is also a big question mark over how useful personalized nutrition really is. Zoe’s nutrition scores are predicated on the idea that each of us responds to the same food in a slightly different way—thanks, in part, to our microbiomes. But translating this into dietary advice is trickier and less well understood. A personalized diet might tell someone to cut out white bread and eat more leafy vegetables, for example, but is this really more effective than the same advice delivered by a family doctor or a public health advertisement?

“Zoe doesn’t eschew all the normal health advice,” Amati says. “We’re not like, ‘Oh, no, don’t eat more fruits and vegetables’—it sits within the recommendations that we know are very good for the majority.”

There is precious little clinical trial data on personalized nutrition apps, says Duane Mellor, a dietitian and researcher at Aston University in the UK. One study from Israel published in 2015 compared personalized diets generated by a machine-learning algorithm with diets selected by a clinical dietitian. The authors found that people in both groups had fewer glucose spikes after meals—indicating a healthier diet.

But whether personalized nutritional plans really make a difference is something Zoe is studying. Next month, Amati says the company will be releasing the results of a randomized controlled trial, called the Zoe Method Study. The trial involved one group of people receiving the full Zoe product and another group simply receiving standard nutritional advice, plus access to support services through an app. The study aims to test the efficacy of a program like Zoe in improving cardiometabolic risk markers in otherwise healthy people, through testing their resulting levels of cholesterol and triglycerides (a type of fat), as well as measuring other things like weight, blood pressure, glycemic control, and hunger levels.

All of this doesn’t come cheap, and Zoe users have to pay membership fees for continued access to their bespoke scores. Prices start at £59.99 ($73) for a single month and go down to £24.99 ($30) per month for a year-long plan. At those prices, Zoe is aimed squarely at wealthier consumers—a point not lost on columnist James Greig, who wrote about Zoe in the newsletter Vittles.“If our environment really is saturated with poisons, then bespoke services like Zoe are not a scalable solution but a form of private health care that will further entrench existing inequalities,” Greig wrote.

Amati acknowledges that Zoe’s program is expensive, but she says, “The product at the moment is the price it is because the testing we do is expensive.” She says the idea is that, as the techniques and technology become more common, the price will come down accordingly, and that Zoe has plans to work with the NHS and other providers to “become part of the health approach.” In the meantime, the company places focus on communicating health advice for free through forums like social media and podcasts.

Zoe is still proving popular, with over 130,000 people having tried the service so far. Part of the appeal of personalized nutrition is that it goes beyond weight loss to address other concerns people have about their health. Zoe markets its diet as a way to improve energy levels, gut health, and sleep. William Viney, a researcher who has worked on personalized medicine, points out that there are a huge number of people who have health issues that aren’t easily addressed by doctors and mainstream diets. “They know that they’re not like everyone else, and they need to get to the bottom of something,” says Viney. “There is an opportunity to bring information, and with it care, to whoever can pay the price for such a product.”

[beardedmrbean]

When China relaxed its zero-COVID policy at the start of December, international observers warned there would be mass outbreaksin the Chinese population, which, it was estimated, lacks sufficient herd immunity or vaccine protection.

One statistical model published by healthdata.org predicts that 300,000 people could die from COVID-19 infections by April 2023 and 1.6 million people could die by the end of the year.

"Infections are steeply on the rise and hospitals are overwhelmed. It's quite [certain] that the situation is spiraling out of control, at least in Beijing and other big cities," said Björn Alpermann, a sinologist at the University of Würzburg in Germany.

COVID wave in China 'thermonuclear bad'

On December 19, a prominent epidemiologist, Eric Feigl-Ding, tweeted that the situation was "thermonuclear bad."

Feigl-Ding predicted "over 60% of China's and 10% of the Earth's population likely infected over the next 90 days. Deaths likely in the millions — plural."

In scenes reminiscent of the early months of the pandemic in 2020, Feigl-Ding posted a video of what looks like an overcrowded hospital, with patients lying close next to each other on the floor.

Other reports suggest morgues and crematoriums are overloaded, with backlogs running into the thousands. "The reports that crematoriums are working 24/7 are deeply disturbing," said Alpermann.

How accurate are the statistics?

It's not known how many people are currently infected with COVID-19 in China or the number of those who have recently died from the disease.

Oliver Radtke who lives in Beijing and is the chief representative of the Heinrich Böll Foundation, an independent political foundation affiliated with Germany's Greens, said it was impossible to know how severe the current COVID wave was by reading the official statistics.

"Judging strictly from personal evidence, scrolling through WeChat [social media] and having conversations with colleagues and friends, I reckon about one third in the city is sick, one third is taking care of the sick and one third simply doesn't dare to venture out," Radtke told DW.

Alpermann said the Chinese government had more or less admitted that its statistics were artificially low when it said that it would only count COVID deaths that had happened due to lung failure. That's Alpermann's personal assessment, but it suggests that those statistics tell only a partial truth.

The lack of accurate statistics about the current COVID situation in China makes predictions about deaths and illness difficult.

"There are so many moving parts in models, so there's a lot of guess work. The subvariant [of omicron, BF.7] circulating in China now isn't well studied, and we don't know how fast people will get boosters this winter," Alpermann said.

Booster campaign to target elderly

So, how are Chinese health authorities responding to the situation? Radtke said authorities had placed responsibility on individuals to keep safe.

"The official slogan these days is 'everybody is responsible for the prevention and control of the pandemic,'" he said.

But the Chinese National Health Commission (NHC) has initiated a large vaccination and booster campaign, especially for the elder and other high-risk groups.

Many health experts outside China have been critical about the effectiveness of Chinese vaccines from Sinovac and Sinopharm compared to mRNA vaccines, such as the BioNTech-Pfizer and Moderna jabs — and the NHC is only administering vaccines made in China.

However, reports suggest they may include new nasal spray vaccines in the booster program. The hope is that the new vaccine types will reduce COVID transmission as well as the risk of severe COVID-19 symptoms.

"Worries about grandparents and older parents are high. Especially regarding family members in the countryside and [remote] provinces, where Intensive Care Unit beds are rare or non-existent," said Radtke.

What caused the latest COVID outbreak in China?

Experts say that the current infection and death rates in China may be because the country has a lower level of population immunity than that in other countries. 

"The Chinese government boasted they won a victory against COVID with their zero-COVID strategy. For some time it looked that way in 2021, but with omicron the picture completely changed," said Alpermann.

China has pursued a zero-COVID policy since the pandemic began.

During zero-COVID, the government implemented mass testing, imposed strict lockdowns and quarantined those people with COVID-19 in special facilities.

Now that it has relaxed its lockdown rules, the population has been going out but with very little natural exposure to infection, especially the more contagious variants, such as omicron — because they were locked in for all that time. In any case, that is the theory you hear from health experts outside China.

Rates of booster vaccine uptake are estimated to be low in China, especially among older people who have a higher risk of developing severe symptoms — only about one-third of over-80s and two-thirds of over 60s have received their first booster shot, according to official data.

"In retrospect, it now looks like the Chinese government did not use the time during zero-COVID to their own advantage to get vaccination rates as high as they should have been. They did not import more advanced mRNA vaccines or approve mRNA vaccines created in China," Alpermann said.

The first of three waves

Speaking at a conference in Beijing on December 17, Zunyou Wu, a chief epidemiologist at the Chinese Center for Disease Control and Prevention, said that the current outbreak would peak this winter and run in three waves for about three months.

The modelling mentioned at the start of this article puts the potential death rate as high as 1.6 million people by the end of 2023. But that depends on whether COVID transmission can or will be contained with new lockdowns and by the success of vaccination programs.

"I am worried about what happens once the current wave reaches the lesser-developed parts of the country, especially in the western hinterland," said Radtke.

Whatever the exact figures, Chinese health authorities appear to be struggling to keep up with the spread of the disease, and that continues to cause concern outside of the country as well.

[thoughtlessarse]

The plants slowly choke to death, wither and dry out. They die en masse, leaves dropping and bark turning grey, creating a sea of monochrome. Since scientists first discovered Xylella fastidiosa in 2013 in Puglia, Italy, it has killed a third of the region’s 60 million olive trees – which once produced almost half of Italy’s olive oil – many of which were centuries old. Farms stopped producing, olive mills went bankrupt and tourists avoided the area. With no known cure, the bacterium has already caused damage costing about €1bn. “The greatest part of the territory was completely destroyed,” says Donato Boscia, a plant virologist and head researcher on Xylella at the Institute for Sustainable Plant Protection in Bari. A decade later, far from nearing resolution, the threat to European plants from Xylella and other diseases is only growing: in February 2024, Puglia scientists found another Xylella subspecies, which had annihilated US vineyards and never previously been detected in Italy. For many farmers, scientists and regulators, the disease is emblematic of a far broader problem: the EU’s difficulty curtailing the introduction of devastating new plant diseases, despite regulatory efforts over the past decade. New data, released to the Guardian, shows that dozens of newly introduced disease outbreaks are detected in the EU every year, even as farmers and scientists struggle to contain previously introduced pathogens. As the climate heats, scientists warn the problem will get worse. Across the EU, data shows, outbreaks of newly introduced plant disease have continued unabated at an average rate of 70 a year between 2015 and 2020, despite regulations introduced to stop their spread in 2016. While a number of member states have taken steps to prevent and curb the outbreaks, scientists, plant epidemiologists and agronomists say it is still insufficient. “I can’t understand how, after Xylella, we learned almost nothing,” says Pierfederico La Notte, an Italian plant epidemiologist.

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[man-and-atom]

Chernobyl did something amazing which most people seem incapable of realizing : it showed us that even the worst conceivable nuclear disaster wasn’t anything like as bad as we had thought.

A little background : back in 1958, the US Atomic Energy Commission published a report known as WASH-740. This was intended as a look at the worst possible consequence of a nuclear power plant accident, and so it postulated the sudden dispersal into the environment of the complete core of a 200 MW light-water reactor. This isn’t something that could actually, physically happen. But it was predicted that 3400 deaths and 43 000 injuries would result.

As it turns out, the RBMK-1000 reactor type had a unique design such that, under certain very unusual conditions, it was possible to disperse about 1/5th of the core of a 1000 MW reactor. Every other type of power reactor ever approved for civilian use is designed and constructed so that such an event is made impossible by the laws of physics ; but the Politburo wanted large reactors now, and when they were warned by the Chief Designer that the calculations weren’t complete, they thought it would be adequate to issue an operators’ manual saying “never for any reason do this”.

In other words, what happened at Chernobyl 38 years ago was beyond the worst nuclear accident that anyone thought could happen, or indeed, that could have happened anywhere else.

Now here’s the really important part. The United Nations Scientific Committee on the Effects of Atomic Radiation has made careful study of the people affected over those 38 years. Estimates of exposure, for instance, have been made for people exposed to the debris cloud, and their health has been compared to the health of unexposed populations from the same region, with the same demographics, diet, et cetera. Furthermore, the “liquidators”, a workforce of well over a hundred thousand people who were sent in to do cleanup, and received the largest allowable radiation dose before being pulled out, have been followed all that time.

The expected harms to human health have failed to appear.

Among the liquidators, for instance, it was confidently expected that, within about 10 years, a very large number of cases of leukemia would be seen, because this is the kind of cancer most likely to be caused by radiation. There should have been what epidemiologists call a large signal, a statistically unambiguous number of cases, several times larger than the number which would occur at random in an unexposed population. All these years later, we’re still waiting to see those cancers.

In face, Greenpeace and others have accused UNSCEAR of a cover-up, because the estimates of deaths and injuries keep getting revised downward in every successive report. Apparently they don’t understand how the scientific method works. Correlation does not necessarily imply causation, but the lack of correlation is very good evidence against causation.

Meanwhile, knowledge of the very real harms of fossil fuels, and of air pollution — which nuclear power plants do not produce — continues to mount.

Civil nuclear energy has never caused any event comparable to the 1952 London smog, and the evidence of Chernobyl is that it cannot.

Oh hell yeah

[partisan-by-default]

Although the investigations were not designed to assess the reason for this trend, scientists suspect the downturn is a result of increased immunity to SARS-CoV-2 (the virus that causes COVID), milder variants of that pathogen and improved treatments. It is a welcome reprieve, but the decline does not help the millions of people who are already suffering from long COVID. Moreover experts warn that the risk is still not zero. And without a clear explanation for the downward trend, it is unclear whether it will continue.

“You have to be vigilant,” says Paul Elliott, an epidemiologist at Imperial College London’s School of Public Health. “You can’t just relax these days and be done.”

There is reason for hope, however. Elliott and his team recently reported that people infected during the pandemic’s Omicron wave were 88 percent less likely to develop long COVID, compared with those infected with the original strain that emerged in Wuhan, China. The research, published in October in Nature Communications, is the latest in a growing number of studies that point to a downswing in the debilitating condition. This summer, the U.S. Centers for Disease Control and Prevention noted that the proportion of people infected with SARS-CoV-2 who went on to develop long COVID dropped from 18.9 percent in June 2022 to 11 percent in January 2023. And just a few months before that European researchers found that the risk of long COVID among cancer patients fell from 19.1 percent in 2020 to 6.2 percent in early 2022. Other studies show similar findings.

Although the studies disagree on absolute numbers, experts argue that the downhill trend is real—that the likelihood of any individual developing long COVID has fallen since the beginning of the pandemic. The question is why.

[epacer]

Education

As more teens overdose on fentanyl, schools face a drug crisis unlike any other

Before the overdose, Griffin Hoffmann was a sophomore, about to lead his Portland, Ore., high school's tennis team. Sienna Vaughn was a junior in Plano, Texas, who participated in Girl Scouts and cheerleading. Laird Ramirez was 17 years old living near Charlotte and competing on his high school's wrestling team. He was rarely seen without his skateboard.

The teens thought they were taking prescription pills for pain and relaxation, drugs like Valium or Percocet, that they bought from friends or from social media. But the pills they took were counterfeits – they hadn't come from a pharmacy and it turned out they contained fentanyl, a potent, often deadly, synthetic opioid. Just 2 milligrams can kill you.

Griffin, Sienna and Laird's deaths are part of a grim crisis happening all across the country. Their stories, taken from local news reports, are among the dozens NPR reviewed, and they illustrate a new challenge for schools this fall.

"[Fentanyl's] infiltration into schools is certainly something that cannot be ignored," says Alberto Carvalho, the superintendent of the Los Angeles Unified School District. LAUSD is one of the largest districts to stock naloxone, a medicine that reverses opioid overdoses, throughout its schools.

"We cannot close our eyes. We cannot look the other way," he says.

Fentanyl was involved in the vast majority of all teen overdose deaths – 84% – in 2021, and the problem has been growing. According to the Centers for Disease Control and Prevention, fentanyl-related adolescent overdose deaths nearly tripled from 2019 to 2021. And nearly a quarter of those deaths involved counterfeit pills that weren't prescribed by a doctor.

Lauren Tanz, an epidemiologist who studies overdose prevention at the CDC, says a number of factors contributed to these alarming numbers.

"The combination of more easily available drugs – particularly highly potent drugs like fentanyl that are available via social media and through counterfeit pills – and a mental health crisis among adolescents that was exacerbated during the COVID-19 pandemic is resulting in an increase in overdose deaths among kids."

This academic year, education leaders are grappling with how to approach a drug use crisis unlike any they've seen before.

"If our students are having contact with these substances, considering the devastating implications and consequences," says Carvalho, "then we need to be active participants in the solution, and not necessarily shy away from it or punt it to somebody else because it falls outside of the realm of traditional education."

Schools can't do it alone

It's happening all across the country – from Tennessee to Texas; from Maryland to Oregon. In some cases, a single high school or school district has seen multiple fentanyl overdose deaths. School buildings have posters in the hallways memorializing students who have died. Social media posts and back-to-school messages from school staff include warnings and pleas to turn in pills students have bought online, "no questions asked."

In addition to stocking naloxone – often known by the brand name Narcan – schools have revamped their drug awareness and prevention programs. Some are promoting the use of test strips to help identify if a pill contains fentanyl, although the small paper tests can still be considered drug paraphernalia and are illegal in several states.

But Becky Pringle, president of the National Education Association, the nation's largest teachers union, warns schools are just one piece of the puzzle.

"We can't possibly do this alone. This is not a school crisis. This is a community crisis," says the former middle school teacher.

"So it's not just educators in schools. It's parents and families. It's the communities themselves. It's every level of government. We have to come together. Too often, the ills of society find the way to our schoolhouse doors, but the resources of society don't follow them."

There are multiple bipartisan pieces of federal legislation aimed at supporting schools in dealing with fentanyl, including one proposed bill that would give money to schools to stock naloxone and train teachers and nurses in updated drug education.

Mourning families are often leading the charge

Some families of students who have died have been frustrated with how schools are responding or say schools could do more. Of the 20 largest districts in the country, only five confirmed to NPR that they stocked naloxone in all of their schools last school year. And in schools across the country, drug education is ad-hoc, not standardized and oftentimes outdated. The 2021 National Survey of Drug Use and Health found only about 60% of surveyed 12-17-year-olds self-reported that they saw or heard drug or alcohol prevention messaging in school.

Avery Kalafatas, an 18-year-old from the Bay Area, says she knew nearly nothing about fentanyl until it killed her cousin, Aidan Mullin. He was like an older brother to Kalafatas; the two shared a love of the outdoors and camping. Mullin had an interest in agriculture, and a fondness for growing peppers and playing the guitar.

In November of 2020, Mullin, then 18, took what he thought was a Percocet. It contained a lethal dose of fentanyl. His death was a devastating blow.

"And it took me a while in my grieving process to obviously get past the shock and the sadness of it. But in that process, I was honestly pretty angry that this wasn't talked about more," she says.

Kalafatas began to educate herself about the synthetic opioid.

"As I became more aware of it through my cousin's death, I really saw a big need for more education, both among parents, and especially teens."

Kalafatas founded the nonprofit Project 1 Life with a mission to educate adolescents and foster youth-led conversations about fentanyl, the deadly and frighteningly ubiquitous opioid found in so many counterfeit pills. "This isn't like the drug crisis we were dealing with 20 years ago, it's a completely different ballgame," Kalafatas says.

A different ballgame because many students aren't intentionally seeking out the deadly drug they're overdosing on.

Ed Ternan, a father from Pasadena, Calif., runs the nonprofit Song for Charlie with his wife, Mary. They use social media to inform teens about fentanyl-laced counterfeit prescription pills.

He says the growing fentanyl crisis requires a new approach to how families and educators talk to students about drugs.

"We need to revive drug education in America. In a way, we need to Narcan drug education – we need to breathe life into it, bring it back," Ternan says.

He says they've learned from consulting with experts in youth mental health and drug education that the "just say no" message of the past isn't an effective way to communicate with teenagers. Instead, they craft fact-based messages they hope teenagers will actually pay attention to.

Rather than focus on "Don't do drugs, they might harm you," Song for Charlie's messaging is: "You're getting ripped off. These dealers advertising on social media do not care. They don't know you, they're not your friend, and they are lying to you about what they're selling you," Ternan explains.

That's what happened to Ternan's youngest son, Charlie.

"He was very much the calming influence...in our family," he says. "A very steady, level-headed guy with more of a subtle, dry sense of humor."

In May 2020, Charlie was on his college campus in northern California. He was weeks away from graduation, and was prepping for a job interview. He was also in pain. Ternan says his son had recently undergone back surgery.

Charlie purchased what he thought was a Percocet off of Snapchat. It contained fentanyl.

"He actually took it a couple hours before he was supposed to have a job interview on the phone," Ternan says. "And so he died very quickly in his room at his frat house waiting for the phone to ring at about four o'clock on a Thursday afternoon."

After his son's death, Ternan says most of the information about fentanyl he could find was buried on government websites and in a smattering of news articles.

"You can put that information in those places for the next 10 years, and Charlie and his friends would never have seen it because that's not where they are."

Where they are is on social media. Ternan and his wife funneled their grief into action; they founded their nonprofit and partnered with social media platforms to disseminate information about fentanyl.

Ternan says their messages also appeal to teenagers' strong social bonds. He's learned that telling teens to warn their friends about fentanyl is more powerful than stoking fear of their own harm.

This kind of awareness could save lives. The latest research from the CDC found there were bystanders present at two thirds of teen overdose deaths. Tanz, the CDC researcher, sees this as a potential opportunity for intervention and education.

"These are people that were nearby who could have intervened or responded to the overdose," she says. "It means we can educate family and friends to recognize warning signs ... and that might improve bystander response and prevent deaths."

Peer-to-peer conversations have also been central to Kalafatas' efforts at Project 1 Life. "Hearing it from someone that's not an adult, parent, or teacher... makes it much more real," she says.

"I think the Fentanyl crisis is an inflection point in our national conversation about drugs," Ternan explains. "It's forced us to look in the mirror and acknowledge our shortcomings and say we got to do better."

Both Kalafatas and Ternan want schools to use some of the lessons they've learned to educate students. With schools also struggling to address mental health, learning loss and so many other challenges, they say it's been an uphill battle.

But they also say it's a necessary one. Schools have the potential to reach millions of kids if they decide to talk to and teach students about the dangers of fentanyl.

"Having these conversations, and having them right, can be the difference between life and death," Kalafatas says. *Reposted article from KPBS by Elissa Nadworny and Lee V. Gaines on August 30, 2023

[covid-safer-hotties]

Also preserved on our archive

"If your child has mild symptoms... they can go to school or childcare." We're BEYOND cooked...

By Ben Hurst

Health officials have warned that the number of Covid patients in hospital has increased, with deaths rising by over 25 per cent. Scientists are currently investigating the potential risks associated with the XEC variant.

Doctors have noted a surge in respiratory viral infections such as colds, flu and Covid, as the nation battles with the 'lurgy'. The UK Health Security Agency's latest update revealed that positive testing rates had climbed to 14.6%, up from 13.5% the previous week.

This figure is based on the percentage of people who test positive in hospital settings. Hospitalisations due to COVID-19 saw a slight increase to 4.64 per 100,000, compared to 4.46 per 100,000 the previous week.

This marks a sharp rise from 3.72 per 100,000 just two weeks ago. Cases have risen by 17.8% to 3,496 in the seven days leading up to October 9.

In the most recent week for which figures are available, ending October 4, there were 163 deaths - an increase of 27.3%. The latest figures show 2,622 patients in hospital with Covid, a six per cent increase, with 68 acute respiratory incidents related to Covid reported.

Positive test rates were highest among those aged 85 or older, with a weekly average positivity rate of 23.7%, marking an increase from the previous week. The North East currently has the highest hospital admission rate at 8.91 per 100,000.

Those aged 85 years and over had the highest hospital admission rate, remaining stable at 52.65 per 100,000 compared with 51.28 in the previous week.

As autumn's chill takes hold, the UK Health Security Agency (UKHSA) is urging those eligible for vaccination to get their winter boosters. Figures up to the end of week 41 reveal that uptake rates sit at 8.5% for people under 65 years in clinical risk groups and 24.7% for those over 65 years in England.

Dr Jamie Lopez Bernal, a Consultant Epidemiologist at the UKHSA, was quoted saying: "If you're eligible to get vaccinated against the three main winter threats – COVID-19, flu and RSV – now is the time to take them up and get winter strong."

He further explained, "We understand people may be concerned about new variants. Our surveillance shows that where covid cases are sequenced, around 1 in 10 are the 'XEC' lineage. Current information doesn't suggest we should be more concerned about this variant but we are monitoring this closely. The most important thing to do is to get your vaccination as soon as possible if you're eligible."

For those experiencing symptoms such as a high temperature, cough, and general malaise potentially indicative of flu or COVID-19, the advice remains cautious: limit contact with others, particularly the susceptible. Although self-isolation rules have been relaxed, NHS guidance recommends staying home and minimizing social interactions for five days post-testing and ten days for contact with those at increased risk following a positive result.

A new COVID-19 variant identified as XEC, initially detected in Germany in June, has made its way into the UK, Denmark, and the United States. According to Monica Gandhi, professor of medicine at the University of California, it presents symptoms very reminiscent of previous variants, including sore throat, cough, body aches, fever, and loss of sense of smell and appetite.

This Omicron subvariant is spreading swiftly across Europe. However, vaccines are expected to provide protection against severe cases in a similar manner to past experiences with other strains.

Gandhi said: "There is no evidence that the symptoms caused by [new variants] differ from the symptoms caused by other Omicron subvariants. The symptoms seem to be the same as with other recent subvariants of Omicron."

She goes on to emphasise that there is minimal cause for alarm about XEC, stating: "I am not very concerned about the new variant because COVID-19 is not an eradicable virus (it is found in too many animal reservoirs for one thing, with rapid evolution in animals such as deer) so we will always see new subvariants."

Symptoms Symptoms of XEC are thought to be similar to other strains of Covid and can include:

A high temperature or shivering (chills) – a high temperature means you feel hot to touch on your chest or back (you do not need to measure your temperature) A new, continuous cough – this means coughing a lot for more than an hour, or three or more coughing episodes in 24 hours A loss or change to your sense of smell or taste Shortness of breath Feeling tired or exhausted An aching body A headache A sore throat A blocked or runny nose Loss of appetite Diarrhoea Feeling sick or being sick What to do if you have Covid symptoms Even if you don’t take a Covid test, the NHS has recommended that you try to stay at home and avoid contact with other people if you have symptoms and either:

Have a high temperature Or do not feel well enough to go to work, school or do your normal activities. “You can go back to your normal activities when you feel better or do not have a high temperature,” the NHS says on its website. “If your child has mild symptoms such as a runny nose, sore throat or mild cough, and they feel well enough, they can go to school or childcare.”

[denimbex1986]

'German epidemiologists are warning of a summer wave of coronavirus infections, blaming in part mass gatherings such as the Barbenheimer double feature craze...

“It could be that we’re having a summer wave,” Timo Ulrichs an epidemiologist at the Berlin Akkon University of Human Sciences, told the news portal Spiegel, adding that the so-called “Barbenheimer effect” was capable of boosting the numbers.

Germany was among the countries where cinemagoers were encouraged to go to watch the blockbuster films Barbie and Oppenheimer as a double feature, in an effort to boost cinema attendance which has yet to recover since the pandemic. So far just under 4 million have seen Barbie, and more than 2.5 million Oppenheimer.

The idea of a Barbenheimer effect on the spread of the virus was first playfully mooted by the vaccine expert Peter Hotez of the National School of Tropical Medicine at the Baylor College of Medicine in Texas.

Suggesting on Twitter that it might be of concern, due to the millions of people surging to cinemas and spending hours in a windowless room together, he concluded: “We’ll probably never know since no one seems to be keeping track of such things any more.”...'

[shahananasrin-blog]

[ad_1] The Public Health Agency of Canada (PHAC) is deploying two epidemiologists to New Brunswick in September to support the province's public health team, at the request of New Brunswick's public health authority.The move follows a letter from a high-profile neurologist warning that a growing number of abnormally young patients are facing a rapid onset of neurological symptoms.Moncton neurologist Dr. Alier Marrero sent a letter to PHAC and New Brunswick public health in January, saying he was seeing an increase in the number of patients, and that some patients were in the "advanced stages of clinical deterioration."In a statement, PHAC confirmed its epidemiologists will work under the supervision of New Brunswick public health and conduct a "three-day scoping exercise that will include an on-site review of patient records that have been collected to date."It said the review of records will inform the next steps for provincial public health. The New Brunswick government did not respond to a request for comment regarding why it asked PHAC for help. Province closed investigation in 2022This decision to involve federal epidemiologists marks a reversal in the provincial government's position.In 2022, the New Brunswick government closed an investigation into a cluster of 48 patients experiencing neurological symptoms — a move The Guardian reported perplexed some federal scientists.An oversight committee appointed by the provincial government determined there is no mystery brain disease, and that the majority of patients in the cluster were misdiagnosed and ought to have been diagnosed with known diseases.The oversight committee cast doubt on Marrero's work, saying it "could not conclude that the main referring neurologist had sought second opinions."Marrero has become a fierce advocate for patients. In his January 2023 letter, he wrote to Canada's top public health official and the province of New Brunswick's chief medical officer, warning them the number of cases has grown from 48 to more than 147, claiming that some are as young as 17 years old.He wrote that some patients are experiencing "very advance evidence of neurodegenerative diseases," including dementia, severe pain syndrome, brain and muscle atrophy and more. "Some of these patients are, unfortunately, in advanced stages of clinical deterioration and near the end of life," he wrote. He also warned that some patients' blood work showed elevated levels for compounds found in herbicides such as glyphosate, and said more testing should be done to rule out environmental toxins, including the neurotoxin BMAA, which is produced by blue-green algae.  "I believe there is an urgency to act promptly and use all means necessary to investigate and get to the root cause," he wrote in the letter. [ad_2]

[liminalrpg]

Canons

Consider the canon reserves officially open! Below you’ll find a list of those available, along with a brief description for each. These will be first come, first serve, so make sure you let us know via an ask if you would like to snag one of these positions.

Edit: For now, everyone will have the opportunity to reserve 1 canon slot each!

For an up-to-date list of which canons have already been claimed, please refer to our Reserves Page.

Decoder Hint 3: C

The Community Chief: Former Advisor to the Mayor Community Leaders

The Agriculturalist: taught the community how to farm

The Teacher: started classes for children

The Cop: tries to keep the peace

The Soldier: trained the community in survival

The Engineer: keeps what appliances still run, running

The Hunter: trained the community to hunt and fish

The Oracle: warns the community of things that may come to pass

Power Plant Operator: keeps the power plant and dam running as best they can

Power Plant Mechanical Engineer: aids the operator in the event of malfunction

Audiologist: studies the blast, the hum, and the formless

Paranormal Investigator: perpetuates wild theories about the formless and the source of the blast and hum

Doctors

Epidemiologist

General Practitioner

Veterinarian

Numbers Stations Runners (5 Slots)

Scouts (5 Slots)

Guards

North Quadrant

East Quadrant

South Quadrant

West Quadrant

Northeast Quadrant

Southeast Quadrant

Northwest Quadrant

Southwest Quadrant

[playingplayer2]

Additionally, a lot of the schools we have for early language learning aren't accessable for a number of reasons.

Fair warning, everything below is personal experience. I speak almost entirely English, I don't travel, and I have a serious disconnect with the non-white-american side of my heritage. Less personal stuff further down.

↓

My sibling and I were homeschooled for several years (starting at pre-k aged to 2nd/3rd grade age), and when my older sibling got sent off to school(6yo), it was to a Mandarin Immersion School in our area because our (now-permanently-out-of-the-picture) father is a Chinese immigrant and it was decided to try that, and if it went well, I'd be going the next year. (Funnily enough he didn't want me or my sibling or our mother learning Cantonese or Mandarin, and not for pleasant or heart-warming reasons.)

It did not go well.

(In fact it went so badly because of abuse in the school system, racism, and ableist bullshit, that my sib got pulled so fucking fast with such a public fuss, that in the coming years that school apparently did a total overhaul to change that. Comparatively, one of my best friend's friends went to a French Immersion School and never had any issues and now, knows French. I on the other hand (public school from 7/8 on up) didn't have an opportunity outside of things at home- and with a recently divorced mother, scrambling to get work and take care of two kids & court, and a P.O.S old man, there really wasn't time for me or my sibling to learn more.)

My mom taught us some Latin, she'd taken Latin in school, and ASL, having learned a lot for/from her deaf friend in high school, and pre-divorce we'd been learning some Mandarin when my father wasn't around.

Now flash forwards, I don't start learning a new language through school until I'm in middle school at 13. I take French for a year. I switch to Spanish in high school a year later, end up with a really bad teacher (no srsly, she taught French and Spanish and kept switching to French lessons, so many people had issues with her teaching Spanish) and so the next year I don't sign up for a school language class, start trying to learn Italian on my own. Then I end up starting French again in 11th grade because most colleges required at least 2 years of a non-english language classes.

I take two years of French, and in the last three months of my senior year there's a Global Pandemic (please note; it isn't over, check with your local epidemiologists for more info). Real wrench in my life plans, y'know?

So, now, three years post hs graduation, the biracial child of an immigrant, and I know a handful very basic words in (textbook) Spanish, I remember French at the weirdest damn times (but can barely speak any of it), and my Cantonese and Mandarin are basically non-existent (Cantonese because my father's side is immigrated from Hong Kong, Mandarin bc that's the "what everyone speaks" in said relatives words).

Now, in terms of travel? I've left my State (I live in the states) twice. Both times add up to less than 12 hours out of state, and less than an hour past the state border each time.

I grew up and I'm still poor, like a huge portion of Americans. I've never been on a vacation outside of school mandatory ones. I've never left the U.S, I don't even have a passport and I don't drive.

My mom? Grew up poor. Vacations aren't a thing for people below a certain income. But bc of where I grew up, all of my friends could afford to go on a family trip to Florida or NY or Cali or wherever every year or two, most of my friends now can and have travelled out of state, even out of country, on a semi-regular basis.

But most of those friends grew up in a 2-income family, remarried/non-divorced households that were already decently well off.

To the less personal stuff.

↓

Every person above has fucking point though. The States could, and quite frankly should, be doing better, should be doing more.

But racism and classism and sexism are all still rampant, frothing at the mouth, vicious and blatant.

Our transportation in-country is horrid. The cost to leave the country is tremendous, starting with the cost of passports to whether or not taking a week off will cost you your job.

And there's a shit ton of clueless, rich Americans who go out there and Americanism all over everything in the most miserably rude, senseless fashion they can, most of them not even realizing it.

There's a ton of faults, and a whole lot of cluelessness that breeds ignorance and insult, on both sides.

Europeans don't, for the most part, understand just how split up the States are, culture, language, etc. Because each state, each region, is vastly different from geography to mannerisms. They don't get just how easy it is for them to travel, their schools promote learning multiple languages. Our schools, our governments? They don't. Well. They do if you're rich, white, and cis. Then it's a "bonus in your job applications." But if someone who isn't one or any of those speaks two or more languages, then it's a count against them.

Again: racism, classism, sexism.

But, Americans also aren't "cultureless." I'm from the Midwest. That's very different from the central plains (now often lumped in w/ the MW) or from the East, South, West, etc. The cultures between regions are incredibly different- and it varies more-so state to state. You can't say NY and NJ are the same, just like MN and WI aren't. CA isn't WA state, and KS, AZ, and GA can't even be compared, region or state.

It's just that the predominant majority of American Tourists come from the same middle-to-upper class, white, nuclear-family backgrounds and their ingrained ignorance paired with the European VP (that we hear the most) is that All Americans Have The Same Opportunities and Upbringings leads to a lot of bullshit fuckery.

europeans will really look americans dead in the eye and say they’re so uncultured because they never leave the us