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Plastics that save us may also hurt us

Hiding in plain sight, in every hospital in the world, is a product that embodies both the extraordi..

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Hiding in plain sight, in every hospital in the world, is a product that embodies both the extraordinary benefits and the unsettling risks that plastics can pose to human health.

This product is the blood bag.

Introduced in 1950, as the United States was about to enter the Korean War, the plastic blood bag was a life-saving solution to a medical problem. Doctors had been collecting blood and performing transfusions since World War I, but the process was just beginning to be scaled up. The glass bottles used to hold blood were far from ideal. Not only did they break easily; they were hard to keep sterile, and air bubbles trapped in the rigid containers could complicate transfusions.

The new bags, invented by two American scientists, had a host of advantages: They were lightweight, cheap, couldnt shatter and took up about half the space in a refrigerator as a bottle holding the same amount of blood. They could also be easily made and kept sterile and thrown away after a single use.

Later, their popularity was boosted by a serendipitous discovery. It turns out that a chemical used to soften the plastic — di(2-ethylhexyl) phthalate, or DEHP — had a conservatory effect on red blood cells, meaning the blood could be stored longer. It was only a matter of time before plastic blood bags could be found in clinics, hospitals and blood banks across the globe.

“The discovery of plastics revolutionized blood storage and transport,” Ole Grøndahl Hansen, project manager at PVCMed Alliance, a consortium of leading companies from the medical PVC sector, wrote of the discovery. It saved “the lives of millions of people around the world.”

Blood chemicals

Plastics had a similar effect across the health care industry. Shatter-proof, cheap, disposable and hypo-allergenic, the material has become indispensable, used for everything from intravenous (IV) tubes to artificial hearts.

But lately, experts are warning that the widespread use of plastics in medical devices can also pose a risk to their users. Because plastic is so crucial to the industry, medical devices have received waivers from regulations banning chemicals as potentially dangerous to human health, despite their intimate association with the body.

“Its always been treated like there are so many benefits of using plastic, it outweighs anything else,” said Dorota Napierska, a chemicals policy officer at the advocacy group Health Care Without Harm.

Take blood bags. DEHP, the chemical that interacts with the red blood cells to extend their shelf time, is whats known as a phthalate, part of a class of chemicals used to soften polyvinyl chloride (PVC) plastics. It makes up as much as 40 percent of the weight of blood bags and 80 percent of IV tubes.

DEHP makes up as much as 40 percent of the weight of blood bags | Gerard Julien/AFP via Getty Images

DEHP doesnt stay put in the plastic. It leaches from the blood bags and tubes into the blood they hold. One study found that DEHP tubing loses 6 to 12 percent of its weight during its use.

Thats worrying because DEHP is an endocrine disrupter, according to the EUs chemical agency, which means it can interfere with normal hormone functioning. Researchers have linked DEHP to asthma, breast cancer, obesity and type 2 diabetes, low IQ scores, brain development issues, attention deficit hyperactivity disorder (ADHD), autism spectrum disorders, and lowered male fertility.

Measures have been taken in Europe to protect people from being exposed to DEHP and other harmful phthalates. Endocrine-disrupting chemicals like DEHP are most dangerous at the stage where the body is developing — so babies and pregnant women are particularly advised to stay away. For this reason, there are specific measures in place banning phthalates in toys.

And since 2012, several phthalates including DEHP, which was the most widely used over the last decades, have been subject to authorization in the EU. This means theyre banned from use unless a company applies specifically for permission.

Medical devices, however, are exempt entirely from this ban.

This is partly because their regulation has been fragmented and dealt with by different laws, and partly because theyre seen as essential components of certain devices. The risks, regulators judge, are outweighed by the benefits.

Vulnerable patients

Researchers have been flagging that were particularly at risk from DEHP exposure through medical devices for 20 years.

In 2008, an EU scientific committee found that the exposure to the chemical among hospital patients rose with the frequency of medical care. The more visits to hospital, being treated with DEHP-coated IVs or receiving blood thats been stored in bags softened by DEHP, the more at risk people were.

Nonetheless, the scientific analysis ultimately concluded that the potential harm caused by DEHP exposure “is justified by the beneficial effects of these [medical] procedures.”

In 2015, the committee updated its analysis and found concrete evidence that patients on dialysis could have side-effects from DEHP. Still, it said, “the potential for replacement of DEHP in these products should be considered against their efficiency in the treatment.”

Individual countries and hospitals have started trying to find alternatives to products with DEHP.

Most people are exposed to trace amounts of phthalates like DEHP through particles in food or indoor air — its been used in everything from traffic cones to fake leather bags to sealants for doors — but average daily exposure is thought to be lower than the level that EU scientists OKed, which is 4.8 milligrams per kilogram of body weight every day.

For patients who need regular blood transfusions, levels of 22 mg/kg of body weight were estimated. For premature infants in the neonatal unit, “being dependent on multiple medical procedures,” their exposure levels could reach 35 mg/kg — more than seven times the limit deemed safe for adults.

Indeed, studies have found that in hospitals, particularly vulnerable groups like premature babies and pregnant women are exposed to high levels of a chemical in plastics that could affect their hormones years later.

In 2016, researchers from Leuven University in Belgium kept tabs on hundreds of children who were often put in intensive care units as babies and were exposed to high amounts of DEHP in their blood. The study tested them four years later and found that they had more attention deficit disorders than their healthy counterparts.

Researchers at the University of Leuven conducted a study into the effects of DEHP on babies | Mark Renders/Getty Images

After carrying out statistical analysis and controlling for other factors, the researchers said that phthalate exposure explained half of the attention deficit in the children.

“The discussion so far has been, well, you have to help these children, theyre very critically ill, and its probably more important to use these medical devices to save their lives than to be worried about long-term consequences of the DEHP leaching [out],” said Greet Van den Berghe, the lead author of the study and head of the intensive care unit at the university of KU Leuven, in Belgium.

“But the long-term neurocognitive legacy is also really, really important,” she said.

Alternatives

Individual countries and hospitals have started trying to find alternatives to products with DEHP.

France banned tubes containing the chemical in maternity, pediatric and neonatal departments of hospitals in 2015. And individual hospitals in several European countries have started phasing out medical devices containing PVC entirely.

The EU is also starting to take action. It reformed its regulation on medical devices in 2017, and as part of the revamp it has proposed increasingly stringent standards for proving that phthalates should be in devices.

Firms that use DEHP and other hazardous chemicals in medical devices will now have to publish a detailed explanation of how and why the chemical is used, an assessment of how the benefits outweigh the risks and an explanation of how possible alternatives could work. A draft of these guidelines was published in early March, and the Commission was asking for feedback on them until the end of April.

“If you get rid of [DEHP] and use another chemical in there, you need to make sure that flexibility is still good enough. Otherwise you may choke the patient” — OliRead More – Source

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Australia

NSW COVID-19 hospitalisations pass 1,000 as cases continue to balloon across Australia

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sbs– New South Wales has recorded another 18,278 COVID-19 cases and two deaths as the state’s outbreak continues to surge.

Sunday’s case numbers are slightly lower than Saturday’s 22,577.

The state recorded two deaths from the virus, while 1,066 people are hospitalised, up from 901 on Saturday. There are 83 in intensive care.

At the peak of the Delta outbreak, on 21 September, there were 1,266 people hospitalised with infections, and 244 in intensive care.

Testing numbers to 8pm on the first day of 2022 were down to 90,019, a drop from 119,278 on New Year’s Eve.

The high case numbers come as Premier Dominic Perrottet continues to focus on hospitalisation and intensive care numbers rather than the daily case total.

Despite comprising about six per cent of the population, unvaccinated people make up the majority of those in intensive care, Health Minister Brad Hazzard says.

To ensure hospital systems can cope, asymptomatic health workers who are in isolation due to being a close contact of a positive case will be permitted to leave isolation in “exceptional circumstances”, NSW Health announced on Friday night.

Victoria posts 7,172 cases, extreme heat closes testing sites

The first day of 2022 hasn’t been kind to 7,172 Victorians, the state’s latest residents to contract COVID-19.

A further three virus-related deaths have also been recorded for 1 January.

However the number of Victorian coronavirus patients in hospital care remains relatively stable at 472, up 19 on Saturday’s figure and 48 beyond the seven-day average.

Of them, 52 are classified as active ICU cases and 22 are in need of ventilation.

Chief Health Officer Brett Sutton’s daily update said on Sunday community sampling had revealed 76 per cent of all samples collected over the Christmas period were the Omicron variant. Further testing to confirm this is being undertaken over the next week.

In total, Victoria is managing 31,461 active COVID-19 cases.

Health authorities says virus testers managed to process 48,252 results in the 24 hours to Saturday evening.

The state is 93 per cent fully vaccinated for everyone aged 12 and over.

Some 7,442 infections were reported on Saturday, another pandemic record. There were 51 actively infectious patients in intensive care and 21 ventilated.

Extreme heat caused the closure of eight of the state’s testing sites on Saturday.

Queensland records 3,587 new cases

Queensland has added 3,587 infections to its COVID-19 caseload as a new indoor mask mandate comes into effect across the state.

Some 16,688 Queenslanders now have the virus. However, hospital numbers remain low with 112 patients in care, five of them in ICUs and none requiring ventilation.

Health authorities say testers processed almost 34,000 results in the 24 hours to 7pm on Saturday.

Queensland is 86.60 per cent fully vaccinated for everyone 16 and over.

Chief Health Officer John Gerrard says despite a jump of more than 1,300 cases in a day, he’s not surprised. In part, the increase is related to a change in reporting protocols which saw case figures taken from a 12-hour window on Friday.

“This number is probably a bit smaller than we had expected,” he said in Brisbane on Sunday of the latest figures.

“It probably (also) relates to testing over the holiday period and so it will not be a surprise at all that in the next couple of days we see a significant increase in cases as more samples are tested and more people come forward.”

Dr Gerrard said what experts were now seeing with the virus was that it was “a vastly different disease” to that which was spreading in the community last year and prior to vaccination.

“With a degree of contagiousness of this virus, we are going to be seeing very large numbers of cases, even though the severity is clearly going to be less,” he said.

“We are going to see very large numbers of cases and a small proportion of a very large number (who fall ill) is still a large number.”

Masks were declared compulsory in “virtually all indoor spaces” in Queensland from 1am on Sunday.

Previously masks were only required indoors at supermarkets, shops, on public transport and ride share as well as airports and planes, cinemas and theatres in Queensland.

They now need to be worn at workplaces unless unsafe to do so, pubs, clubs and cafes unless when seated, indoor stadiums and sport arenas, libraries, hair dressers and nail salons, and medical centre waiting areas.

Queenslanders were also urged to return to work-from-home arrangements where possible.

SA hospitalisations ‘very much within capacity’

South Australia, meanwhile, recorded 2,298 COVID-19 cases on New Years Day from 21,140 tests.

The newest caseload is up from 2,108, while hospitalisations have also risen by 11.

There are currently 82 people in hospital, Premier Steven Marshall said on Sunday, a number which he said was “still very much within our current capacity”.

Seven people are in ICU.

“We see a lot of admissions but also a lot of people are leaving hospital on a daily basis after their conditions have stabilised,” Mr Marshall told reporters on Sunday.

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US follows UK’s lead and shortens isolation for healthcare workers who test positive for Covid-19

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independent– Healthcare workers who test positive for Covid-19 and are asymptomatic only need to isolate for seven days, the Centers for Disease Control and Prevention (CDC) has said.

The CDC reduced the recommended isolation time from 10 days in part due to concerns that the highly transmissible Omicron variant could cause even greater staffing shortages at hospitals.

In new guidance released on Thursday, the CDC said infected healthcare workers could return to work after a week as long as they were asymptomatic and produced a negative test.

The US recorded 261,339 new cases on Thursday, according to data from Johns Hopkins University.

Earlier this week, the UK Health Security Agency announced that essential workers would be allowed to return after a seven-day isolation period amid a worsening staffing crisis in hospitals.

In a statement, CDC Director Rochelle Walensky said it was updating guidelines in response to an “anticipated surge” in patients due to the Omicron variant.

“Our priority, remains prevention—and I strongly encourage all healthcare personnel to get vaccinated and boosted.”

Dr Walensky added that health care workers who were fully vaccinated, including with a booster shot, did not need to isolate after a high-risk exposure.

On Friday, New York Governor Kathy Hochul announced that essential workers who tested positive could return to their jobs after five days if they were fully vaccinated and asymptomatic, and had not had a fever within the past 72 hours.

“This is not Delta, or the first variant,” Ms Hochul said during a live address.

“This is Omicron, and thus far it has demonstrated it’s not as severe in its impact, and therefore we want to make sure that our critical workforce, who we’ve relied on from the beginning, can get back to work.”

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Covid booster jab triggers immune response in days, not weeks, say scientists

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independent– Those who receive a Covid booster jab can expect to mount an immune response in a matter of days – not weeks, scientists say.

The boosters have been shown to restore the body’s immunological defences against Omicron, which appears capable of infecting those who are double-jabbed.

While it takes up to two weeks to prime the immune system against Covid after a first dose, the effects of a booster jab start to be felt within two to three days, experts believe.

“The immunity generated after a booster jab will rise much quicker than the first immune response,” said Gary McLean, a professor in molecular immunology at London Metropolitan University.

That’s because crucial memory cells activated after the first dose will still be present in the body, Prof McLean explained, and therefore “do not require the two-week activation and instruction phase they initially go through”.

These memory cells – T and B – are responsible for hunting down infected cells and producing antibodies that stop the virus from gaining entry in the first place.

Their continuing presence means the immune system is on high alert and ready to spring back into action at the earliest sight of the virus, or anything that mimics it.

“That can then translate into boosted antibody levels and other increases in active T cells within days of the booster,” said Prof McLean. “It is likely that maximal immune activity is reached seven days after the booster.”

Professor Charles Bangham, an immunologist and co-director of the institute of infection at Imperial College London, said that in a secondary or subsequent immune response, T cells and antibodies should start to be detectable within “two to three days” of a booster.

The boosters appear to be 70 per cent effective against omicron infection – and are thought to offer even higher protection from hospitalisation and death – but scientists are concerned that the UK rollout won’t be able to keep up with the spread of the variant.

Doubling at a rate of every two days, Omicron has fuelled a sudden lift in national cases. On Thursday, 88,376 new Covid cases were reported, setting a new pandemic record for the second day running.

However, infections are thought to be running at far higher levels. The UK Health Security Agency said it expects there to be more than one million infections a day by the end of the month.

The government, meanwhile, has set the ambitious target of rolling out one million boosters a day to counter Omicron, and intends to have offered all eligible adults one by the close of the year. Some 745,183 third doses were given on Thursday, bringing the national total to 25.4 million.

Recent research from Israel suggests that rates of infection, severe disease and death from Delta were reduced after three to seven days post-boost – but reduced more after 12 days post-boost – when using the Pfizer vaccine for all three jabs.

The UK’s Cov-Boost study, which investigated the benefits of a booster jab among people who had received doses of the Pfizer or AstraZeneca vaccine, also pointed to an increased immune response by day seven.

“This ‘secondary immune response’ is more rapid than observed following the ‘priming’ course of vaccination, when the body takes 14 days or longer to ‘prime’ the antibody-producing B cells to produce antibody against the virus,” said Penny Ward, a visiting professor in pharmaceutical medicine at King’s College London.

“However when virus antigens [an immune-triggering structure] are ‘re-encountered’ – either by a boosting shot of vaccine or by exposure to infection – these cells react very rapidly to produce antibody more quickly.”

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