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Published1 day agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesMore than three years after Covid-19 was detected in the Chinese city of Wuhan, the question of how the virus first emerged remains a mystery.But on 28 February 2023 the controversial claim that the pandemic might have leaked from a Chinese laboratory – once dismissed by many as a fringe conspiracy theory – resurfaced with FBI Director Christopher Wray’s comments that the bureau believes Covid-19 “most likely” originated in a “Chinese government-controlled lab”.It is the first public confirmation of the FBI’s classified judgement of how the pandemic virus emerged. In response, Beijing accused Washington of “political manipulation”.So what do we know about the competing theories – and why does the debate matter?What is the lab-leak theory?It’s a suspicion that the coronavirus may have escaped, accidentally or otherwise, from a laboratory in the central Chinese city of Wuhan where the virus was first recorded.Its supporters point to the presence of a major biological research facility in the city. The Wuhan Institute of Virology (WIV) has been studying coronaviruses in bats for over a decade.The institute is a 40-minute drive from the Huanan wet market where the first cluster of infections emerged.Those who entertain the theory say it could have leaked from a WIV lab and spread to the wet market. Most argue it would have been an unaltered virus collected from the wild, rather than engineered.The controversial theory first emerged early on in the pandemic, and was promoted by then-US President Donald Trump. Some even suggested it could have been engineered as a possible biological weapon.While many in the media and politics dismissed these as conspiracy theories at the time, others called for more consideration of the possibility. The idea has persisted, despite many scientists pointing out there is no evidence to back it up.A classified US intelligence report – saying three researchers at the Wuhan laboratory were treated in hospital in November 2019, just before the virus began infecting humans in the city – began circulating in US media in 2021. Image source, ReutersBut it was reported the Biden administration had shut down a state department investigation, set up by President Trump, into the lab-leak theory.”That possibility certainly exists, and I am totally in favour of a full investigation of whether that could have happened,” Anthony Fauci, President Biden’s chief medical adviser, told a US Senate committee hearing in May 2021.President Biden says he asked for a report on the origins of Covid-19 after taking office in 2021, “including whether it emerged from human contact with an infected animal or from a laboratory accident”.In May 2021, Mr Biden ordered intelligence officials to “redouble” their efforts on this.Image source, EPAWhat do scientists think?The issue is still hotly contested.A World Health Organization (WHO) investigation was supposed to get to the bottom of it, but many experts believed it produced more questions than answers.A team of WHO-appointed scientists flew to Wuhan in early 2021 on a mission to investigate the source of the pandemic. After spending 12 days there, which included a visit to the laboratory, the team concluded the lab-leak theory was “extremely unlikely”.This video can not be playedTo play this video you need to enable JavaScript in your browser.But many have since questioned their findings. A prominent group of scientists criticised the WHO report for not taking the lab-leak theory seriously enough – it was dismissed in a few pages of a several-hundred-page report.”We must take hypotheses about both natural and laboratory spillovers seriously until we have sufficient data,” the scientists wrote in Science Magazine.They’re not the only experts who called for the laboratory leak to be looked at more closely.Even the WHO’s own director-general, Dr Tedros Adhanom Ghebreyesus, called for a new investigation, saying: “All hypotheses remain open and require further study.”And Dr Fauci said in 2021 he was “not convinced” the virus originated naturally. That was a shift from a year earlier, when he thought it most likely Covid had spread from animals to humans.What does China say?China has hit back at suggestions the virus may have escaped from a laboratory by calling it a smear. State media have consistently accused the US government and Western media of spreading rumours about the source of the pandemic.Responding to Mr Wray’s remarks, China’s foreign ministry spokesperson accused US intelligence agencies of politicising the investigation into the origins of the virus.The US intelligence community had a history of “misdeeds” involving “fraud and deception”, Mao Ning told a press briefing. As such, she said, their conclusions regarding the origins of Covid-19 had no credibility.China has pushed another theory, suggesting the coronavirus may have entered Wuhan in food shipments of frozen meat from elsewhere in China or South-East Asia. The Chinese government has also pointed to research published by one of its leading virologists into samples collected from bats in a remote, abandoned mine. Wuhan – City of silenceWuhan scientist ‘welcomes’ visit over lab leak claimWuhan marks its anniversary with triumph and denialProf Shi Zhengli – often referred to as “China’s Batwoman” – a researcher at the Wuhan Institute, published a report in 2021 revealing that her team had identified eight coronavirus strains found on bats in the mine in China in 2015. The paper says that coronaviruses from pangolins pose more of an immediate threat to human health than the ones her team found in the mine.Added to this is an unsubstantiated conspiracy theory long pushed by Chinese propagandists – and repeated by Mao Ning at the foreign ministry briefing on 1 March 2023 – suggesting the coronavirus was made and leaked from Fort Detrick in Frederick, Maryland, about 80km (50 miles) north of Washington DC.Once the centre of the US biological weapons programme, Fort Detrick currently houses biomedical labs researching viruses including Ebola and smallpox.Is there another theory?Yes, and it’s called the “natural origin” theory.This argues the virus spread naturally from animals, without the involvement of any scientists or laboratories.Supporters of the natural origin hypothesis say Covid-19 emerged in bats and then jumped to humans, most likely through another animal, or “intermediary host”.This video can not be playedTo play this video you need to enable JavaScript in your browser.That idea was backed by the WHO report, which said it was “likely to very likely” that Covid had made it to humans through an intermediate host.This hypothesis was widely accepted at the start of the pandemic, but as time has worn on, scientists have not found a virus in either bats or another animal that matches the genetic make-up of Covid-19, leading some to doubt the theory.Nevertheless, following FBI Director Wray’s remarks, many scientists who have studied the virus have stressed there is no new scientific evidence pointing to a lab leak.A natural origin is still the more likely theory, said Professor David Robertson, head of viral genomics and bioinformatics at the University of Glasgow.”There’s been an accumulation of evidence (what we know about the viruses biology, the close variants circulating in bats and locations of early human cases) that firmly points to a natural origin centred on the Huanan market in Wuhan city,” he said.Prof Alice Hughes from the University of Hong Kong agreed. She said the US Department of Energy’s conclusion that the virus was most likely the result of a lab leak in Wuhan “appears not to be based on new evidence, and remains the weaker of the two main hypothesis of the origin of the virus”. Why does this matter?Given the massive human toll of the pandemic – with the recorded deaths of about 6.9 million people worldwide – most scientists think understanding how and where the virus originated is crucial to prevent it happening again.Image source, Getty ImagesIf the “zoonotic” theory is proved correct, it could affect activities such as farming and wildlife exploitation. In Denmark, fears about the spread of the virus through mink farming led to millions of mink being culled.But there would also be big implications for scientific research and international trade if theories related to a laboratory leak or frozen food chains were confirmed. Any confirmation of a leak may also affect how the world views China, which has already been accused of hiding crucial early information about the pandemic, and place further strain on US-China relations.”From day one China has been engaged in a massive cover-up,” Jamie Metzl, a fellow at the Washington-based Atlantic Council who has been pushing for the lab-leak theory to be looked into, told the BBC in 2021″We should be demanding the full investigation of all origin hypotheses that’s required.”But others have cautioned against pointing the finger at China too quickly.”We do need to be a bit patient but we also need to be diplomatic. We can’t do this without support from China. It needs to be a no-blame environment,” Prof Dale Fisher, of Singapore’s National University Hospital, told the BBC.More on this storyChina hits back as US revisits Covid lab theory27 May 2021Covid lab leak in China ‘extremely unlikely’ – WHO9 February 2021Wuhan scientist ‘welcomes’ visit over lab leak claim21 December 2020

The company said it would cap the out-of-pocket cost of the diabetes drug at $35.Eli Lilly and Company said on Wednesday that it would reduce the price of its most commonly prescribed insulins and expand a program that caps monthly out-of-pocket costs for patients at $35 or less.It said the company was taking the action to “help Americans who may have difficulty navigating a complex health care system that may keep them from getting affordable insulin.”Insulin, a lifesaving drug that is usually taken daily, has grown increasingly expensive in recent years, and many diabetes patients ration their medicines or discontinue them because of the cost. More than 30 million Americans live with diabetes.It comes after years of mounting criticism from Americans who have said the drug should be more accessible. The criticism led to lawsuits and legislation.This is a developing story. Check back for updates.

Published4 days agoShareclose panelShare pageCopy linkAbout sharingThis video can not be playedTo play this video you need to enable JavaScript in your browser.By Vanessa BuschschlüterBBC NewsA Bolivian man has described how he managed to survive for 31 days in the Amazon jungle after he got lost.Jhonattan Acosta, 30, got separated from his four friends while out hunting in northern Bolivia.He says he drank rainwater collected in his shoes and ate worms and insects while hiding from jaguars and peccaries, a type of pig-like mammal.Mr Acosta was finally found by a search party made up of locals and friends a month after he had gone missing.”It’s incredible, I can’t believe people kept up the search for so long,” he said amid tears.”I ate worms, I ate insects, you wouldn’t believe all I had to do to survive all this time,” he told Unitel TV. He also ate wild fruits similar to papayas, known locally as gargateas.”I thank God profusely, because he has given me a new life.”His family said that they would still have to piece together all the details of how Mr Acosta got lost and how he managed to stay alive but that they would ask him gradually as he was still psychologically bruised after the experience. Mr Acosta lost 17kg (37lb) in weight, had a dislocated ankle and was dehydrated when he was found but according to those who found him, was still able to walk with a limp.”My brother told us that when he dislocated his ankle on the fourth day, he started fearing for his life,” Horacio Acosta told Bolivia’s Página Siete newspaper. Image source, Reuters”He only had one cartridge in his shotgun and couldn’t walk, and he thought no one would be looking for him anymore,” Horacio Acosta, the survivor’s younger brother, added. Jhonattan Acosta did not have a machete or a flashlight on him when he got lost and had to use his boots to collect rainwater to drink.He also told his relatives that he had encounters with wild animals including a jaguar.His younger brother says that Jhonattan used his last cartridge to scare off a squadron of peccaries, pig-like herd animals found in the rainforests of South America.After 31 days, he spotted a search party some 300m (980ft) away and limped towards them through thorny bushes, shouting to draw attention to him.Horacio Acosta says that his brother was found by four local people. “A man came running to tell us they’d found my brother. It’s a miracle.”According to the younger Acosta, Jhonattan has decided to give up hunting for good after his ordeal.”He is going to play music to praise God. He promised God that, and I think he will keep his promise,” he said of his guitar-playing brother. Meanwhile police said they would question the four friends of the survivor to understand how he became separated from them.More on this storyTears of relief after man found in jungle. Video, 00:00:36Tears of relief after man found in jungle4 days ago0:36Family survives 34 days in jungle ‘eating berries’27 January 2020Mother and baby survive plane crash26 June 2015

Listen to This ArticleAudio Recording by AudmTo hear more audio stories from publications like The New York Times, download Audm for iPhone or Android.Kris Walterson doesn’t remember exactly how he got to the bathroom, very early on a Friday morning — only that once he got himself there, his feet would no longer obey him. He crouched down and tried to lift them up with his hands before sliding to the floor. He didn’t feel panicked about the problem, or even nervous really. But when he tried to get up, he kept falling down again: slamming his back against the bathtub, making a racket of cabinet doors. It didn’t make sense to him then, why his legs wouldn’t lock into place underneath him. He had a pair of fuzzy socks on, and he tried pulling them off, thinking that bare feet might get better traction on the bathroom floor. That didn’t work, either.When his mother came from her bedroom to investigate the noise, he tried to tell her that he couldn’t stand, that he needed her help. But he couldn’t seem to make her understand, and instead of hauling him up she called 911. After he was loaded into an ambulance at his home in Calgary, Alberta, a paramedic warned him that he would soon hear the sirens, and he did. The sound is one of the last things he remembers from that morning.Walterson, who was 60, was experiencing a severe ischemic stroke — the type of stroke caused by a blockage, usually a blood clot, in a blood vessel of the brain. The ischemic variety represents roughly 85 percent of all strokes. The other type, hemorrhagic stroke, is a yin to the ischemic yang: While a blockage prevents blood flow to portions of the brain, starving it of oxygen, a hemorrhage means blood is unleashed, flowing when and where it shouldn’t. In both cases, too much blood or too little, a result is the rapid death of the affected brain cells.When Walterson arrived at Foothills Medical Center, a large hospital in Calgary, he was rushed to the imaging department, where CT scans confirmed the existence and location of the clot. It was an M1 occlusion, meaning a blockage in the first and largest branch of his middle cerebral artery.If Walterson had suffered his stroke just a few years earlier, or on the same day in another part of the world, his prognosis would have looked entirely different. Instead, he received a recently developed treatment, one established in part by the neurology team at Foothills: what’s called an endovascular thrombectomy, or EVT. In the hospital’s angiography suite, a neuroradiologist, guided by X-ray imaging, pierced Walterson’s femoral artery at the top of his inner thigh and threaded a microcatheter through his body, northbound to the brain. The clot was extracted from his middle cerebral artery and pulled out through the incision in his groin. Just like that, blood flow was restored, and soon his symptoms all but disappeared.A little more than 24 hours later, Walterson’s memory kicked back in, when he was lying in a narrow bed on the stroke ward. He ate breakfast. He answered questions from the doctors on the stroke team as they made their rounds. By Sunday afternoon he could manage to walk around the ward, cracking jokes while a stroke neurology fellow hovered nearby. “Do you want to hold my hand?” she asked. “People will talk,” he replied, and shuffled along on his own. It wasn’t until Monday afternoon, as he laced up his black sneakers and prepared to head home, that he asked another stroke fellow, Dr. Kimia Ghavami, how bad he was on Friday during those hours he could no longer remember.“When I met you,” she said, “you were completely paralyzed on your left side.” Without the EVT, Walterson would most likely have been facing a best case of weeks in the hospital and months more of rehab. The worst case, if he survived at all: a feeding tube, permanent immobilization and a much-shortened life in a bed in a long-term care facility. It could have been catastrophic, but here he was, hearing about his now-vanished symptoms secondhand.Stroke kills about six and a half million people around the world annually. It’s the second most common cause of death worldwide, and it consistently ranks among the top five causes of death in Canada and the United States. Beyond the raw death toll, stroke is also a leading global cause of disability — too often, it leaves behind the kinds of severe deficits that force loved ones to become full-time caregivers. Even smaller, less severe strokes are associated with the onset of dementia and many other complications.Given that toll, it’s no exaggeration to call the EVT one of the most important medical innovations of the past decade, with the potential to save millions of lives and livelihoods. Neurointerventionalists in the United States now complete roughly 60,000 EVTs per year. (Last year, one of them appears to have been done on John Fetterman while he was a Democratic candidate for senator, which means the procedure may have helped determine control of the U.S. Senate.) But the overall number of Americans who could have benefited from an EVT is at least twice that.The challenge is that this medical innovation isn’t as deployable as a new pill or device. It can’t be manufactured by the thousands, packed into shipping containers and distributed to every hospital whose administrator clicks Add to Cart. For a qualified specialist, the extraction of the clot itself can be fairly straightforward — but getting the patient to the table in time is a highly complex process, a series of steps requiring layers of training and a rethinking of the protocols that move people around within the medical system. The new “miracle treatment” is the easy part. Bringing it to the people who need it, around the world? Achieving that will be miraculous.Dr. Mayank Goyal, a neuroradiologist who was heavily involved in early research into EVT.Natalia Neuhaus for The New York TimesDr. Mayank Goyal can recall the moment when the EVT started to feel like a real solution. “I still remember the face of the patient,” he says. She was a younger woman who had immigrated to Canada from the Philippines, and who worked hard to send money home to family members still there. “It was a big, big stroke,” he says, and it probably wouldn’t have responded to the drugs available. So he tried to remove her clot using a new device that he hadn’t tried before. “Within 12 minutes I pulled the clot out.” The next morning, the woman was so fully recovered that she wanted to go right back to work.It was 2009, and Goyal, a neuroradiologist who works at Foothills and the adjoining University of Calgary, had already been trying thrombectomies for about half a decade. When a new method or treatment is in its infancy, practitioners generally only deploy it if there is nothing else to do and the potential consequences of doing nothing are catastrophic. Since the early 2000s, when the first version of a thrombectomy device was cleared by the U.S. Food and Drug Administration, Goyal and other early adopters had been pioneering the technique with patients who had no other hope. The clot-busting drug that was available to treat ischemic strokes wasn’t good enough for the biggest clots and the worst strokes. “Everyone realized they needed a mechanical solution to the problem,” Goyal says, “as opposed to a chemical solution to the problem.”But the first few devices produced didn’t do the job well enough, either. When a new device intended to obstruct blood flow to an aneurysm, called the Solitaire stent, came out, several specialists working in various hospitals around the world came separately to the same conclusion: It might work for EVT too. They tried it, and it did. “‘It was like magic, compared to the previous devices,” Goyal says.This was big news. Medicine had made incredible advances on other fronts, but for stroke patients, shockingly little had changed since Hippocrates wrote about the condition 2,500 years ago. The Greek physician identified the cause of what was then and for many centuries afterward called “apoplexy” as an excess of black bile (one of the four “humors,” in the reigning physiological theory of the time) in the brain. A few hundred years later, another Greek physician, Galen, attributed stroke to phlegm in the brain arteries, and his ideas dominated Western medicine for a millennium. The first link between “apoplexy” and bleeding in the brain — the first, posthumous diagnosis of a hemorrhagic stroke — was not made until the mid-1600s, by the Swiss physician Johann Jakob Wepfer.By the 18th and 19th centuries, the medical establishment was beginning to understand the causal links between blockages, bleeds and strokes. But there was no known treatment, and researchers emphasized prevention through the moderation of lifestyle risk factors. That’s not so dissimilar from today’s efforts at prevention, although the risk factors themselves have changed. Back then the culprits were thought to include “muscular exertion of any kind, but especially ‘straining at stool,’” as well as “violent passions of the mind, cold weather, tight clothing around the neck, constipation and everything in the least bit flatulent,” the neurologists Maurizio Paciaroni and Julien Bogousslavsky wrote in 2009 in the Handbook of Clinical Neurology.Gradually, through the 20th century, a picture of the various common causes of stroke was brought into focus. Although strokes occur in the brain, understanding them required a clear grasp of the mechanics of heart disease — often, thickened or hardened arteries can create clots that travel up into the brain. High blood pressure and low blood pressure are each risk factors for stroke, and atrial fibrillation — an abnormal heartbeat — is, too. By the 1950s aspirin and other blood thinners were being prescribed to try to counter the formation of clots in patients diagnosed with heart disease, but that was mainly about prevention.The first real treatment breakthrough came with the arrival of thrombolytics, colloquially known as clot-busters: drugs used to break down clots found in blood vessels. In 1995, The New England Journal of Medicine published a study led by the National Institute of Neurological Disorders and Stroke (NINDS) that tested the effects of tissue plasminogen activator, or tPA, on patients who were having an ischemic stroke. The study’s authors noted that the drug came with an increased risk of brain bleeds — there’s that yin and yang again, as in some patients the attempt to dissolve the clot may result in a hemorrhage. Still, they found that it improved the long-term outcome for roughly one in three patients. This was an unprecedented breakthrough, the first meaningful treatment for an ongoing stroke.TPA wasn’t a perfect remedy. It had to be given within a relatively narrow time window — the NINDS study focused on treatment within three hours of the onset of a stroke, while today the cutoff can be 4.5 hours — and it worsened outcomes for 3 percent of recipients. That was a lot better than nothing, and it would go on to become a standard treatment worldwide for eligible ischemic stroke patients. But an energized field of neurologists was already exploring what might come next.Their attention turned to a set of techniques and procedures that originated with cardiology but have been increasingly adopted in neuroradiology too: accessing the body endovascularly — that is, using catheters threaded through the arteries. Neuro-endovascular therapies are handled by a hybrid group of specialists known as neurointerventionalists: neuroradiologists, neurosurgeons and neurologists who have received the relevant additional training. Think of it as brain surgery’s answer to laparoscopy: The approach allows the doctor to make repairs in the brain without having to open up a patient’s skull.Once the neurointerventionalists started adapting the Solitaire stent for use in EVT, the medical-device manufacturers quickly caught up, designing thrombectomy-specific versions, which began to roll out around 2010. As Dr. Michael D. Hill, a senior neurologist at Foothills, says: “All of a sudden we had a procedure that looked like it could work.” As the patents were filed and the procedure was formalized, Goyal continued to work with the stroke team at Foothills to extract the clots from eligible patients.A stent retriever used in an EVT — a procedure in which a clot is physically extracted via a long catheter from a stroke patient’s brain, restoring blood flow.Natalia Neuhaus for The New York TimesThe team at Foothills decided to begin its own clinical trial, which became known as ESCAPE, with Hill, Goyal and Dr. Andrew Demchuk as the principal investigators. Using a network of their colleagues and former stroke fellows, who had gone on to work across Canada and elsewhere, they enlisted 22 sites and laid out a strict protocol for the study, emphasizing consistency in patient selection, imaging and — above all — speed. “We just hammered people on being fast,” Hill says. The key to a successful EVT, they believed, was in rushing a patient to a CT scanner, verifying that their clot was a viable target for extraction and then pulling it out without delay.The trial was so successful that it was halted early — given the findings, it was no longer ethical to keep adding patients to the control group. While 29 percent of patients in the control group (who were treated, when eligible, with alteplase, a type of tPA, alone) survived with at least a partial recovery of their deficits and were able to reclaim their independence, 53 percent of patients who received EVT saw the same positive outcomes. And while 19 percent of the control patients died, just 10.4 percent of the EVT patients did. Given that medical progress is often seen in decimal-point increments, these were staggering numbers.The Foothills neurologists weren’t the only team investigating EVT’s potential. The ESCAPE trial ran concurrently with four other major trials, one of which was also led by Goyal. Averaged together, the studies showed that the procedure more than doubles the odds of stroke patients’ returning to an independent life, and nearly triples the odds of their making a complete recovery.On prime-time medical dramas, radical new treatments arrive just in time to save the patient. The brilliant, plucky resident pulls an all-nighter in the stacks, snooping through obscure journals, and races to the operating room brandishing what she has found. But offscreen, transforming medical research into standard clinical practice is slower and far more complex.This can be especially true with innovations like EVT, in which a series of steps must be performed quickly by multiple groups of people. In Alberta, by the time a stroke patient actually arrives at a hospital, the case has been in the hands of as many as five layers of medical response: the original 911 dispatcher, the paramedics, a call center, the transport logistics team and the stroke team that will receive him. And to have the best outcome, those handoffs need to happen in minutes, not hours.The view of an EVT from the control room, from which team members can observe without the need to wear lead shielding against the radiation of the X-ray machine.Natalia Neuhaus for The New York TimesThe high-tech portions of the EVT process all happen in the hospital, but the most critical part happens at the very beginning. If friends and family, bystanders or the patients themselves don’t realize that a stroke is underway, crucial minutes or even hours will be lost. Even after the call comes in, 911 dispatchers and emergency medical workers have to flag and route the patients correctly. Creating an effective EVT program involves training not just hospital staff members but an entire community.After Foothills’s study helped establish the transformative potential of EVT, the neurologists worked with the government of Alberta to implement a provincewide strategy called ERA: Endovascular Reperfusion Alberta. (Reperfusion is the medical term for when the blockage causing a stroke is removed and the blood begins to flow again.) The ambitious goal was to make EVT accessible to every Albertan, more than four million people spread across more than 250,000 square miles. And one of the first steps was to update the training of Alberta’s 4,800 frontline paramedics, in both ground and air ambulance crews, to give them the tools to quickly identify potential EVT recipients in the field.When paramedics respond to a stroke, there is no wound on which to apply pressure, no dramatic chest compression to deploy. Instead, think of it like an extremely high-stakes flow chart: If this, then that.Let’s say a rural grocery store cashier calls 911 because a customer, an older man, has collapsed in front of her till. By the time the ambulance arrives, a few minutes later, someone has helped him to sit up on the pale linoleum floor, and a small, hushed crowd has gathered. The man is listing to one side, his speech is slurred, but he is conscious, cogent, when a paramedic approaches, gently asking for his name.“Can you smile for me?” the paramedic asks, and notes that only the left corner of the man’s mouth curls upward when he tries; the right droops into a frown. “Can you raise both your arms in the air?” The left arm makes it up OK, but the right arm doesn’t respond. The paramedic holds out both her hands. “Can you squeeze my hands for me? Tight as you can.” The man does his best, but his right hand just won’t listen.This is the Los Angeles Motor Scale, or LAMS, a simple three-part test intended to help paramedics on a call get a sense of what they’re dealing with. It’s designed to identify what doctors call hemiplegia — weakness or paralysis on only one side of the body, a classic sign of stroke. The more severe the weakness, the more likely the stroke is to be what’s called an L.V.O., or large-vessel occlusion: a blockage of an artery in the skull, which makes the patient a strong candidate for EVT.There are other stroke field tests, some more complex, but Alberta chose to model its test on LAMS because of its simplicity; it would be relatively easy to retrain thousands of people in its use. In its original form, it was a clear yes/no. If the patient showed any sign of trouble, with either the smiling, the raised arms or the hand squeeze, a stroke was probable. But now the paramedics needed a way to rapidly, and reasonably accurately, separate the L.V.O. cases from the rest. So Alberta added a points system to the test, in which a patient’s score can range from 0 to 5. Scores of 0 to 3 mean the old rules apply, and the crew transports the patient to the nearest stroke center for further assessment and treatment. A score of 4 or 5 means a likely EVT, triggering the new protocol.Syringes in the operating room containing contrast emulsion dye, which is visible on X-rays.Natalia Neuhaus for The New York TimesAt this point, there are more teams that come into play — more people who need to be coordinated and trained to make an EVT program work. If the man at the grocery store has a LAMS score of 4, Alberta’s paramedics now contact a specialized medical phone center, and are connected in a three-way call with two groups: the stroke team at the nearest comprehensive stroke center — as opposed to a primary stroke center, which is capable of administering tPA but not EVT — and the medical transport team. (This three-way “field consultation,” as it’s called in Alberta, is relatively unusual. But, says Foothills’s Andrew Demchuk, who was one of the lead neurologists involved in creating ERA, the model is beginning to spread in other parts of the world.)When ERA started, its goal was to make EVT accessible to every one of the 400 or more Albertans who are eligible for it each year. Last year, the province’s stroke teams completed 378 of the procedures.About 5 to 15 percent of stroke patients turn out to be candidates for an endovascular thrombectomy. But the ones who do receive it tend to be among the most severe cases, and so, says Michael D. Hill, “there’s a visible difference to how stroke patients flow through the hospital now, because we’re able to send them home.” In a strange twist, some patients who might once have wound up on life support, or lingered in a hospital bed for weeks, now walk out under their own power within three or four days — while others who experienced smaller or more moderate strokes might sometimes stay longer.One Sunday afternoon at Foothills, Hill was able to discharge a woman in her mid-50s who underwent her EVT on Thursday night. A huge swath of her brain had been at risk from the clot — but the thrombectomy saved almost all of it. “Look at you,” he said as she walked unassisted down the hallway of the stroke ward. “You’re pretty good.” Her stroke was caused by a heart condition called atrial fibrillation; a prescription for blood thinners would, they hoped, prevent any more clots from recurring. “Good thing you got her here quickly,” Hill told the woman’s daughter. “She’s done well. We’ll see you back in the clinic for follow-up.”Elsewhere on the ward, the variety and cruelty of stroke’s effects was on display. One older woman, asked for her age, could only say wryly: “Too old.” Her sense of humor was intact, but her own biographical details now escaped her. Another patient, an elderly man, could no longer find the language to express his knowledge of the world. When Hill showed him a butter packet, and asked him if he knew what it was, the patient answered “yes,” confidently. But then he paused, struggling, unable to come up with the words. A man in his mid-40s was buoyant, eager to walk on his own, determined to get home and start physical therapy. But he couldn’t yet swallow consistently, and he remained on a liquid diet. So he had to stay.Like patients experiencing heart attacks or major traumas, suspected acute stroke patients bypass the usual E.R. triage procedure. Instead, they’re brought straight to a trauma bay behind the main emergency room, and what comes next is a kind of frenetic choreography. I witnessed the whole dance one Friday night, when, after the page went out — STAT STROKE. ETA 5 MIN — the stroke team gathered behind the E.R. to await the patient, a woman in her early 40s.After a brief stop in the trauma bay for a neurological exam, she was wheeled down the hallway, straight to diagnostic imaging, where two paramedics carefully hoisted her off the gurney and onto the bed of a CT scanner. The machine hummed, and Dr. Steven Peters, the on-call stroke neurologist for the night, peered over the shoulder of a resident at the black-and-white images filling the screen of a desktop computer.Unfortunately, this patient hadn’t been discovered right away; her stroke had been ongoing for several hours. It was too late to consider tPA, but EVT was still worth a try: “It looks like she has a lot of cortex we can save,” Peters said, still staring at the screen. The neurointerventionalists were paged. Mayank Goyal was on call that night, along with a neuroradiology fellow.After the patient was extracted from the machine, Peters spoke to her; she was slurring but conscious. “All the scans we just did, we found that you are having a stroke,” he said. “There is still a large clot in your brain.” He described the EVT procedure to her briefly, seeking her blessing and offering his advice: “That’s our best chance of getting the clot out.” She consented.Heavy lead vests help protect medical staff members from the X-ray radiation used during the EVT procedure.Natalia Neuhaus for The New York TimesJust down the hall from imaging, the angio suite was a blur of rapid, routine movement: staff members draping a sheet over the patient to leave her groin exposed; essential personnel strapping on lead vests to protect against the X-ray radiation; everyone else withdrawing to a windowed control room to observe. By 7:07 p.m., almost exactly one hour after the team was paged, Goyal was questing toward her brain.An EVT begins with a needle, puncturing layers of skin to access the artery. The needle is followed by a specially manufactured wire, flexible enough to move through soft tissues without damaging them but firm enough to be pushed and guided from one end. Once the wire is in place, the interventionalist slides a pliable hollow sheath over the top of it, to hold the puncture hole open and provide stable access into the blood vessel. Then the wire comes out, and a catheter is fed through the sheath and guided up through the larger arteries into a blood vessel in the neck. An even smaller microcatheter and microwire travel inside the larger, nested like Russian dolls, up higher into the narrower arteries of the brain. Once they have advanced to just beyond the site of the stroke, the microwire is withdrawn and replaced by the stent retriever, which emerges from the microcatheter and expands, like a rolled newspaper coming open, pushing the clot to the sides of the vessel, re-establishing blood flow, and — if all goes as designed — capturing the clot in its mesh for a complete removal. In the ESCAPE trial, blood flow was restored in 72.4 percent of EVT recipients.Goyal and his fellow stood on the right side of the patient, feeding catheters gently through their fingers, intermittently using foot pedals to turn on the X-ray machine above them and check how far they’d gone. She groaned as they worked. In the control room, the rest of the team waited and watched the images flickering on a large monitor. “There you go,” someone said, pointing to a dark web on the screen. Everyone exhaled. Blood was flowing through the stricken part of the patient’s brain once again.During an EVT, the stroke team intermittently turns on the X-ray machines using a foot pedal to help guide the catheter to its target.Natalia Neuhaus for The New York TimesBy 8 p.m., she was being bustled upstairs to a bed on the stroke ward. Her recovery wouldn’t be as complete as Kris Walterson’s, or as that of the woman with the atrial fibrillation — they hadn’t reached her in time. But it was still much better than no treatment at all.As the group dispersed, Steven Peters, the neurologist, glanced down at the clot, retrieved from the stent and resting on a piece of bloody gauze. It was thin, deep red and about half an inch long, the size of a scrap of thread.There’s a number that floats around in medicine: It takes, on average, 17 years for a new treatment or technique, or some other form of research breakthrough, to filter down into widespread clinical practice. But the actual timeline varies widely from case to case. “What everybody’s trying to do is speed up that process,” says Dr. Sharon Straus, the director of the Knowledge Translation Program at St. Michael’s Hospital in Toronto. (“Knowledge translation” is one of several terms for a young, multidisciplinary field that aims to better understand and improve the medical research-to-practice pipeline.) “Some things do take off more quickly.”After ESCAPE and the other studies were published, the American Heart Association promptly formed an ad hoc committee to review the research and issue an updated set of guidelines about the new treatment. Dr. William Powers, a veteran neurologist at Duke, was its chairman, and he remembers the work going unusually quickly. “We all thought it was that clear, and that important,” he says. The group issued its strongest recommendation, endorsing the use of EVT in a designated subset of stroke patients. “That degree of independent corroboration,” Powers says of the stroke research they assessed, “I have never seen anything like that, ever.”Blood clots removed from a stroke patient during an EVT.Natalia Neuhaus for The New York TimesStill, even though it has been met with enthusiasm, implementing EVT at scale is an enormous challenge. A recent report from Britain’s Stroke Association found that London residents with eligible ischemic strokes were as much as eight times more likely to receive an EVT than their peers elsewhere in the country, and those disparities are mirrored in the United States. “That is one of the challenges,” says Eric Smith, a neurologist and an associate editor at the journal Stroke. “Arguably maybe we have excessive coverage in some densely populated urban areas, where there could be one hospital on one side of the street with an EVT center, and another hospital on the other side of the street, but because they’re affiliated with different universities, or owned by different H.M.O.s, or this kind of thing, they each want to have their own center.” Rural access, meanwhile, is much patchier.In the United States, Smith says, “there’s no one who can plan and say, You’re not allowed to build an EVT center, and you’re obligated to build an EVT center. That’s not how the system works.”Other parts of the world face a different slate of challenges. In a recent survey of 59 countries, Australia was found to have the highest overall rate of access to EVT, with 46 percent of patients in need receiving one. That’s well above the median rate of access for high-income countries, which was 23 percent, while for low- and middle-income countries, the rate was just 0.48 percent. Globally, as of 2019, only 2.79 percent of potential EVT patients were receiving the procedure.“The disparity in thrombectomy access is just so massive,” says Dr. Dileep Yavagal, a neurologist at the University of Miami. In 2016, Yavagal, who is originally from India, was moved to begin a campaign at the Society of Vascular and Interventional Neurology to promote global EVT access. He knew how long it took for advances in cardiac care, like angioplasty and stenting, to spread across the world, and he didn’t want to see that trend repeated. “I went to medical school in India,” he says, “and I saw a lot of stroke before I came to the U.S. in 1997 to do neurology. I came to a realization that this is not going to really reach my homeland not for one or two or three years, but for decades.”The group he founded to try to change that, Mission Thrombectomy 2020+, created the survey. The results were sobering. “The lowest access to thrombectomy care, excluding countries that have no thrombectomy, in this survey, is in Bangladesh,” he says, “and it’s only 0.1 percent rate of access.” That means an Australian patient who needs an EVT is 460 times more likely to get one than a Bangladeshi patient with a comparable stroke.He identifies two primary challenges to widespread implementation. One is the speed and coordination required, at all levels of a given country’s emergency medical system, to maximize the benefits of EVT. “We never planned for this,” he says. “So basically we have to figure out, with the existing hospital infrastructure, how to optimize these patient transfers. And that brings a major burden on every community and country.” Many jurisdictions aren’t in a position to undertake a campaign like Alberta’s ERA, intended to systematically smooth out every ripple in a complex new protocol.The second challenge is the global work force. Yavagal’s group estimates that around the world, there are only enough qualified neurointerventionalists to meet around 15 percent of the potential demand for EVT.The group focuses on a top-down approach, targeting policymakers, primarily in lower- and middle-income countries, with information about the benefits of EVT. They have regional committees advocating for the procedure in 94 countries now, and a 2020 white paper they produced has caught the attention of several national health ministers. The document emphasizes the longer-term savings offered by investing in EVT upfront. In Canada, for instance, acute ischemic strokes cost the public health system $2.8 billion per year, with much of that money going to long-term care for the kinds of severe deficits that EVT can prevent.The government of India, Yavagal notes, recently decided to pay first in hopes of saving later. It more than doubled its reimbursement rate for each thrombectomy performed in the country’s hospitals, to $7,500, an important boost to the procedure’s prospects there. The group’s effort also received a recent bump from the World Health Organization, which has identified thrombectomy as a “priority clinical intervention,” and the instruments used to extract the clots as “priority medical devices,” meaning that the W.H.O. will now provide guidance and support for national health organizations looking to implement EVT.“Once the right stakeholders see the need and the cost-effectiveness, the elements are there,” Yavagal says. Some countries lag behind in physical infrastructure, like the required angiography suite, or in staffing. “But a lot of countries have the elements — the system is just not organized.”Yavagal’s group estimates that 1.7 million people every year experience an ischemic stroke caused by a large-vessel occlusion — the type of stroke targeted most effectively by EVT. But so far, only about 240,000 thrombectomies are being performed around the world each year. In that yawning gap, Yavagal sees the potential for rapid gains: If you’re only doing 20 thrombectomies a year, doubling that to 40 over a couple of years is achievable. Doubling it again in another two years’ time probably is, too. And so on.Dr. Michael D. Hill, a senior neurologist at Foothills, speaking with a stroke patient.Natalia Neuhaus for The New York TimesIn a world where EVT access was universal, it could save more than 100,000 lives each year. But in addition to fatalities, public health authorities also track something called disability-adjusted life years, or DALYs. A DALY is a unit of measurement: one year of healthy life lost to a given disease. In 2022, the World Stroke Organization attributed 63 million DALYs annually to ischemic stroke.That’s a mouthful of medical jargon, but each DALY also represents something real. It’s a patient who can still chew and swallow her favorite foods; another who can still remember his grandchildren’s names, or his wife’s, or his own. It’s a patient who can still tie his own flies and go fly-fishing on a lazy summer river, or one who can keep singing in a community choir. It’s paychecks and mortgage payments, birthday cards and phone calls, inside jokes and secret handshakes: all the little things that make up a life.Eva Holland is a freelance writer based in Yukon Territory, Canada. She is a correspondent for Outside magazine and the author of “Nerve: Adventures in the Science of Fear.” Natalia Neuhaus is a photographer in Brooklyn, originally from Peru. In 2022, she was one of three women awarded the Leica-VII Agency Mentorship.

Published1 hour agoShareclose panelShare pageCopy linkAbout sharingImage source, Getty ImagesBy Kelly NgBBC NewsHong Kong has lifted its mask mandate, marking an end to one of the world’s longest-running Covid restrictions.The virus is under control in Hong Kong with no major signs of a rebound, the city’s leader John Lee said.Under the mandate, which began in July 2020 and lasted for 945 days, people could be fined up to HK$5,000 (£530; $640).”With the removal of the mandate, Hong Kong will return to normalcy,” Mr Lee said on Tuesday.”In this year and the coming year, we will go all out for the economy and development at full speed.”Before Wednesday, people living in Hong Kong had to wear a mask in any public area.On social media, many residents expressed elation and relief that the day of unmasking had “finally” come.Some criticised the rule’s duration and its sudden scrapping – amid wider criticism of the city’s pandemic policies for the past three years.However many locals could be seen still wearing masks on Wednesday, local media reported.Hong Kong has largely followed mainland China’s lead in efforts to tackle the virus, including attempts to eliminate it with a “zero-Covid” strategy.Other Covid curbs in Hong Kong included strict quarantine rules, limitations on the number of people gathering in public places, as well as restricting visitors in nursing homes.Most of these curbs were rolled back at the end of last year. But some remain – primary and secondary school students still need to test daily for Covid, although some reports say this measure could be lifted later this month.Many residents and business owners have said such tough rules damaged Hong Kong’s economy and international standing. The city’s gross domestic product fell by 3.5% last year.In a bid to woo foreign visitors, the Hong Kong government has announced plans to give away half a million air tickets – beginning on Wednesday.Masks are still worn in several countries in Asia. In South Korea, for instance, they are still required on public transportation, as well as in hospitals and pharmacies.The Japanese government has said it will ease mask-wearing guidelines on 13 March, recommending masks only on trains and buses during rush hour, or where public transportation is particularly congested. Masks have never been mandatory in Japan, but most people have been wearing them.More on this storyHong Kong to scrap almost all its Covid rules28 December 2022Hong Kong shortens Covid hotel quarantine8 August 2022

One in ten early deaths could be prevented if everyone managed at least half the recommended level of physical activity, say a team led by researchers at the University of Cambridge.
In a study published today in the British Journal of Sports Medicine, the researchers say that 11 minutes a day (75 minutes a week) of moderate-intensity physical activity — such as a brisk walk — would be sufficient to lower the risk of diseases such as heart disease, stroke and a number of cancers.
Cardiovascular diseases — such as heart disease and stroke — are the leading cause of death globally, responsible for 17.9 million deaths per year in 2019, while cancers were responsible for 9.6 million deaths in 2017. Physical activity — particularly when it is moderate-intensity — is known to reduce the risk of cardiovascular disease and cancer, and the NHS recommends that adults do at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity a week.
To explore the amount of physical activity necessary to have a beneficial impact on several chronic diseases and premature death, researchers from the Medical Research Council (MRC) Epidemiology Unit at the University of Cambridge carried out a systematic review and meta-analysis, pooling and analysing cohort data from all of the published evidence. This approach allowed them to bring together studies that on their own did not provide sufficient evidence and sometimes disagreed with each other to provide more robust conclusions.
In total, they looked at results reported in 196 peer-reviewed articles, covering more than 30 million participants from 94 large study cohorts, to produce the largest analysis to date of the association between physical activity levels and risk of heart disease, cancer, and early death.
The researchers found that, outside of work-related physical activity, two out of three people reported activity levels below 150 min per week of moderate-intensity activity and fewer than one in ten managed more than 300 min per week.

Broadly speaking, they found that beyond 150 min per week of moderate-intensity activity, the additional benefits in terms of reduced risk of disease or early death were marginal. But even half this amount came with significant benefits: accumulating 75 min per week of moderate-intensity activity brought with it a 23% lower risk of early death.
Dr Soren Brage from the MRC Epidemiology Unit said: “If you are someone who finds the idea of 150 minutes of moderate-intensity physical activity a week a bit daunting, then our findings should be good news. Doing some physical activity is better than doing none. This is also a good starting position — if you find that 75 minutes a week is manageable, then you could try stepping it up gradually to the full recommended amount.”
Seventy-five minutes per week of moderate activity was also enough to reduce the risk of developing cardiovascular disease by 17% and cancer by 7%. For some specific cancers, the reduction in risk was greater — head and neck, myeloid leukaemia, myeloma, and gastric cardia cancers were between 14-26% lower risk. For other cancers, such as lung, liver, endometrial, colon, and breast cancer, a 3-11% lower risk was observed.
Professor James Woodcock from the MRC Epidemiology Unit said: “We know that physical activity, such as walking or cycling, is good for you, especially if you feel it raises your heart rate. But what we’ve found is there are substantial benefits to heart health and reducing your risk of cancer even if you can only manage 10 minutes every day.”
The researchers calculated that if everyone in the studies had done the equivalent of at least 150 min per week of moderate-intensity activity, around one in six (16%) early deaths would be prevented. One in nine (11%) cases of cardiovascular disease and one in 20 (5%) cases of cancer would be prevented.

However, even if everyone managed at least 75 min per week of moderate-intensity physical activity, around one in ten (10%) early deaths would be prevented. One in twenty (5%) cases of cardiovascular disease and nearly one in thirty (3%) cases of cancer would be prevented.
Dr Leandro Garcia from Queen’s University Belfast said: “Moderate activity doesn’t have to involve what we normally think of exercise, such as sports or running. Sometimes, replacing some habits is all that is needed. For example, try to walk or cycle to your work or study place instead of using a car, or engage in active play with your kids or grand kids. Doing activities that you enjoy and that are easy to include in your weekly routine is an excellent way to become more active.”
The research was funded by the Medical Research Council and the European Research Council.
What counts as moderate-intensity physical activity?
Moderate-intensity physical activity raises your heart rate and makes you breathe faster, but you would still be able to speak during the activity. Examples include: Brisk walking Dancing Riding a bike Playing tennis Hiking

Dementia with Lewy bodies (DLB), one of the most common forms of dementia, has no cure. Previous studies suggested that gut bacteria, the microorganisms that live in the human digestive tract, play a role in Parkinson’s disease, another neurodegenerative disorder, but the bacteria involved in DLB had not been identified. Now, a group led by researchers at the Nagoya University Graduate School of Medicine in Japan has identified three bacteria involved in DLB: Collinsella, Ruminococcus, and Bifidobacterium. Their findings, reported in npj Parkinson’s Disease, suggest new avenues for diagnosis and treatment.
The onset of DLB is associated with abnormal deposits of alpha-synuclein, a protein in the brain that plays a role in the transmission of signals between neurons. The presence of these deposits, known as ‘Lewy bodies’, affects chemicals in the brain, leading to declines in thinking, reasoning and memory. Symptoms include confusion, memory loss, impaired movement, and visual hallucinations.
Parkinson’s disease also starts with movement problems, but some patients develop cognitive decline within one year. These patients are diagnosed with DLB when this cognitive decline occurs. Physicians find it difficult to predict which people with Parkinson’s disease will develop cognitive decline within a year and become patients with DLB.
A research group led by Associate Professor Masaaki Hirayama (Omics Medicine), Professor Kinji Ohno (Neurogenetics), and Assistant Professor Hiroshi Nishiwaki (Neurogenetics) of Nagoya University Graduate School of Medicine, in collaboration with Okayama Neurology Clinic, Iwate Medical University, and Fukuoka University, analyzed microorganisms in the gut and fecal bile acids of patients with DLB, Parkinson’s disease, and rapid eye movement behavior disorder. They discovered that three intestinal bacteria, Collinsella, Ruminococcus, and Bifidobacterium, were associated with patients with DLB. This may suggest possible ways of diagnosing and treating this neurodegenerative disease.
The researchers also found similarities between the gut bacteria involved in Parkinson’s disease and DLB. In both diseases, the bacteria Akkermansia, which degrades the intestinal mucosa, increased. On the other hand, the bacteria that produce short-chain fatty acids (SCFA) in the gut decreased. “Decreases in SCFA-producing bacteria have been repeatedly reported in Parkinson’s disease, Alzheimer’s disease, and ALS,” explains Ohno. “This suggests that it is a common feature of neurodegenerative diseases.” SCFA are important because they produce regulatory T cells. These types of cells play a critical role in regulating the immune system by suppressing neuroinflammation.
On the other hand, in patients with DLB, the researchers found an increase in Ruminococcus torques, an increase in Collinsella, and a decrease in Bifidobacterium. This was different from Parkinson’s disease patients, whose levels did not change. In the future using these insights, doctors may be able to analyze the bacteria in a person’s digestive tract to distinguish DLB from Parkinson’s disease.
Importantly, the reduced levels of Bifidobacterium mayalsosuggest possible ways to treat DLB. Bifidobacterium increases brain-derived neurotrophic factor, a key protein that supports the growth, development and maintenance of neurons in the central and peripheral nervous systems. Therefore, its decrease in DLB is likely to be associated with cognitive decline.
Similarly, both Ruminococcus torques and Collinsella are intestinal bacteria that carry an enzyme, the product of which regulates inflammation in a region of the brain called the substantia nigra.The substantia nigra produces dopamine, a neurotransmitter that is involved in the regulation of movement and is deficient in Parkinson’s disease. Compared to Parkinson’s disease, the levels of these bacteria were higher in people with DLB. This may explain why the effect on movement is delayed, a key feature that distinguishes DLB from Parkinson’s disease.
“Our findings can be used both for both diagnosis and treatment,” explains Ohno. “If a patient with Parkinson’s disease develops dementia in one year after the onset of motor symptoms, they are diagnosed with DLB. However, we cannot currently predict whether a patient with Parkinson’s disease will become a DLB patient. The gut microbiome will help to identify such patients.”
“In terms of treatment, the administration of Ruminococcus torques and Collinsella in patients with Parkinson’s is expected to delay neuroinflammation in the substantia nigra,” Ohno added. “Therapeutic intervention to increase Bifidobacterium may delay the onset and progression of DLB and reduce cognitive dysfunction.”
“The presence of intestinal bacteria unique to DLB may explain why some patients develop Parkinson’s disease and others develop DLB first,” Ohno said. “Normalizing the abnormal bacteria shared between DLB and Parkinson’s disease may delay the development of both diseases. Improving the gut microbiota is a stepping stone in the treatment of dementia. Our findings may pave the way for the discovery of new and completely different therapeutics.”