Overlapping symptoms of dengue, Covid-19 confusing in many cases, say doctors

Women living in states with abortion bans obtained the procedure in the second half of 2023 at about the same rate as before the U.S. Supreme Court overturned Roe v. Wade, according to a report released Tuesday.

Women did so by traveling out of state or by having prescription abortion pills mailed to them, according to the #WeCount report from the Society of Family Planning, which advocates for abortion access. They increasingly used telehealth, the report found, as medical providers in states with laws intended to protection them from prosecution in other states used online appointments to prescribe abortion pills.

“The abortion bans are not eliminating the need for abortion,” said Ushma Upadhyay, a University of California, San Francisco public health social scientist and a co-chair of the #WeCount survey. “People are jumping over these hurdles because they have to.”

Abortion patterns have shifted

The #WeCount report began surveying abortion providers across the country monthly just before Roe was overturned, creating a snapshot of abortion trends. In some states, a portion of the data is estimated. The effort makes data public with less than a six-month lag, giving a picture of trends far faster than the U.S. Centers for Disease Control and Prevention, whose most recent annual report covers abortion in 2021.

The report has chronicled quick shifts since the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling that ended the national right to abortion and opened the door to enforcement of state bans.

The number of abortions in states with bans at all stages of pregnancy fell to near zero. It also plummeted in states where bans kick in around six weeks of pregnancy, which is before many women know they’re pregnant.

But the nationwide total has been about the same or above the level from before the ruling. The study estimates 99,000 abortions occurred each month in the first half of 2024, up from the 81,000 monthly from April through December 2022 and 88,000 in 2023.

One reason is telehealth, which got a boost when some Democratic-controlled states last year began implementing laws to protect prescribers. In April 2022, about 1 in 25 abortions were from pills prescribed via telehealth, the report found. In June 2024, it was 1 in 5.

The newest report is the first time #WeCount has broken down state-by-state numbers for abortion pill prescriptions. About half the telehealth abortion pill prescriptions now go to patients in states with abortion bans or restrictions on telehealth abortion prescriptions.

In the second half of last year, the pills were sent to about 2,800 women each month in Texas, more than 1,500 in Mississippi and nearly 800 in Missouri, for instance.

Travel is still the main means of access for women in states with bans

Data from another group, the Guttmacher Institute, shows that women in states with bans still rely mostly on travel to get abortions.

By combining results of the two surveys and comparing them with Guttmacher’s counts of in-person abortions from 2020, #WeCount found women in states with bans throughout pregnancy were getting abortions in similar numbers as they were in 2020. The numbers do not account for pills obtained from outside the medical system in the earlier period, when those prescriptions most often came from abroad. They also do not tally people who received pills but did not use them.

West Virginia women, for example, obtained nearly 220 abortions monthly in the second half of 2023, mostly by traveling — more than in 2020, when they received about 140 a month. For Louisiana residents, the monthly abortion numbers were about the same, with just under 700 from July through December 2023, mostly through shield laws, and 635 in 2020. However, Oklahoma residents obtained fewer abortions in 2023, with the monthly number falling to under 470 from about 690 in 2020.

Telehealth providers emerged quickly

One of the major providers of the telehealth pills is the Massachusetts Abortion Access Project. Cofounder Angel Foster said the group prescribed to about 500 patients a month, mostly in states with bans, from its September 2023 launch through last month.

The group charged $250 per person while allowing people to pay less if they couldn’t afford that. Starting this month, with the help of grant funding that pays operating costs, it’s trying a different approach: Setting the price at $5 but letting patients know they’d appreciate more for those who can pay it. Foster said the group is on track to provide 1,500 to 2,000 abortions monthly with the new model.

Foster called the Supreme Court’s 2020 decision “a human rights and social justice catastrophe” while also saying that “there’s an irony in what’s happened in the post-Dobbs landscape.”

“In some places abortion care is more accessible and affordable than it was,” she said.

There have no major legal challenges of shield laws so far, but abortion opponents have tried to get one of the main pills removed from the market. Earlier this year, the U.S. Supreme Court unanimously preserved access to the drug, mifepristone, while finding that a group of anti-abortion doctors and organizations did not have the legal right to challenge the 2000 federal approval of the drug.

This month, three states asked a judge for permission to file a lawsuit aimed at rolling back federal decisions that allowed easier access to the pill — including through telehealth.

Climate change may be contributing to thousands more wildfire smoke-related deaths every year than in previous decades, a new study suggests — results a Canadian co-author says underline the urgency of reducing planet-warming emissions.

The international study published Monday is one of the most rigorous yet in determining just how much climate change can be linked to wildfire smoke deaths around the world, said Sian Kou-Giesbrecht, an assistant professor at Dalhousie University.

“What stands out to me is that this proportion is increasing just so much. I think that it really kind of attests to just how much we need to take targeted action to reducing greenhouse-gas emissions,” she said in an interview.

The study estimates, using mathematical modeling, that about 12,566 annual wildfire smoke-related deaths in the 2010s were linked to climate change, up from about 669 in the 1960s, when far less carbon dioxide was concentrated in the atmosphere.

Translated to a proportion of wildfire smoke mortality overall, the study estimates about 13 per cent of estimated excessdeaths in the 2010s were linked to climate change, compared to about 1.2 per cent in the 1960s.

“Adapting to the critical health impacts of fires is required,” read the study, published in the peer-reviewed journal Nature Climate Change.

While wildfires are a natural part of the boreal forest ecosystem, a growing number of studies have documented how climate change, driven by the burning of fossil fuels, is making them larger and more intense — and contributing more to air pollution.

The same research group is behind another study published in the same journal Monday that suggests climate change increased the global area burned by wildfire by about 16 per cent from 2003 to 2019.

Those climate-fuelled fires then churn out more fine particle pollution, known as PM2.5, that’s tiny enough to get deep into the lungs — and in the long run can have serious health effects.

The study that estimated the scale of those effects is based on modeling, not historical data about reported deaths from air pollution.

Researchers used established public-health metrics for when pollution is thought to contribute to mortality, then figured out the extent to which wildfire smoke may have played a role in that overall exposure to arrive at the estimates.

Meanwhile, Health Canada estimates that between 2013 and 2018, up to 240 Canadians died every year due to short-term exposure to wildfire air pollution.

Kou-Giesbrecht said Monday’s study did not find that climate change had a major influence on the number of smoke-related deaths from Canada’s boreal wildfires.

She suggested that’s likely due to the country’s relatively small population size, and how tricky it is to model forest fires in the region, given its unique mix of shrubs and peat.

But she also noted that a stretch of devastating Canadian wildfire seasons over the past several years was not captured in the study, and she expects future research could find a bigger increase in deaths and public-health problems linked to climate change.

The most affected regions in the study were South America, Australia and Europe.

Kou-Giesbrecht said the more studies that uncover the link between climate change and disasters as “tangible” as wildfires, the more the case for “drastic climate action” will be bolstered.

“I think that the more and more evidence that we have to support the role of climate change in shaping the past 100 years, and knowing that it will continue to shape the next 100 years, is really important,” she said.

“And I find that personally interesting, albeit scary.”

The study used three highly complex models to estimate the relationship between climate change, land use and fire.

The models, which each contain thousands upon thousands of equations, compare what wildfires look like in the current climate to what they may have looked like in pre-industrial times, before humans started to burn vast amounts of fossil fuels.

The researchers used the models to calculate gas and aerosol emissions from wildfires between 1960 and 2019, and then make estimates about annual smoke-related deaths.

The type of methodology used by Monday’s studies, known as attribution science, is considered one of the fastest-growing fields of climate science. It is bolstered in part by major strides in computing power.

This report by The Canadian Press was first published Oct. 21, 2024.

Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.

The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.

Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.

Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.

Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.

The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.

This report by The Canadian Press was first published Oct. 21, 2024.

-With files from Nicole Ireland

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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