Former surgeon general faces his wife’s cancer – and the ‘Trump Effect’

The Washington Post

Former surgeon general faces his wife’s cancer – and the ‘Trump Effect’

Manuel Roig-Franzia, The Washington Post – November 25, 2022

Former surgeon general faces his wife’s cancer – and the ‘Trump Effect’

Former surgeon general Jerome Adams and his wife, Lacey, often find themselves talking about what they have named the “Trump Effect.”

It followed them from Washington to their home in the Indianapolis suburbs. They felt it when he was exploring jobs in academia, where he would receive polite rejections from university officials who worried that someone who served in the administration of the former president would be badly received by their left-leaning student bodies. They felt it when corporations decided he was too tainted to employ.

Now, two years after Adams left office as only the 20th surgeon general in U.S. history, the couple feel it as acutely as ever. As Donald Trump announced this month that he will run for president again, they had hoped it all would have faded away by now.

They would rather talk about public health, in a very personal way. This summer, Lacey Adams was diagnosed with a third recurrence of melanoma. Both Adamses have been sharing her experiences on social media and in public appearances, hoping to spread a message about skin-cancer prevention. But the stigma of his association with Trump, even though neither of them is a supporter of his political campaign, remains.

Trump is “a force that really does take the air out of the room,” Adams, 48, said. “The Trump hangover is still impacting me in significant ways.” He said the 2024 Trump campaign “will make things more difficult for me.”

The former surgeon general’s predicament underscores one of the givens of today’s political environment: Association with Trump becomes a permanent tarnish, a kind of reverse Midas touch. Whether indicted or shunned or marginalized, a cavalcade of former Trump World figures have foundered in the aftermath of one of the more chaotic presidencies in modern American history.

Lacey saw it coming. She said she “hated Trump” and did not want her husband to leave his comfortable life in Indiana, where he practiced anesthesiology and served as state health commissioner under then-Indiana governor Mike Pence, who was Trump’s vice president when Jerome became surgeon general. Lacey, 46, worried about a lasting “stigma” but her husband talked her into supporting their move by saying he thought he could make a bigger difference inside the administration than outside it, especially when it came to his efforts to combat opioid addiction.

Now Jerome bristles at his forever label as “Trump’s surgeon general,” an image sealed by his highly public role during the much-criticized early White House response to the coronavirus pandemic. Other surgeons general, he feels, have been less intensely identified with the president who appointed them, permitting them to glide into a life of prestigious and sometimes lucrative opportunities, unencumbered by partisan politics.

Not him. “It was a lot harder than he thought to find a landing spot because of the Trump Effect,” Lacey said. For eight months after leaving office, Jerome could not find a job. The couple started to worry about how they would support their three children, especially since Lacey does not work outside the home.

“People still are afraid to touch anything that is associated with Trump,” Jerome said. Though he was quick to add in the interview that he is “not complaining.” He added, “It is context.”

Finally, in September 2021, Purdue University President Mitch Daniels, a former Indiana governor and Republican stalwart, hired Adams as the first executive director of health equity initiatives at the school.

Even as Adams was seeking to define the next chapter of his life, he was engaged in an almost constant battle on social media. His frequent tweets about everything from his personal life to public health issues have invariably drawn attacks from both the right and the left. Rather than ignore his critics, he has often punched back, engaging in Twitter spats that stretch for days.

He has battled on social media over his recommendation that people continue to wear masks in crowded indoor settings, his criticism of President Biden’s declaration of an end to the pandemic and about his advocacy for coronavirus vaccinations for children and for adults to get booster shots. He takes heat from the left for a pro-life stance on abortion and from the right for his opposition to laws that dictate what a doctor can say to a patient about abortion.

“I get mad at him for being addicted to Twitter,” Lacey said. “People hated him because he was part of Trump’s administration. Now the Trump people hate him.”

Carrie Benton, an Ohio medical lab scientist who has tangled with Jerome Adams on social media, is critical of what she considers “blanket statements” he is now making about topics such as masking. But she also feels he should still be held accountable for errors committed by the Trump administration early in the pandemic.

The pushback has done little to dissuade Adams. He invites debate. He wants to argue, genially. He tries to search for ways to use his platform as a former surgeon general that do not turn into politically charged spats.

“It is hard to find an issue,” he said.

In August, an issue found him, and it was precisely the topic that he had hoped would not feel so personal anymore. During a routine follow-up check, doctors discovered tumors on the outside of Lacey’s right thigh.

“Here we go again,” Lacey said to herself.

She had first been diagnosed with melanoma 12 years ago, in 2010, when she spotted a “weird mole.” She had it removed. She thought she was in the clear.

“No big deal,” she said.

As an adolescent growing up in the Midwest, she had been a frequent visitor to tanning beds. She did not worry much about the sun, even though she is very light-skinned. After having the mole removed, she changed her ways. Sunscreen. Long sleeves. She joked that her mother would chase her around with floppy hats. She started getting regular dermatology checks. It was all good. Until it was not.

In early 2018, just as her anesthesiologist husband was starting as surgeon general under Trump, she noticed lumps on her groin while shaving her bikini line. The doctor in her house, newly minted as America’s doctor, was constantly on the go as he sought to get a grasp on his job, serving as a public health advocate and overseeing thousands of members of the U.S. Public Health Service Commissioned Corps. “The doctor in my house is my absent-minded professor, always running in 100 directions,” she said.

So Lacey called the doctor next door: her neighbor in Indiana and dear friend, Amy Hoffman, an emergency room physician. When Hoffman realized why her friend was calling, she put her on the speakerphone, so that her husband, an oncologist, could listen in.

He just had one question: Was it on the same side as the melanoma from years earlier? Yes, she said. She could hear the worry in their voices.

“Stop unpacking,” she said they told her. “Stop going to fancy events with your husband. You need to make this a priority.”

She was soon ushered into a special area of Walter Reed National Military Medical Center reserved for high-ranking officials and their families. She was given a fuzzy robe with an embroidered White House logo.

“All of a sudden it is like you are in the Ritz-Carlton,” she recalled, and asked herself, “Why am I deserving of this special attention?”

A scan showed a tumor somewhere between the size of a pea and a grape. She needed to have surgery. Doctors eventually removed 12 lymph nodes, some of which were cancerous. While she was recovering from surgery, still groggy from the anesthesia, her husband came into the room with a request that was hard for her to comprehend through the fog of the drugs: He wanted her Facebook password.

She had taken a selfie at the medical center and posted it to her Facebook page, and she also took a little dig at the administration. The White House was not happy, he told her. They wanted it taken down.

In the months to come, she would again think she had beaten cancer. She underwent a year of immunotherapy treatments. She rang the bell, a tradition among cancer patients completing treatments, at Walter Reed after scans showed she was cancer free.

“Cancer, schmancer,” she thought.

There were other things to worry about. Her husband had come to Washington hoping to focus on opioid addiction, a plague that had hit members of his family. Instead, he was thrust into a much more public role with the arrival of the coronavirus. As the Trump administration struggled with effective responses, the new surgeon general kept setting off firestorms.

He shared a Valentine’s Day poem on social media that said the regular flu was a greater risk than covid and urged people to get flu shots. He told African Americans, who were contracting the coronavirus in disproportionate numbers, to take precautions to protect their “Big Mama.”

In each instance, he fumbled the messaging, making incomplete or poorly explained statements. He asked people not to buy masks because there was a shortage. He said people were at a greater risk of catching the regular flu than covid because projections by the Trump administration, later shown to be inaccurate, suggested more people would get the regular flu.

He used the words “Big Mama,” which led to accusations that he was using Trump-style racist dog whistles, because it was a term of affection in his own family that he thought would help him connect with African Americans.

Those missteps, which Adams has blamed on a partisan atmosphere, drew heavy criticism, which might be expected. What he had not anticipated was how people would come for his loved ones. On social media, trolls called his family ugly. They criticized Adams, who is Black, for marrying a White woman.

While her husband was trying to fend off critics and nasty commenters by sharpening his messaging, Lacey, like many Americans, was putting off medical appointments while limiting her movements because of the risk of contracting the coronavirus. She had a clear scan in January 2020. It was not until July that year that she returned for another scan. It revealed a tumor on her back.

The cancer had returned for a second round: This time it was Stage 4. She started immunotherapy. And again she beat it. For two years she passed routine scans, with good results. Then, this past summer, came the tests that revealed the cancer had returned. His wife cries herself to sleep some nights. He marvels at her resilience.

She has been speaking and writing about the disease that lurks inside her and threatens to deprive her of so many things she looks forward to, like the days her children, now 18, 16 and 12, graduate or get married.

Some days she is too ill from side effects of her treatments to do much. But other times she is full of energy and ready to go. People might look at her and not know she is sick, and that is one of her points: Melanoma is a stealthy disease, the doctors keep telling her. It can hide inside people without any outward signs. She had once had a mole, but other times nothing showed up on her skin. The disease was hiding from her.

She understands that she has been given a platform few have. No one would be listening to a mom from Indiana if she were not the wife of the former surgeon general.

The other day, her husband asked if he could post a photo of her on Twitter. She said for him to go ahead. It showed her in profile, lying in bed with the covers partly obscuring her face, on a day when she was not feeling great. He asked for prayers, but he also gave some advice: “See a dermatologist right away if a mole changes/looks different from your others!”

What happened next was nothing short of amazing to them. People wished the best for Lacey even though they were not fans of Jerome: “I don’t agree with your politics. God bless your sweet wife.” “I’m sorry your wife has cancer, even though I completely disagree with some of your decisions.”

Some people even wanted advice. “Should we worry about a single mole or look for odd shapes and changes in several?” That person did not mention Trump at all. That might be a person they could help. That might be, they dared to imagine, the end of the Trump Effect, and the beginning of a Lacey Effect.

Krull: House Republicans plan to investigate things that don’t matter to most Americans

The Herald Times

Krull: House Republicans plan to investigate things that don’t matter to most Americans

John Krull – November 24, 2022

INDIANAPOLIS — Some people are slow learners.

And some people never learn at all.

The members of the Republican caucus in the U.S. House of Representatives belong to one of those two groups. The next two years will tell us which one.

Fresh from a midterm election that fell far, far, far short of both Republican expectations and historic norms for parties out of power, the House GOP firebreathers announced their priorities for the coming legislative session, one in which they will have one of the slimmest majorities in American history.

Most sensible politicians would use a moment such as this to lay a foundation for future growth. They would outline an agenda featuring plans and programs designed to sway independent or undecided voters. They would use their platform to persuade.

But that’s not the way the deep thinkers in the House Republican caucus approach things. Their agenda is simple.

They plan a series of investigations — and every one of those investigations will be designed to appeal to the narrowing base of supporters that already supports the GOP.

The Republicans say they will investigate President Joe Biden’s son, Hunter, even though there already are several criminal investigations into the younger Biden’s conduct, and he likely will be indicted soon.

They plan to investigate the U.S.-Mexico border “crisis.” Maybe that investigation will determine why Republicans made top-heavy tax cuts for billionaires their legislative priority rather than border security from 2017 to 2019, when they controlled the presidency, both chambers of Congress and the U.S. Supreme Court.

But I wouldn’t count on it.

The Javerts in the House also intend to dive into the U.S. withdrawal from the Afghanistan War, the cause of the worldwide COVID-19 pandemic and the U.S. Department of Justice.

Of these, only the study of the Afghanistan withdrawal debacle doesn’t seem exclusively partisan in nature.

It’s doubtful, though, that House Republicans will ask the essential question about that costly episode, which is: Once the United States has plunged into a long-term military conflict without an exit strategy in mind, how should we go about extricating ourselves?

The other investigations are nothing more than attempts to throw chunks of red meat to the most rabid and snarling parts of the Republican base. The House GOP brain trust seems to think this is a winning political strategy. They’re wrong about that — for at least two reasons.

The first is none of these investigations connects in any way to the lives of average Americans.

The strongest message Republicans had in the 2022 election focused on the economy and the unease many — perhaps even most — Americans feel regarding galloping inflation.

Voters in the suburbs — once a Republican bastion but now the battlefield in which elections for at least the next decade will be decided — worry the good lives they’ve built for themselves and their families will slip away, one price increase at a time.

Inflationary pressures on the world economy aren’t likely to go away any time soon, so House Republicans could spend their political capital fashioning programs designed to alleviate those concerns. They could create a system of targeted tax cuts aimed at helping the middle class offset costs in other areas.

But no.

The Republicans are going to focus on wooing the voters already with them.

They might as well send every embattled suburban GOP candidate out to campaign wearing a sign reading: “Please send me back to make noise and spend your tax money while accomplishing nothing.”

The second reason the GOP strategy is wrong is that it’s based on a mistaken premise.

Republicans believe the Benghazi investigation fatally wounded 2016 Democratic presidential candidate Hillary Clinton.

The problem with that thinking is Clinton was damaged goods long before the investigation started. For nearly 20 years, she had carried historically high negatives. Polls showed that four out of 10 voters wouldn’t cast a ballot for her under any circumstances, which meant she had to persuade five out of the remaining six to support her.

That’s a tall order.

Joe Biden never has aroused the levels of animosity both Clintons did and do and, if Donald Trump is the Republican nominee again, Biden likely won’t do anything more than say: “Vote for me because I’m not him.”

Republicans have been down this road before.

Pity they didn’t learn anything along the way.

John Krull is director of Franklin College’s Pulliam School of Journalism and publisher of TheStatehouseFile.com, a news website powered by Franklin College journalism students. The views expressed are those of the author only and should not be attributed to Franklin College.

Brain-eating amoeba infections keep spreading to new areas across the US

Insider

Brain-eating amoeba infections keep spreading to new areas across the US

Andrea Michelson – November 23, 2022

deadly amoeba
A map from the Centers for Disease Control and Prevention shows brain-eating amoeba infections from 1962-2019.Centers for Disease Control and Prevention
  • At least three people died of brain-eating amoeba infections in the US this year.
  • The amoeba was found in lakes and rivers in Iowa, Nebraska, and Arizona.
  • As temperatures trend warmer, infections have been reported further north than in previous years.

In 2022, deadly brain-eating amoeba infections were recorded in states that had not seen the water-borne pathogen before.

The amoeba Naegleria fowleri thrives in warm freshwater — mostly lakes and rivers, but it’s also been found in public splash pads. If inhaled up the nose, the microscopic creature can cause a devastating brain infection known as primary amebic meningoencephalitis (PAM).

In past years, this has meant that health officials in southern states spend their summers on the lookout for reports of mysterious brain infections. However, the amoeba’s geographic footprint has expanded as temperatures warm across the US.

About three PAM infections are reported each year in the US, and they’re usually fatal.

By Insider’s count, there have been at least four infections in 2022. The Centers for Disease Control and Prevention have kept a record of PAM cases since 1962, but the agency has not released data for 2022 yet.

One reported case came from Florida, where a teenage boy continues to recover from an infection he contracted in July. The other three individuals who got sick lived further north, and they all died shortly after coming down with symptoms.

States like Florida, which has the most reported PAM infections after Texas, are better prepared to treat any brain infection in a swimmer like a PAM case. As global temperatures continue to rise, a larger swath of health officials will need to prepare for summer infections.

The first exposure in Iowa

A Missouri resident died of PAM in July after going swimming in an Iowa lake.

Testing at the Lake of Three Fires later revealed the presence of N. fowleri in the southwestern Iowa waters.

Iowa officials had not previously detected the amoeba in the state, but it’s possible that it was present in past years. The amoeba only causes harm to humans if it enters the nose, gaining access to the brain.

It was the first recorded case of the season, and the first of two PAM deaths in the Midwest in 2022.

Nebraska’s first recorded case

Nebraska confirmed its first death due to N. fowleri in August, after a child died of a rapidly progressing brain infection. The state had never reported a PAM infection before.

The child fell ill after swimming in the Elkhorn River, located a few miles west of Omaha. Officials later confirmed the amoeba was present in the child.

The river runs along a similar latitude to the Lake of Three Fires, as well as a Northern California lake where officials believe a 7-year-old contracted the amoeba last year.

Infections have been occurring in the northern half of the US with increasing frequency as temperatures rise and water levels drop, Douglas County health officials said at a news conference.

“Our regions are becoming warmer,” county health director Lindsey Huse said. “As things warm up, the water warms up and water levels drop because of drought, you see that this organism is a lot happier and more typically grows in those situations.”

A late infection in Arizona

The brain-eating amoeba is not new to Arizona, according to the CDC. The state has reported eight infections with PAM since 1962, and a Nevada resident died this year after a potential exposure in Arizona waters.

A Clark County, Nevada, resident under the age of 18 died after swimming in the Arizona side of Lake Mead, a reservoir that is split between the two states.

According to the Southern Nevada Health District, the boy went swimming in early October and developed symptoms about a week later. Most infections have been reported in June and July of previous years, so it’s possible the amoeba’s timeline is expanding along with its geographic territory.

How deadly is lung cancer? Signs, symptoms and prevention, according to an expert

Yahoo! Style

How deadly is lung cancer? Signs, symptoms and prevention, according to an expert

Julia Ranney, Lifestyle Editor – November 23, 2022

X-ray of lungs showing lung cancer
Read on to learn more about lung cancer, its causes and key warning signs. (Photo via Getty Images)

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis or treatment. Contact a qualified medical professional before engaging in any physical activity, or making any changes to your diet, medication or lifestyle.

For years, more and more Canadians have faced the often deadly diagnosis of lung cancer. The condition can be hard to detect, and thus difficult to treat.

Almost 100 people every day are expected to be diagnosed with lung cancer in Canada, which is a concerning statistic.

For Lung Cancer Awareness Month, which is recognized in November, Yahoo Canada spoke to Dr. Susanna Yee-Shan Cheng, a Medical Oncologist at Sunnybrook Health Sciences Centre, about the condition and how you might be able to prevent it.

Read on to learn more about lung cancer, its causes and key warning signs.

doctor pointing at a photo of an x-ray of lungs
Lung cancers are usually grouped into two main types called small cell and non-small cell. (Photo via Getty Images)
What is lung cancer?

Cancer is a disease in which cells in the body grow out of control.

According to the Canadian Cancer Society, “lung cancer starts in the cells of the lung,” and when it starts in lung cells, “it is called primary lung cancer.”

Lung cancers are usually grouped into two main types called small cell and non-small cell.

Non–small cell lung cancer usually starts in glandular cells on the outer part of the lung, and small cell lung cancer usually starts in cells that line the bronchi in the centre of the lungs. Non–small cell is more common.

According to Cheng, while lung cancer might not be as common as skin or breast cancer for example, it’s the mortality rate that’s concerning.

“Lung cancer is actually the number one cause of cancer death. It is common but it’s actually the mortality that’s the biggest issue.”Dr. Susanna Cheng

“Lung cancer is actually the number one cause of cancer death,” says Cheng. “It is common but it’s actually the mortality that’s the biggest issue. Stage by stage lung cancer is prognostically worse than most cancers.”

What causes lung cancer?

Cheng says that smoking is “the number one cause” of lung cancer. As per Lung Cancer Canada, the majority of lung cancer cases – about 85 per cent — are directly related to smoking tobacco, particularly cigarettes.

Smoking increases lung cancer risk by:

• Causing genetic changes in the cells of the lungs

• Damaging the lungs’ normal cleaning process by which they get rid of foreign and harmful particles

• Lodging cancer-causing particles in the mucus and developing into cancer tumours

However, Cheng reveals that there’s a “growing number of patients who are non-smokers.”

man smoking a cigarette outside
Smoking is “the number one cause” of lung cancer, according to Cheng. (Photo via Getty Images)

“In particular, we’re now seeing patients who’ve never smoked or never had second-hand smoke exposure developing lung cancer, which is interesting because usually smoking is a key cause,” explains Cheng. “There’s a number of patients who are never smokers and might not have a reason to get lung cancer, so that’s the concerning part.”

Cheng says that “we don’t know why” non-smokers develop lung cancer, so more research needs to be done. However, her best guess is that it’s “related to certain hormones.”

That said, the main focus on lung cancer screening is for people with a history of smoking and who are between the ages of 55-70 years old.

Unfortunately, Cheng adds that “the system doesn’t allow for never smokers to be screened.”

“We’re now seeing patients who’ve never smoked or never had second-hand smoke exposure developing lung cancer.”Dr. Susanna Cheng

What are the signs and symptoms of lung cancer?

In its early stages, lung cancer might not cause any signs or symptoms. As the tumour grows and causes changes in the body, it usually results in coughing and shortness of breath.

However, if you have any of the below signs and symptoms that are linked to lung cancer, it’s important you see a doctor or medical professional as soon as possible:

  • A cough that gets worse or doesn’t go away
  • Shortness of breath
  • Chest pain that you can always feel, and that gets worse with deep breathing or coughing
  • Blood in mucus coughed up from the lungs
  • Wheezing
  • Weight loss
  • Fatigue
  • Hoarseness or other changes to your voice
  • Difficulty swallowing
  • Swollen lymph nodes in the neck or above the collarbone
  • Headache

Cheng notes that she usually sees “cough, infection or pneumonia” as precursors to lung cancer.

However, she reveals that “COVID put a stint in it.”

“Nowadays when someone has has COVID they they can be coughing for weeks and weeks,” she says. “Some cannot really tell what the symptoms are for sometimes, which can make it hard to diagnose at first.”

Male doctor examining patient in hospital gown who is coughing
A cough that gets worse or doesn’t go away is a key sign of lung cancer. (Photo via Getty Images)

She adds that cough, shortness of breath (especially when moving), unexplained weight loss, loss of appetite, chest pain, and hoarse voice are other possible warning signs of lung cancer.

“In smokers they may always have a chronic cough but in non-smokers they may never have a cough or develop it over time. Which can delay a lung cancer diagnosis,” adds Cheng.

How is lung cancer diagnosed and treated?

Lung cancer is usually diagnosed after a visit to your family doctor, who will ask you about your health history, symptoms, and perform a physical exam. You may also take a blood test, or get an X-ray, MRI or CT scan.

If lung cancer is diagnosed, other tests are done to find out how far it has spread through the lungs, lymph nodes, and the rest of the body. This process is called staging.

Screening for lung cancer is another important step that can help detect the condition early. With lung cancer, early detection is vital. The sooner the disease is diagnosed, the greater chances of survival.

“It’s unfortunate that there isn’t really screening for people who aren’t smokers yet, but hopefully soon.”Dr. Susanna Cheng

“It’s unfortunate that there isn’t really screening for people who aren’t smokers yet, but hopefully soon,” says Cheng.

When it comes to treatment, Cheng believes it’s going in a positive direction.

“In the last 20 years things have transformed significantly. We used to only have chemotherapy, but now it’s based on their pathology and their genetic mutations, which predicts what kind of treatment they get, such as immunotherapy and targeted drugs,” Cheng explains.

Woman smoking against a black background holding a poster with black lungs on it.
Stop smoking to reduce your risk of lung cancer. (Photo via Getty Images)
How can I prevent or reduce the risk of lung cancer?

Unfortunately, not all lung cancers can be prevented. However, there are things you can do to help prevent developing the condition, such as changing the risk factors that you can control.

Cheng says that the first thing you can do is to avoid smoking.

“Really, don’t smoke, and try not to be around a loved one who smokes because second-hand smoke risk is also very real,” she says.

Cheng adds that there aren’t many risk factors related to diet or alcohol, but keep an eye on “occupational exposure.”

“Watch occupational exposure like Ephesus. You could also check for radon in your house, but other than that there isn’t really much you could do,” she explains.

Dreaming of beachfront real estate? Much of Florida’s coast is at risk of storm erosion that can cause homes to collapse, as Daytona just saw

The Conversation

Dreaming of beachfront real estate? Much of Florida’s coast is at risk of storm erosion that can cause homes to collapse, as Daytona just saw

Zhong-Ren Peng, Professor of Urban and Regional Planning,

University of Florida November 23, 2022

Dozens of homes were left unstable in the Daytona Beach area after Hurricane Nicole's erosion. <a href=
Dozens of homes were left unstable in the Daytona Beach area after Hurricane Nicole’s erosion. Joe Raedle/Getty Images

Back-to-back hurricanes left an unnerving scene on the Florida coast in November 2022: Several houses, and even swimming pools, were left dangling over the ocean as waves eroded the earth beneath them. Dozens of homes and condo buildings in the Daytona Beach area were deemed unsafe.

The destruction has raised a disturbing question: How much property along the rest of the Florida coast is at risk of collapse, and can it be saved?

As the director of iAdapt, the International Center for Adaptation Planning and Design at the University of Florida, I have been studying climate adaptation issues for the last two decades to help answer these questions.

Rising seas, aging buildings

Living by the sea has a strong appeal in Florida – beautiful beaches, ocean views, and often pleasant breezes. However, there are also risks, and they are exacerbated by climate change.

Sea level is forecast to rise on average 10 to 14 inches (25-35 cm) on the U.S. East Coast over the next 30 years, and 14 to 18 inches (35-45 cm) on the Gulf Coast, as the planet warms. Rising temperatures are also increasing the intensity of hurricanes.

With higher seas and larger storm surges, ocean waves more easily erode beaches, weaken sea walls, and submerge cement foundations in corrosive salt water. Together with subsidence, or sinking land, they make coastal living riskier.

Florida’s erosion risk map shows most of the state’s coastline at critical risk. <a href=
Florida’s erosion risk map shows most of the state’s coastline at critical risk. Florida Department of Environmental ProtectionCC BY-SA

The risk of erosion varies depending on the soil, geology and natural shoreline changes. But it is widespread in U.S. coastal areas, particularly Florida. Maps produced by engineers at the Florida Department of Environmental Protection show most of Florida’s coast faces critical erosion risk.

Aging or poorly maintained buildings and sea walls, and older or poor construction methods and materials, can dramatically aggravate the risk.

Designing better building codes

So, what can be done to minimize the damage?

The first step is to build sturdier buildings and fortify existing ones according to advanced building codes.

Building codes change over time as risks rise and construction techniques and materials improve. For example, design criteria in the Florida Building Code for South Florida changed from requiring some new buildings to be able to withstand 146 mph sustained winds in 2002 to 195 mph winds in 2021, meaning a powerful Category 5 hurricane.

The town of Punta Gorda, near where Hurricane Ian made landfall in October 2022, showed how homes constructed to the latest building codes have a much better chance of survival.

Many of Punta Gorda’s buildings has been rebuilt after Hurricane Charley in 2004, shortly after the state updated the Florida Building Code. When Ian hit, they survived with less damage than those in neighboring towns. The updated code had required new construction to be able to withstand hurricane-force winds, including having shutters or impact-resistant window glass.

Many homes in Punta Gorda fared better in Hurricane Ian’s winds because they had been rebuilt to higher standards after Hurricane Charley in 2002. <a href=
Many homes in Punta Gorda fared better in Hurricane Ian’s winds because they had been rebuilt to higher standards after Hurricane Charley in 2002. Bryan R. Smith / AFP

However, even homes built to the latest codes can be vulnerable, because the codes don’t adequately address the environment that buildings sit on. A modern building in a low-lying coastal area could face damage in the future as sea level rises and the shoreline erodes, even if it meets the current flood zone elevation standards.

This is the problem coastal residents faced during Hurricanes Nicole and Ian. Flooding and erosion, exacerbated by sea-level rise, caused the most damage – not wind.

The dozens of beach houses and condo buildings that became unstable or collapsed in Volusia County during Hurricane Nicole might have seemed fine originally. But as the climate changes, the coastal environment changes, too, and one hurricane could render the building vulnerable. Hurricane Ian damaged sea walls in Volusia County, and some couldn’t be repaired before Nicole struck.

How to minimize the risk

The damage in the Daytona area in 2022 and the deadly collapse a year earlier of a condo tower in Surfside should be a wake-up call for all coastal communities.

Data and tools can show where coastal areas are most vulnerable. What is lacking are policies and enforcement.

Florida recently began requiring that state-financed constructors conduct a sea-level impact study before starting construction of a coastal structure. I believe it’s time to apply this new rule to any new construction, regardless of the funding source.

With Hurricane Nicole’s storm surge coinciding with high tide, the waves breached a condo tower’s sea walls in Daytona Beach in November 2022. <a href=
With Hurricane Nicole’s storm surge coinciding with high tide, the waves breached a condo tower’s sea walls in Daytona Beach in November 2022. Joe Raedle/Getty Images

A comprehensive sea-level impact study requirement should also allow for risk-based enforcement, including barring construction in high-risk areas.

Similarly, vulnerability audits – particularly for multistory buildings built before 2002 – can check the integrity of an existing structure and help spot new environmental risks from sea-level rise and beach erosion. Before 2002, the building standard was low and enforcement was lacking, so many of the materials and the structures used in those buildings aren’t up to the standards of today.

What property owners can do

There is a range of techniques homeowners can use to fortify homes from flood risks.

In some places, that may mean elevating the house or improving the lot grading so surface water runs away from the building. Installing a sump pump and remodeling with storm-resistant building materials can help.

FEMA suggests other measures to protect against coastal erosion, such as replenishing beach sand, strengthening sea walls and anchoring the home. Engineering can help communities, temporarily at least, through sea walls, ponds and increased drainage. But in the long term, communities will have to assess the vulnerability of coastal areas. Sometimes the answer is to relocate.

However, there’s a disturbing trend after hurricanes, and we’re seeing it with Ian: Many damaged areas see lots of money pouring in to rebuild in the same vulnerable locations. An important question communities should be asking is, if these are already in high-risk areas, why rebuild in the same place?

This article is republished from The Conversation, an independent nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Zhong-Ren PengUniversity of Florida. Like this article? subscribe to our weekly newsletter.

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Zhong-Ren Peng receives funding from National Science Foundation, Florida Sea Grant, and Florida Department of Transportation.

Yes, You Can Really Have a Heart Attack From Shoveling Snow

lifehacker

Yes, You Can Really Have a Heart Attack From Shoveling Snow

Beth Skwarecki – November 23, 2022

Photo:  SKatzenberger (Shutterstock)
Photo: SKatzenberger (Shutterstock)

You may have heard of people—elderly folks in particular—getting a heart attack from shoveling snow. But what’s so dangerous about shoveling? And is everybody at risk, or is this pretty rare? Here’s what you should know.

Snow shoveling is hard exercise

The connection between shoveling and cardiac events is real. The American Heart Association cites several studies that found higher rates of heart attacks and sudden cardiac deaths after snowstorms. Shoveling is hard work, and it can cause your blood pressure and heart rate to rise far higher than levels that are considered safe for sedentary people with heart conditions. Cold temperatures also seem to make chest pain more likely, possibly because your arteries can constrict in the cold.

Who should check with a doctor before shoveling?

You may have heard the advice to check with a doctor before beginning an exercise program. We have more information on that here: most people don’t need to check with a doctor, but that depends on your medical history and on whether you intend to do intense exercise.

Since snow shoveling is intense exercise, it’s worth taking a look at those guidelines. If you have cardiovascular disease, diabetes, or kidney disease, and are currently not exercising intensely, you should check with a doctor before you start. That’s true whether the intense exercise you want to do is running, Crossfit, or shoveling six inches of snow from your enormous driveway.

Pushing a snowblower counts too

One surprising thing: The cautions around shoveling snow also apply to using a snowblower. Snowblowing turns out to also be serious exercise, even if, in theory, it should be easier because a machine is doing part of the work.

How to reduce your risk of heart attack

In a news release from the American Heart Association, the cardiologist who was the lead author on a paper on risks of exercise recommends that people who have had bypass surgery or coronary angioplasty, or who have already had a heart attack or stroke, should not do their own shoveling. He also includes current and former smokers, people who have diabetes, obesity, high blood pressure, high cholesterol, and people who are sedentary.

If you’re healthy enough that shoveling snow is reasonably safe, you may still want to take a few precautions to make shoveling easier on your body. Even though running a snowblower is hard work, it’s still easier than shoveling. And if you need to shovel, pushing a shovel is easier on your body than lifting it repeatedly.

I would add that it’s a game changer to shovel multiple times in a single snowstorm. Instead of waiting until you have six inches of snow on the ground, go out when there’s just two inches and it’ll be a breeze. Repeat that process two more times, and you’ll have a clear driveway without ever having to wrestle with ankle-deep snow.

Finally, be aware of how your body is feeling as you shovel, and stop if you don’t feel well. Or as the AHA put it:

if you experience chest pain or pressure, lightheadedness or heart palpitations or irregular heart rhythms stop the activity immediately. Call 9-1-1 if symptoms don’t subside shortly after snow removal.

Hundreds of Arizona Households Set to Be Without Water by End of Year

Gizmodo

Hundreds of Arizona Households Set to Be Without Water by End of Year

Lauren Leffer – November 22, 2022

In every month of 2022, Lake Mead’s water level has been the lowest recorded for the time of year since the reservoir was first filled.
In every month of 2022, Lake Mead’s water level has been the lowest recorded for the time of year since the reservoir was first filled.

More than 500 households in the rural Arizona desert are set to be without running water starting January, 1 2023, as first reported by NBC News. The homes, located in Rio Verde Foothills—an affluent, unincorporated community in the state’s Maricopa County, were built without complying to Arizona’s usual 100-year water supply requirement. Rio Verde Foothills doesn’t have its own water system. Instead, people living in the arid locale rely on private wells or water trucked up from the nearby city of Scottsdale.

However, in response to the ongoing and worsening megadrought, Scottsdale declared late last year that it would cease hauling water to communities outside the city limits on Jan 1, 2023 and encouraged Rio Verde Foothills to find an alternative. Now, with the set deadline fast approaching, residents haven’t found a solution.

At the end of August, Maricopa County rejected a proposal from 550 Rio Verde residents hoping to form their own Domestic Water Improvement District. And though proposed deals have continued to be discussed behind closed doors, Scottsdale Progress reported, no firm decisions have been made and no community-wide fixes are underway.

Under Arizona’s Assured Water Supply Program, housing developments in the state are supposed to have a guaranteed century’s worth of water supply to be approved for construction. But via a semantic loophole, the around 2,200 houses in Rio Verde Foothills were able to skirt that law and be built without a clear long-term water source. Now, even many of the households that once had working wells are running dry.

Scottsdale has been warning for nearly a decade that its water-trucking operation was only ever meant to be a temporary remedy, not a permanent resolution, according to NBC News. And federal pressure amid the ongoing drought has forced the city to try to reduce its water usage.

Last year, when Scottsdale first said it would cease water hauling by January 2023, the U.S. Bureau of Reclamation had declared a Tier 1 water shortage on the Colorado River—reducing the amount of water Southwestern states can get from the river. In August of this year, the Reclamation Bureau upped the shortage designation to Tier 2a.

Scottsdale gets 65% of its water from the Colorado River, and ending its practice of exporting water beyond the city was intended to help Scottsdale lower its total consumption. In addition to cracking down on Rio Verde Foothills, the city has been encouraging its residents to voluntarily lower their usage. And though residents have made some progress and Scottsdale met its initial water reduction goals, the drought persists.

Lake Mead is at its lowest November water level on record since the reservoir was first filled. In fact, in every month of 2022, Lake Mead has been at record low for that time of year. Some seasonal fluctuations are to be expected, but this year’s monsoon season wasn’t nearly enough to make up the deficit. And climate change may be helping to propel already-arid U.S. regions into a permanent state of drought. One study published earlier this year found that 42% of the Southwest’s current drought is attributable to human-caused climate change.

Rio Verde Foothills is yet more evidence that when poor planning and the climate crisis come together, the result is often disastrous.

Accountant testifies Trump claimed decade of huge tax losses

Associated Press

Accountant testifies Trump claimed decade of huge tax losses

Michael R. Sisak – November 22, 2022

Donald Bender, left, a former accountant for Donald Trump, arrives at Manhattan criminal court, Monday, Nov. 21, 2022, in New York. Prosecutors in the Trump Organization's criminal tax fraud trial rested their case Monday earlier than expected, pinning hopes for convicting Donald Trump's company largely on the word of two top executives who cut deals before testifying they schemed to avoid taxes on company-paid perks. (AP Photo/Michael Sisak)
Donald Bender, left, a former accountant for Donald Trump, arrives at Manhattan criminal court, Monday, Nov. 21, 2022, in New York. Prosecutors in the Trump Organization’s criminal tax fraud trial rested their case Monday earlier than expected, pinning hopes for convicting Donald Trump’s company largely on the word of two top executives who cut deals before testifying they schemed to avoid taxes on company-paid perks. (AP Photo/Michael Sisak)
FILE - Former President Donald Trump announces he is running for president for the third time at Mar-a-Lago in Palm Beach, Fla., Nov. 15, 2022. The Supreme Court has cleared the way for the handover of former President Donald Trump's tax returns to a congressional committee after a three-year legal fight. The Democratic-controlled House Ways and Means Committee had asked for six years of tax returns for Trump and some of his businesses, from 2015 to 2020. The court's order Tuesday, Nov. 22 leaves no legal obstacle in the way. (AP Photo/Andrew Harnik, File)
 Former President Donald Trump announces he is running for president for the third time at Mar-a-Lago in Palm Beach, Fla., Nov. 15, 2022. The Supreme Court has cleared the way for the handover of former President Donald Trump’s tax returns to a congressional committee after a three-year legal fight. The Democratic-controlled House Ways and Means Committee had asked for six years of tax returns for Trump and some of his businesses, from 2015 to 2020. The court’s order Tuesday, Nov. 22 leaves no legal obstacle in the way. (AP Photo/Andrew Harnik, File)
Trump Legal Troubles

NEW YORK (AP) — Donald Trump reported losses on his tax returns every year for a decade, including nearly $700 million in 2009 and $200 million in 2010, his longtime accountant testified Tuesday, confirming long-held suspicions about the former president’s tax practices.

Donald Bender, a partner at Mazars USA LLP who spent years preparing Trump’s personal tax returns, said Trump’s reported losses from 2009 to 2018 included net operating losses from some of the many businesses he owns through his Trump Organization.

“There are losses for all these years,” said Bender, who was granted immunity to testify at the company’s criminal tax fraud trial in Manhattan.

The short exchange amounted to a rare public discussion of Trump’s taxes — which the Republican has fought to keep secret — even if there was no obvious connection to the case at hand.

A prosecutor, Susan Hoffinger, questioned Bender briefly about Trump’s taxes on cross examination, at one point showing him copies of Trump tax paperwork that the Manhattan district attorney’s office fought for three years to obtain, before moving on to other topics.

The Trump Organization, the holding company for Trump’s buildings, golf courses and other assets, is charged with helping some top executives avoid income taxes on compensation they got in addition to their salaries, including rent-free apartments and luxury cars. If convicted, the company could be fined more than $1 million.

Trump is not charged in the case and is not expected to testify or attend the trial. The company’s former finance chief testified that he came up with the scheme on his own, without Trump or the Trump family knowing. Allen Weisselberg, testifying as part of a plea deal, said the company also benefited because it didn’t have to pay him as much in salary.

Bender’s testimony came on a day full of Trump-related legal drama, including the U.S. Supreme Court clearing the way for Congress to get six years worth of tax returns for Trump and some of his businesses.

Also Tuesday, the judge in New York Attorney General Letitia James’ civil fraud lawsuit against Trump and his company set an October 2023 trial date; a federal appeals court heard arguments in the FBI’s Mar-a-Lago documents investigation; and Sen. Lindsey Graham, a Trump ally, testified before a Georgia grand jury probing alleged 2020 election interference.

Bender’s tax loss testimony echoed what The New York Times reported in 2020, when it obtained a trove of Trump’s tax returns. Many of the records reflected massive losses and little or no taxes paid, the newspaper reported at the time.

The Times reported Trump paid no income tax in 11 of the 18 years whose records it reviewed, and that he paid just $750 in federal income tax in 2017, the year he became president. Citing other Trump tax records, The Times previously reported that in 1995 he claimed $915.7 million in losses, which he could have used to avoid future taxes under the law at the time.

Manhattan prosecutors subpoenaed Bender’s firm in 2019, seeking access to eight years of Trump’s tax returns and related documents, finally getting them after a protracted legal fight that included two trips to the U.S. Supreme Court.

Bender handled tax returns and other financial matters for Trump, the Trump Organization and hundreds of Trump entities starting in the 1980s. He also prepared taxes for members of Trump’s family and other company executives, including Weisselberg and Weisselberg’s son, who managed a company-run ice rink in Central Park.

Weisselberg, who pleaded guilty in August to dodging taxes on $1.7 million in extras in exchange for a five-month jail sentence, testified that he hid company-paid extras such as Manhattan apartments and Mercedes-Benz cars from his taxable income by having the company’s comptroller, Jeffrey McConney, reduce his salary by the cost of those perks.

Bender testified that Weisselberg kept him the dark on that arrangement — and that he only found out about it from prosecutors last year.

But emails shown in court Tuesday suggested that McConney tried to loop him in as early as 2013, with attached spreadsheets listing Weisselberg’s pay and reductions for extras, including Trump-paid tuition for his grandchildren’s private schooling.

Bender, who testified that he got numerous emails from Trump executives daily, said he didn’t recall seeing those messages. If he had, he said: “We would have had a serious conversation about continuing with the client.”

Mazars USA LLP has since dropped Trump as a client. In February, the firm said annual financial statements it prepared for him “should no longer be relied upon” after James’ office said the statements regularly misstated the value of assets — an allegation at the heart of her lawsuit.

Trump blamed Bender and Mazars for the company’s troubles, writing on his Truth Social platform last week: “The highly paid accounting firm should have routinely picked these things up – we relied on them. VERY UNFAIR!”

Bender testified that he put the onus on Weisselberg to fix any problems as scrutiny of the Trump Organization intensified after Trump’s election in 2016 and advised him to stop one dubious practice: the company’s longstanding, tax-saving habit of paying executive bonuses as freelance income.

The accountant said he told Weisselberg: “If there is anything bothering you, even if there’s the slightest chance, we have to set the highest standards so the company should be, effectively, squeaky clean.”

What Will Russia Without Putin Look Like? Maybe This.

Guest Essay By Joy Neumeyer November 21, 2022

Ms. Neumeyer is a journalist and historian of Russia and Eastern Europe.

Credit…Nanna Heitmann for The New York Times

Russia’s current condition — militarized, isolated, corrupt, dominated by the security services and hemorrhaging talent as hundreds of thousands flee abroad to escape service in a horrific war — is bleak.

In hopes of an end to this grim reality, some wait expectantly for Vladimir Putin to leave office. To change the country, however, it is not enough for Mr. Putin to die or step down. Russia’s future leaders must dismantle and transform the structures over which he has presided for more than two decades. The challenge, to say the least, is daunting. But a group of politicians is devising a plan to meet it.

Composed of well-known opposition figures as well as younger representatives from local and regional governments, the First Congress of People’s Deputies of Russia met in Poland in early November. The location, Jablonna Palace outside Warsaw, was symbolic: It was the site of early negotiations in the round-table talks that led to the end of Communist rule in Poland. There, over three days of intense debate, participants laid out proposals for rebuilding their country. Taken together, they amount to a serious effort to imagine Russia without Mr. Putin.

The first and most pressing priority, of course, is the invasion of Ukraine. Everyone at the congress opposes the war, which they assume will be lost or lead to nuclear disaster. To deal with the consequences and to prevent a repeat tragedy, they propose an “act on peace” that would demobilize the army and end the occupation of Ukrainian territory, including Crimea; create a joint group for the investigation of war crimes; pay reparations for damaged infrastructure and the families of the dead; and reject future “wars of conquest.” In addition to offering a deterrent to future expansionism, this wide-ranging pledge would provide an essential reckoning with Russia’s history of imperialist invasion.

The officials responsible for the devastation will need to be rooted out, too — something that never happened after the collapse of the Soviet Union. The Congress would bar from working in state and educational institutions those who belonged to “criminal” organizations — such as the Federal Security Services or state television channels — or publicly supported the war, as well as restricting their voting rights. It would also create a “de-Putinization” commission to consider the rehabilitation of certain groups, including those who publicly recant and did not commit especially serious crimes, and open the archives of the security services.

Then there’s the structure of Russia itself. The Russian Federation is highly centralized, with a patchwork of over 80 republics and regions that are strongly subordinate to the president, enabling the accumulation of enormous power. The Congress, drawing on decentralized visions from around the time of the Soviet collapse, proposes to dissolve the Russian Federation and replace it with a new parliamentary democracy. According to a broadly worded draft provision on “self-determination,” the future Russian state should be “joined on the basis of free choice by the peoples who populate it.”

This break with the present could correct the failed promises of the past. From Vladimir Lenin to Boris Yeltsin, modern Russian leaders have a history of offering decentralization to win support and then reneging once they consolidate power. Though all federal subjects are legally equal under Russia’s current Constitution, substantial inequalities persist — a fact that has been highlighted by the disproportionate deployment and death of ethnic minorities from poorer republics like Dagestan and Buryatia in the war in Ukraine.

Revisiting the issue of greater sovereignty could allow the breakaway republic of Chechnya, for example, to leave Russia after its brutal subjugation by Mr. Putin, while enabling regions and republics without strong secessionist movements to renegotiate the allocation of resources and balance of power with the center. It would create a fairer country while undermining Russian nationalism.

The congress is vaguest on its economic plans. One act promises to “review the results of privatization” carried out during the 1990s (which led to the rise of Russia’s oligarchs), while another aims to cancel Mr. Putin’s highly unpopular pension reform of 2020. Missing, however, is a commitment to a strong social safety net or any discussion of transitioning Russia’s economy away from its dependence on energy exports. This is a major oversight. Since the 1990s, when privatization and free elections were introduced simultaneously, wealth and power have been intertwined. Political and economic reform cannot be viewed in isolation from each other.

That’s not the only hitch. The congress’s main organizer and sponsor is Ilya Ponomarev, a leftist tech entrepreneur. The only member of the Russian parliament to vote against the annexation of Crimea in 2014, he left the country, obtained Ukrainian citizenship and now runs a Russian-language news channel in Kyiv. A controversial figure in opposition circles, in August he endorsed the assassination of Daria Dugina, the daughter of the Eurasianist philosopher Alexander Dugin, and asserted it was the work of a secret partisan army inside Russia. This uncorroborated claim outraged fellow opposition figures. Mr. Ponomarev was subsequently disinvited from an event organized by the longtime Kremlin critics Garry Kasparov and Mikhail Khodorkovsky.

Despite their disagreements, Russia’s opposition has a loosely converging vision for the future. Mr. Khodorkovsky and Aleksei Navalny, the country’s most well-known dissident, who is currently languishing in a penal colony, have also issued calls to turn Russia into a parliamentary democracy with more power devolved to the local and regional levels. But associates of Mr. Navalny did not attend the congress, nor did Mr. Kasparov or Mr. Khodorkovsky. Its legitimacy — already challenged by a number of Russian antiwar organizations that said it does not represent them — was also questioned by some participants, several of whom left in protest over what they saw as a lack of equality and transparency in how it was being run.

Such feuding doesn’t help the proposals, which can seem far-fetched. Yet history shows that radical developments are often incubated abroad or underground. In the late 19th and early 20th centuries, political émigrés in bickering communities around Europe plotted the downfall of the Russian empire. Among them was Vladimir Lenin, who was living in Poland at the outbreak of World War I.

For now, with most of Russia’s population forced into quiescence while others lose their jobs or freedom for expressing dissent, the possibility of the country’s transformation appears remote. Change, however, can come when it’s least expected. In early 1917, a pessimistic Lenin lamented that he probably wouldn’t live to see the revolution; a few weeks later, the czar was overthrown.

Russia is no more doomed to repeat the past than any other country. The time to reimagine its future is now.

A Soil Fungus That Causes Lung Infections Is Spreading Across the U.S.

Gizmodo

A Soil Fungus That Causes Lung Infections Is Spreading Across the U.S.

Nikki Main – November 21, 2022

The fungus histoplasma, which causes lung infections, was concentrated in the Midwest in the 1950s and 60s (top map), but now causes significant disease throughout much of the country (bottom).
The fungus histoplasma, which causes lung infections, was concentrated in the Midwest in the 1950s and 60s (top map), but now causes significant disease throughout much of the country (bottom).

An illness-causing fungus known as hisoplasma is in the soil of nearly all U.S. states, a new study suggests. The researchers behind the work say doctors may be relying on outdated risk maps and therefore missing diagnoses of the infections, which can sometimes be deadly.

According to the CDC, histoplasma, or histo, is found in the soil of central and eastern U.S. states, primarily in Ohio and the Mississippi River valleys. But that assumption is based on research from the 1950s and 1960s, says the team behind a new paper published in Clinical Infectious Diseases. When a person breathes in spores of the fungus, they can contract an infection called histoplasmosis.

“Every few weeks I get a call from a doctor in the Boston area – a different doctor every time – about a case they can’t solve,” said study author Andrej Spec, an associate professor of medicine at Washington University in St. Louis, in a press release. “They always start by saying, ‘We don’t have histo here, but it really kind of looks like histo.’ I say, ‘You guys call me all the time about this. You do have histo.’”

Lead author Patrick B. Mazi, a clinical fellow in infectious diseases also at Washington University in St. Louis, and his colleagues analyzed more than 45 million Medicare fee-for-service beneficiaries extending from 2007 through 2016. They looked at diagnoses across the country of three fungal diseases: histoplasmosis, coccidioidomycosis, and blastomycosis. Histo, the most common, was causing clinically relevant rates of illness in at least one county in 48 of 50 states, as well as Washington, D.C. The other two infections were each found in more than half of states.

“Fungal infections are much more common than people realize, and they’re spreading,” Spec said in the release. “The scientific community has underinvested in studying and developing treatments for fungal infections. I think that’s beginning to change, but slowly.” Climate change may be driving this spread as warming temperatures make more habitats suitable for the fungi.

While histo can be easily combatted in healthy adults, and many people who are exposed never develop symptoms, those who are immunocompromised as well as infants and people 55 years and older may develop more serious illness, including a cough, fever, chest, pain, body aches, and fatigue, according to the CDC. Symptoms appear within three to 17 days after exposure; most symptoms will go away within a month, but if it spreads from a person’s lungs, the illness can become severe and require months of treatment.

People can be exposed to histo and other fungal pathogens through activities that disrupt soil, like farming, landscaping, and construction. They can also be exposed inside caves and while working in basements and attics. Spec noted: “It’s important for the medical community to realize these fungi are essentially everywhere these days and that we need to take them seriously and include them in considering diagnoses.”