A new study finds that Earth’s water may have come from materials that were present in the inner solar system at the time the planet formed — instead of far-reaching comets or asteroids delivering such water. The findings published Aug. 28 in Science suggest that Earth may have always been wet.

Although helminth infections — including tapeworms and roundworms — are among the world’s top neglected diseases, they are no longer endemic in Europe. However, researchers reporting in PLOS Neglected Tropical Diseases report that these infections were common in Medieval Europe, according to grave samples analyzed from across the continent.

Guidance has changed but the Welsh government says that reflects low infection rates.

The benefit will be trialled in some parts of north-west England where coronavirus cases have risen.

• There is some evidence that antibacterial drugs interact with hormonal contraceptives
• This means that women on the Pill should be careful when taking antibiotics
• Researchers recommend that pharmacy inserts of both kinds of drugs should warn patients of the risk

Doctors have long suspected it, but a comprehensive new study provides more evidence that antibiotics can reduce the effectiveness of birth control pills.

That means women who are using both types of drugs at once should take extra precautions to avoid an unintended pregnancy, the study’s British authors say.

The study couldn’t prove cause and effect. However, it “suggests there is an interaction of antibacterial drugs with hormonal contraceptives, which can potentially impair the effectiveness of the contraceptives,” concluded a team led by Dr Robin Ferner of the Institute of Clinical Sciences at the University of Birmingham.

Additional contraception

The findings didn’t surprise one American ob-gyn.

“We have known for a long time that certain antibiotics will affect the metabolism of the oral contraceptive hormones,” said Dr Mitchell Kramer, who directs obstetrics and gynaecology at Northwell Health’s Huntington Hospital in Huntington, New York.

“Therefore, we advise of patients on birth control pills to use additional contraception, such as condoms or spermicidal suppositories/foam, during the duration of taking the antibiotic just as a precaution,” he said.

According to the UK research team, prior studies on interactions between antibiotics and birth control pills had yielded mixed findings.

Seeking clarity, Ferner and his team tracked reports of suspected unwanted drug side effects (called Yellow Cards) that had been reported by health care providers and the public to the UK’s drug and medical devices regulator, the Medicines and Healthcare Products Regulatory Agency.

Unintended pregnancies

Specifically, they compared the number of unintended pregnancies reported in almost 75 000 Yellow Cards for antibiotics in general, about 33 000 for enzyme-inducing drugs, and more than 65 500 other types of drugs.

There were 46 instances of unintended pregnancies in the Yellow Card reports for antibiotics (a rate of 62 per 100 000), 39 in the enzyme-inducing drug reports (119 per 100 000), and six in reports of other drugs.

Compared with the other types of drugs, unintended pregnancies were seven times more common in Yellow Card reports of antibiotics and 13 times more common in reports of enzyme-inducing drugs, which included some antibiotics.

Congenital birth defects were also reported seven times more often in enzyme-inducing drug Yellow Card reports, according to the study, published on 18 August in the journal BMJ Evidence Based Medicine.

Calculating absolute risks from the data wasn’t possible, and the risk will vary from woman to woman, according to her physiological make-up and circumstances, the researchers stressed.

Warnings needed

They agreed that if a woman is taking hormonal contraceptives and an antibiotic, she is “advised to take extra contraceptive precautions when a short course of an antibacterial drugs is added”.

Dr Jennifer Wu is an ob-gyn at Lenox Hill Hospital in New York City. Reading over the study, she said it was well-designed, with “large numbers and good tracking of patients”.

Based on the findings, Wu believes that “doctors and patients need to have careful discussions about new prescriptions and whether they could interfere with birth control pills.

“Pharmacy inserts of antibiotics and the enzyme-inducing drugs should also warn patients as another precaution,” she said.

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Charities say the scheme should be promoted after less than 40% of schools order free products.

• With autumn on the doorstep in the US, there is the possibility of two overlapping epidemics
• A bad outbreak of ‘regular’ flu combined with an upsurge in Covid-19 could overwhelm health services
• Getting the latest flu shot can reduce one’s risk of at least one of the respiratory infections

Autumn is approaching, and so is the possibility of what public health officials are calling a “twindemic” – overlapping epidemics of both Covid-19 and influenza.

A bad flu season coupled with continued Covid-19 outbreaks could increase people’s risk of fatal illness and overwhelm hospital capacity in communities already scrambling to treat coronavirus patients, experts say.

“I think it’s definitely a possibility and it’s something we’re all worried about,” said Dr Eric Cioe-Pena, director of global health at Northwell Health in New Hyde Park, New York. “The trifecta of a bad flu season, a bad Covid resurgence and an Atlantic hurricane is our doomsday scenario. You could add in civil unrest around the election as a four-way doomsday scenario.”

Blunting the effect of one infection

The concern is so great that officials worldwide have been pressing for people to get this year’s flu shot, even though it’s only now hitting the market.

Getting your flu shot “could at least blunt the effect of one of those two potential respiratory infections”, Dr Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases, told The New York Times.

Fauci shared his thoughts on vaccination in this video:

The US Centers for Disease Control and Prevention usually purchases a half-million doses of flu vaccine for uninsured adults, but this year the agency increased its order by an additional 9.3 million doses, according to the Times.

But the protective strategies that officials have been promoting against Covid-19 – masking, hand-washing and physical distancing – should reduce the risk of a twindemic.

“The same things we do to prevent Covid should work for another virus called influenza,” said Dr Waleed Javaid, director of infection prevention and control at Mount Sinai Downtown, in New York City. “If we follow the same recommendations, they should be effective for influenza and for Covid, and we might not see as much spread of influenza as we’ve seen in previous years.”

Indeed, the Southern Hemisphere is in the middle of its flu season and has seen a dramatic decrease in flu cases thanks to protective measures adopted against the new coronavirus.

The Australian experience

“In Australia, the flu cases are down around 99% compared with last year,” noted Dr Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security, in Baltimore.

Unfortunately, the United States probably won’t see this benefit because the nation has not fully embraced the recommended protections against Covid-19, Adalja continued.

“There is likely to be some effect, but the fact of the matter is even though we have all these measures for Covid, in the United States we haven’t really been as adherent to them as in other countries. We have to prepare for the fact that we may not get the Australian experience of influenza,” Adalja said.

A community facing a twindemic could soon find itself running out of hospital capacity, Adalja added.

‘Back to back’ cases

Last year’s flu season was relatively mild, but still resulted in between 39 million and 56 million cases of flu, as many as 740 000 hospitalisations, and between 24 000 and 62 000 flu deaths, according to preliminary CDC estimates.

“You have to remember those viruses are going to compete for the same hospital beds, ICU beds, ventilators, personal protective equipment and even diagnostic test reagents,” Adalja said.

Doctors are particularly worried about people who catch one of the viruses and then the other, back-to-back.

“I would say a sequential infection could be really a major problem for somebody, to get hit twice in a row. They might have sustained lung damage from Covid and now have to deal with influenza,” Adalja said. “I would think the lung damage one would induce would make you more susceptible to a severe outcome with the other one.”

Both infections at once

That’s why public health officials are pressing for as many people as possible to get the flu shot, so they have some protection against at least one of these circulating viruses.

Cioe-Pena said, “We can’t vaccine-prevent Covid, but we can vaccine-prevent flu visits to hospitals this year. I strongly encourage everyone to get their flu shot.”

The flu vaccine contains particles of three to four different strains of flu that officials guess will be the ones most in circulation during the influenza season in any given year. Even if the vaccine is not an exact match to the flu that winds up being most common, it primes the body to produce an immune response that will limit the severity of a person’s illness.

“People say I took it one year and I got the flu anyway,” Cioe-Pena said. “What you will notice is there are very few people who say, ‘My loved one or I got the flu shot and then I was on a ventilator with pneumonia.’ Even when it doesn’t prevent the illness, it is still the best tool we have at attenuating the effects of the flu.”

In the most severe recent flu season, 2017-2018, the flu vaccine only had an overall estimated effectiveness of 38% across three strains, and was particularly weak against the H3N2 strain, the CDC reported.

Nonetheless, the CDC estimated that the imperfect vaccine still prevented 7.1 million illnesses, 3.7 million medical visits, 109 000 hospitalisations and 8 000 deaths that season.

Record number of shots

“It does prevent severe flu,” Javaid said, “and that is going to be the critical element in this situation. I have seen people get flu and Covid back-to-back, and I can tell you that people who were vaccinated had much better outcomes.”

During the six influenza seasons from 2010 through 2016, the flu vaccine prevented as many as 6.7 million cases of flu, 3.1 million doctor’s visits, 87 000 hospitalisations and 10 000 deaths, the CDC said in its report on this year’s flu vaccine.

Vaccine producers are preparing for a record 98 million flu shots to be handed out in the United States, about 15% more than last year, the Times reported.

However, Americans remain vaccine-hesitant. In the 2018–2019 flu season, only 45% of US adults got the vaccine, with rates particularly low among those aged 18 to 50, the Times noted.

“The best way to prevent this twindemic is to have as high a vaccination rate for influenza as we can, so there is room to take care of these Covid patients and we don’t have to worry about dual infections or sequential infections,” Adalja concluded.

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Experts fear the winter flu season could coincide with a rise in Covid-19 infections.

• Parkinson’s disease affects nearly one million people in the United States 
• Certain symptoms can arise years before the more obvious movement problems 
• There are reasons to suspect that diet is involved in the development of Parkinson’s disease

People who eat healthfully may be less likely to develop a constellation of symptoms that can precede Parkinson’s disease, a large new study suggests.

Researchers found that people who closely adhered to a Mediterranean-style diet were about one-third less likely to develop at least three “prodromal” features suggestive of Parkinson’s disease, compared to those who stuck with meat and potatoes.

Prodromal refers to certain symptoms that can arise years before the more obvious movement problems that mark Parkinson’s. They include constipation, depression, body pain, diminished sense of smell, daytime drowsiness, difficulty seeing colours and a tendency to “act out” dreams.

Multiple symptoms

Individually, some of those issues are quite common, said James Beck, chief scientific officer for the nonprofit Parkinson’s Foundation. And it’s unclear, he added, how often combinations of those symptoms foretell Parkinson’s, specifically.

That said, multiple symptoms do suggest “something’s going wrong in the central nervous system”, said Beck, who was not involved in the study.

And if diet does influence the risk, he said, it will be important to figure out why.

The study, published online in Neurology, is not the first to link diet to Parkinson’s. Several have found a relationship between diet patterns – or particular foods or nutrients – and the risk of developing full-blown Parkinson’s disease.

The new findings are consistent with that, said lead researcher Samantha Molsberry, a postdoctoral research fellow at Harvard T.H. Chan School of Public Health in Boston.

Her team focused on prodromal symptoms, she said, because there has been a “big push” to better understand that phase of Parkinson’s. One hope is to be able to diagnose the disease earlier in its course.

Wide-ranging effects

Parkinson’s disease affects nearly one million people in the United States alone, according to the Parkinson’s Foundation.

It involves an abnormal buildup of a protein called alpha-synuclein in the brain. Over time, the brain loses cells that produce dopamine, a chemical that helps regulate movement and emotional responses. The most visible symptoms of Parkinson’s are movement-related – tremours, stiff limbs and coordination problems – but the effects are wide-ranging and include depression, irritability, and trouble with memory and thinking skills.

But years before the “classic” symptoms of Parkinson’s set in, people can develop prodromal signs.

It’s not clear what sets off the whole process. But experts think the disease arises from a mix of genetic vulnerability and nongenetic factors, according to the Parkinson’s Foundation. Older age is a risk factor, and studies have pointed to some environmental factors – including job exposures to pesticides or heavy metals.

The new findings do not prove diet directly affects the risk, Molsberry said.

But, she added, there are reasons to suspect diet is involved. In theory, a healthy diet could be protective by lowering inflammation throughout the body. And, Molsberry said, early evidence suggests alpha-synuclein may actually first “misfold” and accumulate in the gut.

It’s possible, she speculated, that diet could influence that process.

Multiple prodromal symptoms

For this study, the Harvard team analysed data from two long-running studies of thousands of US healthcare professionals. The researchers used participants’ responses to questionnaires to calculate diet “scores” for each.

One score gauged their adherence to a Mediterranean-style diet – high in fruits, vegetables, legumes, fish, whole grains and unsaturated fats from sources like olive oil.

Overall, people who scored in the top 20% were one-third less likely to develop multiple prodromal symptoms over 20 years, compared to people in the bottom 20%.

The findings were similar when researchers used another diet score, called the Alternate Healthy Eating Index. Again, people on the high-scoring end ate plenty of fruits, vegetables and whole grains, but went light on red meat, sugar and saturated fat.

Replacing junk foods

Beck said more research is needed to understand why diet is linked to prodromal features. “Is it because people on a healthy diet have less exposure to pesticides or heavy metals?” he said. “Is there an effect on inflammation?”

In the meantime, there is no downside to replacing junk food with fruits and vegetables, Beck suggested.

Molsberry agreed. “I think this is one more reason to encourage people to eat a healthy diet,” she said.

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Good ventilation could be key to avoiding coronavirus this autumn as people spend more time indoors.