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Climate change could displace 25 million by 2010


Bonn, June 10 (IANS) By next year - that’s how soon around 25-50 million people will be displaced by climate change as it unleashes more natural disasters and affects farm output, says a senior UN researcher. Northern India will be among the worst affected in the long term.
“Climate change will displace 25-50 million people by next year. The situation will be the worst in the poorer countries,” says Koko Warner of the UN University’s Institute for Environment and Human Security.
“Most people will seek shelter in their own countries while others (will) cross borders in search of better odds.

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“Societies affected by climate change may find themselves locked into a downward spiral of ecological degradation, towards the bottom of which social safety nets collapse while tensions and violence rise.”
Warner has just completed a study on climate-induced migration in collaboration with the UN High Commissioner for Refugees, Columbia University, the World Bank and the NGO CARE.
Warner and her colleagues have been pushing delegates from 182 countries gathered here for a meeting June 1-12 to include migration among the issues they consider as they prepare for a climate summit in Copenhagen this December.
“As climate change increases the frequency and intensity of natural hazards such as cyclones, floods and droughts, the number of temporarily displaced people will rise,” Warner told IANS in an interview.
“This will be especially true in countries that fail to invest now in disaster risk reduction and where the official response to disasters is limited.”
Her study confirms that ‘glacier melt’ will affect major agricultural systems in Asia. As the storage capacity of glaciers declines, short-term flood risks increase. The consequences of glacier melt would threaten food production in some of the world’s most densely populated regions.
In 2000, the river basins of the Indus, Ganga, Brahmaputra, Irrawaddy, Salween, Mekong, Yangtze, and Huang He collectively supported 1.4 billion people, almost a quarter of the world’s population.
Himalayan glaciers are already in retreat. Their dependence on glacier runoff makes downstream populations particularly vulnerable to the consequences, Warner pointed out. The Ganga irrigates 17.9 million hectares in northern India.
“The potential for migration out of irrigated areas could be significant,” Warner added.
“Although destination areas are hard to predict, it is likely that most migrating or displaced people would move to small to medium sized cities inland, and a smaller number would move to large megacities along the coasts or on the main branches of river systems, like Delhi. Many South Asian cities lack the capacity to absorb significant migration streams.”
However, Warner said: “There is potential for significant water saving efficiencies in irrigated areas of Asia, and if properly implemented this may forestall displacements of farmers.
Warner said in the densely populated Ganga, Mekong and Nile river deltas, a sea level rise of one metre could affect 23.5 millionpeople and reduce the land currently under intensive agriculture by at least 1.5 million hectares.
A sea level rise of two metres would impact an additional 10.8 million people and render at least 969,000 more hectares of agricultural land unproductive.
“Many people won’t be able to flee far enough to adequately avoid the negative impacts of climate change,” the researcher warned, “unless they receive support.”
But she said, “Sensationalist warnings must not be permitted to trigger reactionary policies aimed at blocking the movement of environmental refugees without genuine concern for their welfare.”
Countries attending this preparatory meeting are grappling with how much money each will get to adapt to climate change.
“Remember that people displaced by the chronic impacts of climate change, like inadequate rainfall and sea level rise, will require permanent resettlement,” Warner said.
(Joydeep Gupta can be contacted at joydeep.g@ians.in)

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Dressing for the big freeze in New York

When winter's full force hits New York, temperatures dip well below zero. And when the city freezes, New Yorkers ditch their stylish outfits for the "Michelin man" look, as Matthew Price explains.
New Yorkers in winter
New Yorkers swap style for practicality when snow and ice hit the city

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To be honest, I don't think I ever saw this moment coming.
OK, so it had taken some time to get to this stage, but it still crept up on me.
The tipping point came as I stepped out of the splendidly ornate Woolworth Building in Lower Manhattan the other day, just as the Sun was dipping beneath the skyscrapers.
That act removed the rare patches of light (and therefore warmth) which occasionally strike the pavement and help make a winter's day here something approaching bearable.
The wind whacked me smack in the face, burning my lips and my ears. I pulled up my scarf. Tightened my collar. Out came the woolly hat. Still no good. So I ducked into a bank, and got dressed in the foyer. Gloves on. Zips closed. Buttons fastened. Scarf and hat adjusted. Jacket hood pulled up over the lot.
Thank God for the long-johns I had put on that morning.
Back outside and I could not hear a thing through the layers but the Manhattan winter had been successfully shut out. And I looked like a "Michelin man".
Fashion ditched
Sartorially elegant it was not. But after three winters here, I have learnt the hard-stone-cold-frozen way that elegance is not what a New York freeze calls for.
he first year I was based here, I strode around in what I thought was a nice fashionable coat, knees knocking and me cursing myself for forgetting to stick a hat in my bag that morning.
One friend looked me up and down and dismissively told me it was not going to be warm enough.
"Oh, it's just fine thanks," I replied. "Worked a treat back in London." Little did I know.
Still I struggled around, teeth chattering, because, well, if you are an Englishman in New York you need to dress properly, don't you?
By the second year I had learnt something. I bought an extra layer to go under the coat.
View from the Empire State
When the cold is accompanied by snow, New York is the place to be

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But come one day in February, I realised my school-boy error. I stood out on a mid-town pier on the Hudson River on one of those perfect New York days. The Sun shone fiercely down from a cloudless deep blue sky, but it made no difference.
I knew I was in trouble when my Australian colleague, one of those tougher than tough guys who spend most of the year in just a T-shirt, said in his understated manner: "I think we'd better get inside."
His lips were blue. It was -16C with wind-chill.
Wrapping up
It is funny what winter does to a city. New Yorkers are a stylish lot, of course. But come the cold, they go all practical as well.
I have never seen so many men in ear-muffs in my life. So many women sporting full length duvet-style coats. So many ski-outfits not actually on the ski-slopes.
And yes, this year mine will come out on the super-cold days. You can spot the tourists a mile off. They are the ones in the flimsy jackets.
I used to think they looked good in comparison, until I realised they looked silly. Arms tightly folded in against the cold, noses running, trousers flapping around barely-covered ankles.
Central Park, New York
Cross-country skiers and pole-aided walkers take to the snowy streets
Take my advice, if you are coming over for a weekend break, bring the moon-boots. And a pencil. It is the time of year when reporters ditch pens. The ink freezes.
Of course, you do get remarkably used to it. Last winter, I remember stepping out of my front door into what felt like a perfectly balmy spring day.
It actually turned out to be just a degree above freezing, but after a week during which the temperature had stayed well below I left the hat at home.
Winter wonderland
And when the cold is accompanied by snow, New York is the place to be.
Unlike the big freeze in London in early 2009, when an entire city ground to a halt, New York still functions well.
The snow ploughs clear the avenues, the subways still run, and the city looks wonderful. Like a snapshot from an old movie, it turns grey and white.
Brilliant white flakes swirl past the Statue of Liberty, rise up over the Empire State, and settle down with an elegant curtsey in Central Park.
The snow muffles the noise of a city that rarely sleeps. Everything here, for once, feels calm.
And in the hip and gritty Lower East Side, in amongst the dive bars and graffiti, come the cross-country skiers.
Gliding down Rivington, and heading north up Norfolk.
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Snow gives Scots a white Christmas


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Glasgow on Christmas Day
The Met Office said that snow has been confirmed in Glasgow
Flakes of snow have fallen on Glasgow on Christmas morning, giving the city its first white Christmas since 2004.
An official white Christmas requires a single flake to be observed falling in the 24 hours of 25 December.
The Met Office said that snow has been confirmed in Glasgow and was forecast for Edinburgh and the north east.
Forecasters have issued a severe warning of widespread ice across much of the country and more snow across southern and central Scotland.
Anyone planning to use the roads on Christmas Day have been advised to plan their journey carefully and check the Traffic Scotland website.
Although Friday will be quiet on the roads, gritters will continue to salt the icy surfaces.
'Treacherous conditions'
The A93 at the Spittal of Glenshee and the A90 have both reopened after being closed because of ice.
BBC Scotland's weather presenter Gail McGrane warned of the possibility of "treacherous conditions" through southern and central Scotland, with between 5cm to 10cms of snow in places.
She said the north and north east of the country were also likely to see further snow showers, chiefly Aberdeenshire, Moray, East Highlands and the Islands.
Initially they will be heavy and frequent but ease with time, and become confined to the Northern Isles.
Towards evening, a band of rain, sleet and snow will reach Galloway and during the evening and night, this wet weather will push across the southern uplands, into the central lowlands.
Bookmakers had been expecting to pay out on one of the nation's favourite annual wagers, with William Hill making Aberdeen the odds-on favourite to see snow at 4/6. Edinburgh and Glasgow were offered at 10/11.
Coral's David Stevens said: "It was odds-on that there would be snow in Glasgow, so punters have something to cheer, but overall we've escaped a festive hammering, and it's a happy Christmas for the bookies."

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When winter's full force hits New York, temperatures dip well below zero. And when the city freezes, New Yorkers ditch their stylish outfits for the "Michelin man" look, as Matthew Price explains.
New Yorkers in winter
New Yorkers swap style for practicality when snow and ice hit the city


To be honest, I don't think I ever saw this moment coming.
OK, so it had taken some time to get to this stage, but it still crept up on me.
The tipping point came as I stepped out of the splendidly ornate Woolworth Building in Lower Manhattan the other day, just as the Sun was dipping beneath the skyscrapers.
That act removed the rare patches of light (and therefore warmth) which occasionally strike the pavement and help make a winter's day here something approaching bearable.
The wind whacked me smack in the face, burning my lips and my ears. I pulled up my scarf. Tightened my collar. Out came the woolly hat. Still no good. So I ducked into a bank, and got dressed in the foyer. Gloves on. Zips closed. Buttons fastened. Scarf and hat adjusted. Jacket hood pulled up over the lot.
Thank God for the long-johns I had put on that morning.
Back outside and I could not hear a thing through the layers but the Manhattan winter had been successfully shut out. And I looked like a "Michelin man".
Fashion ditched
Sartorially elegant it was not. But after three winters here, I have learnt the hard-stone-cold-frozen way that elegance is not what a New York freeze calls for.
The first year I was based here, I strode around in what I thought was a nice fashionable coat, knees knocking and me cursing myself for forgetting to stick a hat in my bag that morning.
One friend looked me up and down and dismissively told me it was not going to be warm enough.
"Oh, it's just fine thanks," I replied. "Worked a treat back in London." Little did I know.
Still I struggled around, teeth chattering, because, well, if you are an Englishman in New York you need to dress properly, don't you?
By the second year I had learnt something. I bought an extra layer to go under the coat.
View from the Empire State
When the cold is accompanied by snow, New York is the place to be


But come one day in February, I realised my school-boy error. I stood out on a mid-town pier on the Hudson River on one of those perfect New York days. The Sun shone fiercely down from a cloudless deep blue sky, but it made no difference.
I knew I was in trouble when my Australian colleague, one of those tougher than tough guys who spend most of the year in just a T-shirt, said in his understated manner: "I think we'd better get inside."
His lips were blue. It was -16C with wind-chill.
Wrapping up
It is funny what winter does to a city. New Yorkers are a stylish lot, of course. But come the cold, they go all practical as well.
I have never seen so many men in ear-muffs in my life. So many women sporting full length duvet-style coats. So many ski-outfits not actually on the ski-slopes.
And yes, this year mine will come out on the super-cold days. You can spot the tourists a mile off. They are the ones in the flimsy jackets.
I used to think they looked good in comparison, until I realised they looked silly. Arms tightly folded in against the cold, noses running, trousers flapping around barely-covered ankles.
Central Park, New York
Cross-country skiers and pole-aided walkers take to the snowy streets
Take my advice, if you are coming over for a weekend break, bring the moon-boots. And a pencil. It is the time of year when reporters ditch pens. The ink freezes.
Of course, you do get remarkably used to it. Last winter, I remember stepping out of my front door into what felt like a perfectly balmy spring day.
It actually turned out to be just a degree above freezing, but after a week during which the temperature had stayed well below I left the hat at home.
Winter wonderland
And when the cold is accompanied by snow, New York is the place to be.
Unlike the big freeze in London in early 2009, when an entire city ground to a halt, New York still functions well.
The snow ploughs clear the avenues, the subways still run, and the city looks wonderful. Like a snapshot from an old movie, it turns grey and white.
Brilliant white flakes swirl past the Statue of Liberty, rise up over the Empire State, and settle down with an elegant curtsey in Central Park.
The snow muffles the noise of a city that rarely sleeps. Everything here, for once, feels calm.
And in the hip and gritty Lower East Side, in amongst the dive bars and graffiti, come the cross-country skiers.
Gliding down Rivington, and heading north up Norfolk.
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Snow gives parts of UK first white Christmas since 2004

Snow gives parts of UK first white Christmas since 2004

A boy delivers presents in the snow in the Scottish Borders
More snow could fall in some parts of the UK next week

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Snow has fallen in parts of the UK to make the first white Christmas for five years, the Met Office has confirmed.
Edinburgh, Glasgow, Nottingham and Leeds were all officially "white", with the required single flake being seen falling in the 24 hours of 25 December.
Forecasters are now warning that ice could cause problems on Boxing Day.
The Met Office has a dozen severe weather warnings in place for widespread icy roads in Scotland, Northern Ireland and northern England.
The BBC weather centre said sleet and snow may have fallen elsewhere in the northern UK on Friday, but official confirmation has not yet been given of any more white Christmas locations.
A spokesman said the weekend would generally be warmer than previous days, although mornings would still be icy in the north.
Temperatures are, however, set to fall once again next week, leading to a risk of further snow in some central and northern parts of the UK.
After days of travel disruption, the Christmas Eve getaway generally passed off smoothly for motorists as weather improved across much of Britain.
The Highways Agency has lifted roadworks at 44 sites until 3 January and a spokeswoman said Christmas Eve had been quieter than Wednesday.
Andrew Howard, the AA's head of road safety, said it was possible people had waited until Christmas morning to travel.
He warned that even roads where ice had thawed could be dangerous.
"The trouble is that the salt gets washed away. If it refreezes then you don't have salt on the roads and there's very little you can do about it," he said.
"Even if a road has been salted, it doesn't mean it's safe."
The weather has wreaked havoc with the sporting calendar.
The National Hunt Boxing Day meetings at Towcester, Sedgefield, Wetherby and Market Rasen have been called off, while Wincanton and Huntingdon face late inspections.
Meanwhile, all but two of the Scottish Football League's Saturday fixtures have been postponed.

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Evils of False Progress Interfere in Fight for Climate - Now It's up to Us .



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Although one yearns for global warming to indeed not exceed 2 degrees Celsius (or less, as African countries demand), the take-home message from the Copenhagen COP meeting is that polluters and growth mongers, large and small, will not let up. This is because they are not being forced to -- whether by their own peoples or by natural forces such as ecological or economic collapse. Most diabolical is the intention to switch energy as the main strategy for climate protection, when it will not work.

What has happened in Copenhagen -- is it really a matter of degree and the lack of strong measures? Or is it a matter of kind? Most technofixers are clever enough not to call for endless growth, but they may as well say there's unlimited, infinite growth through resource exploitation somehow made "green." Here's the revealing part of World Resources Institute's statement trumpeting the pathetically inadequate COP climate deal:

The political agreement struck today has immediate operational effect, including the mobilization of finance to build the clean energy economy in developing countries... The dealt "does provide the framework for countries to move forward with ambitious national action. Action that will build clean energy markets, create jobs, enhance energy security..."

These ideas are admissions of the determined business-as-usual reformist wing of the industrial elite to preserve, if they can, mass consumerism that feeds megaprofits.

Why should a few more months of negotiating do anything but buy some time for those who refuse to "get it"? Ongoing failure will continue to be dressed up as good-faith efforts within the vicissitudes of statecraft.

The real state of affairs is truly, "It's up to us." From personal lifestyle change that's openly shared and publicized, to concerted and individual direct action, to local initiatives toward weakening corporate power including via boycott, it's all up to us. Nations and global institutions have failed to honor life itself, and they're taking us down -- not unlike the uncounted species going extinct daily. It's hard to face our true challenge when it's easier to wait until the next election and pretend again that one is doing one's bit.

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As long as any climate deal or eventual treaty is in reality a realignment of industrial investment, toward the renewable-energy Holy Grail regardless of oil reality, then the accepted story is a fraud:

"billions in financial commitments from rich countries to the developing world to help in the fight against climate change. It is hoped that all countries will agree to a control mechanism -- meaning that each country agrees to allow its progress toward emissions reduction targets to be internationally verified." [Spiegel, Dec. 18 -- 'The Search for a Deal']

This constitutes a fraud in terms of slashing emissions, when the "energy market" programs and budgets mainly exist for still more funding, as opposed to immediate action that the Earth's crisis demands.

Take the poor countries' situation: their main root problems include cash crops and associated damage, and infrastructure boondoggles that resulted in major debt and concessions to privatization. Meanwhile these societies' strengths -- local indigenous knowledge and strength of community in acceptance of nature -- are being eroded by the transnational corporations and their lackey international lenders and "developed"-nation governments.

Therefore, money for the "developing nations" is not the real answer. It would be nice if it happened, if it went for the right things such as environmental restoration (e.g., tree planting = jobs and food plus carbon sequestration). But the intended big money -- assuming it happens when redistribution of wealth normally doesn't come about without revolution -- will be wasted to a great extent on corruption, cronyism, and the belief in industrial progress. A modern myth is that energy technologies and fuels are all the same -- just "energy" -- and can be somehow maximized and interchanged for continued "growth." Not to completely dismiss energy-technology aid, the distribution of some community solar panels for shared refrigeration and shared computer access, for example, would be helpful. But an unprecedented mass movement to slash emissions is what has to happen.

Let's be real: "$100 billion (€69.5 billion) annually for developing countries by 2020" is just talk, and is not going to happen with any more certainty than the world's population can go up and up indefinitely. The global economy cannot be sustained, let alone grow, with the loss of cheaply extracted petroleum that has already hit. Crash has begun, including petrocollapse, and the great unravelling is in motion.

There's very little evidence that President Obama gets much of this. Post Carbon Institute's Asher Miller's statement on Obama's Copenhagen contribution says it well: "US President Barack Obama has chosen political expediency over truth and justice." One might go further and wonder why one should have expected much from someone who turned out to be another war-machine Uncle Tom.

It is appealing that Chancellor Merkel says ""We have to change our lifestyles," but does this mean what it should: sharing appliances, ceasing commutes, establishing local economics to the exclusion of corporatism? Or does she mean "greener cars" and flicking switches in every home that burn a different form of energy than at present?

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A culture change is overdue. It is underway, but it must become everyone's life purpose.
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Taking Responsibility for the Climate Crisis


The unnatural dominant culture, coldly spewing its noise and heat, subjecting us to dirty machines and pavement, no longer makes sense in terms of our needs as humans. But don't let it get you down and make you give up. Play your guitar, enjoy the company of friends, or whatever else restores your humanity. Perhaps the songs and the conversations will lead to some liberation and justice, alleviating the pain of this senseless system running our lives into the ground. But we must do even more. Finding a "better job" is no solution long-term, however much we think we need money to survive.

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Taking responsibility for our own lot and the climate crisis means we must first reject an unworkable system and culture. I hasten to clarify; this does not mean there aren't a lot of nice people caught up in it. But if they believe elections and voting with their consumer dollars are going to save them from the ecological crisis and the slide into societal chaos of collapse, they are of no help to themselves or to the countless species being driven extinct by modern civilization.
In complaining about the failure of the Copenhagen COP 15 meeting, and continuing to beseech the Barack Obamas of the world to "please take good care of us," we are behaving like overgrown children who have no business coming back to helpless, hopeless parents to save us when we are reluctant to take matters into our own hands for our survival.

Except, the Obamas and Merkels and other corporate front men say to us, "Yes, there there, we're here for you. And we're trying to be green. Now be good and stay out of our way." So we go off and brood, get a bit more frustrated, and then we come back with more proposals, only to be disappointed -- as our graves are dug deeper by the technological war-for-profit growth- is-essential system. To legitimize a fixed game by continuing to play by its rules is foolish and tiresome to those of us who see though the sham and self-delusion.
Blaming the Copenhagen fiasco on... ?
Some activists, such as the "global web movement" Avaaz.org, blame "big polluters" such as the U.S. Chamber of Commerce for the U.S. stance on climate protection, while sparing Obama significant criticism. Avaaz probably did not read Naomi Klein's recent Guardian- UK article that made a good case for blaming Obama. The deeper problem is that many activists want to hope Obama is their guy, not the polluter's guy. Sure, sure.
Still another progressive environmentalist view finds Obama still heroic as a constrained realist facing a tough Congress: a Grist.org column stated, "Instead of directing our frustrations at Obama, let’s direct them at the paralysis of vision and understanding among the American people."
When we face the fact that we are on our own and must build an alternative society, it would seem wise to look at the only sustainable model humanity has known: indigenous, traditional society based on tribes. Except for a few experiments in civilization that eventually failed, such as the Mayans and the Mississippi culture, the cultures of revering nature and the universe as it is -- not as our technology could remake it -- succeeded for millennia.

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Now we are up against the wall, trying to create ecovillages and implement permaculture before we are crushed. It's ironic that so few people see the need. This is one reason it is so hard to jump to a safe haven where these sound practices are followed. It takes a good deal of sacrifice or luck in being able to make major changes in one's life under the yoke of the vicious economic system. Even so, there's really nowhere to run to, when we're all in this together. But we can and should each improve our situations in a responsible way.
So keep your eyes peeled for opportunities to exit the corporate economy, or at least to become more self-sufficient while creating more community. Someday a tribe will form around you, or you'll have to go find one. Driving to the supermarket and shopping online, and in other fashions not working closely with family or neighbors, has no future. It is antisocial as well as ecocidal.
* * * * *
Related reading: Evils of False Progress Interfere in Fight for Climate - Now It's up to Us, by Jan Lundberg
Email alert by Avaaz.org - The People vs. Polluters to raise money for Yes Men-like climate activists busted by the U.S. Chamber of Commerce.
The Guardian, UK - Copenhagen's failure belongs to Obama "The American president has been uniquely placed to lead the world on climate change and squandered every opportunity."
Grist.org - Why is everyone so pissed at Obama?, Dec. 18, 2009
Grow up, America! - Sept. 11th analyzed in Jungian terms by Cal Simone, Culture Change, 14 September 2006
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Looking for a Silver Lining in the Post-Summit Landscape

Much was left undone in Copenhagen, and the many loopholes in the climate accord could lead to rising emissions. But the conference averted disaster by keeping the UN climate negotiations alive, and some expressed hope that the growth of renewable energy technology may ultimately save the day.

Did British climate secretary Ed Miliband save the planet early on the final Saturday of the Copenhagen conference? It sounds like a risible claim, especially coming from a British journalist like myself. But hear me out.

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At 7 a.m. on Saturday, with the conference 14 hours into overtime, the visibly exhausted and procedurally confused chairman of the summit, Danish Prime Minister Lars Lokke Rasmussen, cast a weary eye over the surviving delegates from an all-night session. After listening to more than 40 speeches from the floor and with dozens more delegates waiting to be heard, Rasmussen said there was no consensus on adopting the draft agreement produced by U.S. President Obama and 25 other heads of state the previous day. “Therefore I propose that we...” Almost certainly his next words would have been a recommendation to drop or delete the text.

The rejection of what was already known as the Copenhagen Accord would have been a catastrophic failure for both climate diplomacy and the climate. The United Nations process to fight climate change, set in train at the Earth Summit in Rio 17 years before, would have lain in tatters. The climate equivalent of the collapse of the world trade talks — the “Doha-isation of climate,” as one journalist quipped — would have reverberated for years, unleashing accelerating emissions of greenhouse gases and who knows what climatic tipping points in future years.

Then up spoke Ed Miliband, younger brother of the more famous British Foreign Secretary, David Miliband. “Point of order,” he called from the floor, and asked for an adjournment of the meeting. Rasmussen looked like a drowning man saved.

When the meeting resumed three hours later, with Rasmussen safely tucked in bed and diagnosed as “exhausted” by UN Secretary-General Ban Ki-moon, a procedural formula had been devised. A new chairman moved that the meeting “take note of the Copenhagen Accord,” with those agreeing to it able to add their names to its title and make pledges to stem their rising carbon dioxide emissions. The many critics of the leaders’ draft agreement, mostly in Latin America and Africa, were assuaged. The gavel fell. The accord was saved. Wild applause broke out.

The deadline for signing up to the Copenhagen Accord is February 1. Developing nations among the signatories will then also be able to dip into a “climate fund” created by the U.S. and other rich nations as part of the accord. The fund will begin with $10 billion a year and, if all goes according to their promises, will contain $100 billion a year by 2020.

It may seem a bizarre way to conduct business. But had Miliband not prevented Rasmussen from finishing his sentence, the accord would have had no UN status, countries would not have been asked to commit to emissions cuts, and the climate fund would have been stillborn. Other ways may have been found to achieve some of the same ends. Money usually talks. But the legitimacy of the UN process — the only basis on which most nations agree to participate in action on climate change — would have been lost.

The “noting” of the accord was a victory for climate diplomacy. And a relief to the galaxy of world leaders — Barack Obama, Britain’s Gordon Brown, Germany’s Angela Merkel, Russia’s Dmitry Medvedev, and Brazil’s President Luis Inacio Lula da Silva, among them — who, hours before, had prematurely claimed their work was done when they had agreed to the draft among themselves.

Heading for the airport, they failed to realize the anger that leaders not involved would feel about their exclusion from the dealmaking. And, since the accord was merely “noted” by the conference and not adopted, they had been wrong to claim before departure that, in the words of Gordon Brown, “for the first time, 192 nations of the UN have reached agreement on preventing warming beyond two degrees.” They did not. Only a later, legally binding UN treaty — if that can be achieved in 2010 — will accomplish that.

So the accord was a flawed diplomatic triumph. The show is still on the road. But a triumph for the planet? Not so fast. Across the Bella conference center, scientists who had evaded the tight attendance restrictions on observers were crunching numbers. And the scientists were gloomy.

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The accord may set a goal to limit global warming to 2 degrees C (3.6 F), but it provides no emissions targets on how that should be achieved. On the basis of the commitments so far informally made by nations — which will be appended to the accord as countries sign it — the best estimates are that it will set the world on track to warming of between 3 and 3.5 degrees C, according to Michiel Schaeffer of the consulting group, ECOFYS, and Niklas Hoehne of Climate Analytics, who provided climate analysis for many nations at the conference.

Why this gap between rhetoric and reality? The first problem is the targets themselves. High hopes that many nations would up their promises in Copenhagen came to nothing. The U.S. would not go beyond its pre-conference promise to cut emissions by 14 to 17 percent from 2005 to 2020 — which more or less wipes out its increases since 1990 — the baseline used by the European Union for its pledge to cut by 20 percent. A European offer to go to 30 percent if others were generous was not activated.

China stuck with its pre-conference pledge to cut carbon intensity — that is, emissions per dollar of gross domestic product — by 40 to 45 percent between 2005 and 2020. That sounds good, but will not be enough to halt rising Chinese emissions. And as Premier Wen Jiabao helpfully told the conference, it is actually slightly less than the 46 percent reduction achieved between 1990 and 2005. So, it is arguably no more than business as usual.

India, Brazil, Mexico, South Africa, and others made similar pledges. It is the first time that developing nations have offered to make cuts in their emissions. But all insisted that the targets, while genuine, were voluntary and would not form part of any legally binding treaty. This was the central standoff throughout a conference characterized by repeated clashes on the issue between the U.S. and China. Hillary Clinton called the international verification and “transparency” of emissions promises, especially from China, a “deal breaker.” And so it proved.

But beyond the targets lies a legal morass over the precise definitions of what the target numbers mean. The text of the Copenhagen Accord contains even more loopholes than the 1997 Kyoto Protocol, say analysts.

The environment group WWF — reaching roughly the same conclusions as Climate Analytics and ECOFYS — calculates that rich-world promises to make cuts of 15 to 19 percent in their collective emissions between 1990 and 2020 could, once the loopholes are taken into account, result in an actual increase in emissions by 4 to 10 percent. Another unpublished assessment by Simon Terry of the Sustainability Council of New Zealand puts the increase at 2 to 8 percent.

The main loopholes are:

Hot air. The Kyoto Protocol gave Russia and other Eastern European countries rights to emit far more CO2 than they needed because of the collapse of their industries post-1990. They have accumulated large numbers of excess permits — 10.7 billion tons by the time the Kyoto Protocol expires in 2012, according to a European Union study. Potentially these credits, often called “hot air,” can be sold to other countries. The Copenhagen Accord appears to allow the spare credits to be carried forward for sale after 2012. If the EU bought them all to offset emissions between 2013 and 2020, it could achieve even a 30 percent “cut” in emissions without making any actual domestic cuts at all.

Carbon offsets. This is another way in which countries faced with difficult emissions reduction targets can offset them by investing in projects to cut someone else’s emissions. Done well, they allow carbon to be kept out of the atmosphere more cheaply. Done badly, they amount to carbon fraud, writing off emissions via green energy projects that were going to happen anyway. According to WWF, the European Union has already announced plans to make half a billion tons in emissions “cuts” through offsets in developing countries between 2012 and 2020. Other nations could triple that figure, it says.

Airline and shipping fuel. A notable failure of the Copenhagen Accord is the absence of proposals to limit growing emissions from international shipping and aircraft, which do not fall under the umbrella of anyone’s national emissions. Currently that is another loophole of one to two billion tons a year.

Forests. Copenhagen also failed to reach agreement on a plan to allow countries to claim either cash or carbon emissions credits for changes in managing forests to retain carbon. Insiders say the talks faltered because the U.S. and others refused to close a loophole that would allow countries to claim credits for improving things in one part of the country — by planting trees, for instance — while not being held to account for cutting down trees elsewhere within their borders. Unless fixed, another billion tons could slip through this loophole, says WWF.

Countries could close these loopholes before the final hoped-for legally binding agreement is signed. Then again, they might not.

So how could leaders fly out of Copenhagen, often in private jets, claiming success? More particularly why would some seasoned negotiators shrug their shoulders at the failures and insist that some progress was made?

There were two kinds of optimism on display in the final hours of the conference. The first was techno-optimism. Thus U.S. Congressman Edward Markey, co-author of the Waxman-Markey cap-and-trade bill,
spoke of a coming “technical revolution” in low-carbon energy systems. “It will be not unlike the telecom revolution,” he said, transforming energy technology worldwide far faster than predicted. “We will do far better than our two-degree goal,” he predicted. With several renewable technologies growing annually by 30 percent, even before the grand plans for “green jobs” in the U.S. and elsewhere, this may not be wishful thinking.

Diplomatic optimists, meanwhile, spoke of the progress they have seen in understanding of climate issues among world leaders. Standing in for his boss, Ban Ki-moon, UN assistant secretary general Robert Orr cited, with evident surprise, the leaders’ “meaningful discussion” of the respective scientific merits of adopting 2 degrees C or 1.5 degrees C as a warming limit.

“These were the most genuine negotiations I’ve ever seen leaders engaged in,” Orr said. Such deals are “usually pre-arranged, pre-cooked,” he added, but not this time.Such optimism is not necessarily well-placed. After concluding the accord, British Prime Minister Gordon Brown said: “This is the first step we are taking towards a green and low-carbon future for the world. But like all first steps, the steps are difficult.” He would not have known that almost the same words were used by one of his predecessors, John Major, after the Kyoto Protocol in 1997.

Even so, having followed climate talks since the Earth Summit in 1992, I am in many ways amazed at the progress made. It would have been hard to predict back in Rio that within two decades governments would be discussing cutting emissions by 50 or even 80 percent by mid-century. After all, they are talking about dismantling carbon-based energy systems that have underpinned economies since the industrial revolution. The trouble is that the science of climate change has become scarier, too, since 1992, and the threat seems much closer.

For all the travails and disappointment of the last two weeks, it is still possible to be optimistic that the world is approaching a genuine tipping point in how we get our energy. Will it come in time to prevent tipping points in the climate system? Frankly, nobody knows the answer to that.
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Requiem for a Crowded Planet

This is what the failure of the climate talks means.


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By George Monbiot. Published in the Guardian 21st December 2009
The last time global negotiations collapsed like this was in Doha in 2001. After the trade talks fell apart, the World Trade Organisation (WTO) assured the delegates that there was nothing to fear: they would move to Mexico, where a deal would be done. The negotiations ran into the sand of the Mexican resort of Cancun, never to re-emerge. After eight years of dithering, nothing has been agreed.
When the climate talks in Copenhagen ended in failure last week, Yvo de Boer, the man in charge of the process, urged us not to worry: everything will be sorted out “in Mexico one year from now.”(1) Is Mexico the diplomatic equivalent of the Pacific garbage patch: the place where failed negotiations go to die?
De Boer might pretend that this is just a temporary hitch, but he knows what happens when talks lose momentum. A year ago I asked him what he feared most. This is what he said. “The worst-case scenario for me is that climate becomes a second WTO. … Copenhagen, for me, is a very clear deadline that I think we need to meet, and I am afraid that if we don’t, then the process will begin to slip, and like in the trade negotiations, one deadline after the other will not be met, and we sort of become the little orchestra on the Titanic.”(2)
We can live without a new trade agreement; we can’t live without a new climate agreement. One of the failings of the people who have tried to mobilise support for a climate treaty is that we have made the issue too complicated. So here is the simplest summary I can produce of why this matters.
Human beings can live in a wider range of conditions than almost any other species. But the climate of the past few thousand years has been amazingly kind to us. It has enabled us to spread into almost all regions of the world and to grow into the favourable ecological circumstances it has created. We currently enjoy the optimum conditions for supporting seven billion people.

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A shift in global temperature reduces the range of places than can sustain human life. During the last ice age, humans were confined to low latitudes. The difference in the average global temperature between now and then was four degrees centigrade. Global warming will have the opposite effect, driving people into higher latitudes, principally as water supplies diminish.
Food production at high latitudes must rise as quickly as it falls elsewhere, but this is unlikely to happen. According to the body that summarises the findings of climate science, the Intergovernmental Panel on Climate Change, the potential for global food production “is very likely to decrease above about 3C”(3). The panel uses the phrase “very likely” to mean a probability of above 90%(4). Unless a strong climate deal is struck very soon, the probable outcome is a rise of three or more degrees by the end of the century.
Even in higher latitudes the habitable land area will decrease as the sea level rises. The likely rise this century - probably less than a metre - is threatening only to some populations, but the process does not stop in 2100. During the previous interglacial period, about 125,000 years ago, the average global temperature was around 1.3 degrees higher than it is today, as a result of changes in the earth’s orbit around the sun. A new paper in the scientific journal Nature shows that sea levels during that period were between 6.6 and 9.4 metres higher than today’s(5). Once the temperature had risen, the expansion of sea water and the melting of ice caps in Greenland and Antarctica was unstoppable. I wonder whether the government of Denmark, whose atrocious management of the conference contributed to its failure, would have tried harder if its people knew that in a few hundred years they won’t have a country any more.
As people are displaced from their homes by drought and sea level rise, and as food production declines, the planet will be unable to support the current population. The collapse in human numbers is unlikely to be either smooth or painless: while the average global temperature will rise gradually, the events associated with it will come in fits and starts: sudden droughts and storm surges.
This is why the least developed countries, which will be hit hardest, made the strongest demands in Copenhagen. One hundred and two poor nations called for the maximum global temperature rise to be limited not to two degrees but to 1.5. The chief negotiator for the G77 bloc complained that Africa was being asked “to sign a suicide pact, an incineration pact, in order to maintain the economic dominance of a few countries”(6).
The immediate reason for the failure of the talks can be summarised in two words: Barack Obama. The man elected to put aside childish things proved to be as susceptible to immediate self-interest as any other politician. Just as George Bush did in the approach to the Iraq war, Obama went behind the backs of the UN and most of its member states and assembled a coalition of the willing to strike a deal which outraged the rest of the world. This was then presented to poorer nations without negotiation; either they signed it or they lost the adaptation funds required to help them survive the first few decades of climate breakdown.
The British and American governments have blamed the Chinese government for the failure of the talks. It’s true that the Chinese worked hard to mess them up, but Obama also put Beijing in an impossible position. He demanded concessions while offering nothing. He must have known the importance of not losing face in Chinese politics: his unilateral diplomacy amounted to a demand for self-abasement. My guess is that this was a calculated manoeuvre guaranteed to produce instransigence, whereupon China could be blamed for the outcome he wanted.
Why would Obama do this? You have only to see the relief in Democratic circles to get your answer. Pushing a strong climate programme through the Senate, many of whose members are wholly owned subsidiaries of the energy industry, would have been the political battle of his life. Yet again, the absence of effective campaign finance reform in the US makes global progress almost impossible.
So what happens now? That depends on the other non-player at Copenhagen: you. For the past few years good, liberal, compassionate people - the kind who read the Guardian every day - have shaken their heads and tutted and wondered why someone doesn’t do something. Yet the number taking action has been pathetic. Demonstrations which should have brought millions onto the streets have struggled to mobilise a few thousand. As a result the political cost of the failure at Copenhagen is zero.
Is this music not to your taste sir, or madam? Perhaps you would like our little orchestra to play something louder, to drown out that horrible grinding noise.
www.monbiot.com
References:
1. Yvo de Boer, 19th December 2009. http://unfccc.int/2860.php
2. From transcript of video interview for the Guardian’s “Monbiot Meets” series. You can watch the edited discussion here: http://www.guardian.co.uk/environment/video/2008/dec/08/monbiot-yvo-de-boer-climate
3. IPCC, 2007. Assessing key vulnerabilities and the risk from climate change. Table 19.1. http://www.ipcc.ch/pdf/assessment-report/ar4/wg2/ar4-wg2-chapter19.pdf
4. http://www.ipcc.ch/pdf/supporting-material/uncertainty-guidance-note.pdf
5. Robert E. Kopp et al, 17th December 2009. Probabilistic assessment of sea level during the last interglacial stage. Nature Vol 462, pp863-868. doi:10.1038/nature08686
6. http://www.guardian.co.uk/environment/2009/dec/20/copenhagen-obama-brown-climate
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Carbon Price Drops Are True Signal That Copenhagen Was a Cop-Out

Was Copenhagen historic or a failure (or both)? To discern the value of the Copenhagen deal through the din of spin, look no further than the 9% drop in the European carbon market on Monday, where confidence vanished following the President Obama's "historic accord."

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Last week, President Obama made an audacious effort to save what was a floundering process in Copenhagen. Unfortunately, his administration's claim of "historic accord" is little but spin. What the world was waiting for -- the sinking island nations, the 300,000 that the World Health Organization says die each year from global warming, and the carbon markets -- were binding agreements to cut carbon pollution, end tropical deforestation by 2015, and provide financing to assist developing countries in leap-frogging dirty development with clean energy.
What they got was business as usual. Earlier this year the House passed a deeply flawed climate bill that falls short of what the science says is needed to roll back climate change. The bill's contents were what the president promised in Copenhagen, and his words were met with disappointment the world over.

There is spin from all sides about just what happened in Denmark. Let me share my observations from someone with a global, not just U.S., perspective. The European Union, already actively engaged in the Kyoto Protocol, offered to cut its pollution by 20% and said they would go up to 30% if the U.S. put more ambitious goals on the table. The EU also pledged 30 billion euro per year for financing clean technology and other initiatives in the developing world. China, already outpacing the U.S. in the development and deployment of renewable energy technologies, offered to decrease the energy intensity of its emerging economy. India pledged the same.
The U.S. pressed China to allow its efforts to cut global warming pollution to be independently measured. China resisted the U.S. proposal to allow the U.S. to come in and inspect its industry, but felt that the negotiations with the U.S. were making progress on this point when it accepted an EU proposal on reporting and occasional checks. Meanwhile, the U.S. was punching loopholes into the pact.
The deal could possibly be sealed if the U.S. offered financing for developing countries and resolved the issue of transparency with China.
Enter Hillary Clinton, offering to somehow figure out how to give an unstated contribution of money from an unknown source to a $100 billion fund. In the process, she offended the Chinese premier, who was in such a fury that his negotiating staff was in a panic.
Enter President Obama. His speech, clearly written for one audience - the U.S. Senate - said three things to the heads of state in the room: hey foreign leaders, we don't want foreign oil; hey China, even though we've been building trust and negotiating all year well, I'm going to scold you for the benefit of domestic politics; and hey world: even though these are negotiations, I have nothing to offer. It's my way or the highway.
The President laid out what the U.S. had offered the world for the last eight months, budging on nearly nothing. He put forward a goal of cutting pollution by 4% below 1990 levels - about one tenth of what the EU offered. In fairness, he had little to offer. The combination of the President's hesitance to lead to overcome special interests to achieve his own stated objectives - whether on a public option in health care or pollution reductions of any respectable size - and the power of the coal and oil lobbies put the his negotiators in the awkward positoin of negotiating without very much to give.

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The Chinese premier stormed out of the room and refused to meet with the President. Finally, the President secured a meeting and hammered out a deal that has the value of the carbon markets today: very little.
So few people had a clue about the "deal" that when President Obama later announced it the EU negotiators were still forging a deal and G77 delegates were talking in the halls about the perilous state of the Summit. Ultimately, most signed on, because if they did not, then their countries would not get a cut of a $30 billion package for clean energy and adapting to current global warming. A few brave countries, not wanting to be bought, said "no" to the deal. The historic accord was "noted" by the process, a nod to its existence.
The world still expects great things of President Obama and the US, but we cannot expect him to save the world on his own. We can expect - and must demand - that the president leads in recommitting the U.S. to the democratic UN process, doubles his efforts through the EPA and other methods to cut global warming pollution without the loopholes, clean air act rollbacks, impending nuclear disasters, and green light for coal that we see in current legislation, and approaches the negotiations as what they are - negotiations to save millions of lives, dozens of countries, 70% of the world's species, and a future that is worth passing on to our children.
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WHO: World H1N1 Deaths Now at Least 11,516

GENEVA —  At least 11,516 people around the globe have died from the H1N1 flu virus since the pandemic emerged in April, the World Health Organization (WHO) reported on Wednesday.



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But in its weekly update, which showed an increase in officially reported deaths of nearly 1,000 since its last report, it said the disease appeared to have peaked or plateaued in Western Europe and North America while transmission was declining in parts of Asia.
In the United States and Canada, the virus remained geographically widespread but overall levels of flu-like illnesses had declined substantially and hospitalizations and deaths were dropping, the WHO said.


In Europe, active transmission of the virus was still widespread across the continent but in a majority of countries its activity appeared to have peaked — although it was increasing in central and eastern parts of the continent.
In an earlier report on Tuesday, the United Nations agency said the pandemic remained moderate but continued to infect and sometimes kill much younger people than traditional seasonal flu.
But although it gives figures of confirmed deaths from H1N1, sometimes known as swine flu, officials at the WHO say comparing mortality numbers from the two types of flu is complicated and can be misleading.


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H1N1 Deadlier in Children Than Seasonal Flu



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BOSTON —  H1N1 swine flu can kill children at a much higher rate than seasonal flu, and the elevated risk for pregnant women extends as long as two weeks after they give birth, researchers reported.
The findings show that the H1N1 pandemic, while overall no more deadly than seasonal flu, is capable of hitting vulnerable women and children far harder than regular flu usually does.
"Pediatric 2009 H1N1 influenza was associated with pediatric death rates that were 10 times the rates for seasonal influenza than in previous years," Dr. Romina Libster of Hospital Posadas in Buenos Aires and colleagues wrote in the New England Journal of Medicine.
They said hospitalization rates for children with H1N1 were twice those of the 2008 rate for seasonal influenza.
H1N1 flu has killed more than 10,000 people in the United States alone, infected nearly 50 million and put 200,000 into the hospital. Pregnant women and children were known to be at higher risk and had already been given priority for the vaccine.
The results show that prompt treatment is important, Dr. Fernando Pollack of Vanderbilt University in Tennessee said in a telephone interview. Roche AG's Tamiflu and GlaxoSmithKline's Relenza can help ease symptoms if given quickly.
"We cannot chase this disease from behind. Once it gets going, it is very difficult to treat. All our fatal cases had not been treated within 48 hours of the development of symptoms," he said.
"Patients with lung problems or neurologic problems are at serious risk of not only having serious disease, but dying of swine flu," Pollack added. "They should not only be targets for vaccination, but for treatment."
Of 251 children hospitalized with H1N1 at six pediatric centers in Buenos Aires through July, 19 percent ended up in the intensive care unit and most of them required mechanical ventilation.
The death rate was 5 percent. Nearly one third had no pre-existing health problems, and the risk was highest among children less than 1 year old.
In contrast, none of the youngsters hospitalized for seasonal influenza required intensive care.
A second study, involving 94 pregnant women who became ill with H1N1 before Aug. 11 in California, found that those who delayed treatment were four times more likely to end up in the intensive care unit or die compared to those who received antiviral therapy no later than two days after symptoms appeared.

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"Although pregnant women frequently presented with mild or moderate symptoms, many had a rapid clinical progression and deterioration," Dr. Janice Louie of the California Department of Public Health and colleagues wrote.
Eight women who were hospitalized for H1N1 flu had given birth less than two weeks earlier, four required intensive care and two died, "highlighting the continued high risk immediately after pregnancy," the researchers said.
That result was surprising, Louie said in a telephone interview. She did not know why women continue to be vulnerable after giving birth.

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Guidance for expanded use of oseltamivir (Tamiflu®) in children under one year of age in the context of Pandemic (H1N1) 2009

The following guidance should be read in conjunction with relevant provincial and territorial guidance documents. The Public Health Agency of Canada will be posting regular updates and related documents at www.phac-aspc.gc.ca.

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ntroduction

This guidance document has been prepared by the Public Health Agency of Canada to assist clinicians in the management of children under one year of age presenting with influenza-like-illness (ILI) in the context of the pandemic (H1N1) 2009 (pH1N1).  This guidance has been updated based on current scientific evidence, expert opinion and the Interim Order, issued by the Federal Minister of Health, permitting the expanded use of oseltamivir for the influenza A H1N1 virus in children under 1 year of age.Although there are limited data regarding the use of Tamiflu® in children under one, there continues to be a need for recommendations to treat this population, given their increased risk for morbidity and mortality from influenza.   Similar actions have also been taken internationally by the US FDA and the EMEA .  This guidance is subject to review and change as new information becomes available.  These guidelines should be used in conjunction with guidance contained in the Clinical recommendations for patients presenting with respiratory symptoms during the 2009-2010 influenza season, H1N1 PHAC Guidelines for health professionals, Annex E and Annex G of the Canadian Pandemic Influenza Plan.

Influenza and children

Healthy children under 24 months and children with certain chronic health conditions are at increased risk of influenza-related complications and hospitalization from seasonal influenza6 .  Recent Canadian epidemiological data for pH1N1 indicates higher rates of hospitalization and ICU admissions in children under 1 year of age compared with all pH1N1 cases in Canada.  In children under the age of 2 years, greater than 90% have presented with fever when infected with pH1N1. Children may have higher fevers and may have febrile seizures. Atypical presentations are most common in infants, the elderly and immunocompromised persons. Unexplained fever may be the only manifestation of the disease in infants.  In infants less than 2 months old, the condition can progress rapidly to severe illness.  Younger children may experience nausea, vomiting, diarrhea and abdominal pain7 .  Infants may also present with neurologic symptoms suggestive of meningitis or encephalitis, although the data for pH1N1 indicates these symptoms have occurred in < 5% of cases. *
* Public Health Agency of Canada. Unpublished data. 

CLINICAL MANAGEMENT of children under 1 year of age

Antivirals can reduce complications and mortality from influenza. Currently, the pH1N1 virus is susceptible to oseltamivir (Tamiflu®) and zanamivir (Relenza®), but resistant to amantadine.  Relenza® is indicated only in children 7 years or older.  The Interim Order issued by the Federal Minister of Health, pursuant to her authority under the Food and Drugs Act, permits the expanded use of oseltamivir as a treatment or prophylaxis for children under 1 year of age, for infection caused by the pH1N1 virus1. Adverse event data regarding use in children over 1 year of age is available in the Product Monograph8
Clinical recommendations for the management of children under 1 year of age presenting with suspected, probable or confirmed pH1N1 infection, include early antiviral treatment (within 48 hours of symptom onset) and close follow-up, as they are at high risk for complications of influenza. When pH1N1 is known to be circulating in the community, clinicians should not wait for laboratory confirmation prior to initiating treatment. The parents or guardian should be informed that this is exceptional use. A recent review of the available clinical safety data indicates that there are no new safety signals for this age group and that the safety profile remains similar to that seen in children over one year of age. Currently available pharmacokinetic data supports updating Canadian recommendations for oseltamivir dosing. If oseltamivir is prescribed, the following dosing is recommended:
A) Treatment
Age
Recommended Dose (weight-based), 1, 2
1 month to < 12 months
3mg/kg/dose twice daily for 5 days
< 1 month
2 mg/kg/dose twice daily for 5 days
1 Not to exceed 30 mg twice daily, in accord with recommended dosing for patients > 1 year of age
2 Weight-based dosing is preferred, however, if weight is not known, dosing by age for full-term infants may be necessary as follows: 0-<3 months =  12 mg twice daily; 3-<6 months =  20 mg twice daily; 6 -<12 months = 25 mg twice daily

The Health Canada recommended dosing for infants under the age of 1 year is not intended for premature infants (those < 37 weeks gestational age at birth who have not reached their expected due date), and may result in high drug concentrations in this age group.
Very limited data from a cohort of premature infants receiving a mean dose of 1.7 mg/kg BID demonstrated drug concentrations higher than those observed in term infants given a dose of 3 mg/kg BID. Insufficient data is available at this time to make specific recommendations for premature infants. It is recommended that clinicians consult with an infectious disease specialist and/or pharmacist when considering antiviral treatment of pre-term infants. In addition, an important consideration in the treatment of infants with lower body weight is the significant difference between weight-based dosing and age-based dosing; therefore it is important to get an accurate weight and use weight-based dosages as soon as possible.
Commercially manufactured Tamiflu for Oral Suspension should be used if available; if not, refer to the instructions found in “Emergency Compounding of an oral suspension from Tamiflu® capsules” on page 16 of the Tamiflu® This link will take you to another Web site (external site)product monograph8 .
Children under 1 year of age with influenza should be treated in hospital.  If during the H1N1 pandemic demands on hospital resources become too great, hospitalization is still indicated in children less than 3 months, due to their increased risk of progressing rapidly to severe disease.  Treatment should be started as soon as possible as the benefit wanes if treatment is initiated after 48 hours of the onset of symptoms. 
B) Prophylaxis

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At phase 6 of the pandemic, prophylactic use of antivirals is recommended only for outbreak control in closed health care settings or other closed facilities where high risk persons reside. If after a careful risk/benefit assessment this is thought to be clinically indicated for a particular patient, the following dosing with oseltamivir is recommended: 
Age
Recommended Dose (weight-based), 1, 2
3 month to < 12 months
3mg/kg/dose twice daily for 10 days 3
< 3 month
Not recommended at this time4
1 Not to exceed 30 mg once daily, in accord with recommended dosing for patients > 1 year of age
2 Weight-based dosing is preferred, however, if weight is not known, dosing by age for full-term infants may be necessary as follows: 3-<6  months =  20 mg once daily; 6-<12 months = 25 mg once daily
3 In children and the elderly, viral shedding may continue for up to 14 days after the onset of influenza illness. Therefore, if the index case is a child or an elderly person, prophylaxis with TAMIFLU may continue for up to 14 days.
4 Based on the available data, prevention of influenza in infants under 3 months of age is not recommended at this time unless there has been significant exposure and/or the risk of severe illness is considered to be high.

Adverse Reaction Reporting
Reports of adverse reactions to antiviral medications are important as this information will be used to guide their safe and effective use, particularly in certain populations where there may only be limited safety data available, for example pregnant women and children .
The Interim Order regarding the expanded use of Tamiflu® for children under one year of age applies to all strengths and formulations:
DIN#02304848, 30mg capsule
DIN#02304856, 45mg capsule
DIN#02241472, 75mg capsule
DIN#02245549, 12mg/ml (reconstituted) oral suspension
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Heart disease to cost U.S. $503 billion in 2010

Heart group says many cases could have been prevented.


A U.S. heart patient is prepared for a two-hour surgery at Bangkok Heart Hospital in Bangkok.

WASHINGTON - Cardiovascular disease and stroke will cost the United States an estimated $503.2 billion in 2010, an increase of nearly 6 percent, and many cases could have been prevented, the American Heart Association said on Thursday.
The figure includes both health care costs and lost productivity due to death and disease, according to an update published online in the journal Circulation.
The heart association says obesity and other risk factors, like too little exercise and poor diet, are fueling the expected increase in health care costs associated with heart disease and stroke.
"Current statistical data show Americans to be on average overweight, physically inactive and eating a diet that is too high in calories, sodium, fat and sugar," said Dr. Donald Lloyd-Jones, head of the American Heart Association Statistics Committee.
Lloyd-Jones, a cardiologist at Northwestern University in Chicago, said too many people do not take cholesterol-lowering medicines that could lower their risk.
"One reason it will cost us more to treat tomorrow's patients is because there will be more of them if current trends continue," Lloyd-Jones said in a statement.
According to the heart association, 59 percent of adults who responded to a 2008 national survey described themselves as physically inactive.
The report also says fewer than half of people with heart disease symptoms are receiving cholesterol-lowering drugs, like statins.
Heart disease is the No. 1 killer of men and women in the United States and in most industrialized countries. According to the World Health Organization, cardiovascular diseases and diabetes accounted for 32 percent of all deaths globally in 2005.
The heart association said the number of inpatient cardiovascular operations and procedures jumped 33 percent from 1996 to 2006, from 5.4 million to 7.2 million.
By 2020, the American Heart Association hopes to reduce U.S. deaths from cardiovascular diseases and stroke by 20 percent.
"To reach the 2020 goals, Americans must start making healthier lifestyle choices," Lloyd-Jones said.


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Danger at home: Rare form of TB comes to U.S.

First U.S. case of extremely drug-resistant strain of tuberculosis diagnosed 

Editor's note: Once curable diseases such as tuberculosis and malaria are rapidly mutating into aggressive strains that resist drugs. The reason: The misuse of the very drugs that were supposed to save us has built up drug resistance worldwide. First of a five-part series.


Oswaldo Juarez looks out of the window from his room at the A.G. Holley State Hospital on June 4 in Lantana, Fla. Shortly after coming to the United States to study English at age 19, Juarez was diagnosed with extremely drug-resistant tuberculosis, the first case ever seen in this country. He was treated at a sanitarium for nearly two years before being discharged.
LANTANA, Fla. - It started with a cough, an autumn hack that refused to go away.
Then came the fevers. They bathed and chilled the skinny frame of Oswaldo Juarez, a 19-year-old Peruvian visiting the United States to study English. His lungs clattered, his chest tightened and he ached with every gasp. During a wheezing fit at 4 a.m., Juarez felt a warm knot rise from his throat. He ran to the bathroom sink and spewed a mouthful of blood.
I'm dying, he told himself, "because when you cough blood, it's something really bad."
It was really bad, and not just for him.
Doctors say Juarez's incessant hack was a sign of what they have both dreaded and expected for years — this country's first case of a contagious, aggressive, especially drug-resistant form of tuberculosis. The Associated Press learned of his case, which until now has not been made public, as part of a six-month look at the soaring global challenge of drug resistance.
Juarez's strain — so-called extremely drug-resistant (XXDR) TB — has never before been seen in the U.S., according to Dr. David Ashkin, one of the nation's leading experts on tuberculosis. XXDR tuberculosis is so rare that only a handful of other people in the world are thought to have had it.
"He is really the future," Ashkin said. "This is the new class that people are not really talking too much about. These are the ones we really fear because I'm not sure how we treat them."
Forty years ago, the world thought it had conquered TB and any number of other diseases through the new wonder drugs: antibiotics. U.S. Surgeon General William H. Stewart announced it was "time to close the book on infectious diseases and declare the war against pestilence won."
Today, all the leading killer infectious diseases on the planet — TB, malaria and HIV among them — are mutating at an alarming rate, hitchhiking their way in and out of countries. The reason: overuse and misuse of the very drugs that were supposed to save us.
Just as the drugs were a manmade solution to dangerous illness, the problem with them is also manmade. It is fueled worldwide by everything from counterfeit drugmakers to the unintended consequences of giving drugs to the poor without properly monitoring their treatment. Here's what the AP found:
  • In Cambodia, scientists have confirmed the emergence of a new drug-resistant form of malaria, threatening the only treatment left to fight a disease that already kills 1 million people a year.
  • In Africa, new and harder to treat strains of HIV are being detected in about 5 percent of new patients. HIV drug resistance rates have shot up to as high as 30 percent worldwide.
  • In the U.S., drug-resistant infections killed more than 65,000 people last year — more than prostate and breast cancer combined. More than 19,000 people died from a staph infection alone that has been eliminated in Norway, where antibiotics are stringently limited.
"Drug resistance is starting to be a very big problem. In the past, people stopped worrying about TB and it came roaring back. We need to make sure that doesn't happen again," said Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, who was himself infected with tuberculosis while caring for drug-resistant patients at a New York clinic in the early '90s. "We are all connected by the air we breathe, and that is why this must be everyone's problem."
This April, the World Health Organization sounded alarms by holding its first drug-resistant TB conference in Beijing. The message was clear — the disease has already spread to all continents and is increasing rapidly. Even worse, WHO estimates only 1 percent of resistant patients received appropriate treatment last year.
"We have seen a huge upburst in resistance," said CDC epidemiologist Dr. Laurie Hicks.
Image: Lung X-ray
Lynne Sladky / AP
This photo taken July 30 shows X-rays from a tuberculosis patient at A. G. Holley State Hospital, a quarantine hospital in Lantana, Fla., that is now managing new and virulent forms of the disease.

A ‘time bomb’

Juarez' strain of TB puzzled doctors. He had never had TB before. Where did he pick it up? Had he passed it on? And could they stop it before it killed him?
At first, mainstream doctors tried to treat him. But the disease had already gnawed a golf-ball-sized hole into his right lung.
TB germs can float in the air for hours, especially in tight places with little sunlight or fresh air. So every time Juarez coughed, sneezed, laughed or talked, he could spread the deadly germs to others.
"You feel like you're killing somebody, like you could kill a lot of people. That was the worst part," he said.
Tuberculosis is the top single infectious killer of adults worldwide, and it lies dormant in one in three people, according to WHO. Of those, 10 percent will develop active TB, and about 2 million people a year will die from it.
Simple TB is simple to treat — as cheap as a $10 course of medication for six to nine months. But if treatment is stopped short, the bacteria fight back and mutate into a tougher strain. It can cost $100,000 a year or more to cure drug-resistant TB, which is described as multi-drug-resistant (MDR), extensively drug-resistant (XDR) and XXDR.
There are now about 500,000 cases of MDR tuberculosis a year worldwide. XDR tuberculosis killed 52 of the first 53 people diagnosed with it in South Africa three years ago.
Drug-resistant TB is a "time bomb," said Dr. Masae Kawamura, who heads the Francis J. Curry National Tuberculosis Center in San Francisco, "a manmade problem that is costly, deadly, debilitating, and the biggest threat to our current TB control strategies."
Juarez underwent three months of futile treatment in a Fort Lauderdale hospital. Then in December 2007 he was sent to A.G. Holley State Hospital, a 60-year-old massive building of brown concrete surrounded by a chain-link fence, just south of West Palm Beach.
"They told me my treatment was going to be two years, and I have only one chance at life," Juarez said. "They told me if I went to Peru, I'm probably going to live one month and then I'm going to die."
Holley is the nation's last-standing TB sanitarium, a quarantine hospital that is now managing new and virulent forms of the disease.
Tuberculosis has been detected in the spine of a 4,400-year-old Egyptian mummy. In the 1600s, it was known as the great white plague because it turned patients pale. In later centuries, as it ate through bodies, they called it "consumption." By 1850, an estimated 25 percent of Europeans and Americans were dying of tuberculosis, often in isolated sanatoriums like Holley where they were sent for rest and nutrition.
Then in 1944 a critically ill TB patient was given a new miracle antibiotic and immediately recovered. New drugs quickly followed. They worked so well that by the 1970s in the U.S., it was assumed the disease was a problem of the past.
Once public health officials decided TB was gone, the disease was increasingly missed or misdiagnosed. And without public funding, it made a comeback among the poor. Then immigration and travel flourished, breaking down invisible walls that had contained TB.
Drug resistance emerged worldwide. Doctors treated TB with the wrong drug combinations. Clinics ran out of drug stocks. And patients cut their treatment short when they felt better, or even shared pills with other family members.

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There are two ways to get drug-resistant TB. Most cases develop from taking medication inappropriately. But it can also be transmitted like simple TB, a cough or a sneeze.
In the 1980s, HIV and AIDS brought an even bigger resurgence of TB cases. TB remains the biggest killer of HIV patients today.
For decades, drug makers failed to develop new medicines for TB because the profits weren't there. With the emergence of resistant TB, several private drug companies have started developing new treatments, but getting an entire regimen on the market could take 24 years. In the meantime, WHO estimates each victim will infect an average of 10 to 15 others annually before they die.

 

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