Asclepius

We are poisoning our environment and everything in it - including ourselves.

Asclepius — Thu, 09 Apr 2026 13:50:17 GMT

A Contaminated World

We have, over the course of a century of industrialisation, turned the planet into an (failed) experiment. The atmosphere, the oceans, the soil, and the bodies of almost every living creature on Earth now carry chemical signatures that did not exist before the mid-twentieth century. Three categories of pollutant dominate the contemporary evidence base: per- and polyfluoroalkyl substances (PFAS), microplastics, and pesticide residues. Together, they represent what some researchers have termed a ‘slow poisoning’.

This is not a story of individuals making poor lifestyle choices. It is a story of structural decisions, about what industries are permitted to do, where they are permitted to do it, and who is left to bear the consequences.

PFAS: The Forever Chemicals That Will Outlast Us All

PFAS - per- and polyfluoroalkyl substances - is an umbrella term covering nearly 10,000 individual chemicals, united by their extraordinary chemical stability. That stability is precisely why they were so commercially attractive: they repel water, grease, and heat. Non-stick cookware, waterproof clothing, food packaging, firefighting foam, dental floss, PFAS have become the invisible backbone of modern consumer life.

They are also essentially indestructible. PFAS do not break down in the environment. They accumulate in water, soil, wildlife, and human tissue, a property that gives them their informal name: forever chemicals. Drinking water sources across England have now been found to be contaminated with PFAS, and concerns over the adequacy of UK regulatory limits have increased since a parliamentary inquiry was launched into the risks they pose.

The health implications are serious. Epidemiological studies have linked PFAS exposure to suppression of vaccine-induced immune responses in children, elevated cholesterol, changes in liver enzymes, reduced birth weight, and increased risks of kidney and testicular cancer. The Parliamentary Office of Science and Technology, in a 2025 briefing, confirmed these associations while noting that significant data gaps remain, particularly regarding the dose-response relationship for the thousands of less-studied PFAS compounds.

In the UK, the regulatory picture has become a source of concern. Since leaving the European Union, the UK has struggled to maintain the pace of chemical regulation set by its continental neighbours. A specific case in point: the herbicide Flufenacet, a known precursor to trifluoroacetic acid (TFA), itself a PFAS, remains approved for use in the UK despite having been withdrawn in the EU. Flufenacet acts as an endocrine disruptor that interferes with thyroid-stimulating hormones, creating a risk to brain development during pregnancy. It is also a skin sensitiser and has neurotoxic properties.

Meanwhile, the EU is moving toward a universal PFAS restriction across whole chemical classes; the UK has yet to match that ambition. A coalition of environmental organisations, including RSPB, the Rivers Trust, and Pesticide Action Network UK, has called for alignment with EU standards, warning that the UK’s voluntary drinking water standards are considerably weaker than the EU’s legally binding limits and even weaker still than those adopted in the United States.

The inequity of PFAS exposure is not incidental. Contamination hotspots cluster around industrial sites, military airbases, where firefighting foam was historically used, and landfill sites, facilities that, in the UK as elsewhere, have been disproportionately sited near deprived communities. A 2025 UKHSA analysis confirmed that people in the most deprived areas face disproportionate exposure to chemical and environmental hazards, with worse health outcomes as a consequence.

Microplastics: Part of Us, Whether We Like It or Not

Microplastics - particles under 5mm in size - are now ubiquitous in the environment. They have been detected in Arctic ice, deep ocean sediment, and even the summit of Everest. They have also been detected in human blood, placental tissue, lung tissue, brain and, most recently, in arterial plaques.

A landmark 2024 study published in the New England Journal of Medicine found microplastics and nanoplastics embedded in atherosclerotic plaques removed from patients undergoing carotid endarterectomy. Those with detectable particles in their arterial wall atheromatous plaques had a significantly higher risk of subsequent cardiovascular events, including heart attack and stroke. A subsequent Lancet Planetary Health review, published in late 2025, summarised a growing body of evidence linking microplastic exposure to metabolic, respiratory, cardiovascular, renal, hepatic, and neurodegenerative disorders, as well as an emerging, though not yet definitive, association with cancer.

Humans are exposed through ingestion, inhalation, and possibly dermal contact. We consume them in drinking water, seafood, beer, salt - just about anything we eat or drink. We inhale them in urban air. Most particles pass through the body without being absorbed, but a proportion, particularly the smallest nanoplastic particles, may cross biological barriers, entering the bloodstream and accumulating in tissues.

Research from the University of Birmingham published in 2024 raised another concern: when PFAS and microplastics were tested in combination, their toxic effects on aquatic life were synergistic - their combined effect is greater than the sum of the effects of each acting alone. The mixture caused developmental failure, stunted growth, and reproductive disruption in test organisms at concentrations routinely found in lakes, a finding with implications for human health, given that both pollutants are typically co-released from consumer products and travel together through water systems.

Occupationally, workers in textile manufacturing, recycling facilities, and plastic processing industries face far higher exposure than the general population, and those industries employ a workforce that is disproportionately drawn from lower-income groups, migrant communities, and the Global South. At a population level, communities living near busy roads and industrial zone, again the most deprived areas, face higher concentrations of airborne plastic particles alongside other forms of particulate pollution.

Pesticides: The Price Paid by Those Who Grow Our Food

Pesticide use has become a defining feature of industrialised agriculture. These chemicals protect crops from pests, disease, and competition, but they have also become one of the most thoroughly documented examples of chemically-mediated occupational harm, harm that falls almost exclusively on some of the world’s most economically marginalised workers.

A systematic review published in Environmental Research and Public Health in 2024 looked at decades of evidence and found consistent associations between chronic pesticide exposure and cancer, neurological disorders, endocrine disruption, and respiratory disease. Farmworkers with prolonged, high-intensity exposure had a 32% higher risk of developing COPD compared to unexposed individuals. Organochlorine metabolite levels, chemicals with at least one carbon-chlorine bond and a marked propensity towards bio-accumulation, were found to be nearly four times higher in patients with Alzheimer’s disease than in controls, a finding that echoes mounting concern about the neurotoxic effects of long-term low-level exposure. Reproductive harm, including impaired sperm quality and increased risk of birth defects, has also been documented across multiple studies.

This health risk does not fall on those who profit from these products; it falls on the seasonal workers who apply them, often without adequate protective equipment or meaningful safety training. In the Global South, where international regulatory frameworks are weakest and enforcement patchiest, the problem is severe. An estimated 385 million cases of acute pesticide poisoning occur globally each year, affecting approximately 44% of the world’s agricultural workforce.

Even for those who never set foot on a farm, exposure is still a fact of life. Pesticide residues persist in food, enter waterways, and, as research now demonstrates, include PFAS-based herbicides and fungicides that contribute directly to the broader forever chemicals crisis. In the UK, the pesticide Flufenacet continues to be applied to millions of hectares of arable land each year, generating PFAS contamination that the Environment Agency is now scrambling to map and monitor.

What We Are Doing to the Rest of Life?

The evidence from wildlife populations now tells a story that is in many respects further advanced than the human health data; animals have been accumulating these exposures for longer and in less regulated conditions.

The picture from UK freshwater and marine ecosystems is especially concerning. PFAS have now been detected in every otter liver sampled across England and Wales, a finding with profound implications, since otters sit at the apex of the river food chain and absorb concentrated chemical burdens from the fish, amphibians, and crustaceans they eat.

Harbour seals and grey seals around the British coast show elevated levels of PFAS and flame-retardant chemicals; these compounds affect hormonal regulation and can be passed to offspring through maternal milk, compromising the reproductive viability of future generations. Marine fish species including herring, cod, and mackerel have been found to contain PFAS, as have the freshwater fish that populate many of Britain’s rivers and reservoirs, frequently in association with pharmaceutical residues, bisphenols, and pesticides.

Bisphenols in particular have been shown to disrupt endocrine function in fish, including altering sex determination, a phenomenon that has even been documented in rivers receiving treated effluent across the UK. Wildlife biology is being changed by human activity.

In our seas, the microplastics crisis has become an existential one for many species. A 2019 study examining marine mammals stranded around the British coastline found microplastics in every single animal tested. A 2025 study published in the Proceedings of the National Academy of Sciences established lethal dose thresholds for plastics ingestion across marine animal groups: for seabirds such as the Atlantic puffin, consuming less than three sugar cubes’ worth of plastic carries a 90% probability of death. One in twenty sea turtles studied in that research died directly from plastic ingestion. Seabirds are now being found to develop ‘plasticosis’ - a newly described condition in which plastic particles cause structural scarring of the stomach lining - and toxic pollutants, carried by the plastics, are transferring from mother birds to their eggs. Around the World, plastic debris causes the deaths of over a million seabirds each year.

Recently, monitors documented the demise of a pod of Orcas off the north coast of Scotland - evidence suggested that microplastics, and the endocrine disrupting chemicals they contain, played a major role.

The food web ensures no organism, including humans, is insulated from these harms. Microplastics ingested by zooplankton pass to the small fish that eat them, and upward to larger predators, concentrating at each step. In a 2025 review of over 500 fish species, more than two thirds had consumed plastic. Coral reefs, which support approximately a quarter of all marine biodiversity, show evidence of microplastic-induced gut blockages and reduced feeding. Microplastic particles have been found to interfere with phytoplankton growth and photosynthesis so threatening the base of the marine food chain.

The pollinators on which terrestrial food production depends are not spared either. The UK supports over 270 bee species and many are already in steep decline from habitat loss. Research has now confirmed that bees contain both PFAS and multiple pesticide residues, and that these can cause the death of whole colonies. The herbicide and insecticide compounds found in bee bodies include chemicals approved for continued use in the UK despite being linked to neurological disruption and reproductive failure in pollinating insects. Hedgehogs, who are insectivorous, have been found to carry persistent flame retardants and pesticide residues at levels capable of compromising their survival and fitness.

We share food webs, water systems, and air with the species whose bodies now function as involuntary monitors of our own contamination. Their decline is not a separate crisis.

A Crisis of Structural Inequality

The distribution of chemical harm in the UK (and globally) follows the contours of poverty, race, and class with striking consistency. UKHSA’s 2025 health inequalities report found that people in the most deprived areas of England experience higher levels of air pollution than less deprived and less ethnically diverse areas, and that this gap extends to radiation, chemical, and environmental hazards more broadly. Research from the University of York confirmed that deprivation-based inequality in air pollution emissions persists across every major source category: transport, domestic heating, industry, and power generation.

In London, 46% of the most deprived neighbourhoods exceed EU nitrogen dioxide limits, compared to just 2% of the least deprived. Regions with the poorest physical environments have 18% more deaths than expected compared to less environmentally deprived regions, a figure drawn from WHO Europe’s own analysis of UK data.

In the Global South, the situation is worse. Communities in low-income countries bear a grossly disproportionate share of chemical harm as a direct consequence of decisions made by wealthy nations and multinational corporations. Electronic waste from Europe and North America is shipped to informal recycling sites in Ghana, Nigeria, and Bangladesh, where workers, often children, are exposed to toxic metals and flame retardants without protection. Pesticides withdrawn from sale in the EU on safety grounds continue to be exported to countries with less stringent regulations. The chemical burden of affluent consumption is, in a very literal sense, exported to those least able to refuse it.

Regulatory decisions about which chemicals may be manufactured, used, and disposed of, and where, are political choices. So is the decision to underfund the Environment Agency, to leave drinking water standards on a voluntary rather than statutory footing, or to delay alignment with EU chemical regulation post-Brexit. These choices have consequences, and those consequences land hardest on people who already face the greatest health disadvantages.

What Needs to Change?

The evidence base is now substantial enough to demand action rather than further study. Several priorities emerge clearly from the literature and from recent UK policy discussions.

First, UK drinking water and food safety standards for PFAS must be placed on a statutory footing and tightened in line with EU and US standards. The current voluntary guidelines leave millions of people drinking water that may exceed safety limits applied elsewhere in the developed world.

Second, the UK should move toward class-based PFAS regulation - treating all PFAS as a group for the purposes of restriction rather than assessing each of the nearly 10,000 individual substances separately. This approach, advocated by the European Environment Agency, Chem Trust, and a coalition of UK environmental NGOs, is the only practically workable route to meaningful control.

Third, occupational protections for agricultural workers must be strengthened, with enforceable standards rather than voluntary guidance. This is particularly urgent for migrant and seasonal workers who currently have the least access to regulatory protection.

Fourth, the NHS, public health bodies, and clinicians need better data. The UK lags behind comparable European nations in large-scale human biomonitoring of chemical exposure. Without that data, the true scale of population-level harm cannot be assessed, and without that assessment, the political urgency for change is perpetually deferred.

For healthcare workers, the implications of this evidence are immediate and practical. Chemical toxicity should be considered in the differential diagnosis for a range of presentations - from unexplained cardiovascular events in younger patients, to reproductive difficulties, to neurological decline. The social and occupational history should ask about industrial proximity, agricultural work, and housing in former industrial areas. Addressing chemical pollution is, in the deepest sense, a matter of health equity and urgency.

Meanwhile, human activity - especially that of the multinational corporations and billionaires in their mad dash for profit and exploitation - is destroying the health and quality of life for all on this planet. It needs to stop.

When War Becomes a Public Health Crisis: The Global Health Consequences of the Conflict in Iran

Asclepius — Mon, 16 Mar 2026 12:36:13 GMT

Photo by UX Gun on Unsplash

On 28 February 2026, US and Israeli forces launched Operation Epic Fury — nearly 900 airstrikes in the first twelve hours targeting Iranian military infrastructure and leadership, often involving civilian areas. Supreme Leader Ali Khamenei was killed. Iran retaliated with waves of missiles and drones across the region. Within days, the world had not merely a geopolitical crisis, it had a public health emergency. And as is so often the case in times of conflict, the costs are not shared equally.

Direct Casualties and the Collapse of Healthcare in the Region

The immediate toll has been steep. According to the World Health Organization, by 11 March Iranian national health authorities had reported more than 1,300 deaths and over 9,000 injuries since the start of the conflict, with Lebanon reporting at least 570 deaths and more than 1,400 injuries. Healthcare workers have not been spared: WHO verified 18 attacks on health facilities in Iran within the first two weeks, resulting in 8 health worker deaths. In Lebanon, 49 primary healthcare centres and five hospitals have closed following military evacuation orders, and, recently, 11 healthcare workers were killed when a medical centre in Southern Lebanon was hit in an Israeli attack [1].

Each destroyed clinic represents patients with diabetes unable to collect insulin, mothers unable to access antenatal care, trauma victims dying before reaching a surgical team. The WHO’s Regional Director, Dr Hanan Balkhy, has made clear that 16 countries are now affected by the expanding crisis — and that the disruption reaches far beyond the battlefield [2].

The Dubai Bottleneck: When Global Aid Grinds to a Halt

One of the conflict’s most consequential and least-visible health impacts concerns a logistics hub in Dubai. The International Humanitarian City (IHC) in Dubai is the world’s premier disaster relief logistics centre. Last year it fulfilled over 500 emergency health orders for 75 countries across all six WHO regions [2]. On 1 March, Dubai’s Jebel Ali port - the largest container terminal in the Middle East - caught fire after debris from an intercepted Iranian missile struck it. Operations at the IHC were temporarily suspended.

The result was that $18 million in humanitarian health supplies became inaccessible, with a further $8 million in shipments unable to reach the hub at all [2]. The UN’s World Food Programme warned that shipping containers now face a $3,000 emergency surcharge, driving up the cost of life-saving operations in countries entirely uninvolved in the conflict including Sudan, Myanmar and Afghanistan [3]. The war in Iran is creating rationing of medicines thousands of miles away.

Photo by Pavel Neznanov on Unsplash

The Strait of Hormuz: A Chokepoint for Health as Well as Oil

The Strait of Hormuz carries roughly one-fifth of global petroleum and more than a quarter of global seaborne oil trade. Iran’s closure of the strait has sent oil prices surging — at one point above $120 a barrel, the highest since 2022, when Russia invaded Ukraine [4]. For wealthier nations, this means increasing petrol prices and rising energy bills. For low- and middle-income countries, it means something far more serious.

The Strait is also a major chokepoint for fertiliser exports. Around 20–30% of global fertiliser, including urea and ammonia nitrate, transits through the Hormuz strait [5]. Qatar, Saudi Arabia, Iran, and Oman together supply a large share of the world’s traded fertilisers. A blockade during key planting seasons risks devastating crop yields in countries already facing food insecurity. In addition, the UN’s International Monetary Fund has stated that every 10% increase in energy prices adds almost half a percentage point to global inflation [6] - inflation that translates directly into hunger in the world’s poorest communities.

Analysts have identified Sub-Saharan Africa as the most vulnerable region. Farmers there are heavily dependent on imported fertiliser and households spend a disproportionate share of income on food. The war’s fertiliser shock threatens both harvests and prices [7].

A Polycrisis for the World’s Most Vulnerable

The Council on Foreign Relations has described the compound effects of the conflict as a “polycrisis”: logistics gridlock, dollar appreciation, fertiliser shortages, and oil shocks converging to push the food insecure toward emergency, and those in emergency toward famine [3]. Before the conflict began, the Middle East and surrounding region was already home to 25 million displaced people [3]. That number is rising rapidly.

The conflict’s health consequences for Afghan immigrants inside Iran deserve particular attention. Iran hosts millions of Afghan migrants, documented and undocumented, who have been exposed to military strikes, economic collapse, and accelerating deportations since hostilities began. As the Lancet noted in its analysis of the conflict’s health implications, this is compounding an already fragile humanitarian situation for women and children in Afghanistan, threatening further destabilisation and cascading displacement across the region [8].

The World Food Programme, already severely weakened after losing 40% of its funding last year and shedding 6,000 staff, has warned that rising fuel and operating costs from the conflict threaten its capacity to reach children facing severe malnutrition [9].

What This Means for the UK

Britain has sought to distance itself from offensive operations, with Prime Minister Sir Keir Starmer confirming the UK will not participate in direct strikes against Iran, though limited defensive support continues [10]. But geopolitical neutrality offers no immunity from health consequences.

The UK imports roughly 40% of its oil and 60% of its gas, and although much comes from Norway rather than the Gulf, the conflict’s effects on global energy markets are already feeding through. In rural communities dependent on heating oil, Labour MPs in the Rural Research Group have reported elderly and vulnerable constituents being told their confirmed deliveries have been cancelled and re-priced - a situation one MP described as becoming “a public health issue” [11].

Food prices are also under pressure. Around 35% of key fertilisers, including urea and ammonia nitrate, come through the Strait of Hormuz [5]. British farmers are warning of severe inflationary pressures passing through the supply chain to the retail shelf. Trade experts have cautioned that food prices could rise within weeks, and the “big worry,” as one logistics specialist put it, is that they will not come back down [12].

The NHS is also vulnerable. Already affected by fragile supply chains - pharmacies reported significant difficulties sourcing even aspirin in the weeks before the conflict [13] - the disruption to global logistics adds new pressure. The Centre for Long-Term Resilience has flagged the UK’s dependence on supply chains for antibiotics, vaccines, and diagnostic equipment as “highly brittle and vulnerable” [13].

Inequality Is Not Incidental — It Is the Architecture

The health consequences of this conflict are not randomly distributed. They follow the existing architecture of global inequality. Wealthy Gulf states can fly food in by alternative routes. The United States is a net energy exporter and will benefit marginally from higher oil prices. European economies face a slowdown.

Low-income countries face famine.

In the UK, the cost of living crisis that the Iran conflict is now deepening falls most heavily on those who were already struggling. Food inflation is a regressive tax. Heating oil price spikes harm rural communities with fewer alternative energy sources. NHS supply chain fragility was already disproportionately affecting communities with least access to private healthcare alternatives.

The Lancet’s analysis of Iran’s health system noted that decades of sanctions, another form of structural violence, had already been linked to higher mortality from non-communicable diseases before a single bomb fell [8]. War does not create health inequality per se, but it amplifies it.

Conclusion

The conflict in Iran is, among other things, a public health emergency, one whose effects are radiating far beyond the Middle East. The immediate casualties are staggering. The humanitarian supply chain disruption is global. The food and energy price shocks threaten the most vulnerable communities on earth. And in the UK, a war in which we are not combatants is already threatening the food security and health of those who can least afford another crisis.

For healthcare workers, understanding these connections, between geopolitics, supply chains, food systems, and health, is not peripheral to clinical practice. It is essential to it.

It would have been better for all our sakes, except for the few already disproportionately rich who will profit financially, if this war had not started.

References

1. World Health Organization. Conflict deepens health crisis across Middle East, WHO says. 11 March 2026.

2. World Health Organization. Health impact of the escalation of conflict in the Middle East. 5 March 2026.

3. Vigersky S. The Iran War Is Breaking Global Humanitarian Aid Efforts. Council on Foreign Relations, 12 March 2026.

4. AP / Washington Times. Analysis: Iran war becomes a contest of who can take the most pain. 11 March 2026.

5. ITV News. Food prices, energy bills, mortgages and pensions: What is the broader impact of the Iran war? 9 March 2026.

6. CFR Global Conflict Tracker. Iran’s War With Israel and the United States. March 2026.

7. CNBC. A global food price shock looms as Middle East war rages on. Here’s who will be hit hardest. 12 March 2026.

8. Lankarani KB et al. Iran and beyond: perilous threats to population health. The Lancet. August 2025.

9. The National. Iran war will raise cost of food and hit struggling humanitarian groups, WFP warns. 10 March 2026.

10. Distilled Post. Britain Drawn into Conflict with Iran? The Risks and Impact on the NHS. March 2026.

11. LabourList. Think tanks and MPs call for targeted response as Iran war impacts cost of living. 13 March 2026.

12. Yahoo Finance / Logistics UK. Food prices could rise within weeks — but the ‘big worry’ is that they won’t come back down. March 2026.

13. The Week. NHS vulnerable to ‘fragile’ supply chains. 23 February 2026.

Forever Chemicals, Accelerated Ageing, and Why Your Postcode Matters

Asclepius — Thu, 12 Mar 2026 14:49:53 GMT

Photo by Maria Baranova on Unsplash

The pan on your hob. The takeaway box from Friday night. Your waterproof jacket. Each of these everyday objects may share a hidden ingredient — and new research suggests it could be quietly ageing us.

The chemicals in question are PFAS: per- and polyfluoroalkyl substances. There are over 10,000 variants. They’ve been manufactured since the 1940s and are prized in industry for being heat-resistant, waterproof, and virtually indestructible. That last quality is precisely the problem. The stability of their carbon-fluorine backbone means they’re expected to take up to a thousand years to break down; hence the nickname that has stuck: forever chemicals.

What the new science says

A study published in February in the journal Frontiers in Aging has sharpened the conversation considerably. Researchers found that two specific PFAS compounds -PFNA (Perfluorononanoic acid, used in the production of non-stick coatings and in fire-fighting foam) and PFOSA (Perfluorooctanesulfonamide, found in food packaging) - appear to speed up biological ageing in middle-aged men, but not in women. The team measured something called the epigenetic clock: an analytical method used as a biomarker of aging using chemical tags on DNA that reveal how fast the body is truly ageing, independent of how old someone looks or feels. PFNA and PFOSA appeared in the blood of 95% of participants, and higher levels of these chemicals were linked to faster biological ageing.

Why men specifically? Researchers suspect that men may be at higher risk because the ageing markers analysed are heavily influenced by lifestyle factors such as smoking, which can compound the damaging effects of these pollutants. Science Alert There’s also a biological dimension: premenopausal women appear to clear some PFAS through menstruation, a pathway men simply don’t have.

The sample in this study was was relatively small and it demonstrates an association rather than a definite cause and effect. Larger longitudinal studies are needed, but the finding arrives on top of a growing pile of evidence linking PFAS to cancers, thyroid disease, high cholesterol, infertility, and immune disruption.

Photo by Serenity Mitchell on Unsplash

The UK picture

This is not an abstract American problem. The UK faces a large scale of legacy PFAS contamination, including land contaminated from firefighting foams and from emissions from industry and landfill. In response, Britain unveiled its first-ever national plan to tackle forever chemicals in February 2026, aiming to understand where these chemicals are coming from, how they spread, and how to reduce public and environmental exposure. The full extent of PFAS in England’s estuaries and coastal waters is to be assessed for the first time.

It’s a welcome step. Critics, however, note that the plan is heavy on monitoring intentions and light on enforcement, and that meaningful bans on PFAS in consumer products remain years away.

Where the social justice lens matters

This part of the story rarely makes it into the headlines: PFAS contamination is not evenly distributed. Industrial facilities, military airfields (which used PFAS-laden firefighting foam for decades), and waste sites are disproportionately located near lower-income communities. People living near these sources face higher exposures; exposure determined by where they can afford to live, or where their work takes them.

While harmful substances do not discriminate and everybody can be exposed, the people most at risk of adverse health effects are those exposed to high levels of PFAS and vulnerable population groups, such as children and the elderly. Industrial workers in manufacturing, firefighting, and agriculture where PFAS-contaminated sewage sludge has been spread on fields carry a disproportionate risk.

For clinicians, this matters. A patient presenting with unexplained thyroid dysfunction, elevated cholesterol unresponsive to lifestyle changes, or recurrent immune issues is rarely asked about their occupational or residential history in relation to chemical exposure. Perhaps they should be.

What can people do now?

The researchers recommend looking for reasonable ways to reduce exposure - checking local drinking water reports, using certified water filters designed to reduce PFAS, and limiting the use of stain- or grease-resistant products when alternatives are available.

But individual action only goes so far when the chemicals are already in the water, the soil, and the food chain. The deeper prescription here is regulatory and political, and the UK’s new PFAS Plan, for all its limitations, is at least an acknowledgement that the problem is real, present, and overdue for a national response.

“Forever chemicals are not a forever problem,” Environment Minister Emma Hardy said at the plan’s launch. Whether that optimism proves well-founded will depend on how much pressure is maintained on government and industry in the years ahead.

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From Coast to Clinic

Asclepius — Thu, 26 Feb 2026 20:19:37 GMT

When someone hears the words “You have cancer”, it should not matter where they live. And yet, quietly and persistently, it still does. Across the UK, people in rural, coastal and more deprived communities are often diagnosed later and treated more slowly than those living near large hospitals and specialist centres. This is not because they neglect their health or wait longer to report symptoms, it is because access is harder, services are stretched and expertise is unevenly distributed.

Recent plans to train more cancer specialists outside major cities are a welcome step because they acknowledge something important: expertise should live where people are. When doctors, nurses, and diagnostic teams are trained locally, they are more likely to stay, to know their communities, and to become trusted parts of the landscape rather than distant names on a referral letter. Training posts alone are not enough. Doctors need time, teams, and tools. They need reliable diagnostics, stable multidisciplinary working, and the sense that caring for patients outside big centres is valued, supported work — not second best.

Earlier diagnosis matter just as much. Many cancers are still found late, especially in poorer communities. If attending an appointment costs time, money or fear, delay becomes understandable. Compassionate healthcare has to take these realities seriously.

At heart, this is about fairness. A health system built on care and solidarity cannot be comfortable with outcomes that depend on a postcode.

These changes will take time, patience, and sustained commitment. But they are worth making. Because cancer already takes enough from people — where they live should not take their chance as well.

Cold Homes, Cold Bodies.

Every winter, fuel poverty affects millions of UK households. It disproportionately affects older adults, single parents, and, owing to their reduced capacity to earn, people with chronic illness.

People living in cold housing are at increased risk of respiratory infections, including pneumonia, cardiovascular events, including heart failure, hypothermia and excess winter mortality. Of course, other factors, such as the winter viruses, take their toll.

In the UK, excess winter deaths (EWDs) are calculated by comparing the number of deaths in the winter months (Dec–Mar) with the average of non-winter months (Aug–Nov and Apr–Jul). Historically, England and Wales saw 20,000–50,000 excess winter deaths per year before the pandemic, rising with severe seasonal conditions. In one recent winter (2020–21), there were about 60,760 EWDs, partly due to COVID-19 alongside cold exposure.

Estimates attribute around 4,700–5,000 excess winter deaths per year directly to cold, damp homes in England, Scotland and Wales — a marker of fuel poverty and deprivation.
Previous analyses suggest about 10% of excess winter deaths are directly linked to fuel poverty and 21.5% to cold homes specifically.

A UK analysis found that in the last decade, a quarter of a million older people died from cold-related illness — roughly one older person every 7 minutes — with poor housing a key driver. A Europe-wide study estimated approximately 363,500 deaths annually from cold exposure, compared with ~43,700 from heat (baseline 1991–2020).

Winter places stresses upon healthcare systems. The sometimes critical increases in respiratory virus infections mean that the services are less able to cope with diseases associated with cold housing. There is a knock-on effect. Further, children from cold homes have higher rates of asthma exacerbations and missed school days. Winter in the Northern Hemisphere involves some of the richest countries on Earth. Still, there is fuel poverty, homelessness, suffering, morbidity and increased mortality. Resources that could help the poor and unsheltered are being hoarded by a small percentage of the population. The excess deaths seen in winter are not a meteorological or even a purely medical phenomenon. They are a social problem. Like poverty, cold is not a lifestyle choice.

Photo by National Cancer Institute on Unsplash

Health Inequality in Cancer Care.

Every year in the UK there are an estimated 30,000 new cases of cancer which are attributable to socio-economic deprivation, with cancer of the lung the neoplasm most strongly associated with poverty.

Healthcare Inequality - defined as unfair, systematic and avoidable differences in health between groups - exists across the cancer spectrum and has become worse since the onset of the pandemic.

Poorer communities tend to have higher levels of risk factors (for example: smoking, obesity), less awareness of the consequences of poor lifestyles and of the importance of specific symptoms, greater barriers to seeking help and lower uptake of screening programmes.

The trend towards distance consultations, present before the pandemic but much increased since, is also a potential factor. Not only is the uptake of screening lower in deprived communities, the availability of technology required for teleconsultations is also less complete.

The Inverse Care Law.

Those in most need are the least likely to receive help.

Photo by Kristine Wook on Unsplash

The UK loses its measles elimination status.

According to the World Health Organisation, the UK has recently lost its measles elimination status, defined as “No endemic (continuous) transmission for 12 months or over, with high-quality surveillance”. Imported cases and small outbreaks can still occur.

This follows a notable recent increase in measles cases, with several thousand confirmed infections and at least one child’s death reported. Sustained transmission, and so the number of cases, is a consequence of a reduction in the coverage of the MMR vaccine, which has declined below the 95 % threshold needed for herd immunity.

Measles is one of the world’s most contagious viral diseases; outbreaks are occurring in many countries where vaccination coverage has fallen. Most high-income countries have NOT eliminated measles reliably and loss of elimination status is now common, not exceptional. The problem is not vaccine failure, but vaccine coverage and uptake.

Measles remains a reliable marker of health-system equity and trust

Measles elimination is increasingly fragile in high-income countries. Though much of this fragility can be blamed upon serious wealth inequality, much is due to the reduction in vaccine uptake - often inexplicably promoted by global interests - with a consequent overall reduction in measles immunity.

This vaccine avoidance has already led to increased numbers of children being treated in intensive care units and to avoidable deaths.

Photo by Emma-Jane Hobden on Unsplash

Beetroot and High Blood Pressure.

A recent study at the University of Exeter has found that beetroot can help lower blood pressure in the over 60s.

Beetroot (and other nitrate-rich vegetables) can lower blood pressure, mainly by boosting nitric oxide (NO) via the nitrate - nitrite - nitric oxide pathway, which relaxes blood vessels and improves the function of the blood vessel wall.

The study found that adding beetroot to the diet had an effect upon oral bacteria in the older person, with an increase in useful bacteria and a decrease in harmful bacteria. There was an associated, if mild, drop in blood pressure. These changes were not seen in the younger participants, who are more likely to have normal blood pressures and a healthy oral bacteria population.

Other studies have found a small reduction in both systolic and diastolic pressures associated with regular dietary beetroot, though the evidence strength is low.

It must be realised that beetroot is not a treatment for high blood pressure but can help as an adjunct to medically recommended therapy, and, for those who don’t like beetroot, other vegetables such as rocket/arugula, spinach, lettuce, Swiss chard, celery (often comparable or higher nitrate density than beetroot, depending on growing conditions) are alternatives.

The Creeping Cold has fingers.

Figures for the effects of cold weather upon mortality in the UK for the winter of 2024/5 have been released.

Over a period of 10 days, involving three cold spells, the temperature fell to less than 2 degrees Centigrade (yellow cold warning), and was associated with a total of 2544 deaths. Diseases of the heart and circulation were responsible for the majority of the deaths, with respiratory causes and infections following closely.

Cold weather increases risks by increasing the stresses on the body, affecting its ability to maintain a healthy temperature. Stress and lower body temperatures increase the susceptibility to infection while snow and ice increase the risk of falls and injuries.

Those at most risk are the elderly, the frail, those with chronic diseases, the poor, homeless and undernourished. Again, the inequalities of society in an acknowledgedly rich country put some in comfort and rude health while others suffer and die.

New Flu strain emerging.

Reports in the British Medical Journal have shown an increase in flu cases in the UK, mainly among young adults and school children. This appears to be due to a new H3N2 strain, which has mutated several times over the summer and has increased in severity.

Though this is not an entirely new strain, there are sufficient differences for it to side-step community immunity and vaccine cover. That is side-step, not dodge. Existing acquired immunity still offers some protection, and this can be ‘topped up’ by this year’s vaccine.

The advice remains as before: take sensible precautions to avoid spread, use masks in public places, wash your hands and ... get vaccinated.

Infectious diseases watch.

Two cases of Nipah virus infection have been confirmed in West Bengal, India in early 2026, both in healthcare workers. Rapid contact tracing and testing (~196 contacts) have identified no additional cases, and the World Health Organization currently assesses the risk of wider spread as low.

Nipah virus, a zoonotic pathogen carried by fruit bats, can cause severe respiratory and neurological illness with a high fatality rate (40–75%), but human-to-human transmission tends to require close, prolonged contact.

There is no vaccine or specific treatment; management is supportive. Several Asian countries have heightened traveler screening as a precautionary measure.

At present, the outbreak appears contained, and the global risk remains low, though vigilance and strong surveillance continue to be important.

Resources

Keeping people warm:

Fuel poverty is one of the most preventable winter health risks:

National Energy Action - Advice, advocacy, and direct support for households struggling to heat their homes.
Citizens Advice - Eligibility checks for energy grants, benefits, debt advice, and crisis support.
GOV.UK – Winter Fuel Payment & Cold Weather Payment - Direct financial support for older people and low-income households during cold spells.
Energy Saving Trust - Advice on insulation, heating efficiency, and grants that reduce long-term cold exposure.

Health, Aging and Vulnerability.

Age UK - Winter warmth programmes, befriending services, benefits advice, and local outreach
NHS - Stay Well This Winter - Vaccination, respiratory illness prevention, and advice for carers and vulnerable adults.
Royal Voluntary Service - Volunteers delivering food, companionship, and support to isolated older people.
Trussell - Volunteers delivering food parcels, foodbanks around the UK.

Diplopia After COVID-19: A Cautious Neuro-Ophthalmic Perspective

Asclepius — Thu, 26 Feb 2026 14:11:02 GMT

Photo by Ion Fet on Unsplash

As understanding of post-COVID syndromes matures, clinicians increasingly encounter neurological symptoms extending beyond fatigue and cognitive dysfunction. Visual complaints are common, but most are non-specific. Diplopia is less frequent, yet it warrants careful attention because it usually indicates disturbance of ocular alignment or ocular motor control rather than primary ocular surface disease.

The published evidence to date supports a cautious position: ocular motor palsies and diplopia have been reported following SARS-CoV-2 infection, chiefly in acute and subacute settings, and their prevalence and natural history within clearly defined Long Covid cohorts remain incompletely characterised. Early in the pandemic, Neurology reports described COVID-19 presenting with ophthalmoparesis attributable to cranial nerve palsy. Subsequent literature has continued to document oculomotor, trochlear, and abducens nerve palsies temporally associated with COVID-19 infection.

Beyond discrete cranial nerve palsies, a separate strand of evidence concerns oculomotor control in post-COVID condition (PCC). Objective eye-tracking studies in PCC, particularly among individuals with cognitive complaints, have reported alterations across saccades, pursuit, fixation, vergence, and pupillary parameters. Other cohorts have reported vision-related symptoms and measurable oculomotor findings in non-hospitalised post-COVID populations. These studies support the broader proposition that ocular motor function may be affected in some PCC patients. However, it remains premature to claim that specific syndromes such as convergence insufficiency are common without stronger prevalence data.

A small but important differential is myasthenia gravis (MG). New-onset MG has been reported after SARS-CoV-2 infection, sometimes beginning with oculo-bulbar symptoms including diplopia and ptosis. While myasthenia gravis is unlikely to explain most post-COVID visual complaints, its consequences are significant enough that fluctuating diplopia or fatigable ptosis should trigger appropriate evaluation and referral.

For generalists, the practical message remains one of measured vigilance. New-onset diplopia requires structured assessment and urgent triage where red flags are present. Where investigations are unrevealing and symptoms are stable, a post-infectious mechanism may be considered---but only after exclusion of time-critical pathology.

In summary, the evidence supports that diplopia and ocular motor dysfunction can occur after SARS-CoV-2 infection, and objective studies suggest oculomotor control changes in some PCC patients. What remains uncertain is how often diplopia forms part of Long Covid, which patients are at risk, and which interventions best help. Until better cohort data emerge, clinical curiosity should be paired with careful follow-up.

Long Covid and diplopia — key clinical points

From Coast to Clinic: Tackling Cancer’s Postcode Lottery

Asclepius — Sun, 01 Feb 2026 08:28:13 GMT

Photo by Alejandro Garay on Unsplash

Where you live should not determine whether your cancer is caught early, treated promptly, or managed by a specialist team. And yet, in the UK, it still too often does.

Recent announcements about expanding cancer specialist training posts in rural and coastal areas are welcome — not because they are radical, but because they address a truth clinicians and patients alike have known for years: expertise is unevenly distributed, and illness exploits that inequality mercilessly.

Cancer outcomes in the UK vary markedly by geography. Survival is consistently poorer in deprived regions, coastal communities, and areas distant from major teaching hospitals. These differences are not explained by biology alone. They reflect later presentation, reduced access to diagnostics, workforce shortages, and overstretched local services. In short, they reflect systems — not patients.

The quiet geography of expertise

Specialist care tends to cluster where training, research, and prestige already exist. Large urban centres attract oncologists, radiologists, pathologists, and specialist nurses because that is where career progression is most visible and professionally supported. Meanwhile, smaller hospitals struggle to recruit and retain the same depth of expertise, even as their populations age and cancer incidence rises.

The result is a subtle but powerful “postcode lottery”:

Delays to imaging or biopsy
Fewer subspecialty opinions
Longer waits for definitive treatment
Greater reliance on patient travel or fragmented care

None of this is deliberate. It is simply what happens when workforce planning follows gravity rather than need.

Training as redistribution, not just expansion

The proposed strategy to train more cancer specialists outside traditional centres is significant because it re-frames training as a tool of redistribution, not merely workforce growth. Training doctors and allied professionals where they are needed increases the likelihood they will stay, embed, and build local expertise over time.

But training posts alone are not enough. Specialists require:

Diagnostic infrastructure they can rely on
Multidisciplinary teams that are stable and supported
Protected time for learning, audit, and reflection
A sense that practising outside a major centre is not a professional cul-de-sac

Without this, new posts risk becoming short-term rotations rather than long-term solutions.

Early diagnosis still matters most

Redistributing expertise will only translate into better outcomes if it is paired with earlier diagnosis. Many of the starkest regional differences in cancer survival reflect late presentation — often driven by deprivation, health literacy, access barriers, and competing life pressures.

For patients juggling insecure work, transport difficulties, caring responsibilities, or mistrust of institutions, “come back if it gets worse” can mean “come back too late”. Tackling the postcode lottery therefore also means investing in:

Community diagnostics
Primary care capacity
Outreach and culturally competent health messaging

Cancer equity begins long before a patient meets an oncologist.

A moral, not merely managerial, challenge

At its heart, this is not a question of efficiency or targets. It is a moral challenge. A health system founded on solidarity and equity cannot accept predictable, preventable variation in outcomes simply because of geography.

The current proposals are a step in the right direction — cautious, imperfect, but necessary. Whether they succeed will depend on whether we treat cancer workforce planning as a long-term commitment to place, rather than a short-term fix to rota gaps.

Because if we truly believe that everyone deserves the same chance of survival, then expertise must travel — not just patients.

The Renin-Angiotensin-Aldosterone System - An Overview.

Asclepius — Sun, 01 Feb 2026 08:16:04 GMT

Photo by Joshua Chehov on Unsplash

Summary.

The RAAS is a critical hormonal cascade that helps maintain arterial blood pressure, extracellular fluid volume, and electrolyte balance. It co-ordinates renal, vascular, and adrenal functions and interfaces with the sympathetic nervous system, vasopressin release, natriuretic peptides and local tissue systems (notably in the heart, kidney, and brain). It is a finely tuned, multi-organ system that maintains cardiovascular and fluid homeostasis.

Dysregulation contributes to hypertension, heart failure, kidney disease, and inflammatory pathologies. The RAAS is a critical hormonal cascade that helps maintain arterial blood pressure, intravascular volume, and electrolyte balance. It co-ordinates renal, vascular, and adrenal functions and interfaces with the sympathetic nervous system, vasopressin release, and local tissue systems (notably in the heart, kidney, and brain).

Modern therapeutics target this system at multiple points — renin, ACE, AT₁ receptors, and aldosterone — to modulate its activity and prevent end-organ damage.

Pathway.

Renin is synthesised and stored in juxtaglomerular (JG) cells of the kidney afferent arteriole, and is released into the blood in response to reduced renal perfusion pressure (detected by juxtaglomerular baroreceptors) and to reduced sodium chloride delivery to the macula densa.

It is also released in response to sympathetic activation via β₁-adrenoceptors at the juxtaglomerular cells.

Renin, an aspartyl protease, cleaves angiotensinogen in plasma to the decapeptide angiotensin I (Ang I).

Angiotensinogen, itself, is a glycoprotein produced mainly by the liver. Its production is increased by oestrogen, corticosteroids, thyroid hormone, and inflammation (IL-6–mediated).

Circulating angiotensin I is inactive but is converted to the active angiotensin II by Angiotensin-Converting Enzyme (ACE) on the vascular endothelial cells - particularly in the pulmonary and renal circulations. Angiotensin-Converting Enzyme removes two amino acids from angiotensin I to form angiotensin II (Ang II). It also degrades bradykinin, a vasodilator peptide, adding to the vasoconstrictive effect .

Angiotensin II acts mainly on the angiotensin II receptors AT₁ and AT₂ (both G protein-coupled receptors).

AT₁R: Mediates vasoconstriction, aldosterone release, sympathetic activation, sodium retention, and cellular growth.

AT₂R: Counter-regulatory — promotes vasodilation, anti-proliferation, apoptosis, and NO release. Although angiotensin II binds both AT₁ and AT₂ receptors, many of the vasodilatory and anti-fibrotic effects classically attributed to AT₂ activation are mediated in parallel by the angiotensin-(1–7)/Mas receptor axis.

Aldosterone is synthesised in the zona glomerulosa of the adrenal cortex. It is released following Ang II stimulation, directly in hyperkalaemia and, to a lesser extent, in response to ACTH.

It binds mineralocorticoid receptors in the distal nephron (principal cells) to:

↑ Na⁺ reabsorption via the epithelial sodium channels (ENaC) channels.

↑ K⁺ secretion via the renal outer medullary potassium (ROMK) channels.

↑ water reabsorption (secondary to sodium retention).

Aldosterone activity results in expanded extracellular volume and elevated blood pressure.

The effects of RAAS activity are counterbalanced by ACE2 which converts Ang II to Ang (1–7). This acts via Mas receptors producing vasodilation, anti-fibrosis, and anti-inflammatory effects.

Natriuretic peptides (ANP, BNP) also oppose RAAS activity by promoting loss of sodium in the urine, vasodilation, and suppression of renin/aldosterone.

Physiological Effects.

Cardiovascular.

Angiotensin II acts directly upon AT₁ receptors in vascular smooth muscle producing vasospasm, so increasing systemic vascular resistance (SVR). If the cardiac output remains constant, this action will increase the blood pressure.

Direct cardiac effects include positive inotropy and myocardial hypertrophy. Chronic stimulation can lead to myocardial fibrosis.

Renal.

RAAS activity promotes efferent arteriolar constriction which maintains glomerular filtration pressure during hypotension.

At the renal tubules, aldosterone increases Na⁺ reabsorption and K⁺ secretion in the principal cells of the distal tubule and collecting duct via its effect upon the epithelial sodium channels (ENaC) and the renal outer medullary potassium channels (ROMK channels).

Neurohormonal.

The RAAS can stimulate thirst through its effects upon the hypothalamus, and increase ADH (vasopressin) release which leads to water retention.

There is also sympathetic activation via brainstem nuclei, with consequent adrenergic effects upon the heart and circulation.

Cellular Mechanisms.

AT₁ Receptor: A G-protein–coupled receptor (GPCR) activating phospholipase C leads to IP₃ + DAG, ↑ intracellular Ca²⁺ and, consequently, vasoconstriction, aldosterone synthesis, and cellular growth.
Aldosterone mechanism: Nuclear receptor binding leads to increased transcription of ENaC and Na⁺/K⁺-ATPase subunits so facilitating increased Na⁺ re-uptake.

Clinical Relevance.

In heart failure, chronic RAAS activation leads to vasoconstriction, sodium retention and cardiac remodelling. ACE inhibitors, ARBs, MRAs (spironolactone) can be beneficial.

Hypertension is associated with over-activity of the angiotensin II/aldosterone axis. Appropriate therapeutic options include ACE inhibitors, angiotensin receptor blockers and renin inhibitors.

Glomerular hypertension and fibrosis from persistent from persistent angiotensin II stimulus is a feature of chronic kidney disease (CKD). RAAS blockade can slow CKD progression.

In COVID-19, use of ACE2 receptor by the coronavirus disrupts balance between angiotensin II and angiotensin (1-7) and AT₁R and MasR signalling - a possible link to endothelial injury and cytokine storm; also to potential therapeutic options.

Flu Season Update — What the H3N2 “Subclade K” Means

Asclepius — Mon, 26 Jan 2026 17:39:30 GMT

Photo by Kristine Wook on Unsplash

As we settle into the heart of respiratory virus season, flu continues to be the most commonly detected seasonal illness in many parts of the world — including here in the UK. Recent surveillance confirms that influenza A, and in particular the H3N2 subtype, dominates this year’s circulating viruses. Of those H3N2 viruses that have been genetically characterised, the majority belong to a variant called subclade K, a slightly drifted version of the virus compared with previous seasons.

But what does this mean in everyday terms?

Viruses like influenza are constantly changing, and seasonal variants emerge as they “drift” to escape some of the immunity we’ve built up from past infections or vaccinations. The H3N2 subclade K strain has several genetic changes that differentiate it from the H3N2 components used when this season’s vaccines were selected. This partly explains why the flu season in the UK began earlier than usual — and why case numbers climbed quickly in children and young adults last autumn.

Importantly, recent evidence does not suggest that this strain causes inherently more severe disease than typical seasonal flu. Although media outlets have sometimes dubbed it “super flu”, experts stress this is misleading.

Here’s what’s relevant for the general population now:

Flu remains circulating at moderate levels in the UK winter season, with hospital visits and laboratory diagnoses continuing to show influenza A as the main driver.
Vaccination still matters — even with a slight genetic mismatch, early vaccine effectiveness data suggest ongoing protection against serious outcomes, including hospital attendance and admission.
Because the virus has drifted, some people may still get mild or moderate illness despite vaccination — but vaccinated individuals are generally less likely to become severely ill than those who are unvaccinated.

The message from public health professionals remains consistent: get your flu vaccine if you haven’t already, practice good respiratory hygiene (like handwashing and masking when symptomatic), and reach out to healthcare advice lines early if you are high-risk or develop concerning symptoms.

Flu doesn’t disappear simply because it’s mid-winter — and understanding how it’s evolving helps all of us make better choices for our health.

Winter's Shadowy Fingers

Asclepius — Wed, 07 Jan 2026 14:02:40 GMT

Photo by Fabrice Villard on Unsplash

Cold Homes, Cold Bodies

Every winter, fuel poverty affects millions of UK households. It disproportionately affects older adults, single parents, and, owing to their reduced capacity to earn, people with chronic illness.

People living in cold housing are at increased risk of respiratory infections, including pneumonia, cardiovascular events, including heart failure, hypothermia and excess winter mortality.

Of course, other factors, such as the winter viruses, take their toll.

In the UK, excess winter deaths (EWDs) are calculated by comparing the number of deaths in the winter months (Dec–Mar) with the average of non-winter months (Aug–Nov and Apr–Jul). Historically, England and Wales saw 20,000–50,000 excess winter deaths per year before the pandemic, rising with severe seasonal conditions. In one recent winter (2020–21), there were about 60,760 excess winter deaths, partly due to COVID-19 alongside cold exposure.

A UK analysis found that in the last decade, a quarter of a million older people died from cold-related illness — roughly one older person every 7 minutes — with poor housing a key driver. A Europe-wide study estimated approximately 363,500 deaths annually from cold exposure.

Further, children from cold homes have higher rates of asthma exacerbations and missed school days.

Winter in the Northern Hemisphere involves some of the richest countries on Earth. Still, there is fuel poverty, homelessness, suffering, morbidity and increased mortality. Resources that could help the poor and unsheltered are being hoarded by a small percentage of the population.

The excess deaths seen in winter are not a meteorological or even a purely medical phenomenon. They are a social problem.

Like poverty, cold is not a lifestyle choice.

Deprivation as a Multisystem Disease

The effects of poverty upon health can be seen as poverty behaving like a chronic inflammatory state. Poverty is associated with poor nutrition and reduced access to health care. Each has drastic effects upon the well-being of the poor.

Nutritional deficiencies can lead to poor health. Calories are cheap, so obesity is more likely among the poorer population. Dietary inadequacies can lead to poor tissue repair, immune system inefficiencies and specific vitamin and amino acid deficiencies.

The everyday problems of poor accommodation, poor nutrition, inadequate clothing and fuel poverty lead to chronic stress. The consequent rises in cortisol and sympathetic tone can lead to an increased risk of cardiovascular disease and diabetes.

Reduced access to preventative care makes common diseases more likely and delayed presentation leads to more advanced disease when help is sought.

Of course, the poor are more exposed to seasonal changes.

Why are there more deaths in winter?

Cold makes things worse.

When cold exposure contributes to excess mortality, it typically does not appear on the death certificate as “cold”, but acts as a trigger or exacerbating factor for other conditions.

The main causes associated with cold exposure are increases in cardiovascular deaths, such as heart attacks and strokes, and in respiratory deaths, such as from pneumonia and COPD exacerbations (cold stress and indoor crowding in winter facilitate respiratory infection and airway strain).

Influenza and other seasonal viruses contribute significantly to winter mortality.

Lower temperatures, icy conditions, and decreased mobility increase fall risk in older, more frail adults. Falling might mean a fractured hip, and, unless help is quickly to hand, a simple fall might lead to hypothermia.

Vulnerable populations.

Cold-related mortality is heavily concentrated in groups with less capacity to adapt. By far the majority of cold victims are from the 65 and over age group. People in poor housing, with a higher indoor exposure to cold, and those with heart and lung problems are also at risk from the cold.

Homeless people and people with insecure housing living in an exposed environment without adequate protection are a further risk group (exact UK homeless cold-death statistics are sparse but clinical and shelter data indicate a very high vulnerability).

Long COVID: what we understand better now.

With greater experience of the Long COVID syndrome comes a clearer definition and a clearer sense of scale.

The WHO now frames “post-COVID-19 condition” as symptoms starting within 3 months of infection and lasting at least 2 months, and estimates about 6 in 100 infected people develop it. A key shift is accepting that “long COVID” is likely to be several overlapping conditions, not one illness.

Several clinical presentations are now recognised, such as dysfunction of the autonomic nervous system (dizziness on standing, heart-rate changes), neurocognitive impairment, and exercise intolerance.

There are several possible ways that COVID can cause long-term health problems. Damage to the immune system and a subsequent chronic inflammatory response can keep symptoms going after the initial infection has resolved. Viral persistence or antigen persistence in some tissues is another possibility under serious consideration.

Damage to the linings of, and micro clots within, small blood vessels has been suggested as one possible contributor to fatigue, breathlessness, and exercise intolerance. Disruption of the autonomic nervous system would explain dizziness, palpitations, temperature intolerance and fatigue often seen post-COVID.

Management of the various Long COVID presentations needs to be tailored not only to the presentation but also to the individual. Symptoms often improve over months, but a meaningful minority have prolonged impairment.

Antimicrobial drug resistance.

Resistance to antibiotics and similar drugs used to fight infection is growing. This puts everybody at risk.

The UK health Security Agency reports that in England 2024 there were nearly 400 antibiotic-resistant infections per week, with estimated deaths in people with a resistant infection rising from 2,041 in 2023 to 2,379 in 2024.

This is not a theoretical problem. It means longer hospital admissions, fewer oral options, more IV therapy, and “routine” infections becoming complicated and possibly fatal.

We need better antimicrobial stewardship in order to slow the development of resistant infections and to allow our current antibiotics to remain effective.

The UK’s AMR National Action Plan 2024–2029 aims to reduce the need for antibiotics, optimise their use, and support new treatments and diagnostics options.

Think of stewardship as preventing avoidable exposure and protecting future effectiveness, while still treating serious infection promptly.

This means choosing the right drug, right duration, right indication. Shorter effective courses are preferable where evidence supports their use and we must avoid “just-in-case” antibiotics for clearly viral infections.

Without these measures, currently manageable infections can become much more serious and surgical operations at present made possible by of the availability of effective antibiotics will become unsafe or impossible to undertake.

What can we all do to help?

Don’t seek antibiotics for colds/flu-like illness unless red flags develop.
Don’t keep leftovers.
Don’t share antibiotics.
Finish the prescribed course.
Accept offered vaccinations.
Make sure your indoor environment is well-ventilated.

New Flu strain emerging.

Though this is not an entirely new strain, there are sufficient differences for it to side-step community immunity and vaccine cover. That is side-step, not dodge. Existing acquired immunity still offers some protection, and this can be ‘topped up’ by this year’s vaccine.

The advice remains as before: take sensible precautions to avoid spread, use masks in public places, wash your hands and ... get vaccinated.

Resources:

Keeping People Warm

Fuel poverty is one of the most preventable winter health risks.

National Energy Action - Advice, advocacy, and direct support for households struggling to heat their homes.
Citizens Advice - Eligibility checks for energy grants, benefits, debt advice, and crisis support.
GOV.UK – Winter Fuel Payment & Cold Weather Payment - Direct financial support for older people and low-income households during cold spells.
Energy Saving Trust - Advice on insulation, heating efficiency, and grants that reduce long-term cold exposure.

Health, Ageing & Vulnerability

Age UK - Winter warmth programmes, befriending services, benefits advice, and local outreach.
NHS – Stay Well This Winter - Vaccination, respiratory illness prevention, and advice for carers and vulnerable adults.
Royal Voluntary Service - Volunteers delivering food, companionship, and support to isolated older people.
Trussell - Volunteers delivering food parcels, foodbanks around the UK

Small actions matter.

Keeping one home warm, reporting one person sleeping rough, or helping one older person access support does not solve poverty, but it can prevent illness, hospitalisation, or death - and it matters to that one household, that one person.

Cold is a risk factor we know how to treat.

Short Days, Long Nights and Lonely People

Asclepius — Sat, 20 Dec 2025 13:42:17 GMT

Photo by Annie Spratt on Unsplash

We are officially in winter in the northern hemisphere and, as I write this, the shortest day of the year is almost upon us.

Winter brings its own familiar medical challenges. There was a time when this would inevitably include injuries from slipping on ice, though that seems to trouble us less than it once did. Today, seasonal health concerns are more likely to revolve around respiratory viruses, excess merriment, cold exposure, which does not require freezing temperatures to be dangerous, and, less visibly but no less importantly, loneliness.

Merriment itself carries risks. Lying in the rain on a cold, deserted street has never been good for one’s health, despite what certain urban legends might suggest, and is best avoided.

There are smaller hazards too: be cautious when unpacking last year’s artificial tree, and perhaps avoid breathing deeply beside a freshly cut natural one.

More troubling, however, is the effect of the season on mental health. For those who are lonely, watching others gather to celebrate warmth, companionship and joy can sharpen feelings of isolation rather than soften them.

Christmas is traditionally a time for reflection and gratitude - for warmth, shelter, and the presence of others - whether one expresses that gratitude through prayer or quiet thought. But it is also a reminder to hold in mind those who are cold, alone, elderly, or homeless. While generosity often peaks at this time of year, care itself should never be seasonal.

Perhaps we should keep the Christmas lights on all year.

Tinsel Tendinitis: Surge in Minor Upper-Limb Injuries from Decorating

There has been a predictable yearly rise in small sprains, tendon irritations and ladder-related bumps due to festive decorating and imbibation.

Occupational therapists have jokingly dubbed it “tinsel tendinitis.”

December is a particularly risky month for minor (and some more major) injuries, so be careful on those ladders - particularly after a couple of sherries.

The Return of Christmas Tree Syndrome

Hospitals continue to see seasonal spikes in allergic rhinitis and asthma flares triggered by mould spores found on stored artificial trees or by terpene-rich sap from freshly-cut natural ones.

If you experience these allergies, it might be advisable to consider showering artificial trees before putting them up and let real trees air out outside for a day or two.

Photo by Mariana B. on Unsplash

Viral Round-Up: RSV and Influenza Rising Earlier Than Expected

Respiratory viruses are climbing just in time for Christmas, a time of festivities and family gatherings. RSV is already causing pressure on paediatric and elderly services and flu cases are rising but vaccine uptake is lagging behind targets.

Of particular concern is that flu cases appear to be more severe, and there has been an increase in the numbers of people admitted to hospital for treatment of their influenza and its complications.

Government advice is that people who have symptoms suggestive of a flu infection should wear face masks in public. Ordinary surgical masks are sufficient in most cases to help reduce spread by an infected person. They are much less effective as protection against infection.

Without masks, coughs and sneezes should be caught in the crook of the elbow or in clothing (such as a scarf) - not in a bare hand. This, of course, is one of the reasons that you should not shake hands.

It’s still not too late to have a flu jab; it’s a lot better than spending Christmas in hospital.

Seasonal Affective Disorder Peaks — but Christmas Lights Help

SAD-related presentations peak in December, but several small UK studies suggest festive lighting and outdoor Christmas markets actually improve mood.

Perhaps a reminder that small environmental changes meaningfully support mental health.

Cold-Weather Cardiology: “Shoveller’s Heart” Back Again

Cold weather places additional stress upon the heart and lungs. Cold peripheries can increase pressure upon the heart as the body tries to conserve heat, and breathing cold air can induce lung reactions which can affect breathing.

This, in turn, can also place additional pressure upon the heart.

With early cold snaps, cardiology departments often see increased numbers of cases of exertion-triggered angina and occasional arrhythmias following sudden, unaccustomed activity such as clearing snow - shoveller’s heart.

At this time of year, people with established heart or lung conditions should pace themselves carefully rather than just jumping in to clear their drive.

Alcohol-Related Attendances Spike Post-Christmas Parties

Early-December data suggest a slightly higher volume of alcohol-related admissions—mostly mild injuries, intoxication, and late-night hypothermia compared to previous years.

There has also been a rise in patients wearing full Father Christmas costumes arriving at A&E departments.

Photo by Matt Collamer on Unsplash

The Health Benefits of Kindness

Kindness isn’t just a virtue — a report published by the Mental Health Foundation has shown it to have measurable benefits for mental well-being. Acts of kindness foster a sense of belonging, reduce stress, strengthen social connectedness, and support emotional resilience.

Everyday kindness and friendliness, like helping a neighbour or simply smiling and acknowledging a stranger when out for a walk, are linked with better mood and improved satisfaction with life - for both parties.

Especially during winter and around the holidays, when people can be at their most vulnerable, small acts of kindness can be public health actions in their own right — inexpensive, widely accessible, and emotionally powerful.

Homelessness at Christmas: Cold Nights, Warm Hearts

For many, Christmas brings warmth, festivities and the comfort of home. For others, the winter season only highlights the harsh reality of having nowhere safe to sleep. Homelessness continues to grow in the UK, and the festive period can be one of the most dangerous times of the year for those without secure housing.

Estimates suggest that over 300,000 people in England alone will be homeless at Christmas, including rough sleepers and those in temporary accommodation — where a roof may be present, but stability and safety often are not. Temporary housing can be overcrowded, insecure, or unsuitable, particularly for families and young people.

People sleeping rough face direct threats from cold exposure, abuse and violence. Freezing temperatures, wet winter weather and long nights increase the risk of hypothermia, frostbite and severe respiratory infections. Without reliable shelter, regular meals or warm clothing, the body’s ability to stay safe in the cold is significantly compromised.

The festive season also brings heightened emotional stress. Winter nights are longer and darker, intensifying loneliness and isolation for those without home, family or community support. This can worsen pre-existing mental health conditions, create additional psychological burdens, and make daily survival feel even more overwhelming.

Rising homelessness statistics reflect deeper structural issues: a long-standing shortage of affordable housing, rising rents, the cost-of-living crisis, and complex interactions with welfare and immigration systems. Recent reports show sharp increases in the numbers entering temporary accommodation and in rough-sleeping counts across major cities, illustrating that the problem is not only persistent but worsening for many.

In response, charities and community groups step up pivotal winter and Christmas-time services. For more than 50 years, Crisis at Christmas has provided food, warmth, companionship and access to services such as healthcare, showers and housing advice to people experiencing homelessness in several UK cities.

Emergency protocols like the Severe Weather Emergency Protocol (SWEP) are also triggered by councils and outreach teams when temperatures drop, offering additional shelter spaces during periods of severe cold. However, these responses are not guaranteed everywhere and do not replace long-term housing solutions.

What this means for all of us is a reminder that homelessness is not an abstract winter issue — it’s a year-round challenge with acute risks in cold weather. Small acts of awareness, small acts of kindness, compassion and advocacy can make a real difference during this time of year.

Photo by Nick Fewings on Unsplash

If you’d like to help

For readers in the UK who wish to translate concern into action, there are several well-established organisations working year-round, with increased activity over the winter months:

Support people experiencing homelessness

Crisis – housing advice, winter shelters, and the long-running Crisis at Christmas programme.

Shelter – legal advice, housing advocacy, and homelessness prevention.

Mungo’s – outreach, emergency accommodation and health support.

The Salvation Army – accommodation, food parcels, hot meals.

Trussell - food parcels, foodbanks around the UK

If you’re worried about someone sleeping rough

StreetLink – alert local outreach teams if you see someone sleeping rough in England or Wales

Telephone: 0300 500 0914

Cold weather emergency support

SWEP (Severe Weather Emergency Protocol) – information via local councils

Local kindness

Many local shelters, food banks and churches welcome donations, volunteers, or warm clothing. These are often listed on council or NHS Trust websites.

A brief conversation, a hot drink, or signposting someone to help can matter more than we realise.

Photo by Ev on Unsplash

Fortified Wines - Their Effects Upon Health.

Asclepius — Thu, 04 Dec 2025 16:15:19 GMT

Photo by Bruno Martins on Unsplash

Why Fortified Wines Hit Harder Than You Think.

Asclepius — Tue, 02 Dec 2025 17:58:26 GMT

Photo by Bruno Martins on Unsplash

Fortified wines aren’t just “regular wine but sweeter.” They have a very different chemical profile, and that comes with different effects on the body. In this article, I’ll walk you through what’s actually in them, what those ingredients do, and why some people – especially older adults, asthmatics, migraine sufferers, and those on certain medications – can react quite strongly.

Fortified wines occupy a strange corner of the drinking world: elegant and old-fashioned, but surprisingly potent. They tend to “go straight to the head,” cause intense hangovers, or make some people feel oddly unwell after even modest amounts. They’re traditional, elegant, and usually sipped rather than gulped. Yet they also have a reputation for hitting harder than their genteel image suggests.

Here’s why.

1. They’re much stronger than regular wine

Fortified wines typically sit between 17–22% alcohol, far above the 11–14% of normal wines. A small glass of port can contain the alcohol equivalent of two standard drinks. This means faster onset, deeper intoxication, and far more intense hangovers.

Older adults are especially vulnerable: impaired balance, confusion, and dehydration are common.

2. They contain a lot of sugar

Port, sweet sherries, and madeira can be heavy in glucose and fructose. This causes rapid spikes in blood sugar, followed by the “crash” that produces shaking, nausea, sweats, and headaches. Sugar also worsens hangovers and adds significantly to caloric load.

3. Acetaldehyde is a major culprit

Acetaldehyde is a toxic intermediate produced by alcohol metabolism — and fortified wines, especially oxidatively aged ones (like sherry), may contain more of it naturally. It causes flushing, palpitations, headaches, nausea, and contributes to long-term cancer risk from alcohol.

People who “go red” after wine tend to react even more strongly.

4. Histamine and tyramine can cause headaches and asthma symptoms

Barrel-aged wines develop higher levels of biogenic amines, especially histamine and tyramine. These can trigger:

migraine
flushing
nasal congestion
bronchospasm in asthmatics
blood-pressure swings

If you use MAOI antidepressants, tyramine-rich drinks like sherry are unsafe.

5. Sulphites affect a subset of people

Sulphites are safe for most, but in sensitive asthmatics they can trigger wheezing, coughing, and chest tightness. Fortified wines may contain higher levels due to longer ageing and stabilisation requirements.

6. More congeners = worse hangovers

Dark, aged fortified wines often contain more fusel alcohols and congeners, which intensify nausea, dehydration, and inflammation. This is why two glasses of port do not feel like two glasses of white wine.

7. Ochratoxin A is rare but real

Some fortified wines, especially those stored long-term in warm cellars or barrels, may contain low levels of ochratoxin A, a toxin from moulds. Occasional drinkers are not at risk, but heavy chronic drinkers could accumulate low-level kidney stress.

8. Interactions with medications

Fortified wines can interact with:

MAOIs (due to tyramine)
Sedatives/opioids (greater respiratory and consciousness depression)
Warfarin (botanical extracts in vermouth)
Diabetes medications (sugar + alcohol swings glucose)

So—should you avoid fortified wines?

Not necessarily.
They’re enjoyable, cultural, historic beverages.

But it helps to respect them for what they are:

Strong
Sweet
Chemically complex
Easy to overdo
Hard on the system if you’re vulnerable

A small glass after a meal is perfectly harmless for most people. Problems arise when:

servings are underestimated,
drinking becomes frequent, or
underlying medical conditions make reactions more likely.

A practical takeaway

Fortified wines are “stronger than they look” drinks, with:

more alcohol
more sugar
more fermenting by-products
and occasionally more contaminants

than ordinary wine.

If you enjoy them, keep the serving small, avoid drinking them quickly, and be mindful of how your body responds. Fortified wines are delicious and deeply cultural — but they’re stronger, sweeter, and chemically more complex than ordinary wine. For most people, the key is moderation and awareness of how your body responds

Phantosmia

Asclepius — Mon, 24 Nov 2025 13:51:30 GMT

Photo by Battlecreek Coffee Roasters on Unsplash

The Health Impacts of Climate Change.

Asclepius — Sat, 15 Nov 2025 18:38:59 GMT

Climate change, defined as long-term changes in temperature and increases in extreme weather caused by greenhouse gases, has been called “the greatest global health threat of the 21st century”.

Though of concern, climate change isn’t just about increased rainfall and flooding, hotter summers with devastating wildfires, or melting ice caps — it also affects our health in many other ways.

Those working in healthcare are already seeing the impact; these problems will only increase if nothing is done to reduce emissions.

How can climate change affect health?

A rise in temperatures increases the risks of heatstroke and dehydration, leading to kidney problems, and can make worsen heart and lung problems.

Air quality suffers with climate change. Rising temperatures make air pollution and pollen counts worse, increasing asthma attacks, worsening bronchitis and making allergies worse. Air pollution at ground level worsens and this can adversely affect heart and circulatory disorders, leading to an increased risk of heart attacks and strokes. The increase in temperature can trap traffic pollution, particularly ozone, at ground level. This causes inflammation and damage to the lung and cardiovascular system.

Of course, extreme weather events such as hurricanes, floods and wildfires, made much more likely by climate change, pose a physical threat to health and well-being, as well as to property and the economy.

The spread of warmer, wetter weather from the tropics will increase the range of countries where insect disease carriers, mosquitoes and tics primarily, can live and breed. And where they live and breed is where they also bite. Diseases such as malaria, Dengue fever, Zika, Chikungunya, Lyme disease are expected to spread, becoming more of a health risk in the formerly milder climes.

With the increased risk of flood comes an increased risk of waterborne disease such as cholera and Cryptosporidiosis, warmer oceans mean an increased risk of Vibrio cholerae infections, and there will be an increase in salmonella risks with heat-associated food spoilage.

Crop failure and shortage of water will lead to malnutrition, dehydration and famine, poor sanitation with associated health risks, and displacement pressure upon populations.

There are no health benefits to climate change.

Is another pandemic brewing in China? - the enigma of hMPV.

Social media and the more sensationalist mainstream media in particular have become heated recently with rumours of a sharp rise in respiratory infections, with overcrowded hospitals and strained health services, in China.

The scare has been provoked by a rise in the incidence of viral respiratory infections, particularly in Human Metapneumovirus (hMPV) infections.

Human Metapneumovirus, like all colds viruses, is spread by droplets (coughing and sneezing) and by contact. It exists worldwide and, by the age of 5 years, just about everyone will have had an hMPV infection. Infections are seasonal and account for between 5 and 10\% of winter paediatric hospital admissions, a proportion similar to that of the Respiratory Syncytial Virus (RSV). Both are significant causes of bronchiolitis in infancy.

Like many respiratory viruses, hMPV rarely causes problems except in the very young, the very old, those with co-existing conditions (COPD, heart disease) or those with a compromised immune system.

The current situation in China is similar to that in the rest of the world, with hMPV infections contributing their usual proportion of seasonal viral chest infections. There was an unusually high incidence last year, but this has been ascribed to a lower community resistance to the virus following the measures, particularly isolation measures, taken during the Covid-19 pandemic. There have been no changes in the makeup of the virus which would make it a greater threat.

There is nothing to suggest that a new pandemic involving hMPV is likely in the near future.

Is missing breakfast bad for your health?

Photo by Joseph Gonzalez on Unsplash

A recent analysis of several observational studies found that people who skipped breakfast had a statistically higher risk of developing metabolic syndrome (defined broadly as a combination of risk factors such as high blood pressure, high blood sugar, abdominal obesity, raised lipids) compared with those who ate breakfast.

Metabolic syndrome is an important warning sign for future problems like type 2 diabetes, cardiovascular disease and kidney disease. Anything that helps identify modifiable risk factors (like when or even if you eat) may be useful for prevention.

Regular breakfast-eating might be more important than we think—so don’t assume skipping breakfast is always harmless.

However, other aspect of behaviour, such as sleep quality, diet, exercise and socioeconomic status might play a similar or even more important role.

The Rise in Antimicrobial Resistance.

Photo by GUY GRANDJEAN on Unsplash

A study from the London School of Hygiene \& Tropical Medicine (LSHTM) highlights that as European populations get older, the burden of antimicrobial-resistant bloodstream infections is expected to increase substantially, particularly in men over 65.

Drug-resistant infections - so-called “superbugs” - are a major global health threat. Hospitals, care-homes and older people are especially vulnerable. An ageing population means that the problem might become worse. The UK’s surveillance programme (English Surveillance Programme for Antimicrobial Utilisation and Resistance — ESPAUR) reports that in England the number of severe antibiotic-resistant infections increased from an estimated ~59,171 in 2018 to ~66,730 in 2023 — a ~12.8 \% rise.

The number of estimated deaths from drug-resistant infections rose from 2,393 in 2019 to 2,640 in 2023. 65 \% of the antibiotic-resistant bloodstream infections in the last five years were caused by Escherichia coli. People in the most deprived areas have a 43\% higher risk of antibiotic-resistant infection compared to the least deprived, up from ~29 \% in 2019.

When an infection is resistant to first-line antibiotics, treatment gets more complex, expensive, longer, with more side-effects and greater risk of complications or death. This increases the burden on hospitals, care-homes, and the NHS budget — both directly (treatment) and indirectly (more hospital days, more intensive care).

It affects everyone: even “routine” infections could become harder to treat in future if the trend continues.

Drug-resistant infections also threaten the foundations of modern medicine: many surgeries and treatments depend on reliable antibiotics (e.g. cancer chemotherapy, joint replacements).

The antibiotics we have relied upon are not invincible — older adults especially may face higher risks of infections that are harder to treat, which means prevention (vaccines, hygiene, stewardship) becomes more important.

It is more important than ever to use antibiotics only when prescribed and needed (they are ineffective and so not useful for viral infections) and to finish the full course so that hidden resistant bacteria don’t survive.

It is also very important to practise good hygiene, especially in hospitals and when visiting (hand-washing, social distancing when unwell, etc.) and to stay up to date with vaccines, since preventing infections reduces need for antibiotics.

Hospital at Home.

Photo by Joshua Chehov on Unsplash

The push in the UK for remote monitoring, telehealth, use of health-data analytics and digital patient pathways is still accelerating, especially as hospitals and GP services face capacity issues. The hold-up has been not just the technology -appropriate technology has been available for some time - but data governance, interoperability, workforce training, and equity of access.

As flu, respiratory viruses and drug-resistant infections place more pressure on acute services, digital and remote-care models may allow for better triage and monitoring at home, and help to reduce avoidable admissions.

Remote consultations might become even more common with increased use of wearable monitoring and remote diagnostics. There is already diagnostic potential built in to computerised wristwatches.

Access is important for the scheme to be successful, and the “digital divide” - for example, the availability of broadband - could reinforce inequalities.

This is not a new idea. Versions of the hospital at home have been tried over the past two decades but have faltered due to poor funding and insufficient foresight and imagination.

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Are we facing a winter quademic?

Asclepius — Fri, 24 Oct 2025 15:28:23 GMT

Every winter, populations experience a rise in viral illnesses, particularly those cause by respiratory viruses (common cold, flu). These infections are often mild and do not lead to hospital admission.

This year, there is concern about a potential “quademic”.

Doctors are concerned about a possible four-pronged threat this winter. Covid-19 has not gone away - two new strains have been identified and cases are rising - and influenza (flu) is always a winter threat. Add to these a rising incidence of respiratory syncitial virus (RSV) and the ever-present colds and gut viruses such as norovirus, the potential to put strain upon the provision of healthcare is clear.

One of the problems is that the symptoms of flu, COVID-19, and RSV overlap (fever, cough, tiredness), making diagnosis tricky. Some people can even catch two viruses at once.

Each of these “prongs” has the capacity to cause serious illness, especially in older adults, pregnant women, young children, and people with long-term conditions, sometimes necessitating hospital admission. An increase in the number of patients requiring admission to hospital will put strain on the health services with potentially a knock-on effect causing delays in treatment for people with less urgent conditions.

It is our duty to do what we can to reduce this pressure on the healthcare system.

Fortunately, there are effective vaccines available. The NHS offers free vaccines to help protect against flu, COVID-19, RSV, and pneumococcal infections for specific patient groups. Those eligible for the vaccines should take advantage of their availability, unless there is a medical contraindication.

Update on Coronavirus recommendations UK Autumn 2025

Coronavirus cases are increasing substantially as new strains of the virus are spreading. Updated mRNA vaccines that match recent strains are available to help to maintain protection as immunity fades and the new variants appear. It is recommended that those in at risk groups have this vaccination to reduce the chance of contracting COVID, or to reduce the severity of the disease.

This year, the autumn/winter COVID-19 vaccination programme is more focused (i.e. not mass population boosters as before). This is causing some concern among advocates for those with chronic lung, heart, kidney or neurological disease.

The groups eligible in 2025 include:

All adults aged 75 years and over
Residents in care homes for older adults
Persons aged 6 months and over who are immunosuppressed (due to health condition or treatment)

So unlike in previous years, the booster is not universally offered to all adults — it’s targeted.

Influenza.

Influenza (flu) is a problem every winter, and can cause serious illness. In fact, the flu season extends fro September to March and vaccination is available throughout this period.

The Influenza virus undergoes changes every year. Because of this, yearly vaccination is recommended.

The vaccine is given by nasal spray for most children and injection for adults.

Who is eligible for the vaccine?

Everyone aged 65 and over
Pregnant women
People with long-term conditions, such as asthma, diabetes, heart, kidney, or liver disease
Carers and frontline health or care workers
Living in a care home or long-stay residential facility
Living with someone with weakened immunity
Children aged 2 to 11 years

Respiratory Syncytial Virus (RSV)

RSV can cause serious illness at both extremes of life and in people with weakened immune systems.

In infants, it can cause bronchiolitis, a very serious condition, and in the elderly and immunocompromised it can cause pneumonia. In between, it is a cause of the common cold.

In the UK, the vaccine is offered to pregnant women and the elderly. It is not yet offered to those with weakened immunity as clinical trials are still on-going.

For pregnant women, a single dose is given preferably between the 28th and the 32nd week of pregnancy. The confired immunity is passed to the infant through the placenta. This vaccine needs to be repeated in each subsequent pregnany.

The vaccine is also offered to those of 75 years or over. At the moment, it is a one-time dose.

The Nobel Prize in Medicine

The 2025 Nobel Prize in Medicine went to three scientists who discovered how the immune system stops itself from attacking the body. Their work should lead to better understanding of autoimmune diseases and of cancer treatments.

It might also inspire ways of treating the autoimmune catastrophes that overwhelm the body in severe infections and injury, and could pave the way for new drugs that calm an overactive immune system (like Rheumatoid and Lupus) — or boost it when fighting cancer.

Weight-Loss Drug Protects the Heart

The drug semaglutide, also known as Wegovy or Ozempic, not only helps people lose weight — it also cuts the risk of heart attack or stroke, even if little weight is lost.

As the protection is seen even in those who do not lose much weight, the drug appears to protect the heart in other ways, perhaps by lowering inflammation or improving blood vessels.

A New Hope for Blindness

Doctors have tested a small retinal implant that allowed some people with age-related blindness to read again.

The implant is placed in the retina of patients with dry Age-related Macular Degeneration (dry AMD) and early results of the trial are promising.

It must be emphasised that the trial is in its very early stages and to future benefit, and costs, of this technology are not clear. However, it does provide hope for a condition previously considered to be untreatable.

UK Dementia Research Spur

A UK government-backed initiative has launched a research challenge aimed at speeding up diagnosis, early detection and treatment of dementia by 2029. Earlier diagnosis of dementia will allow more effective management, and new treatments, if effective, would be extremely welcome.

Earlier diagnosis can also help shed light onto the risk factors, such as vascular disorders, pollution, infection, and toxins, involved in the disease processes of dementia.

Avian Flu Update

The potential threat of Avian Flu remains a concern.

To date, there has been one case of Avian flu (H5N1) in humans in England and one in Northern Ireland.

However, the risk to humans remains very low in the UK. The risk is still confined to people with direct exposure to infected birds or animals, or work in a contaminated environments. This includes poultry workers, workers in infected premises, wildlife handlers, and others with unprotected close contact. There have been no cases of human to human transmission of the virus, so an epidemic remains unlikely.

The Hidden Health Crisis.

Sun, 12 Oct 2025 16:26:33 GMT

Climate change poses one of the greatest threats to global health in the twenty-first century. Rising temperatures, poor air quality, shifting weather patterns, and more frequent natural disasters are not only transforming our environment but also endangering human well-being.

From heat-related illnesses and the spread of infectious diseases to food insecurity and mental distress, the health impacts of a warming planet are widespread and profound. Vulnerable populations—particularly children, the elderly, and those in low-income communities—bear the brunt of these changes.

Understanding the link between climate and health is essential if we are to build resilience, protect public health, and ensure a sustainable, equitable future for all.

Understanding the Connection Between Climate and Health.

Climate change is not solely an environmental issue — it is a direct and growing public health emergency. As global temperatures rise, the delicate balance that sustains life begins to shift. These changes affect clean air, safe water, adequate food, and secure shelter — essential for human health and well-being.

The World Health Organization (WHO) warns that climate change could result in an additional 250,000 deaths per year between 2030 and 2050, primarily from malnutrition, malaria, diarrhoea, and heat stress. This is not a distant forecast; the consequences are already visible in many parts of the world.

Rising Temperatures and Heat-Related Illnesses

Global warming has led to more frequent and intense heatwaves, posing serious risks to human health. Extreme heat can overwhelm the body’s natural cooling mechanisms, resulting in heat exhaustion, heatstroke, and strain upon the heart and circulation, leading to heart failure and strokes.

The elderly, outdoor labourers, and people with pre-existing health conditions are particularly at risk. In urban areas, the so-called urban heat island effect—where concrete and asphalt trap heat—can raise temperatures even further. Europe’s record-breaking heatwaves in 2022, which claimed thousands of lives, underscore the danger.

Preventive measures such as staying hydrated, wearing light clothing, and avoiding strenuous activity during peak heat can reduce personal risk. On a broader scale, urban greening, cool roofing, and climate-resilient city planning are vital to protecting communities.

The Spread of Infectious Diseases

As temperatures rise and rainfall patterns shift, the habitats of disease-carrying insects are expanding. This has led to the resurgence and spread of vector-borne diseases such as malaria, dengue fever, Zika virus, and Lyme disease in regions previously unaffected.

Stagnant water following floods creates ideal breeding grounds for mosquitoes, while milder winters allow ticks to survive and spread. Public health authorities must strengthen disease surveillance, vaccination programmes, and sanitation systems to mitigate these risks.

“Our planet is a lonely speck in the great enveloping cosmic dark. In our obscurity, in all this vastness, there is no hint that help will come from elsewhere to save us from ourselves.” - Carl Sagan

Air Quality and Breathing Problems

Climate change contributes significantly to air pollution, which is a leading cause of respiratory and cardiovascular diseases. Wildfires—fuelled by prolonged droughts—release vast quantities of fine particulate matter that can travel across continents. These pollutants aggravate asthma, chronic obstructive pulmonary disease (COPD), and even lung cancer.

Children and those with existing respiratory conditions are most vulnerable. Transitioning to clean energy sources, improving public transport, and enforcing air quality regulations are crucial steps towards protecting public health.

Water-Borne Illnesses and Contaminated Water

Extreme weather events are disrupting the availability and safety of water supplies. Floods can mix sewage with drinking water, spreading diseases such as cholera, typhoid, and hepatitis A. Conversely, droughts reduce access to clean water, forcing people to rely on unsafe sources.

Strengthening water management systems, investing in sanitation infrastructure, and adopting community-level purification technologies are key to preventing outbreaks of water-borne diseases.

“The health of our waters is the principle measure of how we live on the land.” - Luna Leopold.

Food Security and Nutrition Challenges

Changing weather patterns threaten global food production and nutrition. Crops like wheat, maize, and rice are highly sensitive to heat and drought, leading to reduced yields and increased prices.

Additionally, elevated carbon dioxide levels diminish the nutritional value of staple crops, reducing essential nutrients such as iron, zinc, and protein. These trends could exacerbate malnutrition, especially among children in low-income countries.

Promoting climate-resilient agriculture, diversifying crops, and supporting local food systems can help secure a healthier future.

The Mental Health Impacts of Climate Change

The psychological effects of climate change are profound but often overlooked. Individuals exposed to repeated natural disasters frequently experience post-traumatic stress disorder (PTSD), anxiety, and depression.

Even those not directly affected may develop eco-anxiety—a chronic fear about the planet’s future. Providing mental health support, community counselling, and education on resilience can help people cope and recover from climate-related stress.

Vulnerable Populations Most at Risk

Climate change worsens existing social and economic inequalities. The elderly, children, pregnant women, and low-income communities face the greatest health burdens.

Older adults are more susceptible to heat and air pollution due to underlying health issues. Children, with their developing lungs and immune systems, are at heightened risk of respiratory infections and malnutrition. Meanwhile, people in poverty often live in flood-prone or poorly insulated housing, with limited access to healthcare.

Addressing these disparities requires equitable climate policies, universal healthcare access, and targeted community support.

Urban Health Challenges in a Warming World

Cities amplify the health impacts of climate change through heat islands, polluted air, and limited green spaces - under pressure from government austerity and billionaire companies, councils are forced to build on existing green spaces. Poor drainage systems and overcrowded living conditions worsen the spread of disease after floods.

To counter this, urban planners are beginning to incorporate green roofs, tree canopies, and energy-efficient public housing. These measures not only reduce temperatures and pollution but also enhance overall well-being and mental health.

Natural Disasters and Emergency Health Responses

Floods, droughts, hurricanes, and wildfires are becoming more intense and frequent. The immediate consequences — injuries, fatalities, and displacement — are obvious, but the long-term health repercussions can persist for years.

Contaminated water, food shortages, and disrupted medical care compound the crisis. Strengthening emergency response systems, healthcare resilience, and disaster preparedness is essential to safeguard public health in the era of climate extremes.

“Man’s attitude toward nature is today critically important simply because we have now acquired a fateful power to alter and destroy nature. But man is a part of nature, and his war against nature is inevitably a war against himself.” - Rachel Carson

How Climate Change Impacts Maternal and Child Health

Climate stressors increase risks for pregnant women and young children. Extreme heat raises the likelihood of preterm births and low birth weights, while food and water shortages heighten risks of undernutrition and developmental delays.

Integrating climate resilience into maternal and child healthcare — through better nutrition, vaccination, and sanitation programmes — can significantly reduce these risks.

The Economic Burden of Climate-Related Health Crises

The health consequences of climate change carry enormous economic costs. Increased healthcare expenses, productivity losses, and damaged infrastructure place a heavy strain on national economies.

Reports from the Lancet Countdown on Health and Climate Change estimate that heat-related productivity losses already amount to billions annually. Investing in preventive measures offers a far better return than post-disaster recovery spending.

Mitigating Health Risks Through Adaptation

Mitigation and adaptation are both vital to reducing health impacts. Strategies include:

Developing early warning systems for heatwaves and disease outbreaks
Transitioning to renewable energy sources
Expanding green infrastructure and urban cooling
Ensuring universal healthcare coverage
Raising public awareness about sustainable habits

Collaboration between governments, scientists, and communities is essential to protect global health.

What Individuals Can Do to Stay Healthy

While climate change is a global challenge, individual actions can collectively make a difference.

Stay informed about local climate risks and health alerts
Hydrate and rest during heatwaves
Reduce exposure to polluted air by checking air quality forecasts
Eat sustainably, focusing on local and plant-based foods
Save energy and water at home
Advocate for climate-conscious policies in your community

By taking small, consistent steps, individuals can protect both their health and the planet.

Photograph by Kelly Sikkema on Unsplash

FAQs About Climate Change and Health

How does climate change affect human health? - It influences health through rising temperatures, poor air quality, unsafe water, food shortages, and more frequent disasters.
Who is most vulnerable? - Children, the elderly, and low-income communities are at the greatest risk due to biological and socio-economic factors.
Can climate change affect mental health? - Yes, it can lead to anxiety, depression, and trauma from environmental loss or disaster experiences.
Which diseases are most linked to climate change? - Malaria, dengue fever, heatstroke, asthma, and diarrhoeal diseases are the most common.
What role does air pollution play? - Air pollution both accelerates global warming and worsens respiratory and cardiovascular illnesses.
How can governments respond effectively? - By investing in renewable energy, healthcare resilience, and public education on environmental health.

“I do have reasons for hope: Our clever brains, the resilience of nature, the indomitable human spirit, and above all, the commitment of young people when they’re empowered to take action.” - Jane Goodall.

Photograph by Marcus Spiske on Unsplash

Long Covid

Tue, 30 Sep 2025 17:01:29 GMT

Long Covid, or Post-Covid Syndrome, is a greatly-varied collection of symptoms that persist beyond the recovery period following infection with the SARS-CoV-2 virus. Though more common following severe infection, the syndrome can occur following a mild, or even subclinical, disease.

Why are doctors concerned about dengue fever?

Asclepius — Tue, 07 Jan 2025 16:48:31 GMT

Every year a number of tourists catch dengue fever. Sadly, a number of these unfortunate people die of the disease.

Usually a mild or asymptomatic disease, dengue fever is, however, the cause of over 80,000 deaths each year and is a risk for over 4 billion people with 12 million reported cases annually, mainly in the Americas.

For those who develop symptoms, the experience can be traumatic. Symptoms can include severe muscle and bone pains, severe enough for the condition to be called 'breakbone fever'.

Dengue fever is caused by infection with the dengue virus, of which there are four types. Infection with one of the dengue sub-types confers lifelong immunity to that type and limited, short-term, immunity to the other types. However, subsequent infection with another dengue variant is more likely to lead to serious illness. Risk of serious illness also increases with the length of time between infections.

It has been estimated that about 5% of infections progress to serious disease with an overall mortality of 1%.

Until recently, dengue fever has been considered to be a disease of the tropics and sub-tropical regions. This is because transmission to humans is dependant upon the presence of specific mosquitoes (Aedes aegypti and Aedes albopictus) which require warm, damp conditions, with ample standing water, in order to breed. There is no human to human transmission.

The range of the mosquito vectors, and the size of the human population within that range, suggest that dengue infection is under-reported and that a large majority of infections are symptomless.

So why all the fuss?

Dengue is spreading. More specifically, the range of the insect vectors is increasing as the warm, wet conditions necessary for mosquito breeding are progressing further from the endemic equatorial regions owing to the effects of climate change. Aedes albopictus is already breeding in Southern Europe and there has been similar spread north of mosquito vectors in the United States. Estimates suggest that the disease might be endemic in the south of the UK by the middle of this century.

The overall mortality of dengue infection of 1% is similar to that seen during the recent Covid-19 pandemic but the higher caseload is likely to place a greater strain on the health services; the services that almost collapsed during the covid pandemic.

So what can be done?

Efforts to limit climate change are essential but are unlikely to have an appreciable effect upon a potential dengue pandemic. There is no specific treatment for dengue but there is a vaccine, containing attenuated virus, which has recently gained approval. The main weapon in preventing the spread of dengue is the control of mosquito numbers and breeding grounds. Clearing breeding grounds, improving sanitation, and lifting living standards is expensive, but it is an investment it would be wise to make.

Does antibiotic use during a flu infection worsen lung damage?

A recent study has shown that the use of antibiotic therapy during an influenza infection can damage the lung's defence against bacteria.

Antibiotic prescription for viral chest infections is unfortunately commonplace. This is partly due to clinician factors such as misdiagnosis or uncertainty, but is greatly influenced by patient pressure. Apart from the fact that such prescribing will have no beneficial effects upon the clinical course of the infection, there is also the possibility of detrimental effects such as increasing microbial antibiotic resistance, so encouraging the emergence of 'superbugs', and weakening the patient's defences to further bacterial infection. The study focused upon the latter.

Asclepius

We are poisoning our environment and everything in it - including ourselves.

A Contaminated World

PFAS: The Forever Chemicals That Will Outlast Us All

Microplastics: Part of Us, Whether We Like It or Not

Pesticides: The Price Paid by Those Who Grow Our Food

What We Are Doing to the Rest of Life?

A Crisis of Structural Inequality

What Needs to Change?

Further Reading

When War Becomes a Public Health Crisis: The Global Health Consequences of the Conflict in Iran

Direct Casualties and the Collapse of Healthcare in the Region

The Dubai Bottleneck: When Global Aid Grinds to a Halt

The Strait of Hormuz: A Chokepoint for Health as Well as Oil

A Polycrisis for the World’s Most Vulnerable

What This Means for the UK

Inequality Is Not Incidental — It Is the Architecture

Conclusion

References

Forever Chemicals, Accelerated Ageing, and Why Your Postcode Matters

Resources:

Videos:

From Coast to Clinic

Cold Homes, Cold Bodies.

Health Inequality in Cancer Care.

The Inverse Care Law.

The UK loses its measles elimination status.

Beetroot and High Blood Pressure.

The Creeping Cold has fingers.

New Flu strain emerging.

Infectious diseases watch.

Resources

Keeping people warm:

Health, Aging and Vulnerability.

Diplopia After COVID-19: A Cautious Neuro-Ophthalmic Perspective

Long Covid and diplopia — key clinical points

From Coast to Clinic: Tackling Cancer’s Postcode Lottery

The quiet geography of expertise

Training as redistribution, not just expansion

Early diagnosis still matters most

A moral, not merely managerial, challenge

The Renin-Angiotensin-Aldosterone System - An Overview.

Summary.

Pathway.

Physiological Effects.

Cardiovascular.

Renal.

Neurohormonal.

Cellular Mechanisms.

Clinical Relevance.

Suggested Reading.

Flu Season Update — What the H3N2 “Subclade K” Means

Winter's Shadowy Fingers

Cold Homes, Cold Bodies

Deprivation as a Multisystem Disease

Why are there more deaths in winter?

Vulnerable populations.

Long COVID: what we understand better now.

Antimicrobial drug resistance.

New Flu strain emerging.

Resources:

Keeping People Warm

Health, Ageing & Vulnerability

Small actions matter.

Short Days, Long Nights and Lonely People

Tinsel Tendinitis: Surge in Minor Upper-Limb Injuries from Decorating

The Return of Christmas Tree Syndrome

Viral Round-Up: RSV and Influenza Rising Earlier Than Expected

Seasonal Affective Disorder Peaks — but Christmas Lights Help

Cold-Weather Cardiology: “Shoveller’s Heart” Back Again

Alcohol-Related Attendances Spike Post-Christmas Parties

The Health Benefits of Kindness

Homelessness at Christmas: Cold Nights, Warm Hearts

If you’d like to help

Support people experiencing homelessness

If you’re worried about someone sleeping rough

Cold weather emergency support

Local kindness

Fortified Wines - Their Effects Upon Health.

Why Fortified Wines Hit Harder Than You Think.