Abuja, Nigeria — Cholera is surging in Nigeria, health officials said this week, with the number of cases and deaths increasing by more than 200% this year.

The Nigerian Center for Disease Control said in this week’s epidemiological report that the country has recorded nearly 11,000 cases of cholera this year — a 220% increase compared with the same point in 2023.

The report said fatalities over the same periods have increased from 106 to 359 — a rise of 239%.

The state of Lagos accounted for 43% of the nation’s cases, while Kano, Katsina, Jigawa and Borno also recorded significant numbers.

Last month, the worst flooding in 30 years ravaged conflict-ridden Borno state, worsening an already dire humanitarian situation there. Hundreds of thousands of people were displaced and moved to overcrowded camps.

“We’re now facing a significant public health challenge that demands urgent attention and action,” Borno Health Commissioner Baba Mallam Gana said. “This outbreak is concerning, especially in the aftermath of a flooding incident.

“The floods have created ideal conditions for the spread of waterborne diseases like cholera by contaminating water sources and disrupting sanitation systems,” he said.

Cholera is a bacterial disease, usually spread by contaminated food or water. It causes severe diarrhea and dehydration.

The Nigerian CDC launched a national emergency response along with state authorities to bring numbers down, but the number of cases is surging, Gana said.

“We must now act swiftly to prevent further spread of this disease,” he said.

As part of the flood intervention responses, Gana said, the Borno public health emergency center was converted into a control center to coordinate surveillance, risk communication and community engagement, as well as essential health services, infection prevention, water sanitation and hygiene.

Nigeria’s Health Ministry is sending hundreds of thousands of doses of cholera vaccine to the affected areas. Borno alone received 300,000 doses, and state authorities say the vaccine has been distributed to camps for those displaced by the floods.
…

new york — Humanity is hitting the upper limit of life expectancy, according to a new study.

Advances in medical technology and genetic research — not to mention larger numbers of people making it to age 100 — are not translating into marked jumps in lifespan overall, according to researchers who found shrinking longevity increases in countries with the longest-living populations.

“We have to recognize there’s a limit” and perhaps reassess assumptions about when people should retire and how much money they’ll need to live out their lives, said S. Jay Olshansky, a University of Illinois-Chicago researcher who was lead author of the study published Monday by the journal Nature Aging.

Mark Hayward, a University of Texas researcher not involved in the study, called it “a valuable addition to the mortality literature.”

“We are reaching a plateau” in life expectancy, he agreed. It’s always possible some breakthrough could push survival to greater heights, “but we don’t have that now,” Hayward said.

What is life expectancy?

Life expectancy is an estimate of the average number of years a baby born in a given year might expect to live, assuming death rates at that time hold constant. It is one of the world’s most important health measures, but it is also imperfect: It is a snapshot estimate that cannot account for deadly pandemics, miracle cures or other unforeseen developments that might kill or save millions of people.

In the new research, Olshansky and his research partners tracked life expectancy estimates for the years 1990 to 2019, drawn from a database administered by the Max Planck Institute for Demographic Research. The researchers focused on eight of the places in the world where people live the longest — Australia, France, Hong Kong, Italy, Japan, South Korea, Spain and Switzerland.

The U.S. doesn’t even rank in the top 40. But is also included “because we live here” and because of past, bold estimates that life expectancy in the U.S. might surge dramatically in this century, Olshansky said.

Who lives the longest?

Women continue to live longer than men and life expectancy improvements are still occurring — but at a slowing pace, the researchers found. In 1990, the average amount of improvement was about 2½ years per decade. In the 2010s, it was 1½ years — and almost zero in the U.S.

The U.S. is more problematic because it is harder hit by a range of issues that kill people even before they hit old age, including drug overdoses, shootings, obesity and inequities that make it hard for some people to get sufficient medical care.

But in one calculation, the researchers estimated what would happen in all nine places if all deaths before age 50 were eliminated. The increase at best was still only 1½ years, Olshansky said.

Eileen Crimmins, a University of Southern California gerontology expert, said in an email that she agrees with the study’s findings. She added, “For me personally, the most important issue is the dismal and declining relative position of the United States.”

Why life expectancy may not be able to rise forever

The study suggests that there’s a limit to how long most people live, and we’ve about hit it, Olshansky said.

“We’re squeezing less and less life out of these life-extending technologies. And the reason is, aging gets in the way,” he said.

It may seem common to hear of a person living to 100 — former U.S. President Jimmy Carter hit that milestone last week. In 2019, a little over 2% of Americans made it to 100, compared with about 5% in Japan and 9% in Hong Kong, Olshansky said.

It’s likely that the ranks of centenarians will grow in the decades ahead, experts say, but that’s because of population growth. The percentage of people hitting 100 will remain limited, likely with fewer than 15% of women and 5% of men making it that long in most countries, Olshansky said.
…

GENEVA  — Billions of people are facing a future of water scarcity as global rivers dry up, glaciers melt, and intense heat and other extreme weather events caused by climate change create critical changes in water availability around the world, according to the State of Global Water Resources report issued Monday by the World Meteorological Organization. 

“Water is the canary in the coal mine of climate change,” said Celeste Saulo, WMO secretary-general. “Water is the basis of life on this planet, but it can also be a force of destruction.”  

She told journalists at a briefing in Geneva that “water is becoming increasingly unpredictable, what we call an erratic hydrological cycle, leading to extreme rainfall, sudden floods, and severe droughts.”   

“Climate change is one of the causes of these extreme behaviors,” she said, noting that these extreme events “wreak a heavy toll on lives, ecosystems and economies.” 

“Melting ice and glaciers threaten long-term water security for many millions of people. And yet we are not taking the necessary urgent action,” she warned. 

“To mitigate the impact of such potential catastrophes, we must gather reliable data. After all, we cannot appropriately manage what we do not measure,” she said, adding that scientific data gathered by WMO “indicates the situation will worsen over the coming years.” 

The report finds 2023 was the driest year for global rivers in 33 years, marking the last of five consecutive years of widespread below-normal conditions for river flows, thereby reducing “the amount of water available for communities, agriculture and ecosystems, further stressing global water supplies.” 

It notes that 2023 was also the second consecutive year in which all regions in the world with glaciers reported ice loss, the year in which “glaciers suffered the largest mass loss ever registered in 50 years.” 

“The glaciers are retreating rapidly,” said Stefan Uhlenbrook, WMO director of hydrology, water and cryosphere. “The latest data for this year actually shows that in the Swiss Alps, at least, it has been continuing and more glaciers have been reduced. 

“If a glacier is melting more and more, that means more water becomes available downstream,” he said. “However, if the glacier is gone in a few more decades, it will be very dramatic because then the summer high flows from the melting glaciers will disappear because there is no storage anymore. 

“If the glacier disappears, that changes completely the hydrological regime. It changes completely the conditions for ecosystems. It changes completely the availability of water for farmers. So, it has really severe consequences,” he said. 

One manifestation of this was seen last week when Switzerland and Italy redrew part of their shared border in the Alps because melting glaciers due to climate change had moved their long-defined national border. 

The report says 3.6 billion people currently face inadequate access to water at least one month a year, and this is expected to increase to more than 5 billion by 2050.   

While no region is spared from disastrous hydrological extreme events, it says floods and droughts affected Africa most in terms of human casualties. The report says major flooding in Libya due to two collapsed dams, triggered by Storm Daniel, killed more than 11,000 people. Floods also impacted the Greater Horn of Africa, Democratic Republic of Congo, Rwanda, Mozambique and Malawi. 

“Jordan is one of the most water scarce countries because of the high population density and the very arid conditions,” Uhlenbrook observed, adding that many parts of Asia, North and South America, and Russia among other regions are “very vulnerable to the changes we see from climate change.” 

“We see the increasing variability of the hydrological cycle causing tension and stress and providing the source of conflict in many parts of the world,” he said. 

The WMO report is calling for urgent action and international cooperation to address the scarce water issues. It says cooperation through data sharing and building of trust between nations is critical for managing shared water resources. 

“We must fill the gaps in our understanding. We need to expand our hydrological monitoring, especially in regions where data is scarce. We cannot afford blind spots when it comes to our water resources,” WMO chief Saulo said. “I urge nations to invest in hydrological monitoring and commit to sharing this critical data, because without it, we are navigating without a map.” 

She underscored the importance of early warning systems in addressing climate-induced disasters such as floods and extreme weather events. “These global challenges transcend borders and conflicts because water is once again the basis of life on Earth, so we must work together to address the water issues,” she said. 
…

CAPE CANAVERAL, Fla. — A spacecraft blasted off Monday to investigate the scene of a cosmic crash. 

The European Space Agency’s Hera spacecraft rocketed away on a two-year journey to the small, harmless asteroid rammed by NASA two years ago in a dress rehearsal for the day a killer space rock threatens Earth. Launched by SpaceX from Cape Canaveral, it’s the second part of a planetary defense test that could one day help save the planet. 

The 2022 crash by NASA’s Dart spacecraft shortened Dimorphos’ orbit around its bigger companion, demonstrating that if a dangerous rock was headed our way, there’s a chance it could be knocked off course with enough advance notice. 

Scientists are eager to examine the impact’s aftermath up close to know exactly how effective Dart was and what changes might be needed to safeguard Earth in the future. 

“The more detail we can glean the better as it may be important for planning a future deflection mission should one be needed,” University of Maryland astronomer Derek Richardson said before launch. 

Researchers want to know whether Dart — short for Double Asteroid Redirection Test — left a crater or perhaps reshaped the 150-meter (500-foot) asteroid more dramatically. It looked something like a flying saucer before Dart’s blow and may now resemble a kidney bean, said Richardson, who took part in the Dart mission and is helping with Hera. 

Dart’s wallop sent rubble and even boulders flying off Dimorphos, providing an extra kick to the impact’s momentum. The debris trail extended more than 10,000 kilometers (6,200 miles) into space for months. 

Some boulders and other debris could still be hanging around the asteroid, posing a potential threat to Hera, said flight director Ignacio Tanco. 

“We don’t really know very well the environment in which we are going to operate,” said Tanco. “But that’s the whole point of the mission is to go there and find out.” 

European officials describe the $400 million (363 million euro) mission as a “crash scene investigation.” 

Hera “is going back to the crime site and getting all the scientific and technical information,” said project manager Ian Carnelli. 

Carrying a dozen science instruments, the small car-sized Hera will need to swing past Mars in 2025 for a gravity boost, before arriving at Dimorphos by the end of 2026. It’s a moonlet of Didymos, Greek for twin, a fast-spinning asteroid that’s five times bigger. At that time, the asteroids will be 195 million kilometers (120 million miles) from Earth. 

Controlled by a flight team in Darmstadt, Germany, Hera will attempt to go into orbit around the rocky pair, with the flyby distances gradually dropping from 30 kilometers (18 miles) all the way down to 1 kilometer (a half-mile). The spacecraft will survey the moonlet for at least six months to ascertain its mass, shape and composition, as well as its orbit around Didymos. 

Before the impact, Dimorphos circled its larger companion from 1,189 meters out. Scientists believe the orbit is now tighter and oval-shaped, and that the moonlet may even be tumbling. 

Two shoebox-sized Cubesats will pop off Hera for even closer drone-like inspections, with one of them using radar to peer beneath the moonlet’s boulder-strewn surface. Scientists suspect Dimorphos was formed from material shed from Didymos. The radar observations should help confirm whether Didymos is indeed the little moon’s parent. 

The Cubesats will attempt to land on the moonlet once their survey is complete. If the moonlet is tumbling, that will complicate the endeavor. Hera may also end its mission with a precarious touchdown, but on the larger Didymos. 

Neither asteroid poses any threat to Earth — before or after Dart showed up. That’s why NASA picked the pair for humanity’s first asteroid-deflecting demo. 

Leftovers from the solar system’s formation 4.6 billion years ago, asteroids primarily orbit the sun between Mars and Jupiter in what’s known as the main asteroid belt, where millions of them reside. They become near-Earth objects when they’re knocked out of the belt and into our neck of the woods. 

NASA’s near-Earth object count currently tops 36,000, almost all asteroids but also some comets. More than 2,400 of them are considered potentially hazardous to Earth. 
…

Washington — The U.S. Supreme Court declined on Monday to hear a bid by President Joe Biden’s administration to enforce in Texas federal guidance requiring hospitals to perform abortions if needed to stabilize a patient’s emergency medical condition.  

The justices turned away the Justice Department’s appeal of a lower court’s decision that halted enforcement of the guidance in Texas, where a Republican-backed near-total ban on abortion is in effect, and against members of two anti-abortion medical associations.  

The Biden administration issued the guidance in July 2022 to protect access to abortion after the Supreme Court’s conservative majority the previous month overturned the landmark 1973 Roe v. Wade ruling that had legalized abortion nationwide.  

The guidance reminded healthcare providers across the country of their obligations under a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA) to ensure Medicare-participating hospitals offer emergency care stabilizing patients regardless of their ability to pay. Medicare is the government healthcare program for the elderly. Hospitals that violate EMTALA risk losing Medicare funding.  

The guidance made clear that under that law physicians must provide a woman an abortion if needed to resolve a medical emergency and stabilize the patient even in states where the procedure is banned, and that the measure preempts state bans that offer no exceptions for medical emergencies or with exceptions that are too narrow.

Texas law prohibits abortions unless the pregnancy places the woman at risk of death or “substantial impairment of a major bodily function.”

Republican-governed Texas and two anti-abortion medical associations – the American Association of Pro-Life Obstetricians & Gynecologists and the Christian Medical & Dental Associations, sued the administration, arguing that the guidance unlawfully purports to compel healthcare providers to perform abortions.

U.S. District Judge James Wesley Hendrix in 2022 blocked enforcement of the guidance, finding that it is an unlawful interpretation of the EMTALA statute, and would allow abortions beyond what is permitted by Texas law.

The New Orleans-based 5th U.S. Circuit Court of Appeals on Jan. 2 upheld Hendrix’s decision, ruling that “EMTALA does not mandate any specific type of medical treatment, let alone abortion.” The 5th Circuit’s decision came a month after the top court in Texas ruled against a woman who was seeking an emergency abortion of her non-viable pregnancy.  

Abortion rights advocates have challenged the scope of abortion ban exceptions in several states due to uncertainty, including among physicians, about what medical emergencies during pregnancy would permit health providers to perform the procedure.

In a similar case in June, the Supreme Court permitted, for the time being, abortions to be performed in Idaho when pregnant women are facing medical emergencies.

The Supreme Court’s 6-3 ruling in the Idaho case revived a federal judge’s decision that EMTALA takes precedence over Idaho’s Republican-backed near-total abortion ban when the two conflict. While the justices lifted a block they had placed on the judge’s ruling in the case, they did not resolve the dispute on its merits, opting instead to dismiss it as “improvidently granted.”
…

STOCKHOLM — The Nobel Prize in physiology or medicine was awarded Monday to Americans Victor Ambros and Gary Ruvkun for their discovery of microRNA, tiny pieces of genetic material that alter how genes work at the cellular level and could lead to new ways of treating cancer. 

The Nobel Assembly at the Karolinska Institute, which awarded the prize, said the duo’s discovery is “proving to be fundamentally important” in understanding how organisms develop and function. 

MicroRNA have opened up scientists’ approaches to treating diseases like cancer by helping to regulate how genes work at the cellular level, according to Dr. Claire Fletcher, a lecturer in molecular oncology at Imperial College London. 

Fletcher said microRNA provide genetic instructions to tell cells to make new proteins and that there were two main areas where microRNA could be helpful: in developing drugs to treat diseases and in serving as biomarkers. 

“MicroRNA alters how genes in the cell work,” said Fletcher, who is an outside expert not associated with the Nobel prize. 

“If we take the example of cancer, we’ll have a particular gene working overtime, it might be mutated and working in overdrive,” she said. “We can take a microRNA that we know alters the activity of that gene and we can deliver that particular microRNA to cancer cells to stop that mutated gene from having its effect.” 

Ambros performed the research that led to his prize at Harvard University. He is currently a professor of natural science at the University of Massachusetts Medical School. Ruvkun’s research was performed at Massachusetts General Hospital and the Harvard Medical School, where he’s a professor of genetics, said Thomas Perlmann, Secretary-General of the Nobel Committee. 

Perlmann said he spoke to Ruvkun by phone shortly before the announcement. 

“It took a long time before he came to the phone and sounded very tired, but he quite rapidly was quite excited and happy, when he understood what it was all about,” Perlmann said. 

Last year, the Nobel Prize in Physiology or Medicine went to Hungarian-American Katalin Karikó and American Drew Weissman for discoveries that enabled the creation of mRNA vaccines against COVID-19 that were critical in slowing the pandemic. 

The prize carries a cash award of ($1 million from a bequest left by the prize’s creator, Swedish inventor Alfred Nobel. 

The announcement launched this year’s Nobel prizes award season. 

Nobel announcements continue with the physics prize on Tuesday, chemistry on Wednesday and literature on Thursday. The Nobel Peace Prize will be announced Friday and the Nobel Memorial Prize in Economic Sciences on Oct. 14. 

The laureates are invited to receive their awards at ceremonies on Dec. 10, the anniversary of Nobel’s death. 

Fletcher said there are clinical trials ongoing to see how microRNA approaches might help treat skin cancer, but that there aren’t yet any drug treatments approved by drug regulators. She expected that might happen in the next five to 10 years. 

She said microRNA represent another way of being able to control the behavior of genes to treat and track various diseases. 

“The majority of therapies we have at the moment are targeting proteins in cells,” she said. “If we can intervene at the microRNA level, it opens up a whole new way of us developing medicines and us controlling the activity of genes whose levels might be altered in diseases.” 
…

Washington — SpaceX’s workhorse Falcon 9 rocket can return to flight for a mission planned for Monday to launch the European Space Agency’s Hera spacecraft from Florida, the U.S. Federal Aviation Administration said Sunday.

Elon Musk’s company, which has engaged in a public quarrel with the FAA in recent weeks, said Sunday it is planning the liftoff for 10:52 a.m. ET (1452 GMT) from Cape Canaveral.

“The SpaceX Falcon 9 vehicle is authorized to return to flight only for the planned Hera mission scheduled to launch on Oct. 7 from Cape Canaveral Space Force Station in Florida,” the FAA said Sunday.

The agency said it has “determined that the absence of a second stage reentry for this mission adequately mitigates the primary risk to the public in the event of a recurrence of the mishap experienced with the Crew-9 mission.”

The FAA on Sept. 30 said SpaceX must investigate why the second stage of its Falcon 9 malfunctioned after a NASA astronaut mission, grounding the launch vehicle for the third time in three months. The malfunction caused the booster to fall into a region of the Pacific Ocean outside of the designated safety zone that the FAA approved for the mission.

Hera is set to study the effects of the 2022 impact that NASA’s DART spacecraft had with the asteroid Dimorphos in a test of a planetary defense system — the first time a spacecraft managed to alter the motion of any celestial body. Dimorphos is a moonlet of Didymos, which is defined as a near-Earth asteroid.

The Hera mission is expected to provide data for future asteroid deflection missions with an eye toward redirecting objects that could pose a future collision threat for Earth.

Falcon 9 launched DART in 2021.

The FAA on Sept. 17 proposed fining SpaceX $633,000 for violating agency rules ahead of two 2023 Falcon 9 launches.

“They’ve been around 20 years, and I think they need to operate at the highest level of safety,” FAA Administrator Mike Whitaker said on Sept. 24.

SpaceX took issue with Whitaker’s comments, saying the company is the “safest, most reliable launch provider in the world, and is absolutely committed to safety in all operations.”

Whitaker defended the FAA’s decision to delay a planned September Starship 5 launch, noting that SpaceX failed to complete a timely sonic boom analysis as required. The FAA has said it does not expect a license determination before late November for that launch.

Musk has criticized FAA leaders over the agency’s proposed fine and called for Whitaker’s resignation.

In February 2023, the FAA proposed a $175,000 penalty against SpaceX for failing to submit some safety data to the agency prior to an August 2022 launch of Starlink satellites. The company paid that penalty.
…

KIGALI — Rwanda said Sunday it had begun administering vaccine doses against the Marburg virus to try to combat an outbreak of the Ebola-like disease in the east African country, where it has so far killed 12 people. 

“The vaccination is starting today immediately,” Health Minister Sabin Nsanzimana said at a news conference in the capital Kigali. 

He said the vaccinations would focus on those “most at risk, most exposed health care workers working in treatment centers, in the hospitals, in ICU, in emergency, but also [in] the close contacts of the confirmed cases.” 

The country has already received shipments of the vaccines including from the Sabin Vaccine Institute. 

Rwanda’s first outbreak of the viral hemorrhagic fever was detected in late September, with 46 cases and 12 deaths reported since then. Marburg has a fatality rate as high as 88%. 

Marburg symptoms include high fever, severe headaches and malaise within seven days of infection and later severe nausea, vomiting and diarrhea. 

It is transmitted to humans by fruit bats and then spreads through contact with the bodily fluids of those infected. Neighboring Uganda has suffered several outbreaks in the past. 

“We believe that with vaccines, we have a powerful tool to stop the spread of this virus,” the minister said. 
…

GOMA, Congo — Congolese authorities on Saturday began vaccinations against mpox, nearly two months after the disease outbreak that spread from Congo to several African countries and beyond was declared a global emergency by the World Health Organization.

The 265,000 doses donated to Congo by the European Union and the United States were rolled out in the eastern city of Goma in North Kivu province, where hospitals and health workers have been overstretched, struggling to contain the new and possibly more infectious strain of mpox.

Congo, with about 30,000 suspected mpox cases and 859 deaths, accounts for more than 80% of all the cases and 99% of all the deaths reported in Africa this year. All the Central African nation’s 26 provinces have recorded mpox cases.

Although most mpox infections and deaths recorded in Congo are in children under age 15, the doses being administered are only meant for adults and will be given to at-risk populations and frontline workers, Health Minister Roger Kamba said this week.

“Strategies have been put in place by the services in order to vaccinate all targeted personnel,” Muboyayi ChikayaI, the minister’s chief of staff, said as he kicked off the vaccination.

At least 3 million doses of the vaccine approved for use in children are expected from Japan in the coming days, Kamba said.

Mostly undetected for years

Mpox, also known as monkeypox, had been spreading mostly undetected for years in Africa before the disease prompted the 2022 global outbreak that saw wealthy countries quickly respond with vaccines from their stockpiles while Africa received only a few doses despite pleas from its governments.

However, unlike the global outbreak in 2022 that was overwhelmingly focused in gay and bisexual men, mpox in Africa is now being spread via sexual transmission as well as through close contact among children, pregnant women and other vulnerable groups, Dr. Dimie Ogoina, the chair of WHO’s mpox emergency committee, recently told reporters.

More than 34,000 suspected cases and 866 deaths from the virus have been recorded across 16 countries in Africa this year. That is a 200% increase compared to the same period last year, the Africa Centers for Disease Control and Prevention said.

But access to vaccines remains a challenge.

The continent of 1.4 billion people has only secured commitment for 5.9 million doses of mpox vaccines, expected to be available from October through December, Dr. Jean Kaseya, head of the Africa CDC, told reporters last week. Congo remains a priority, he said.

Province at risk of outbreak

At the vaccination drive in Goma, Dr. Jean Bruno Kibunda, the WHO representative, warned that North Kivu province is at a risk of a major outbreak due to the “promiscuity observed in the camps” for displaced people, as one of the world’s biggest humanitarian crises caused by armed violence unfolds there.

The news of the vaccination program brought relief among many in Congo, especially in hospitals that had been struggling to manage the outbreak.

“If everyone could be vaccinated, it would be even better to stop the spread of the disease,” said Dr. Musole Mulambamunva Robert, the medical director of Kavumu Hospital, one of the mpox treatment centers in eastern Congo.

Eastern Congo has been beset by conflict for years, with more than 100 armed groups vying for a foothold in the mineral-rich area near the border with Rwanda. Some have been accused of carrying out mass killings. 
…

wellington, new zealand — A magnitude 5.7 earthquake struck near New Zealand’s capital city of Wellington, government seismic monitor GeoNet said on Sunday, but initial reports indicated there were no injuries or significant damage. 

The quake hit at 5:08 a.m. on Sunday (1608 GMT on Saturday) striking 25 kilometers (15.5 miles) west of Wellington at a focal depth of 30 km (19 miles). 

GeoNet said more than 37,000 people had reported feeling the shake, some as far north as Auckland in the North Island. 

GeoNet said there was no tsunami warning as a result of the quake. 

A spokesperson for Fire and Emergency New Zealand said the service had not received any calls for assistance. 

Government-owned Radio New Zealand said there were no reports of significant damage or reports of injury. 
…

KAMITUGA, Congo — It’s been four months since Sifa Kunguja recovered from mpox, but as a sex worker, she said, she’s still struggling to regain clients, with fear and stigma driving away people who’ve heard she had the virus. 

“It’s risky work,” Kunguja, 40, said from her small home in eastern Congo. “But if I don’t work, I won’t have money for my children.”

Sex workers are among those hardest-hit by the mpox outbreak in Kamituga, where some 40,000 of them are estimated to reside — many single mothers driven by poverty to this mineral-rich commercial hub where gold miners comprise the majority of the clientele. Doctors estimate 80% of cases here have been contracted sexually, though the virus also spreads through other kinds of skin-to-skin contact.

Sex workers say the situation threatens their health and livelihoods. Health officials warn that more must be done to stem the spread — with a focus on sex workers — or mpox will creep deeper through eastern Congo and the region.

Mpox causes mostly mild symptoms such as fever and body aches, but serious cases can mean prominent, painful blisters on the face, hands, chest and genitals.

Kunguja and other sex workers insist that despite risks of reinfection or spreading the virus, they have no choice but to keep working. Sex work isn’t illegal in Congo, though related activities such as solicitation are. Rights groups say possible legal consequences and fear of retribution — sex workers are subject to high rates of violence including rape and abuse — prevent women from seeking medical care. That can be especially detrimental during a public health emergency, according to experts.

Health officials in Kamituga are advocating for the government to shutter nightclubs and mines and compensate sex workers for lost business.

Not everyone agrees. Local officials say they don’t have resources to do more than care for those who are sick, and insist it’s sex workers’ responsibility to protect themselves.

Kamituga Mayor Alexandre Bundya M’pila told The Associated Press that the government is creating awareness campaigns but lacks money to reach everyone. He also said sex workers should look for other jobs, without providing examples of what might be available.

Sex work a big part of economy

Miners stream into Kamituga by the tens of thousands. The economy is centered on the mines: Buyers line streets, traders travel to sell gold, small businesses and individuals provide food and lodging, and the sex industry flourishes.

Nearly a dozen sex workers spoke to AP. They said well over half their clients are miners.

The industry is well organized, according to the Kenyan-based African Sex Workers Alliance, composed of sex worker-led groups. The alliance estimates that 13% of Kamituga’s 300,000 residents are sex workers.

The town has 18 sex-worker committees, the alliance said, with a leadership that tries to work with government officials, protect and support colleagues, and advocate for their rights.

But sex work in Congo is dangerous. Women face systematic violence that’s tolerated by society, according to a report by UMANDE, a local sex-worker rights group.

Many women are forced into the industry because of poverty or because, like Kunguja, they’re single parents and must support their families.

Getting mpox can put sex workers out of business

The sex workers who spoke to AP described mpox as an added burden. Many are terrified of getting the virus — it means time away from work, lost income and perhaps losing business altogether.

Those who recover are stigmatized, they said. Kamituga is a small place, where most everyone knows one another. Neighbors whisper and tell clients when someone is sick — people talk and point.

Since contracting mpox in May, Kunguja said she’s gone from about 20 clients daily to five. She’s been supporting her 11 children through sex work for nearly a decade but said she now can’t afford to send them to school. To compensate, she’s selling alcohol by day, but it’s not enough.

Experts say information and awareness are key

Disease experts say a lack of vaccines and information makes stemming the spread difficult.

Some 250,000 vaccines have arrived in Congo, but it’s unclear when any will get to Kamituga. Sex workers and miners are among those slated to receive them first.

Community leaders and aid groups are trying to teach sex workers about protecting themselves and their clients via awareness sessions where they discuss signs and symptoms. They also press condom use, which they say isn’t widespread enough in the industry.

Sex workers told AP that they insist on using condoms when they have them, but that they simply don’t have enough.

Kamituga’s general hospital gives them boxes of about 140 condoms every few months. Some sex workers see up to 60 clients a day — for less than $1 a person. Condoms run out, and workers say they can’t afford more.

Dr. Guy Mukari, an epidemiologist working with the National Institute of Biomedical Research in Congo, noted that the variant running rampant in Kamituga seems more susceptible to transmission via sex, making for a double whammy with the sex industry.
…

ASHEVILLE, North Carolina — Nearly a week after Hurricane Helene brought devastation to western North Carolina, a shiny stainless steel tanker truck in downtown Asheville attracted residents carrying 19-liter containers, milk jugs and buckets to fill with what has become a desperately scare resource — drinking water.

Flooding tore through the city’s water system, destroying so much infrastructure that officials said repairs could take weeks. To make do, Anna Ramsey arrived Wednesday with her two children, who each left carrying plastic bags filled with 7.6 liters of water.

“We have no water. We have no power. But I think it’s also been humbling,” Ramsey said.

Helene’s path through the Southeast left a trail of power outages so large the darkness was visible from space. Tens of trillions of liters of rain fell and more than 200 people were killed, making Helene the deadliest hurricane to hit the mainland U.S. since Katrina in 2005. Hundreds of people are still unaccounted for, and search crews must trudge through knee-deep debris to learn whether residents are safe.

It also damaged water utilities so severely and over such a wide inland area that one federal official said the toll “could be considered unprecedented.” As of Thursday, about 136,000 people in the Southeast were served by a nonoperational water provider and more than 1.8 million were living under a boil water advisory, according to the Environmental Protection Agency.

Western North Carolina was especially hard hit. Officials are facing a difficult rebuilding task made harder by the steep, narrow valleys of the Blue Ridge Mountains that during a more typical October would attract throngs of fall tourists.

“The challenges of the geography are just fewer roads, fewer access points, fewer areas of flat ground to stage resources” said Brian Smith, acting deputy division director for the EPA’s water division in the Southeast.

After days without water, people long for more than just a sponge bath.

“I would love a shower,” said Sue Riles in Asheville. “Running water would be incredible.”

The raging floodwaters of Helene destroyed crucial parts of Asheville’s water system, scouring out the pipes that convey water from a reservoir in the mountains above town that is the largest of three water supplies for the system. To reach a second reservoir that was knocked offline, a road had to be rebuilt.

Boosted output from the third source restored water flow in some southern Asheville neighborhoods Friday, but without full repairs schools may not be able to resume in-person classes, hospitals may not restore normal operations, and the city’s hotels and restaurants may not fully reopen.

Even water that’s unfit to drink is scarce. Drew Reisinger, the elected Buncombe County register of deeds, worries about people in apartments who can’t easily haul a bucket of water from a creek to flush their toilet. Officials are advising people to collect nondrinkable water for household needs from a local swimming pool.

“One thing no one is talking about is the amount of poop that exists in every toilet in Asheville,” he said. “We’re dealing with a public health emergency.”

It’s a situation that becomes more dangerous the longer it lasts. Even in communities fortunate enough to have running water, hundreds of providers have issued boil water notices indicating the water could be contaminated. But boiling water for cooking and drinking is time consuming and small mistakes can cause stomach illness, according to Natalie Exum, an assistant professor at Johns Hopkins Bloomberg School of Public Health.

“Every day that goes by, you could be exposed to a pathogen,” Exum said. “These basic services that we take for granted in our everyday lives actually do do a lot to prevent illness.”

Travis Edwards’ faucet worked immediately after the storm. He filled as many containers as he could for himself and his child, but it didn’t take long for the flow to weaken, then stop. They rationed water, switching to hand sanitizer and barely putting any on toothbrushes.

“(We) didn’t realize how dehydrated we were getting,” he said.

Federal officials have shipped millions of liters of water to areas where people also might not be able to make phone calls or switch on the lights.

Power has been restored to about 62% of homes and businesses and 8,000 crews are out working to restore power in the hardest hit parts of North Carolina, federal officials said Thursday. In 10 counties, about half of the cell sites are still down.

The first step for some utilities is simply figuring out how bad the damage is, a job that might require EPA expertise in extreme cases. Ruptured water pipes are a huge problem. They often run beneath roads, many of which were crumpled and twisted by floodwaters.

“Pretty much anytime you see a major road damaged, there’s a very good chance that there’s a pipe in there that’s also gotten damaged,” said Mark White, drinking water global practice leader at the engineering firm CDM Smith.

Generally, repairs start at the treatment plant and move outward, with fixes in nearby big pipes done first, according to the EPA.

“Over time, you’ll gradually get water to more and more people,” White said.

Many people are still missing, and water repair employees don’t typically work around search and rescue operations. It takes a toll, according to Kevin Morley, manager of federal relations with the American Water Works Association.

“There’s emotional support that is really important for all the people involved. You’re seeing people’s lives just wiped out,” he said.

Even private well owners aren’t immune. Pumps on private wells may have lost power and overtopping floodwaters can contaminate them.

There’s often a “blind faith” assumption that drinking water won’t fail. In this case, the technology was insufficient, according to Craig Colten. Before retiring to Asheville, he was a professor in Louisiana focused on resilience to extreme weather. He hopes Helene will prompt politicians to spend more to ensure infrastructure withstands destructive storms.

And climate change will only make the problem more severe, said Erik Olson, a health and food expert at the nonprofit Natural Resources Defense Council.

“I think states and the federal government really need to step back and start looking at how we’re going to prepare for these extreme weather events that are going to be occurring and recurring every single year,” he said.

Edwards has developed a system to save water. He’ll soap dirty dishes and rinse them with a trickle of water with bleach, which is caught and transferred to a bucket — useable for the toilet.

Power and some cell service have returned for him. And water distribution sites have guaranteed some measure of normalcy: Edwards feels like he can start going out to see friends again.

“To not feel guilty about using more than a cup of water to, like, wash yourself … I’m really, really grateful,” he said. 
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