"The malicious incompetence that resulted in hundreds of thousands of unnecessary deaths starts at the top, with the former President and his enablers" -Rep. Ted Lieu

 

“After Former White House coronavirus response coordinator Dr. Deborah Birx said this weekend that hundreds of thousands of Covid-19 deaths in the United States could have been avoided had the previous administration responded more quickly and purposefully, Democratic Rep. Ted Lieu of California slammed the official for enabling former President Donald Trump's ‘malicious incompetence.’

“During an interview featured in a CNN documentary titled Covid War: The Pandemic Doctors Speak Out, which aired Sunday, CNN chief medical correspondent Sanjay Gupta asked Birx to describe ‘how much of an impact’ she thinks it would have made had public authorities taken earlier and more decisive action to mitigate the spread of the virus.

“‘I look at it this way: The first time, we have an excuse. There were about 100,000 deaths that came from that original surge,’ Birx told Gupta. ‘All of the rest of them, in my mind, could have been mitigated or decreased substantially.’

“The national Covid-19 death toll is approaching 550,000, which means that, if Birx's assessment of the country's pandemic response is correct, more than 400,000 Americans died—and millions of loved ones suffered—unnecessarily as a result of political negligence. One journalist called the admission ‘utterly devastating.’

“Birx's acknowledgement that coronavirus cases, hospitalizations, and deaths in the United States could have been significantly lower provoked a sharp rebuke from Lieu, who criticized the former White House official for not publicly objecting to Trump's lethal mishandling of the pandemic.

“‘The malicious incompetence that resulted in hundreds of thousands of unnecessary deaths starts at the top, with the former President and his enablers,’ Lieu said in a tweet. ‘And who was one of his enablers? Dr. Birx, who was afraid to challenge his unscientific rhetoric and wrongfully praised him.’ As the Washington Post reported Saturday, ‘Last March, Birx praised Trump for being 'so attentive to the scientific literature and the details and the data' with regards to the outbreak.’

“In addition, the newspaper noted, ‘Birx had presented overly optimistic data several times,’ and she ‘also sat quietly at a news conference last April when Trump pondered whether people could be injected with disinfectant to 'knock out' the coronavirus.’

“In a Dissent article published earlier this month, historian Colin Gordon acknowledged that ‘the Trump administration's response to the Covid-19 pandemic set new standards for incompetence, defiance of basic science and public health precautions, and petty politicization of the smallest policy details.’ Nevertheless, Gordon added, ‘the administration's failures marked a difference in degree, not in kind. Deep inequities in health provision, underinvestment in public health, and indifference to the punishing inequality hardwired into our economy and our social policies all preceded Trump and—without bold action—will certainly outlast him.’ ‘An important part of this longer history,’ Gordon wrote, ‘is federalism: the abdication of national responsibility for basic social policy standards to state governments.’

“As Common Dreams reported earlier this month, a new peer-reviewed study shows that as 2020 progressed, Covid-19 incidence and death rates became higher in states led by Republican governors—an outcome the researchers attribute to diverging approaches to public health policies that affected the spread of the virus.

“‘Republican governors... were slower to adopt stay-at-home orders, if they did so at all,’ while ‘Democratic governors had longer durations of stay-at-home orders,’ the researchers wrote. In addition, they pointed out that having a Democratic governor was ‘the most important predictor of state mandates to wear face masks.’

“As Gordon noted, ‘deference to state governments—many without the capacity or the willingness to make meaningful investments in public goods and services—also has significant effects on the broader social determinants of health.’

“Gordon's observation about the relationship between policymaking and well-being dovetails with other recent research documenting how union-busting and austerity—key components of the past half-century of neo-liberalization—have worsened socio-economic inequalities, vulnerabilities, and coronavirus mortality” (Kenny Stancil, Common Dreams).

The Endangered African Elephant

 

“Humans have been over-exploiting African elephants for centuries. More than 2,000 years ago, the Roman Empire’s demand for ivory led to the extinction of genetically distinct elephant populations in northern Africa. But in recent times, population increases among southern African elephants and declines across the rest of the continent have made it hard to clearly assess how threatened the species is overall.

“I serve on a team of scientists that recently reviewed African elephants’ status for the International Union for Conservation of Nature (IUCN). We compiled data from over 400 sites across Africa, spanning 50 years of conservation efforts – and our results were grim.

“The number of African savanna elephants – the largest subspecies of elephants – has declined by 60% since 1990. And forest elephants, which the IUCN is treating as a separate species for the first time, have declined in number by over 86%. Based on our assessment, the IUCN has changed its listing from ‘vulnerable’ for all African elephants to ‘endangered’ for savanna elephants and “critically endangered” for forest elephants.

Two species

“By separating savanna and forest elephants into independent assessments, our report reveals the critical state of the more elusive forest elephants, which was obscured in previous reviews that lumped all of Africa’s elephants together. Scientific evidence for separating the species has been building over the past two decades, and many taxonomists felt this recognition was long overdue.

“Increased research on forest elephants highlights the dramatic declines these secretive giants are undergoing. Studies also show that they are among the slowest-reproducing mammals on the planet. This means that even if they receive adequate protection, their recovery will take decades.

 

Global threats, global solutions

“Scientists believe that elephant populations across Africa actually increased during the early 20th century, when nations were entrenched in global wars and consumption of ivory and other luxury items declined. After World War II, however, conspicuous consumption surged. Over-hunting for ivory drove severe declines in the number of elephants in the 1970s and 1980s.

“Thanks to interconnected global trade networks, along with porous and unregulated borders in many parts of Africa, rising ivory demand in one part of the world quickly translates into higher black market ivory prices in Africa. And these higher prices lead to poaching.

Removing elephants from an area can pave the way for converting forests and grasslands to agriculture. This cycle has led to the depletion of much of African elephants’ historic range.

“Habitat loss also brings elephants and humans closer together, leading to more human-elephant conflict. Such clashes lead to the direct loss of elephants. They also are a burden for local communities that can erode their interest in and support for conservation.

“While the scale of decline in Africa’s elephant populations is overwhelming, there are many examples of successful conservation efforts across the continent. The KAZA (Kavango-Zambezi) Trans-frontier Conservation effort, anchored by Botswana, holds the largest contiguous elephant population on the continent, and that population has experienced strong growth over the past 50 years. This success reflects government collaboration across borders and work with local communities.

“Joint international efforts to reduce the illegal ivory trade are raising awareness of the problems with ivory consumption. China banned domestic ivory trade in 2017, and concurrently ivory poaching across many elephant populations in Africa declined – including in the largest populations in Tanzania and Kenya, which were under severe pressure less than 10 years ago. The core population of forest elephants in Gabon, which declined by 80% between 2004 and 2014, has stabilized with increased government investment and reduced poaching pressure.

“Innovative work with communities in countries such as Namibia and Kenya to enhance people’s livelihoods by developing wildlife-supported economies has led to the protection of enormous tracts of lands as conservation areas. And researchers and conservationists are working to find solutions to conflicts between human activities and elephant needs that can be applied across Africa.

“By highlighting the precarious state of Africa’s two elephant species, my colleagues and I hope that this Red List Assessment can help motivate African countries with elephant populations and the international community to invest in measures that support elephant conservation.

“Elephants provide much more than just aesthetic benefits. Recent studies show forest elephants also play an important role in fighting climate change by enhancing carbon storage in central African forests, among the most important carbon reserves on the planet. The elephants disperse seeds and thin out young trees as they forage, which makes room for larger trees to thrive.

“Elephants also are a linchpin of the wildlife-based economy across Africa. And elephants, in compliment with fire, are considered to be ecosystem engineers that structure the balance between trees and grass on Africa’s savannas. Along with many other conservation experts, I see reversing their decline as a global imperative that requires concerted global support" (The Conversation).

 

George Wittemyer, Associate professor of Fish, Wildlife and Conservation Biology, Colorado State University. George Wittemyer is a member of the IUCN African Elephant Specialist Group and serves as the Chairman of the Scientific Board for Save the Elephants, a Kenyan non-governmental organization.

 

"Steven Donziger has been detained at home since August 2019, the result of a Kafkaesque legal battle stemming from his crusade on behalf of Indigenous Amazonians"

 

“Many of us will have felt the grip of claustrophobic isolation over the past year, but the lawyer Steven Donziger has experienced an extreme, very personal confinement as a pandemic arrived and then raged around him in New York City.

 

“On Sunday, Donziger reached his 600th day of an unprecedented house arrest that has resulted from a sprawling, Kafkaesque legal battle with the oil giant Chevron. Donziger spearheaded a lengthy crusade against the company on behalf of tens of thousands of Indigenous people in the Amazon rainforest whose homes and health were devastated by oil pollution, only to himself become, as he describes it, the victim of a ‘planned targeting by a corporation to destroy my life.’

“Since August 2019, Donziger has been restricted to his elegant Manhattan apartment, a clunky court-mandated monitoring bracelet he calls ‘the black claw’ continuously strapped to his left ankle. He cannot even venture into the hallway, or to pick up his mail. Exempted excursions for medical appointments or major school events for his 14-year-old son require permission days in advance. An indoor bike sits by the front door in lieu of alternative exercise options.

“‘There’s no comparison to quarantine because I can’t even go outside for a walk. If my kid is sick I can’t go to the drug store to get a prescription,’ Donziger said. ‘I never truly understood freedom until I was put in this situation.’

“The nights are hardest for Donziger, when he has to struggle to get his jeans off over the boxy tag and lie in bed next to his wife ‘with the government still there on my ankle.’ Each morning he wakes up in angst. A flag reading ‘SOS Free Steven’ sometimes flutters defiantly from the window, but efforts to end the unusually long detention have yet to be granted.

“‘It’s been brutally difficult for him,’ said Paul Paz y Miño, associate director of Amazon Watch, a conservation group allied to Donziger. ‘It’s taken a huge toll on him and his family. Chevron wants the narrative to be that he’s a criminal. The implications of that for the entire environmental movement against oil companies is terrifying.’

 

“There are moments of relief, such as sticking his head outside to taste a sunny day or talking to his growing legion of outraged supporters, which now spans Alec Baldwin, Pink Floyd singer Roger Waters and dozens of Nobel laureates. ‘There’s never a day off, I can never properly relax,’ Donziger said. ‘But you either grow or die in a situation like this. And I’ve been growing.’

“The dispute with Chevron centres upon a landmark 2011 decision by the Ecuador courts to order the company pay $9.5bn in damages to people blighted by decades of polluted air and water. Chevron has never paid up, claiming ‘shocking levels of misconduct’ and fraud by Donziger and the Ecuadorian judiciary.

“But the subsequent web of events that has led to Donziger being detained and stripped of his law license is befuddling even to legal scholars. ‘Frankly, I scratch my head when I look at this case,’ said Larry Catá Backer, a professor of international law at Penn State University. ‘It is this strange multi-front battle with one extraordinary explosive development after another. It has had this magical quality to enrage everyone involved in it.’

“Donziger was first touched by the case that would consume his life as a young lawyer acting as a public defender in Washington. In 1993, he joined a legal team investigating reports of pollution in the Lago Agrio region of northern Ecuador, nestled next to the country’s border with Colombia.

 

“The oil company Texaco had carved out drilling outposts in this tract of the Amazon since the 1960s, leaving what Donziger calls ‘grotesque’ Olympic swimming pool-sized waste pits of oil. Pollution flowed freely into rivers and streams used by the Indigenous population for drinking water. Cancers of the stomach, liver and throat reportedly became more common in the region, as did childhood leukemia. ‘People there are living in a humanitarian crisis of epic proportions,’ Donziger said.

 

“A Spanish speaker, Donziger became ever more enmeshed in the case, traveling to Ecuador hundreds of times to assemble a case in behalf of local people. Despite lengthy attempts by Chevron, which bought Texaco, to block the case, the action ultimately went to trial and resulted in a historic judgement against the oil company.

“Donziger’s elation was short-lived, however, with Chevron claiming that his team ghostwrote what should have been an independent assessment and offered a $500,000 bribe to sway the judgment. Donziger denied any wrongdoing and the Ecuador supreme court later affirmed the original ruling, but Chevron has refused to pay the $9.5bn in damages.

“A US federal judge then concurred with the fraud allegations, negating the possibility of wrenching the money from Chevron in its home country, finding that Donziger conducted a ‘pattern of racketeering activity’ under statutes more commonly used to target mob bosses.

Donziger was made liable for millions of dollars in Chevron’s legal costs and the company was granted seizure of his laptop and cellphone. When he appealed this, claiming the devices contained sensitive client information, the judge, Lewis Kaplan, hit him with criminal contempt charges, upheld on appeal, that led to his house arrest.

“In one of the stranger episodes in this saga, Chevron relocated Alberto Guerra, an Ecuadorian judge, and his family to the US, paid for his health insurance and a car while meeting with him more than 50 times before he provided testimony that Donziger discussed the bribe with him at a Quito restaurant. Guerra has since admitted that his testimony was exaggerated in parts, untrue in others.

“This deception, the unprecedented length of detention for a misdemeanor charge, legal disbarment and personal financial wipeout has fueled a sense of persecution in Donziger. Kaplan’s conduct, Donziger said, has been an ‘abomination, unethical and abusive. I never thought this could happen in the US.’ Other lawyers have voiced more measured concerns over Kaplan. Chevron has ‘captured’ the judge, Donziger said, and now the oil company seems omnipresent in his fate.

“His contempt charge will be heard by Judge Loretta Preska, who was on the advisory board of the New York chapter of the Federalist Society, who took the unusual step of appointing a law firm that has previously done work for Chevron, Seward & Kissel, to prosecute Donziger after the department of justice declined to take the case. ‘Why am I being tried by a Chevron-connected judge and prosecuted by a Chevron-connected lawyer? It’s just wrong,’ Donziger said. ‘This is all part of a plan concocted by Chevron to dismantle my life. They want to do this to avoid paying up and to turn me into a weapon of intimidation against the whole legal profession.’

“Christiana Ochoa, an expert in environmental law at Indiana University, said Kaplan and Preska’s connections do not themselves prove any sort of bias, and that Kaplan’s strongly worded judgment suggests ‘not great behavior’ by Donziger. But she added that the severity of Donziger’s treatment is ‘odd’ and that questions remain over the conflict of interest in his prosecution.

“‘Certainly it’s very important to corporations like Chevron to protect themselves from liability from ecological harms,’ she said. ‘They’ve refused to apologize to the victims. They don’t want any chink in the armor.’

“A Chevron spokesman said an international tribunal has confirmed the Ecuadorian decision was ‘fraudulent’ and he denied the company has persecuted its long-time adversary. ‘Donziger has no one to blame but himself for his problems,’ the spokesman said. ‘The court initiated the pending criminal case against him. Chevron is not involved in that case.’

 

“In Donziger’s eyes, the only real corruption has occurred in the US system, not Ecuador’s, a symptom of what he views as a ‘colonial’ mindset that has airily dismissed judgments made outside the US and obscured the ultimate protagonists of this saga, the people of Lago Agrio.

 

“Shortly before his house arrest, in the summer of 2019, Donziger toured some villages in Ecuador, discovering some people he’d previously met had died of cancer. The toxic pits remain, despite a piecemeal attempt by the government at a cleanup. ‘The human suffering is immense,’ he said. ‘It was hard to see. Ultimately, all this isn’t about me. It’s about what has happened to these people’” (Oliver Milman, The Guardian).

"Several experts are concerned that schools may be opening during an inflection point in the pandemic and are being misguided about how to do so"

 

“Late last week the Centers for Disease Control and Prevention (CDC) issued updated guidance on school reopening, saying that 3 feet, not 6 feet, of physical distancing between students was sufficient in most elementary schools—regardless of the level of community spread of COVID-19.

“At the same time that CDC officials were updating school policy, they were also warning that B117, a variant strain 50% more transmissible than the wild-type virus, would likely become the dominant strain in the United States by April. In some states, such as Florida and California, the variant, which was first detected in the United Kingdom, already accounts for 25% of cases.

“Now several experts are concerned that schools may be opening during an inflection point in the pandemic and are being misguided about how to do so.

CDC, states struggle with school openings

“Across America almost all schools closed in March and April of 2020 as the pandemic entered its first wave and peaked in places like New York City. A barrier to reopening in the fall, especially in crowded, urban school districts, was that classrooms could not accommodate students with the CDC-recommended 6 feet of physical distancing.

“The CDC said mounting evidence shows little difference in school transmission rates when students are separated by 3 or 6 feet, and it points to mounting research on student mental health, physical health, and even parental job security that shows that in-person instruction is superior for most American children and families.

“‘It's a balance,’ said Ruth Lynfield, MD, Minnesota state epidemiologist. Minnesota, along with Michigan, and North Carolina, has seen school-related B117 outbreaks spread into the community in recent weeks. ‘We are in a race to vaccinate as variants spread, and currently kids and their parents are not vaccinated, so communities need to work that much harder to make in-person school happen,’ Lynfield said. ‘That means wearing masks, and not gathering with other families outside of school.’

“Lynfield said she is seeing B117 cases increase yet at the same time sees hope via vaccination. ‘But we could have another surge,’ she said. ‘And nobody wants that.’

“Michael T. Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of CIDRAP News, is worried B117 will lead to a different level of transmission than the country has seen before. ‘We're already seeing substantial transmission,’ said Osterholm, who had supported the opening of K-8 schools given the dynamics of the wild type virus. Osterholm said the CDC recommendations were based on data done when only the original, wild-type virus was circulating, not B117. ‘What little science supports 3 versus 6 feet goes out the window here. Is 6 feet even safe?’ he said…

Elephants in the (class)room: Lunch and aerosols Room ventilation is key
 

“When CDC Director Rochelle Walensky, MD, MPH, introduced the 3-feet guidelines, she cited a study recently published in Clinical Infectious Diseases. That paper showed similar spread of the virus in Massachusetts schools that implemented masking and 3 feet of physical separation, compared with masking and 6 feet. ‘The paper is asking the wrong question,’ said Lisa Brosseau, ScD, a research consultant with CIDRAP. ‘Does 3 feet or 6 feet matter when kids are in a classroom for 6 hours?’

“Moreover, the recommendation still ignores aerosol transmission of the virus, said Donald Milton, MD, DrPH, MOH, of the University of Maryland in College Park. ‘The concept of 3 feet or 6 feet is based on droplet spray in the first place,’ Milton said. ‘If we were only talking about spray-borne transmission, that distance is important. But that's not what's happening at this point.’

“The Massachusetts study, according to Milton and Brosseau, also fails to address the real-world challenges schools present to infection control. ‘The elephant in the room is lunch,’ Milton said. ‘We know a high-risk activity is dining. People can't eat with a mask on. I don’t see people talking about that in the context of schools.’ The CDC's current guidelines suggest 6 feet of distancing should be maintained when students are not wearing masks.

“Brosseau said though the Massachusetts study, and thus the CDC guidelines, focuses on face-covering policies, not enough attention is given to the ventilation systems in school districts. ‘If those with less than 3 feet policies also improved their ventilation, that would dilute the impact—so to speak—of more people closer together. I suspect none of the districts made any ventilation changes, but that would have been an appropriate variable to include in their models,’ Brosseau said.

“Kim Prather, PhD, of the University of California San Diego, has been helping San Diego Unified, one of the biggest school districts in California, plan for its reopening on Apr 12. She said she is encouraging schools to maintain 6 feet of distance. ‘If you tell kids 3 feet, it becomes 1 foot,’ Prather said. ‘And what worked for schools in the fall will only get harder with the variant.’

“All of the experts agreed that safety opening schools must be a top priority, but one that cannot be addressed properly until the CDC acknowledges what it knows—and doesn't know—about the virus. Until then, Prather is recommending that schools invest in ventilation, HEPA (high-efficiency particulate air) filters, and close-fitting masks for kids. She advised San Diego Unified to ban children who are not wearing masks from coming indoors, and recommended lunch be served al fresco for the time being. ‘The chance of things calming down right now are so close with vaccines,’ she said. ‘And the variant can't take off unless you give it the opportunities’” (Center for Infectious Disease Research and Policy, University of Minnesota).

 

“There [was] only one story [yesterday]” by Heather Cox Richardson

 

“It is not the coronavirus pandemic, although 547,000 of us have died of Covid-19, and a study today suggested that we could have avoided nearly 400,000 deaths if we had adopted masks and social distancing early on. It is not the coronavirus even though [yesterday] President Joe Biden noted that we will reach 100 million vaccinations tomorrow and that he aims to reach 200 million vaccines by his 100th day in office….

“It is not the situation on our southern border, where a surge of migrants apparently matches the seasonal pattern of people trying to make it into the United States….

“It is not the economy, although the U.S. Treasury said today it had issued 37 million payments this week, worth $83 billion, from the $1.9 trillion American Rescue Plan....

“The story [yesterday]—and always—is the story of American democracy.

“[Last night], Governor Brian Kemp of Georgia signed a 95-page law designed to suppress the vote in the state where voters chose two Democratic senators in 2020, making it possible for Democrats to enact their agenda. Among other things, the new law strips power from the Republican secretary of state who stood up to Trump’s demand that he change the 2020 voting results. The law also makes it a crime to give water or food to people waiting in line to vote.

“The Georgia law is eye-popping, but it is only one of more than 250 measures in 43 states designed to keep Republicans in power no matter what voters want.

“This is the only story from [yesterday] because it is the only story historians will note from this era: Did Americans defend their democracy or did they fall to oligarchy?

“The answer to this question right now depends on the Senate filibuster. Democrats are trying to fight state laws suppressing the vote with a federal law called the For the People Act, which protects voting, ends partisan gerrymandering, and keeps dark money out of elections.

“The For the People Act, passed by the House of Representatives, is now going to the Senate. There, Republicans will try to kill it with the filibuster, which enables an entrenched minority to stop popular legislation by threatening to hold the floor talking so that the Senate cannot vote. If Republicans block this measure, the extraordinary state laws designed to guarantee that “Democrats can never win another election will stay in effect, and America as a whole will look much like the Jim Crow South, with democracy replaced by a one-party state. Democrats are talking about reforming the filibuster to keep Republicans from blocking the For the People Act.

“They have been reluctant to get rid of the filibuster, but today President Joe Biden suggested he would be open to changing the rule that permits Republicans to stop legislation by simply indicating opposition. Republicans are abusing the filibuster, he says, and he indicated he would be open to its reform.

“The story [yesterday] is not about coronavirus vaccines, or border solutions, or economic recovery, because all of those things depended on the election of Joe Biden. If the Republicans get their way, no matter how popular Democrats are, they will never again get to direct the government”—Heather Cox Richardson

—-

Notes:

https://www.reuters.com/article/us-health-coronavirus-usa-economy/u-s-covid-response-could-have-avoided-hundreds-of-thousand-of-deaths-research-idUSKBN2BH1DK

https://www.washingtonpost.com/politics/georgia-voting-restrictions/2021/03/25/91009e72-8da1-11eb-9423-04079921c915_story.html

 

"Republicans are pushing sweeping bans on trans youth healthcare"

 

“Lawmakers in Arkansas are voting this week to restrict medical care for transgender children and punish doctors who treat them, in one of more than a dozen US states where Republicans are pushing sweeping bans on trans youth healthcare.
 
“Proponents of the healthcare bans argue that kids are too young to consent to treatments like hormone therapy and puberty blockers and that the bills aim to prevent ‘medical experimentation’ on children. Some bills claim that trans kids ‘will outgrow’ their identities.

“But supporters of gender-affirming healthcare, including major medical associations, human rights groups and affected families, say that the treatments are well established and part of a gradual process that has been shown to dramatically improve the mental health of the most vulnerable kids. The bills, they argue, misrepresent the care model with false and fearmongering narratives. Trans teens who have received treatments say they would suffer serious harm if they were stripped of the care.
 
“‘We’re talking about criminalizing doctors for providing best-practice medical care to their patients, and making it child abuse for parents to support access for their children,’ said Kasey Suffredini, CEO of Freedom for All Americans, an LGBTQ+ rights group. ‘These bills are very, very extreme … and these are life and death issues.’

“The bills are part of an escalating culture war involving trans kids. As Joe Biden has vowed to protect LGBTQ+ people and a 2020 supreme court ruling protected trans rights in the workplace, conservative legislators have introduced more than 80 bills restricting trans rights – most that would either block trans kids’ use of gender-affirming care or limit their access to certain sports teams. It is the highest number of anti-trans legislative proposals ever filed in a single year…
 
“The number of kids receiving gender-affirming care in the US is limited. Jules Gill-Peterson, professor of gender, sexuality, and women’s studies at the University of Pittsburgh, said that access to the treatment is extremely restricted, given that there are few clinics that do this work and that families often need significant time and money to advocate for and get treatment.

“‘We’re facing the proposition of banning forms of healthcare that almost no trans kids even have access to,’ she said. She noted that at a clinic in Pittsburgh, some families drive from five hours away to get care. ‘We’re talking about healthcare that at the moment is generally accessible only to upper-middle-class families.’ Some families wait months to get an appointment, said Dr Jack Turban, a child psychiatry fellow at Stanford.

“The gender-affirming care model targeted in the bills is aimed at alleviating the severe distress many trans children face while forced to present as the gender assigned to them at birth. They start by making clear that trans and non-conforming identities are not a mental disorder, and that the mental health challenges many trans kids face are often a result of facing stigma and discrimination. A Centers for Disease Control survey in 2019 found that 35% of high school trans students had attempted suicide in the previous year, compared with roughly 7% of cisgender students.
 
“‘Children are supported in their expressions of their identity,’ said Dr Lauren Wilson, a pediatric hospitalist who works with trans children in Montana, where lawmakers have proposed a healthcare ban. She is also the vice-president of the Montana chapter of the American Academy of Pediatrics. For young children, she said, ‘Sometimes that means choosing different clothes, different haircuts, changing pronouns or presenting as a different gender at school and socially.’
 
“When youth are ‘consistent, insistent and persistent’ about their gender identity, families and doctors can consider further treatments. At the onset of puberty, some youth can be prescribed ‘blockers,’ which suppress or pause puberty and allow kids more time before their bodies undergo changes.
 
“Blockers are reversible but they have sparked contentious political debates, particularly in the UK, where a court has restricted their use, arguing that youth under 16 cannot give informed consent. Critics have called for more research on their long-term impacts, but clinicians working with trans children say the treatment is safe and note that they have been used since the 90s to treat cisgender children who experience early puberty. Research has shown that blockers have huge benefits for teens who have accessed them. One study found that when youth receive the medication, the odds of suicide decrease by 70%.
 
“Older trans teens can be prescribed affirming hormones that initiate puberty to match their gender. These treatments, which are also linked to mental health improvements, are much more serious, with some irreversible impacts. Research has shown that only a small fraction of people who take them later ‘de-transition,’ with a comprehensive Dutch study finding that only 0.3 to 0.6% of trans people expressed ‘regret’ about their treatment. Doctors say they generally work closely with families and youth before treatments are prescribed.
 
“‘These are not decisions that patients or families or providers take lightly,’ said Dr Patty Pinanong, a clinical professor of medicine at University of Southern California, who works with trans youth. ‘It is a very thoughtful and intentional process.’

“…The GOP proposals seek to outlaw various components of affirming care, including blockers and hormones, in some cases with bills that misstate how treatments work or seek to ban practices that don’t actually occur. Several bills would also punish parents and providers who allow kids to access gender-affirming care, with some proposals threatening hefty fines, revoked medical licenses and jail time.
 
“‘Most outlaw gender-affirming surgeries for minors, even though the standards of care that doctors follow establish that genital surgeries are not offered until adulthood,’ said Turban, the child psychiatry fellow at Stanford: ‘The bills themselves contain misinformation.’ Turban, who researches care for trans youth, warned that there would be mental health repercussions if treatment were outlawed: ‘There’s no question in my mind that all those kids would have worsening anxiety and depression. If bans were enacted, some youth might seek access to hormones without doctors’ supervision,’  he added…” (Sam Levin, The Guardian).