Guest News Brief by Kip Hansen – 18 December 2020
The New York Times and The Guardian are both reporting a “landmark ruling” from Britain. “A 9-year-old girl who suffered a fatal asthma attack in 2013 became the first person in Britain to officially have air pollution listed as a cause of death, a British official said. . . . In the ruling on Wednesday, assistant coroner Philip Barlow in London said air pollution had significantly helped induce and exacerbate Ella’s asthma, adding that she had been exposed to levels of nitrogen dioxide and particulate matter in excess of World Health Organization guidelines.” [ source: NY Times ]
In a recent essay here, I discussed the problems with the reporting of Cause of Death and some of the details on how this is done in the United States. For the details, read (or re-read) Cause of Death: A Primer.
The fact is that Cause of Death is not simple, not cut-and-dried, not always obvious and often contentious. It is important to know that deaths in the UK are handled differently than in the United States.
In the United States, a doctor or coroner simply fills out a Death Certificate listing the chain of events or chain of diseases that led to the death, including any contributing factors. In England and Wales, there are a long list of cases in which a death must be subject to an inquest. If you watch British TV shows, you may be familiar with the older version of an inquest, in which some coroner must rule a death a natural death, a suicide, a murder or “death by misadventure”.
The Guardian reports the case this way:
A coroner has made legal history by ruling that air pollution was a cause of the death of a nine-year-old girl.
Philip Barlow, the inner south London coroner, said Ella Kissi-Debrah’s death in February 2013 was caused by acute respiratory failure, severe asthma and air pollution exposure.
He said she was exposed to nitrogen dioxide and particulate matter (PM) pollution in excess of World Health Organization guidelines, the principal source of which were traffic emissions.
The coroner said the failure to reduce pollution levels to legal limits possibly contributed to her death, as did the failure to provide her mother with information about the potential for air pollution to exacerbate asthma.
“Ella died of asthma contributed to by exposure to excessive air pollution,” said the coroner on Wednesday.
This young girl’s death had been subject to an inquest in 2014, which found she had died of acute respiratory failure. But, Cause of Death can be contentious and sometimes, political. In this case:
Ella’s mother, Rosamund Kissi-Debrah, a former teacher, spent years fighting to have her daughter’s death examined by a second coroner. Her resilience was repaid on Wednesday when Barlow agreed with expert medical evidence provided by the family which said Ella’s particular form of acute asthma was exacerbated by air pollution.
Kissi-Debrah’s lawyers submitted that air pollution was a public health emergency and there was a pressing need for it to be recorded as a cause of death to ensure public health programmes to tackle toxic air were prioritised.
In evidence to the two-week inquest, Prof Stephen Holgate, an immunopharmacologist and consultant respiratory physician of the University of Southampton and Southampton general hospital, said a biological cause of Ella’s disease getting worse in the winter months was the seasonal worsening air pollution.
He said it was the cumulative effect of the toxic air Ella was breathing in living within 30 metres of the South Circular road that caused her final acute asthma attack.
For those not familiar with London, UK, the South Circular Road is not a multi-lane major highway, but rather: “The South Circular is 20.5 miles (33.0 km) long. The majority of the road is single carriageway, one lane each way, aside from a small section of dual carriageway near the Woolwich Ferry. It is a primary road for its entire length” and “The South Circular has received sustained criticism for congestion and pollution and is one of the least popular roads in Britain.” [source: Wiki ]
In this case, we see the sad end of a young girl’s life. A young girl that had suffered from severe asthma for years and had been repeatedly hospitalized for asthma attacks and seizures. Somehow, the public health doctors had reportedly failed to inform her mother that asthma sufferers should not live where there are exacerbating circumstances, such as high ozone levels, high dust levels, high levels of roadway auto and truck exhaust. Her mother, a school teacher, should have known this, with or without public health officials specifically informing her, as all medical web sites on asthma feature this information.
In the end, it appears that a second coroners inquest has found, as should have been obvious from the beginning, that, as is common medical knowledge, roadway air pollutants can be a contributing trigger for asthma attacks. The landmark ruling though is almost entirely political — the shocking thing being that her family apparently remained ignorant of the basic facts that every parent of a child suffering from asthma would know.
As for Cause of Death, we see once more that it is not always a matter of simple medical facts and that the medical facts can be confused and conflated with other considerations and popular social movements.
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Author’s Comment:
The area in which I live, the Central Hudson Valley of New York State, is listed as #19 on the Allergy Capitals of America list – one of the worst paces for allergy and asthma sufferers to live. Everyone with pollen allergies living here knows this and is rudely and painfully reminded of this twice a year (we are lucky enough to have two allergy seasons). If any parent of a child suffering from severe allergies living here had tried to claim ignorance of this simple fact, they would be laughed out of court.
As for science, in a greater sense, the concept of cause is a difficult issue, and, in my opinion, is most often mis-assigned based on vague association.
As many medical practitioners have begun to point out, Covid Deaths being reported in the media are more correctly characterized as “Deaths Involving Covid” and in many more cases, “Deaths with some vague association to Covid”.
Cause of Death is simply not simple.
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I watched the report on this on the BBC last night, and totally agree with your comments. It’s absolutely fine accepting that air pollution was a contributory factor in this case but, as you rightly say, anyone with half a brain knows, and has known for decades, that this is the case and her parents should have done something tangible about reducing that risk.
Mother should be careful what she wishes for. If air pollution is accepted as a cause in a situation where the area is famous for its car pollution, mother can become liable for parental negligence and be added as a cause of death.
Meanwhile back at the ranch, Dale and Roy learned that Wildfire Smoke Carries Infectious Agents. http://dx.doi.org/10.1126/science.abe8116
They are doomed, DOOMED I tell ya!
As I have said in regards to Covid (or ChiComFlu, as I like to call it), with apologies to George Orwell, “All deaths are equal, but some deaths are more equal than others.”
And yet the medical fraternity still have no explanation for the rise in asthma as the air in cities has never been cleaner.
As for the WHO limits – how do we know they are valid given the political nature of the WHO and its poor performance in relation to Covid? The much-vaunted weekly consumption of units of alcohol has no scientific basis as an admission from one member ‘well, we had to come up with something’ shows.
Between 12/9/20 and 12/16/20 CDC logged 14,531 deaths attributed to Covid-19.
There were 74,340 deaths due to all cause. C-19 would represent about 20%.
They were distributed as follows:
Under 1 year 1 0.01%
1–4 years 1 0.01%
5–14 years 1 0.01%
15–24 years 9 0.06%
25–34 years 60 0.41%
35–44 years 184 1.27%
45–54 years 500 3.44%
55–64 years 1405 9.67%
65–74 years 3071 21.13%
75–84 years 4350 29.94%
85 years + 4949 34.06%
The 65+ demographic was accountable for 85% of those deaths.
If you are 65+ w multiple health issues in a crowded nursing home and the staff brings in C-19 you are screwed, but then you were screwed anyway. In other words: If you are already seriously ill, C-19 will probably finish you off, i.e. no different from the seasonal flu.
C-19 is not a problem for the young and healthy herd. Mother Nature and her buddy Grim Reaper are just doing their jobs, culling the herd of the too many, too old, too sick warehoused too close together as Medicare/Medicaid cash cows in poorly run contagious lethal elder care facilities.
Japan has the highest percentage of 65+, 27%, yet just over 2,700 deaths. (WHO)
What do they know/do the rest of the world does not?
Very well written article Kip. Whilst this is clearly a very sad case indeed, you are right to infer at least an element of guilt on the parents, for unfathomable ignorance if nothing else.
The “South Circ”, along with its sibling the “North Circ” was a much earlier version of the M25 that now orbits London further out. The idea was to skirt around the central areas of the city. Even by the time I was a young adult in the 80s, both roads were notorious for being congested almost 24/7, and vehicle pollution was far worse then too. Thus, if you had a child with potential problems with this, the last place you would choose to live would be 30 yards from these incredibly busy roads. Further, if you were forced to live there for some reason, you would move heaven and Earth to move as soon as practicable. It is not obvious from the story (as documented at the time) that this family attempted to do so.
All very sad but I cannot see that the British authorities were responsible for this.
UK Government figures show that air pollution has dropped by 75% in the last 50 years.
https://www.gov.uk/government/publications/emissions-of-air-pollutants/emissions-of-air-pollutants-in-the-uk-1970-to-2018-summary
And air quality figures from this year prove that traffic is not a major cause of emissions as during the Pandemic Lockdowns , with a massive reduction in traffic , air quality did not alter .https://airqualitynews.com/2020/09/08/pm2-5-pollution-did-not-decline-during-lockdown-in-scotland/. Although there has been a large effort to keep the truth hidden.
So this has almost certainly been a political decision to try to blame at least 1 death on air quality so that the insanity of trying to ban fossil fuel vehicles has a bit of ammunition.
Not to make light about the death of ant children, but the general theme reminded me of a death in Texas. The Texas Rangers chased after an escaping wanted felon and finally found him. The wanted felon ignored their warnings to stop and raise his hands, whereupon the wanted felon starts running. The Texas Rangers shot him about 20 times. The coroner listed the cause of death as “suicide”. When asked about that the coroner declared “it is suicide to run from the Texas Rangers. Case closed.
Excellent job Kip. There is an example closer to your home where the concept of cause is a difficult issue. New York State’s current air quality “crisis” is peaking power plants. Peaker plants are claimed to have an outsized effect on communities and the environment because there are old and inefficient, some run on kerosene, and are disproportionately located in communities of color in New York City. The argument goes that they release harmful pollutants like nitrogen oxides, sulfur oxides, and tiny, easily inhalable particles that contribute to respiratory issues. Environmental justice activists claim that these power plants need to be replaced inferring that once they are replaced that there will be observable changes in the health outcomes in these neighborhoods.
A primary public health reference in their arguments is the Department of Health and Mental Hygiene’s (DOHMH) Air Pollution and the Health of New Yorkers report (https://www1.nyc.gov/assets/doh/downloads/pdf/eode/eode-air-quality-impact.pdf) which concludes: “Each year, PM2.5 pollution in [New York City] causes more than 3,000 deaths, 2,000 hospital admissions for lung and heart conditions, and approximately 6,000 emergency department visits for asthma in children and adults.” These conclusions are for average air pollution levels in New York City as a whole over the period 2005-2007. Based on their results the report notes that: “Even a feasible, modest reduction (10%) in PM2.5 concentrations could prevent more than 300 premature deaths, 200 hospital admissions and 600 emergency department visits.” Their conclusions were based on average air pollution levels in New York City as a whole over the period 2005-2007.
In a post entitled PM2.5 Health Impacts in New York City (https://wp.me/p8hgeb-nC) and others summarized in New York Peaking Power Plants and Environmental Justice Summary (https://wp.me/p8hgeb-q6) I reviewed these claims. I found that the latest available average (2016-2018) to compare to the DOHMOH pollution levels show a 38% decrease since 2005-2007. If someone were to show me the resulting improvements in deaths, hospital admissions, and emergency room visits then I might have more sympathy for these claims. Furthermore, the health impacts rely on not only the PM2.5 impacts but also ozone which are both secondary pollutants. That means that they don’t have local impacts so observable power plant impacts on local neighborhoods from either pollutant are unlikely. In fact, if a local power plant has any effect on a neighborhood it would be to reduce ozone levels because nitrogen oxides scavenge ozone before they react with volatile organic compounds to create ozone.
As someone recently pointed out, on WUWT, the one immutable fact about this thing called life is that none of us are getting out of it alive. All of this death assignment is akin to assessing blame which is something the political left do with great aplomb to menace the masses with hobgoblins in order to advance collectivist agendas e.g. death by COVID, death by climate change, death by violent weather, death by WOO WOO.
“Pointed threats they bluff with scorn
Suicide remarks are torn
From the fools gold mouthpiece the hollow horn
Plays wasted words, proves to warn
That he not busy being born
Is busy dying”
It’s Alright, Ma (I’m Only Bleeding)
Bob Dylan
Cause of death: Stupidity. Case closed. One has to wonder, as well, was there no inhaler or epi-pen handy, and if not, why not.
so the thousands who died in the killer smogs of London in the 1950s didn’t die from air pollution? Sadly this girl was far from the first.
I wonder what the reason of around 12,000 deaths in 1962 in London was, perhaps airpollution ?
The young girl certainly was not the first, as sad it is for the family
My Sister in Law Doreen left Leyton in London after she got married at 21 and moved to Ringmer in Sussex to a bungalow surrounded by fields. Doreen had smoked cigarettes a little but stopped when she got married.
Since moving to Ringmer Doreen was bedevilled with repeated chest infections requiring treatment with antibiotics. Then overtime taking antibiotics at home was not sufficient and she needed to be hospitalised to be treated with 3 intravenous antibiotics.
These repeated infections and hospitalisation plagued her life until she died age 68 from chronic bronchiectasis. Doreen also contracted Churg Straus Syndrome.
Where as I drove 50,000 miles a year for 30 years with cars that had no filtration so everything that came into the car went in to my lungs. As far as I know up to age 72 I have not suffered any obvious ill effects. But when I went skiing in Austria I contracted bronchitis in two days. First and last time I contracted bronchitis. My father was invalided out of the army age 16 with chronic bronchitis and chain smoked until the GP said he had six months unless he stopped I think at age 52, he died just before his 80th birthday. My brother smoked 60 a day until he was given the same message and died at 87 because his lungs like my fathers were in an awful state Ron had COPD but it was the scaring on his kidneys which was the final cause death because he could not make red blood cells.
Both of my sisters smoked they both got cancer only one survives but neither my father brother or sisters contracted lung cancer. My Mother did not smoke and neither have I. Mum lived to 91 and eat butter cream saturated fat everything that the greens say we should not eat but had no arterial disease at 91, she decided she had had enough.
I think people don’t care enough about what they eat and those that complain about air pollution and saturated fat and eating meat as life threatening will cheerfully consume many bottles without a care in the world because it is their drug of choice. I don’t eat anything that doesn’t look like food and thus far it has served me well. Lung oxygenation 98/99%, blood pressure when training 115/70. You pays your money and takes your choice genetics is hugely important and food is next, dense nutrition is critical to survival on a hostile planet, having said that last year it was reported a 93 year old solicitors clerk walked 3 miles up and down a hill twice a day, eat one bowl of porridge for breakfast and dinner and a sandwich for lunch the young female reported could not keep up with him walking up the hill. Makes you think?
Causative contribution or correlation conspiracy?
I Grew up in Bradford in the 50’s/’60’s. Once the wool capital of the World the number of Mills was staggering as was the number of attendant mill chimneys. I well remember trips home where if one could see the next street light one was lucky an eerie experience for an infant. This level of industrial outpourings was repeated across the country especially in the North. To make this claim is so bizarre it creates the danger of Aneurism in any adult capable of thought. Thousands upon thousands, in all likelihood into the millions throughout the Industrial Age in the UK died from air pollution, hence the Clean Air Act. Palpable nonsense.
What about the danger to our mental health hearing or reading bollox like this. The World is truly insane and unfortunately the Asylum is in the hands of the Lunatics.
I have a large medical dictionary and on the basis of the number of deadly diseases listed I am surprised at anyone gets to live beyond puberty. A mere few hundred thousand have spawned 7.6 billion souls so to a huge extent inbreeding is a fact of life, it is a lottery but isn’t that why we have a health service. Though in the UK the NHS was not put in place to help people get back to health it was put in place after WWII to soak up employment which is were the doctor knows best syndrome came about and most often they did not know better top down bureaucracy was the rule and we just existed to servants to the cause and very little has changed.
Why does a mother who lost a child to asthma six years ago need lawyers to make public news statements about the cause of death in 2020? That is the question people should ask themselves.
The single page Record of Inquest is here:
https://www.innersouthlondoncoroner.org.uk/news/2020/nov/inquest-touching-the-death-of-ella-roberta-adoo-kissi-debrah
The Inquest was held under consideration of the Human Rights Act as specified in Section 5(2) of the Coroners and Justice Act 2009:
“Where necessary in order to avoid a breach of any Convention rights (within the meaning of the Human Rights Act 1998 (c. 42)), the purpose mentioned in subsection (1)(b) is to be read as including the purpose of ascertaining in what circumstances the deceased came by his or her death.”
https://www.legislation.gov.uk/ukpga/2009/25/section/5
https://www.hja.net/legal-team/jocelyn-cockburn-2/
If the coroner can be goaded into this decision, then the cause of death of the poor child really should be listed as “child abuse due to wilful disregard of the pollution or extreme criminal negligence of factors affecting the health of the child.” There should be another inquest to probe the parents for not moving sooner.
SARS-COv2 is life imitating the movie “Final Destination”.
Cheat death now, it comes back for you later.
With so few details it is difficult to know if this is a valid attribution of risk or a politically convenient claim to be used to advance more punishing but possibly ineffective environmental regulations. If particulates and chemical aerosols are as dangerous as claimed using poorly designed, often non-transparent and highly questionable correlation studies then many natural environments including forests, dry dusty lands, national parks, geothermal formations, volcanos and vigorous sea sprays must be considered hazards. Similarly a wide variety of naturally occurring plants and other allergens are hazards. In this case blaming possible anthropogenic pollution for a winter asthma death and not mentioning the adverse effect of cold temperatures plus/minus seasonal viruses would be a very selective view of things.
Asthma is a chronic disease requiring ongoing medical therapies both for prevention and management of symptoms. Was there good medical supervision and was there compliance with appropriate therapies? I have managed asthmatics early in my career who were resistant to virtually all therapies and in many cases would return with life-threatening exacerbation on a regular basis. Therapies today are much more effective but nothing is foolproof. My suspicion is that no-one can reliably attribute a death such as this to ambient pollution without strong evidence proving cause and effect. This would be especially difficult for a medical practitioner to reach a conclusion long after the tragic event as cause and effect would be largely based on speculation.
Will a rationed health care system ever be found to be responsible for any death in England and Wales?