Impact of climate change and loss of habitat on sirenians

Although the impacts of climate change on the welfare of individual manatees and dugongs are still uncertain, the effects are likely to be through indirect interactions between meteorological and biotic factors and the human responses to climate change. We divided the potential impacts into (1) those that will potentially affect sirenians directly including temperature increases, sea-level rise, increased intensity of extreme weather events and changes in rainfall patterns and (2) indirect impacts that are likely to cause harm through habitat loss and change and the increase in the likelihood of harmful algal blooms and disease outbreaks. The habitat modification accompanying sea-level rise is likely to decrease the welfare of sirenians including increased mortality. Many species of tropical seagrasses live close to their thermal limits and will have to up-regulate their stress-response systems to tolerate the sublethal temperature increases caused by climate change. The capacity of seagrass species to evoke such responses is uncertain, as are the effects of elevated carbon dioxide on such acclimation responses. The increase in the intensity of extreme weather events associated with climate change is likely to decrease the welfare of sirenians through increased mortality from strandings, as well as habitat loss and change. These effects are likely to increase the exposure of sirenians to disease and their vulnerability to predators, including human hunters. Climate-related hazards will also exacerbate other stressors, especially for people living in poverty. Thus the risks to sirenians from climate change are likely to be greatest for small populations of dugongs and manatees occurring in low-income countries. The African manatee will be particularly vulnerable because of the high levels of human poverty throughout most of its range resulting in competition for resources, including protein from manatee meat

Outcomes from elective colorectal cancer surgery during the SARS‐CoV‐2 pandemic

Aim This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58–14.06), postoperative SARS-CoV-2 (16.90, 7.86–36.38), male sex (2.46, 1.01–5.93), age >70 years (2.87, 1.32–6.20) and advanced cancer stage (3.43, 1.16–10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks