Conflicts about water in Lake Chad: are environmental, vulnerability and security issues linked?

This paper builds on the growing literature that explores the relations between environmental change and non-traditional security, defined as non-military threats that challenge the survival and well-being of peoples and states. The Lake Chad basin in Africa is used as a case study for analysis. Focusing on a set of questions that has dominated recent theoretical debates, the paper investigates if conflicts resulting from water scarcity are as much about the broader vulnerability of the Lake Chad region as they are about changes in the Lake system and its environment. It argues that conflict is a probable outcome only in locations that are already challenged by a multitude of other context-specific factors beside resource scarcity. In the Lake Chad context, the likelihood of scarcity-driven conflict depends on whether vulnerability increases or decreases in the face of a declining water supply. The paper provides perspectives for a nuanced understanding of how the receding Lake Chad has led to conflict and outlines an integrated, forward-looking research agenda for linking environmental change, vulnerability and security issues in integrated human-environment systems

Global Impact of COVID-19 on Stroke Care and IV Thrombolysis

OBJECTIVE: To measure the global impact of COVID-19 pandemic on volumes of IV thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with 2 control 4-month periods. METHODS: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95% confidence interval [CI] -11.7 to -11.3, p < 0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95% CI -13.8 to -12.7, p < 0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95% CI -13.7 to -10.3, p = 0.001). Recovery of stroke hospitalization volume (9.5%, 95% CI 9.2-9.8, p < 0.0001) was noted over the 2 later (May, June) vs the 2 earlier (March, April) pandemic months. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was noted in 3.3% (1,722/52,026) of all stroke admissions. CONCLUSIONS: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID-19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months. © 2021 American Academy of Neurology