Assignment: Saving Lives, Speculative Writing on #theCoIncidence of #Asthma Hospitalizations and #COVID-19 Disease, ... Ongoing Reflections on Sars-CoV-2, A Compromised Immune System and Risk Assessment

Handout, Assignment …Saving Lives: Speculative Analysis on #theCoIncidence of #AsthmaHospitalizations and #COVID-19Disease, …Ongoing Reflections on Sars-CoV-2, A Compromised Immune System and Risk Assessment, 11Published to Zenodo: https://doi.org/10. 5281/zenodo.4107131 by K Moses JD PhD - reach me at [email protected] 26, 2025 Dear All, Thank you for contributing to this re-design of the course Cancer Prevention acknowledging the era of SARS-CoV22infections responsible 2Severe Acute Respiratory Syndrome Coronavirus Clade 2 …Find NCBI SARSCoV-2 literature, sequence, and clinical content here https://www.ncbi.nlm.nih.gov/ sars-cov-2/. for the disease COVID-19 and the potential role of a compromised Immune System in the progress of an infection, disease. We are also covering the role of a compromised Immune System in the progress of metastatic cancer. I hope we will become interested in causation stories, proofs of things. Another hope is we form collaborations. One of the aims of this course is to encourage you to always be an analyst. Your presence has helped me push the renaming of the course for Spring 2023: Prevention Research: Lights and Shadows in Viral Infections and Cancer. Please check this out, I like the repository Zenodo a lot, established by the EU at CERN and open to all. ... I placed the paper you are reading now there: Moses, K. Handout: Assignment - Saving Lives, Speculative Reasoning on #theCoIncidence of #Asthma Hospitalizations and #COVID-19 Disease. Ongoing Reflections on Sars-CoV-2, A Compromised Immune System and Risk Assessment, (Version Draft_4). Zenodo. http://doi.org/10.5281/zenodo.4107132 Thanks, Assignment: Why do you think a Health Disparity Border exists and how would you investigate it? Please see below, Keywords: #CoIncidence #HealthBorders #HealthDisparities #AsthmaHospitalizations #SarCoV2 #COVID-19Disease #ImmuneSystem #HealthDisparities #Harlem you nosotras nous all hope us more • If we raise the Science of Health3we should embrace the current health 3Is the telling of a human health story, the telling of reducing injuries to the Immune System, e.g., lowering the incidence of DNA Injury, premature Telomere shortening, Deleterious Mutations with safer environments and more dietary health interventions? Less Stress in all its forms? …For background see here http://bit.ly/AssignedReading_ WallsOfDeath, the reading includes the paper http://bitly.com/Wachteretal2013. crisis, COVID-19 Disease. Some of us are encountering the novel virus and not surviving and some of us are surviving. Death, Survival appears to be a reveal on the conditions of our lives and the potentially compromised state of our Immune Systems. The survivors can provide plasma that contains antibodies and killer T-cells that neutralize the novel Coronavirus. I hope our course will help you move towards speculative reasoning and writing. It is always worth starting because we have visible, un-remedied Health Disparities. Theory 1: the survivors have an uncompromised Immune System4which is critically important to our defences 4Compromised Immune Systems against invading viruses, bacteria and cancer cells, and, e.g., builds over time a successful immune response to Sars-CoV-2 and cells infected with Sars-CoV-2. Theory 2: the asymptomatic survivors have an uncompromised Immune System which is critically important to our defences against Draft: 20251226 DRAFT K Moses invading viruses, bacteria and cancer cells and produces or builds an immune response that suppresses, e.g., Sars-CoV-2 before symptoms can arise. Our course will focus on the Immune System, its relevance to defending us. We will consider the role of telomere length in the journey to a compromised Immune System. Figure 1: Hey ya, …‘3000, for the sake of everyone in the band, act like you got some sense,’ Introducing Causality - Thinking Causal Framework •Causal Inference –the process of drawing a conclusion about the effect of an exposure on an outcome is foundational to Public Health and Environmental Protection where it is used by the school of thought I hope we will join to guide new interventions for screening and precautionary policies. Think Flint, see ‘US judge approves $626m water settlement for Flint, Michigan.’ Al Jazeera, 11 Nov. 2021, www.aljazeera.com/news/2021/ 11/11/us-judge-approves-626m-water-settlement-for-flint-michigan. …a showing of why precaution is vital. • In this course5we are taking the role of observers and reviewers, I propose 5The conditions of our lives, we also adopt a topic in Causal Inference called ‘transportability’, to quote a good working description we could use this in our practice: ‘transferring causal knowledge collected in several heterogeneous domains to a target domain in which [there are / were] only passive observations and limited experimental data [][could] be collected.’ 6,7 8 9 6Elias Bareinboim and Judea Pearl. Transportability from multiple environments with limited experiments: Completeness results. page 280–288, 2014. URL https://perma.cc/CF7C-MM7X 7Transportability 8For me(KM) this resonated with a Precautionary Principle strategy of trying to reduce danger to Flora and Fauna (including us) and Environments, 9…On the usage of the description ‘Transportability’ here: let’s say we have some causal mechanistic knowledge from several heterogeneous systems that are parallels to or related to the system of interest where we only have very limited observations/data …We do speculative causal reasoning with what we have, drawing parallels. I hope this helps, •I have tried to steer us to explicitly deciding on what are critical observations for our health and environment status. This is effectively looking for what things - the exposures - correlate to our health - the outcomes. Looking for the correlates, • I propose we adopt Popper’s View, a deductivist view, when our theories (hypotheses, models) make predictions found not to be a reality, the theories need rejecting or modifying or a designing restart. Our theories are also our guides for the how and which data to collect (Darwin’s guiding notes on methods). Darwin advised us that without a theory you might as well count the stones on Brighton Beach, England.10 I propose we look for the 10 David Penny. Charles darwin as a theoretical biologist in the mechanistic tradition. 1(1):e1–e1. ISSN 2036-265X. doi: 10.4081/eb.2009.e1. URL https: //www.pagepress.org/journals/index.php/ eb/article/view/eb.2009.e1. Number: 1 correlates using a theory to guide our looking. If our looking / collecting of data identifies our reasoning as flawed, then our theories need rejecting or modifying or a design restart. It is likely our theories will depend on exposure and outcome observations and the consistency of the observations. Our theories are ideas on situations that have yet to be proven, our work is to move closer to emergent truths. If Consistency of the observations supporting the Theory appears to identify the Theory as a valid explainer of Page 2 of 40 DRAFT K Moses a situation, we can argue that this Theory can move to an emerging truth, e.g., Darwin’s Survival of the Fittest. • Of course this framework is available for your critique, adaptations, re-design. My hope is your analysis11 will include suggestions on how 11 My reference to your analysis is referring to including in your response to the assignment a section(s) on developing theories on why and how the border exists, those theories guiding data collection. Assignment: Why do you think a Health Disparity Border exists and how would you investigate it? to investigate the below Health Disparity Borders with or not with this suggestion for a causal framework, adapt as you wish. Figure 2: I would argue that ‘why’ is a little different from ‘what’, I am asking you to respond with your take on ‘why’ is this happening, if you include ‘what’ or just do ‘what’ that is also acceptable. I liked the above representation because it has ‘why’ drifting into ‘what’ We are going for ‘why’ . Please try to do ‘Why, Compared to What’, Figure 3: I hope this helps with thinking about addressing ‘why’ with a Hypothesis/Theory. My Blue Arrow is about the flow of generating a Theory out of the collected data. My one Green Arrow is about using a Theory to guide the collection of (new) data. Think about the importance of a Scientific Imagination with this narrative flow for Causal Reasoning. •Hill’s view-points / criteria, includes dose-response observations and consistency of the observations, (See slide 11 in this show, https://bit.ly/ Inquiry_A_Review) •Speculative causal diagramming, (See slide 13), and thinking with the http://bit.ly/Ornishetal2013 data: –Modifiable Risk Factors, LifeStyle Choices: Exercise, Eat Plants, Social and Psychological support –> –Longer Telomeres –> –Health of the Immune System: our objective is to maintain an uncompromised Immune System across a lifetime. See Reference 23 in http://bit.ly/Ornishetal2013: Damjanovic et al. ‘Accelerated Telomere Erosion Is Associated with a Declining Immune Function of Caregivers of Alzheimer’s Disease Patients.’ Journal of Immunology vol. 179, no. 6, 15 Sept. 2007, p. 4249. https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2262924/ … I am not proposing you read the paper, please read the Abstract, and see if you can visualize the Telomere shortening in Figure 3. There is a section in the paper on Figure 3. titled: ‘Caregivers of AD patients have significantly shorter telomere length of PBMC than controls’ on page 5. The majority of primary caregivers of people with AD are relatives. • I also propose that understanding molecular interactions guides our interpretation of a dose-response curve, a biological gradient. Consider this example for in vitro endpoints for asbestos toxicity including the generation of oxidative stress which results in DNA damage. DNA Damage at low levels, while measurable in vitro, is removed in vivo via cellular apoptosis - cells die, which is a much better health outcome than having staying around damaged DNA. Apoptosis represents an adaptive response and a threshold effect. Responses at low levels may not be indicative of disease outcomes, but rather of adaptive responses that indicate a threshold for disease observation, observing the biological gradient, a dose-response, causality: asbestos exposure ->oxidative stress->DNA damage. Page 3 of 40 DRAFT K Moses • One of my hopes for this course is we are developing Critical Thinking, into this conversation I would put in a how to on updating our theories based on information, new information, newly unearthed information, formerly hidden information, formerly differently construed information. I see this as part of the lineage of Darwin. Some of my colleagues (in Product Liability) believe and hold it is updating our theories by a specific amount based on evidence strength. This is effectively a reference to the work of Thomas Bayes.12 For classroom teaching, I have found the latter to be 12 D. R. Bellhouse. The reverend thomas bayes, frs: A biography to celebrate the tercentenary of his birth. Statistical Science, 19(1), Feb 2004. ISSN 0883-4237. doi: 10.1214/088342304000000189. URL https: //bit.ly/2ZhMK1T less seductive to the class members. I share as: gradually getting better theories by constantly updating in proportion to the weight of the evidence and being ready for the acceptance of falsification evidence. (Darwin, Popper, Bayes) I support a collaboration with the theorist Toni Morrison for looking with subjectivity revealed. A way of running this is to consider the survival of our theories are guided by our learning of adequate and acceptable new evidence. The core logic in science is testing our ideas with new evidence; I argue that this is science literacy, • I place Darwin as our ally prompting us to test our theories/ideas with new evidence; I argue that this is science literacy. I run Darwin’s core insight on scientific analysis with Toni Morrison’s directions to observe with her ‘bowl’ theory in mind. The year before she was awarded the Nobel Prize in Literature Toni Morrison (TM) published Playing in the Dark: Whiteness and the Literary Imagination, (1992) in which she argued that the ‘seminal works’ of American literature are informed by their authors’ determination to define themselves and their fellow white world against the Black ‘other’. TM maintained that the suppression of this analysis made it difficult to perceive race as a vitally important context. TM framed this beautifully, it was as if she had been looking at the contents of a fishbowl,‘and suddenly I saw the bowl, the structure that transparently (and invisibly) permits the ordered life it contains to exist in the larger world’.13 TM urges us to look 13 Toni Morrison. Playing in the dark: Whiteness and the literary imagination. 1992 at the ‘bowl’. For this Assignment I propose you use the ‘bowl’(s) theory to develop speculative analysis and writing on the exposures and outcomes. 14 Can the ‘bowl’ be seen and what is seen? Can we look with a version of 14 You can reject this theory of course, and come up with a theory to use for your collection and analysis of exposures and outcome. the Charles Darwin15 approach: using the ‘bowl’(s) theory to guide what 15 Darwin advised us to use our theories to guide our choosing of data to collect, and on designing adequate causal questions. He said something along the lines of ‘If you don’t have a theory you might just as well count the stones on Brighton beach.’ circa 1861. See, Penny, David. *’Charles Darwin as a Theoretical Biologist in the Mechanistic Tradition.’* Trends in Evolutionary Biology, vol. 1, no. 1, Sept. 2009, https://www. pagepress.org/journals/index.php/eb/article/ view/eb.2009.e1 to look for. The jarring outcomes of Health Disparities attached to race may provide a pathway to examining the ‘bowl’(s) or using the ‘bowl’(s) to look with greater acuity for correlates to Health. Speculating that the ‘bowl’ is real and a material force16, raises the question is it a presence in 16 To see an attempt to call on the ‘bowl’ please view Amy Cooper performing Racism, Central Park, NYC 2020, https: //youtu.be/iUQWd4q3tjA the production of Health Disparities. These questions will let us broaden the potential focus for the construction of ideas on Health Disparities and support us in entering the arena of hypothetico-deductive analysis built by Darwin, Bayes and Popper.17 17 Please see Appendix 1. for the development of causal reasoning in my current teaching, Page 4 of 40 DRAFT K Moses • Here I am raising TM’s theory of the ‘bowl’ as a guide for our collection of data in observational studies and the designing of causal questions. TM’s theory also raises the issue of health disparities distributed on a racial gradient serving a greater ideological purpose. Traveling this path raises the issue are the health disparities as comforting as the literature TM critiques for some and dismaying, destructive to others. • Speculating that the ‘bowl’ is real and a material force raises a next step, that the ‘bowl’ is a presence in the generation of Health Disparities. Is there evidence for the ‘bowl’ creating and organizing the distribution of Health Disparities? Is there evidence for the ‘bowl’ creating and organizing the distribution of Air Pollution?18 I(KM) am suggesting that this is a 18 Please see the Tessum et al results commentary on Air Pollution. See page 1 of 6 of the Tessum et al paper, top of second column, first paragraph. And see Harriet Washington’s Chapter 3 of her book, A Terrible Thing to Waste: Environmental Racism and Its Assault on the American Mind. Christopher W. Tessum, David A. Paolella, Sarah E. Chambliss, Joshua S. Apte, Jason D. Hill, and Julian D. Marshall. PM2.5 polluters disproportionately and systemically affect people of color in the united states. 7(18):eabf4491. doi: 10.1126/sciadv.abf4491. URL https://www.science. org/doi/10.1126/sciadv.abf4491. Publisher: American Association for the Advancement of Science; and Harriet Washington. Chapter 3poisoned world - the racial gradient of environmental neurotoxins. 2019. URL https://www.hachettebookgroup. com/titles/harriet-a-washington/ a-terrible-thing-to-waste/9780316509428/ Theory that can guide the formation of adequate causal questions; this is me(KM) speculating, it does not have to be part of your analysis. It is an attempt to both ‘Zoom in’ and ‘Zoom out’ with how we are focusing on issues. Adequate causal questions let’s us broaden the potential focus points for the construction of causal reasoning frameworks using Hill’s viewpoints / criteria, causal inference, and speculative causal diagramming for Health Disparities and their borders. Can we investigate the Health Disparities with the theory provided by Toni Morrison’s ‘bowl’ in mind? Does it help us ask adequate causal questions, and collect data? Are there other theories to help us ask adequate causal questions, and collect data? Is Darwin’s analysis of without a theory / might as well ‘count stones on Brighton Beach,’ UK a good marker for us? • Please spend a little time thinking about the above description of looking for the correlates and transportability, and consider this data, • I have curated two sets of data visuals that will hopefully aid us in considering exposures, outcomes, causes, transportability and Why Does Place Matter. I have placed the data visuals in the section titled ‘Health Disparity Borders’. Consider the below identified #CoIncidence of Asthma Hospitalizations19 and COVID-19 Disease-related Deaths. At the end of 19 I became aware of the Asthma Hospitalizations Health Disparity Border running along East 96th Street while teaching at a school on East 96th between First and Second Avenue, Life Sciences Secondary School (LSSS), 2016 - 2017. the Spring Semester 2020, this course raised the role of Compromised Immune Systems in the progress of a #SarsCoV2 Infection to COVID-19 Disease. • My hope is we can develop together a working framework for our version of establishing causation. Below I present a work in progress on this, please consider joining the conversation; we are using Perusall for sharing annotations to the article you are currently reading. Page 5 of 40 DRAFT K Moses A Very Selective Collection of Other Literature - Thinking Causal Framework • Here is my attempt to describe a very selective collection of other literature in this field: • The presence of the co-morbidities, e.g., obesity, 20 hypertension and 20 Kenneth C. Y. Wong and Hon-Cheong So. Uncovering clinical risk factors and prediction of severe COVID-19: A machine learning approach based on UK biobank data. page 2020.09.18.20197319. doi: 10.1101/2020.09.18.20197319. URL https: //www.medrxiv.org/content/10.1101/2020.09. 18.20197319v1 chronic obstructive pulmonary disease increases the risk of developing severe COVID-19 Disease is established. Age is the strongest risk factor for severe COVID-19 outcomes, people with these underlying medical conditions are also at higher risk. Higher numbers of underlying conditions a person has, the higher the risk for severe COVID-19 outcomes. 21 21 CDC. Science brief: Evidence used to update the list of underlying medical conditions associated with higher risk for severe covid-19 (updated 15 june 2022). Centers for Disease Control and Prevention, Feb 2020. URL https://www.cdc.gov/coronavirus/ 2019-ncov/science/science-briefs/ underlying-evidence-table.html • Age-ing and loss of Naïve CD8 T-Cells may be linked risk factors for Covid-19 Disease. See Rydyznski et al. ‘Antigen-Specific Adaptive Immunity to SARS-CoV-2 in Acute COVID-19 and Associations with Age and Disease Severity.’ Cell, vol. 183, no. 4, Nov. 2020, pp. 996-1012.e19. https://doi.org/10.1016/j.cell.2020.09.038.22 and see our shared analysis on 22 Carolyn Rydyznski Moderbacher, Sydney I. Ramirez, Jennifer M. Dan, Alba Grifoni, Kathryn M. Hastie, Daniela Weiskopf, Simon Belanger, Robert K. Abbott, Christina Kim, Jinyong Choi, Yu Kato, Eleanor G. Crotty, Cheryl Kim, Stephen A. Rawlings, Jose Mateus, Long Ping Victor Tse, April Frazier, Ralph Baric, Bjoern Peters, Jason Greenbaum, Erica Ollmann Saphire, Davey M. Smith, Alessandro Sette, and Shane Crotty. Antigen-specific adaptive immunity to SARS-CoV-2 in acute COVID19 and associations with age and disease severity. 183(4):996–1012.e19. ISSN 00928674. doi: 10.1016/j.cell.2020.09.038. URL https://www.sciencedirect.com/science/ article/pii/S0092867420312356 Pasqualino and the video recording on Compromised Immune Systems.23 23 Kevin Moses. A compromised immune system in the era of sars-cov-2. May 2020. doi: 10.5281/zenodo.6620638. URL https://zenodo.org/record/6620638 The relation of COVID-19 Disease with Asthma remains to be resolved. In the Assignment we are analyzing a coinciding Health Disparity Border for COVID-19 Disease and Asthma-related hospitalizations. We are thinking about Asthma Hospitalization and COVID-19 Disease severity. • An April 2021 publication of a meta-analysis24 assessing the association 24 Paul D. Terry, R. Eric Heidel, and Rajiv Dhand. Asthma in adult patients with COVID-19. prevalence and risk of severe disease. 203(7):893–905. ISSN 1535-4970. doi: 10.1164/rccm.202008-3266OC between Asthma and COVID-19 Disease identified that the results of analysis do not provide clear evidence of increased risk of COVID-19 Disease diagnosis, hospitalizations, severity, or mortality due to Asthma; this result includes adjustment for known potential confounders.25 The result 25 If you do not know of an action(s) of a confounding factor(s) you might misinterpret an Outcome and Exposure. Please see next page …If U - on the next page - is a confounding factor, e.g., a causative factor of both the Outcome and Exposure, we have to control for U to observe the relationship between the Exposure and the Outcome. We therefore find naturally occurring situations or construct situations where the U ‘back door’ path to affecting both the Outcome and Exposure is blocked. This gives us the opportunity to check on ... Does the Exposure cause Outcome. is also consistent with earlier reporting analysed by Martinez 2021:26 ‘the 26 Fernando D. Martinez. Asthma in the time of COVID-19. 203(7):785–786. ISSN 1073449X. doi: 10.1164/rccm.202102-0389ED. URL https://www.atsjournals.org/doi/full/ 10.1164/rccm.202102-0389ED. Publisher: American Thoracic Society - AJRCCM consistency of the evidence suggests that we are in the face of a surprising paradox: how is it possible that a disease that is known to be associated with increased susceptibility to a wide variety of viruses (including coronaviruses) (Ref.) may decrease the severity of one of the most lethal respiratory viruses ever encountered by humanity?’ Is this still a valid observation in the closing days of 2022? No, Other Narratives are emerging. One of your colleagues (Francisca Onyinye Egede, Fall 2022) raised that she disagreed with Martinez. In communication with Francisca I brought forward my position is (1) The Asthma cohort was/is super careful to reduce the likelihood of infection, (2) See that border at East 96th Street I have highlighted and my Figure 2, page 8; Dear All please bring the Asthma Severity and COVID-19 Disease Severity coinciding Health Disparity Border to Figure Page 6 of 40 DRAFT K Moses 2. We need to understand that coinciding by investigation and when there are holes in the data, do speculative causal writing …The thing I am trying to persuade you to do. I put Martinez 2021 in because I wanted to raise their usage of ‘paradox’ ... My take is that Asthma Severity and COVID19 Disease Severity are coinciding. I hoped you might think of Figure 2 and come up with causal theories, I believe Martinez 2021 is not on the right track with their usage of ‘paradox’. I would like to see a populationlevel examination of telomere length, plotting a map that travels block by block, measuring telomere length erosion. I would ensure that our plots crossed the Health Disparities, Gradients, and Borders for Asthma Hospitalization and COVID-19 Hospitalization. See the maps on the page http://bit.ly/SpeculativeWriting or in the document you are reading now at page 24 - 26 of 43. A proposed biomarker of Persistent Asthma is telomere length, telomere erosion. • I did a a review of Asthma and Telomere Erosion at Google Scholar. I felt this article can be added to a Proposal, if you are working on your Lit Review Proposal: –Al-Battawi et al. 2025 ‘Association of Traffic Volume and Leukocyte Telomere Length of Malaysian Populations Living in Urban and Rural Areas.’ Environmental Chemistry and Ecotoxicology, vol. 7, pp. 635 - 643, https://doi.org/10.1016/j.enceco.2025.03.007. Accessed 2 Dec. 2025. –Highlights: –First evidence to measure LTL in Malaysia’s urban and rural adults –High-traffic (KL) group had significantly shorter LTL than low-traffic (HL) group …I (KM) interpret this as exposure to reactive oxygen species, emitted by petrol-burning vehicles, see Lee et al in #TheCircumstances, https://bit.ly/TheCircumstances eroding DNA, eroding Telomeres, see https://bit.ly/DetailingOxidativeStress.kmNOTE > MyInvestigation > …I have to update this page with description generated for Frank. –There is a strong inverse relationship between traffic volume and LTL –Individual covariates were negatively correlated with LTL • Please keep these points in mind: (A) Ecological fallacy in epidemiology …is the failure in reasoning that arises when an inference is made about an individual based on aggregate data from a group cohort/population. This runs in both directions. And (B) Consider confounding factors: poverty - socio-economic stress- , Stress of all sorts, Mental Health, Food Deserts, Page 7 of 40 DRAFT K Moses quality of healthcare, healthcare access, availability of health insurance, population size, vaccination, governmental policies, etc. …There is quite a list which also includes http://bit.ly/Ornishetal2013. For reference here is Martinez 2021 asserting a ‘paradox’ …https://www.evernote.com/l/ AAdkw6saE6tJ8r49CcfGeM5Gt_EFXuNnr2s • We are in the midst of an evolving story and need to track the research: below please consider Bloom et al and Shi et al. • Bloom, Cullinan, and Wedzicha. ‘Asthma phenotypes and covid-19 risk: A population based observational study.’ American Journal of Respiratory and Critical Care Medicine, 205(1):36 - 45, Jan 2022. ISSN 1073-449X. doi: 10.1164/rccm.202107-1704OC. URL https://www.atsjournals.org/doi/full/ 10.1164/rccm.202107-1704OC •Bloom et al., Conclusion: ‘More severe asthma was associated with more severe COVID-19 outcomes[.]’ • Shi, Pan, Vasileiou, Robertson, and Sheikh. Risk of serious covid-19 outcomes among adults with asthma in Scotland: a national incident cohort study. The Lancet Respiratory Medicine, 10(4):347 - 354, Apr 2022. ISSN 2213-2600. doi: 10.1016/S2213-2600(21)00543-9. URL https://www. sciencedirect.com/science/article/pii/S2213260021005439 •Shi et al., Conclusion: ‘Adults with asthma who have required two or more courses of oral corticosteroids in the previous 2 years or a hospital admission for asthma before March 1, 2020, are at increased risk of both COVID-19 hospitalization, ICU admission or Death.’ • For Google Scholar curated citations to Terry et al 2021 see ‘Terry: Asthma in adult patients with COVID-19. prevalence... - Google Scholar.’ 28 Oct. 2021, https://www.scholar.google.com/scholar?cites= 6616865767956558079&as_sdt=2005&sciodt=0,5&hl=en. • Martinez 2021 is published in the same journal and is a review of Terry et al 2021. Martinez 2021 speculates it is possible that ‘type 2 inflammation may interfere with the receptor system for SARS-CoV-2 (Ref.) and that therapy with inhaled corticosteroids may decrease susceptibility to COVID-19 (Ref.), but the issue is far from settled.’ Page 8 of 40 DRAFT K Moses • Severe Asthma, Asthma Hospitalization is also being associated with increased risk of COVID-19 hospitalization by some of the research output. 27 28 29 30 Our identified coincidence is asking us to consider causal 27 Bloom, Cullinan, and Wedzicha. Asthma phenotypes and covid-19 risk: A populationbased observational study. American Journal of Respiratory and Critical Care Medicine, 205(1):36 – 45, Jan 2022. ISSN 1073-449X. doi: 10.1164/rccm.202107-1704OC. URL https://www.atsjournals.org/doi/full/10.1164/ rccm.202107-1704OC 28 Bloom et al., Conclusion: ‘More severe asthma was associated with more severe COVID-19 outcomes[.]’ 29 Shi, Pan, Vasileiou, Robertson, and Sheikh. Risk of serious covid-19 outcomes among adults with asthma in scotland: a national incident cohort study. The Lancet Respiratory Medicine, 10(4):347 – 354, Apr 2022. ISSN 2213-2600. doi: 10.1016/S2213-2600(21)00543-9. URL https://www.sciencedirect.com/science/ article/pii/S2213260021005439 30 Shi et al., Conclusion: ‘Adults with asthma who have required two or more courses of oral corticosteroids in the previous 2 years or a hospital admission for asthma before March 1, 2020, are at increased risk of both COVID-19 hospitalization and ICU admission or death.’ frameworks for observed disease severity. Investigation of Health Disparity Borders • Please see page 32 of 40: Appendix 3. Interlude: A Narrative-to-Data Framework for Mapping the Environmental Determinants of Immune Vulnerability. Page 9 of 40 DRAFT K Moses * I(KM) am trying to open up opportunities for current and future theory generation in observational studies and the identification of potential new targets for screening and precautionary policies founded in the Precautionary Principle ... going for identifying the conditions of our lives that lead to Compromised Immune Systems, * What are critical observations, I am arguing a dose-response observation of lengthening telomeres, that is reproducible, …gets me/us to we are looking at a causation story, we do not have causal steps, we are building a picture, details, * This is the foundational work for telomere length: The Nobel Prize 54 in Physiology or Medicine 2009. www.nobelprize.org/prizes/ 54 The Nobel Prize medicine/2009/illustrated-information. Identifying a telomere, the enzyme telomerase and their roles, * There is work trying to reach the causal steps of telomere shortening, consider reviewing Oxidative Stress bit.ly/DeBriefing_Resources_ Dose_Response … maybe good Literature Review material for a Final Project, Causal Question • Here are four points I think we should consider for working with a Theory,55 55 Working with a Theory –Can we develop a theory, adequate Causal Question(s) (Darwin),56 does 56 Try to draw a real simple diagram illustrating the question, the question help us in designing methods for our study, collecting data, –We need a theory to guide the collection of data, –Can we reach a causal analysis with our study? …the adequate causal question(s) should hover above us during the Assignment, –Fourth, I hope we are choosing an ecological approach; e.g., ‘there are suggestions that certain populations, such as South Asian groups, may develop metabolic syndrome and diabetes at lower levels of obesity as assessed by BMI than other populations such as Caucasians.’ …taken from reflections posted by Basu et al., ‘The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data.’57 For me too, the basic tenets of an 57 Sanjay Basu, Paula Yoffe, Nancy Hills, and Robert H. Lustig. The relationship of sugar to population-level diabetes prevalence: An econometric analysis of repeated cross-sectional data. 8(2):e57873. doi: 10.1371/journal.pone.0057873. URL http: //dx.doi.org/10.1371/journal.pone.0057873 ecological approach are true: outcomes in their environments are the phenomena to be explained.58 59 58 Karen E. Adolph. An ecological approach to learning in (not and) development. 63 (3):180–201. ISSN 0018-716X, 1423-0054. doi: 10.1159/000503823. URL https: //www.karger.com/Article/FullText/503823. Publisher: Karger Publishers 59 Be Aware: Ecological fallacy in epidemiology is the failure in reasoning that arises when an inference is made about an individual based on aggregate data from a group. We are not making that mistake. Page 16 of 40 DRAFT K Moses Overweight and COVID-19 Disease Vulnerabilities • I thought the following great work on the relationship of being overweight / obese and risks of COVID-19 Disease [... ] ‘Results: A total of 1191 severe and 358 fatal [COVID-19 Disease] cases were identified. [... ] Since only pre-diagnostic clinical data were available, the main objective of this analysis was to identify baseline risk factors. [... ] For the prediction of mortality, the top features were age, systolic blood pressure, waist circumference (WC), urea and [waist-hip ratio(WHR)].’ Wong and So. Uncovering clinical risk factors and prediction of severe COVID-19: A machine learning approach based on UK Biobank data.60 60 Kenneth C. Y. Wong and Hon-Cheong So. Uncovering clinical risk factors and prediction of severe COVID-19: A machine learning approach based on UK biobank data. page 2020.09.18.20197319. doi: 10.1101/2020.09.18.20197319. URL https: //www.medrxiv.org/content/10.1101/2020.09. 18.20197319v1 •Are we losing the vulnerable because we do not know enough about variations in vulnerability, would measuring telomeres help our knowledge? –Of course, ‘environmental factors such as sugar consumption should be investigated as potential factors in this interaction.’ Basu et al., –We are looking for the patterns of health disparities for different diseases, e.g., ¿do we see that some diseases have the same pattern of health disparities? ¿Is it Place? –This observation would suggest investigating the social and environmental determinants of health if we see the same Health Disparity Borders for disease x, disease y and disease … Our Course • In our course, we are trying to reach an understanding that prevention is dependent on the development and application of exposure and outcome observations,61 we might not get to experiment for a range of health and 61 Exposure and outcome observations, ethical concerns. We can of course spend our energies looking for Fortuitous Randomisation arising without our intervention in the World around us. Fortuitous Randomisation, is e.g., finding a community living adjacent to a pesticide production plant and finding a similar community not living adjacent to a pesticide production plant. E.g., finding a community living with access to a Mediterranean Diet and finding a similar community living with no access to a Mediterranean Diet. We would look into the World for situations where we speculate there is a causal pathway to an outcome we have observed, all other pathways not being there, or canceled out. See https://bit.ly/CausalAnalysis_History. • Think of the Health Disparity Border identified above, approximately at East 96th street, I would be willing to argue the disparities at that border Page 17 of 40 DRAFT K Moses are an emergency and intervention requires us to …? –Measure telomere lengths on both sides of the Health Disparity Border is a start, • Our attempts to develop Causal Reasoning: included Hill’s 62 contri62 Sir Austin Bradford Hill. The environment and disease: association or causation? Journal of the Royal Society of Medicine, 108(1): 32, Jan 2015. doi: 10.1177/0141076814562718. URL https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4291332/ bution to Causal Inference, the embracing of a hypothetico-deductive reasoning approach distilled from Charles Darwin, Thomas Bayes, Karl Popper, see our slide show https://bit.ly/Inquiry_A_Review, the DeBriefing for Pasqualino, https://www.evernote.com/l/ AAdQaINJ8GtHTqQeXtOXZLbxNjDDwhFk9gA and the surfacing up of fragments, notions of mechanistic causal knowledge/research, –In this show we do an analysis of supporting a Correlation type statement but maintain the objectives of a causal analysis, see Assignment_#1 Fall 2020, •Assignment_#1 - Telomere Length, Is there a causation story,63 is also try63 Is there a causation story, ing to highlight the need for prevention strategies in human health, http: //bit.ly/Assignment_1_20200824. The theme of Assignment_#1 was continued in a 2020 Assignment, http://bit.ly/Assignment_2_Autumn2020, Question (a) Is measuring Telomere Length a means to identify vulnerable populations? Discuss, Question (b) If the conditions of our lives are a collection of Modifiable Risk Factors, possibly affecting individual or/and group experienced Environments, please design the public health interventions to identify and help populations64 including an identification of any 64 I(KM) came across this excellent vehicle for health messaging: Treanor & Nunis ‘Why Africa’s animation scene is booming.’ BBC World Service, 14 Oct. 2020, www.bbc.co. uk/news/business-54438334. My thoughts went to health messaging, healthy eating, Modifiable Risk Factors of concern? Discuss, –I have printed a DeBriefing on the meaning of Telomere Length and made it part of this combined PDF, see the next page, –See also the assignment on:https://bit.ly/Pasqualino_SurvivorStories and a PreBriefing here, check out the Loom videos, bit.ly/ PreBriefingPasqualino, this is us beginning our story of Biological Age-ing, telomere shortening and a Compromised Immune System, Thank you for all your submissions, reading this, K Moses JD PhD Page 18 of 40 DRAFT K Moses Other Notes: an Assignment DeBriefing on Telomere Length and Modifiable Risk Factors, –Here is an excerpt from the DeBriefing: * Consider this, can telomere length lead us to better public health interventions. While public interest for interventions exists, the language used is often interpreted as curtailing, e.g., in the USA particular constructions of freedom intervene and cast government initiatives as interference in ‘private’ choices for one’s life. Such narratives undermine the acceptability of gov. interventions to protect population health. Would knowledge of shorter telomeres make it easier to reach narratives for health as a Human Right, can we then reach processed food reformulations,65 regulate advertising 65 Reformulating Processed Foods, and promotions, fruits and vegetable subsidies, higher taxation of tobacco, alcohol and highly processed foods …please consult the WHO’s ‘best buys’ for preventing noncommunicable diseases (NCDs),66 66 World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. (WHO/NMH/NVI/17.9), 2017. URL https: //apps.who.int/iris/handle/10665/259232. Accepted: 2017-10-12T15:09:59Z Behavioural Change –Do you think knowledge of Telomere Length might provide people with better reassurance for adjusting to, for in many cases, drastic Lifestyle changes?67 And it might be just about raising health literacy, 67 Oliver T. Mytton, Emma Boyland, Jean Adams, Brendan Collins, Martin O’Connell, Simon J. Russell, Kate Smith, Rebekah Stroud, Russell M. Viner, and Linda J. Cobiac. The potential health impact of restricting less-healthy food and beverage advertising on UK television between 05.30 and 21.00 hours: A modelling study. PLOS Medicine, 17(10): e1003212, Oct 2020. ISSN 1549-1676. doi: 10.1371/journal.pmed.1003212. URL https://journals.plos.org/plosmedicine/ article?id=10.1371/journal.pmed.1003212 giving people the opportunity for more health knowledge. How can we persuade the vulnerable to buy into our health recommendations, and avoid highly processed foods? Is it really the case that highly processed foods are out-competing fruit and vegetables on price? How can we get those who need it the most to The Precautionary Principle, http://bit.ly/PrecautionaryP?68 Sharing information on Telomere 68 Do you think knowledge of Telomere Length might provide people with a better incentive for adjusting to Lifestyle changes? What is seductive knowledge? Length is possibly an introductory step to making lifestyle changes. In an era of assessing sustainability, the impact of consumption on the status of planet Earth is very relevant to lifestyle choices made. What interventions can transform our realities? How do we enrich learning outcomes, –A public health community initiative will need to move to the underlying cultural, social, political nature of the issues, including the conditions of our lives. A smart approach would use language embracing local communities, framing the issues as our health, our longevity, showing proposed solutions concerning, e.g., taxes on sugary beverages and regulation going to healthy levels of salt and trans fats in Page 19 of 40 DRAFT K Moses highly processed foods. We must build counter-narratives to guide us to health, Page 20 of 40 DRAFT K Moses Figure 4: My (KM) Causal Teaching Notes: Thinking about Confounding Factors …poverty, quality of healthcare, availability of health insurance, population size, vaccination, governmental policies, food deserts, discrimination, … Page 21 of 40 DRAFT K Moses Figure 5: The map provides confirmed death counts with a positive result since March 2020, NYC.Gov, Page 22 of 40 DRAFT K Moses Figure 6: The map provides death rates with a positive result over 28 days. To accommodate standard reporting delays for hospitalization and death data, these are published at a 14-day lag. Accessed 20210414, Page 23 of 40 DRAFT K Moses Figure 7: The map provides hospitalization rates with a positive result over 28 days. To accommodate standard reporting delays for hospitalization and death data, these are published at a 14-day lag. Accessed 20210414, Figure 8: This Figure is from NYC.Gov, “Asthma Facts,” May 2003. Page 24 of 40 DRAFT K Moses Figure 9: Walk on by …or demand change, Reformulation –How are we going to persuade people who are eating highly processed foods to demand less salt and less trans fats? What can we learn about addressing the social and environmental determinants of health? Is Telomere Length a way of bringing people to a consideration of their long term health,69 69 Is Telomere Length a way of bringing people to a consideration of their long term health, –There are some observations in the field that say precaution now.There are stories for a correlation between ‘nuchal (neck) subcutaneous adipose tissue (SAT) thickness, a surrogate marker of central trunkweighted obesity,’ [as an independent predictor of shortening Telomere Length,]70 70 Harald Mangge, Markus Herrmann, Gunter Almer, Sieglinde Zelzer, Reinhard Moeller, Renate Horejsi, and Wilfried Renner. Telomere shortening associates with elevated insulin and nuchal fat accumulation. Scientific Reports, 10(11):6863, Apr 2020. ISSN 2045-2322. doi: 10.1038/s41598020-63916-6. URL https://www.nature.com/ articles/s41598-020-63916-6 Speculative Design and Writing –A speculative concept is shorter telomeres are part of a causation story leading to a Compromised Immune System,71 which may be, e.g., 71 A speculative concept is shorter telomeres are part of a causation story leading to a Compromised Immune System, needed for understanding the relationship between obesity and the risk of COVID-19 Disease progressing, see bit.ly/DeBriefing_Resources_ Dose_Response for a beginning of our analysis on the impact of Oxidative DNA Damage and Stress on the functioning of telomerase and telomeres.72 Reminder telomerase is the enzyme we are focusing on as 72 A putative theory, the maintainer of telomere length. –I highly recommend Wong and So. ‘Uncovering clinical risk factors and prediction of severe COVID-19: A machine learning approach based on UK Biobank data.’ medRxiv, Cold Spring Harbor Laboratory Press, 22 Sept. 2020, Preprint Server, https://www.medrxiv.org/content/ 10.1101/2020.09.18.20197319v1, –Wong and So provide great work on obesity and COVID-1973 73 Wong and So, 2020 is great work on obesity and COVID-19, …‘Results: A total of 1191 severe and 358 fatal [COVID-19] cases were identified. [] Since only pre-diagnostic clinical data were available, the main objective of this analysis was to identify baseline risk factors. [] For the prediction of mortality, the top features were age, systolic blood pressure, waist circumference (WC), urea and waist-hip ratio(WHR).’ –I would put the above forward as a putative theory, there is a correlation between excessive weight gain and increased risk of the COVID-19 Acute Respiratory Syndrome progressing, –If this is the flow, Theory: being overweight, being obese promotes the development of shorter telomeres, leading to a compromised Immune System, creating a vulnerability to COVID-19 disease progressing, …it might be precautionary to urge measurement of telomeres, show the Page 25 of 40 DRAFT K Moses Figure 13: #AutoGPT running at the COMMANDLINE of iTerm2> THE COINCIDENCE OF HEALTH DISPARITIES, VOLUME IV Appendix 3. Interlude: A Narrative-to-Data Framework for Mapping the Environmental Determinants of Immune Vulnerability Abstract: • Traditional epidemiological models often fail to capture the granular, real-time ‘Health Borders’ where environmental triggers and clinical vulnerabilities collide. This interlude proposes an evolution of the Saving Lives project, moving from an anecdotal collection of Narrative Interviews to a Systematic, Searchable Data Science framework. –Health Disparity Borders: * In late Spring 2020 I thought I saw in the COVID-19 related deaths data a Health Disparity Border running along East 96th Street, it resonated with my experience of teaching at a school on East 96th between First and Second Avenue; the school, Life Sciences Secondary School (LSSS), is on a border of Asthma hospitalizations for young people, I had prior knowledge of the incidence of Asthma hospitalizations.82 I highlighted this border in our slide 82 My former Env. Sci. course, LSSS proposal, https://drive.google.com/file/d/ 1aYyTP9hLol1cXiay4A4r7W5DZNHOKTCH/ view?usp=sharing <- just a historical marker for the origins of this document, …you don’t need this for the Assignment, show, Healthy Life Expectancies, https://www.loom.com/share/ 80e92d3e79e1407f8bac0d909be323eb. * I am presenting the border as a transition in the COVID-19 Disease hospitalization and death rate (circa 2020), and hospitalization rate related to Asthma (Circa 2000). * I am speculating that there is an air pollution gradient and border running parallel with the COVID-19 Disease hospitalization and death rate, and the hospitalization rate related to Asthma. Page 32 of 40 DRAFT K Moses Consider can we develop an air pollution gradient map that can match the maps showing a gradient for COVID-19 Disease and Asthma. Limited resources mean we will not be measuring Air Pollutants. An available methodology is Senior High Schoolers interviewing Senior High Schoolers in an Environmental Science class on their encounters with Health, Bad Air Smells, Pollution, Asthma, Stories of Asthma. We will talk of trying to move anecdotal observations of environments to a systematic science by tagging the #NarrativeInterviews, e.g., #SmelledDiesel, #AHSurvivor. We will talk of investigating the health of Immune Systems around the 96th Street Health Disparity Border. See, Ural et al., 2022 ‘Inhaled particulate accumulation with age impairs immune function and architecture in human lung lymph nodes.’ Nature Medicine, 21 Nov. 2022, pp. 1-11, doi:10.1038/s41591-022-02073-x. https://www.nature.com/articles/s41591-022-02073-x …for assistance on mechanistic notions on exposure and outcome relationships. * If we are in a situation of limited resources the route to follow is a methodology of Senior High Schoolers interviewing Senior High Schoolers in an Environmental Science class on their encounters with Health, Bad Air Smells, Pollution, Asthma, Stories of Asthma. * When high-cost environmental sensors aren’t available, I develop methodologies that treat the community as the sensor - using structured narrative tagging to turn lived experiences into actionable clinical intelligence. * The Tagging Glossary: Systematic Science Metadata: • Central to this methodology is a Qualitative Metadata Schema, utilizing targeted hashtags (e.g., #AsthmaHospitalizationSurvivor, #AHSurvivor, #EnvironmentalBorder) to transform personal histories into structured, geocoded data. By tagging Narratives with specific clinical markers and environmental stressors (such as diesel corridors or ‘Health Borders’ akin to the South Bronx/Harlem/), we create a ‘Bottom-Up’ data stream. • This approach addresses the ‘Gatekeeper Science’ problem by empowering patients - particularly those from under-represented and undocumented communities - to contribute to a shareable, systematic database of modifiable root causes. • The resulting ‘Epistemic Community’ platform allows for the overlay of qualitative patient experience onto quantitative clinical records (e.g., HL7 FHIR standards or SNOMED CT coding) and environmental sensor data. Page 33 of 40 DRAFT K Moses Metadata Tag Category Data Definition / Clinical Significance #AHSurvivor Clinical Asthma Hospitalization Survivor: Indicates a history of acute respiratory distress requiring inpatient admission. #LupusFlare Clinical Autoimmune Activity: Self-reported period of increased systemic inflammation or symptomatic Disease activity. #SmelledDiesel Exposure Particulate Proxy: Qualitative detection of diesel exhaust; functions as a proxy for high NO2/PM2.5 exposure in the absence of sensors. #RedRouteProximity Exposure Geospatial Risk: Narrative indicates residency or schooling within 50m of a major NYC Truck Corridor. #GatekeeperScience Structural Access Barrier: Narrative indicates a denial of diagnostic testing or environmental investigation by formal authorities. #HealthBorder Structural Disparity Marker: Indicates the event occurred at a known socioeconomic/environmental transition zone (e.g., East 96th St, ). Table 1: Tagging Glossary for Narrative-toData Systematic Science This framework provides a blueprint for a consensus on the environmental determinants of disease, shifting the focus from reactive treatment to proactive, precision-based public health intervention. My hashtags like #AHSurvivor are essentially ‘User-Generated SNOMED codes.’ In a professional system, I would eventually map #AHSurvivor to the official SNOMED code for Exacerbation of Asthma. • Building Infrastructure: The next step is evidenced by the publication of ‘The Environmental Justice Matters Workshop’ by Fischer, S., Holloman, S., Moses, K. (2025) https://doi.org/10.5281/zenodo.16049080 ... Building a Collaborative, an Epistemic Community is the path to take. Page 34 of 40 DRAFT K Moses … This suggests to me you should all consider using #AI as a #ResearchAssistant, Curator. I highly recommend you take over this search and take it further, the above is just first steps, Ask me any questions you wish, Best to you, K Moses JD PhD [email protected] Mobile: +13473526626 Page 35 of 40 K Moses Digitally signed by K Moses DN: cn=K Moses, o, ou, [email protected] M, c=US Date: 2025.12.26 12:21:51 Z DRAFT K Moses References Karen E. Adolph. An ecological approach to learning in (not and) development. 63(3):180–201. ISSN 0018-716X, 1423-0054. doi: 10.1159/000503823. URL https://www.karger.com/Article/FullText/503823. Publisher: Karger Publishers. Jonathan K. Alder, Vidya Sagar Hanumanthu, Margaret A. Strong, Amy E. DeZern, Susan E. Stanley, Clifford M. Takemoto, Ludmila Danilova, Carolyn D. Applegate, Stephen G. Bolton, David W. Mohr, and et al. Diagnostic utility of telomere length testing in a hospital-based setting. Proceedings of the National Academy of Sciences, 115(10):E2358–E2365, Mar 2018. ISSN 0027-8424, 1091-6490. doi: 10.1073/pnas.1720427115. URL https://www.pnas.org/content/115/10/E2358. Elias Bareinboim and Judea Pearl. Transportability from multiple environments with limited experiments: Completeness results. page 280–288, 2014. URL https://perma.cc/CF7C-MM7X. Sanjay Basu, Paula Yoffe, Nancy Hills, and Robert H. Lustig. The relationship of sugar to population-level diabetes prevalence: An econometric analysis of repeated cross-sectional data. 8(2):e57873. doi: 10.1371/journal.pone.0057873. URL http://dx.doi.org/10.1371/journal.pone.0057873. D. R. Bellhouse. The reverend thomas bayes, frs: A biography to celebrate the tercentenary of his birth. Statistical Science, 19(1), Feb 2004. ISSN 08834237. doi: 10.1214/088342304000000189. URL https://bit.ly/2ZhMK1T. Bloom, Cullinan, and Wedzicha. Asthma phenotypes and covid-19 risk: A population-based observational study. American Journal of Respiratory and Critical Care Medicine, 205(1):36 – 45, Jan 2022. ISSN 1073-449X. doi: 10.1164/rccm.202107-1704OC. URL https://www.atsjournals.org/doi/full/10. 1164/rccm.202107-1704OC. Marcus W. Butler, Aoife O’Reilly, Eleanor M. Dunican, Patrick Mallon, Eoin R. Feeney, Michael P. Keane, and Cormac McCarthy. Prevalence of comorbid asthma in COVID-19 patients. 146(2):334–335. ISSN 00916749. doi: 10.1016/j.jaci.2020.04.061. URL https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC7284278/. CDC. Science brief: Evidence used to update the list of underlying medical conditions associated with higher risk for severe covid-19 (updated 15 june 2022). Centers for Disease Control and Prevention, Feb 2020. URL https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/ underlying-evidence-table.html. Page 36 of 40 DRAFT K Moses Mario Coccia. Factors determining the diffusion of COVID-19 and suggested strategy to prevent future accelerated viral infectivity similar to COVID. 729:138474. ISSN 0048-9697. doi: 10.1016/j.scitotenv.2020.138474. URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169901/. Amanda K. Damjanovic, Yinhua Yang, Ronald Glaser, Janice K. KiecoltGlaser, Huy Nguyen, Bryon Laskowski, Yixiao Zou, David Q. Beversdorf, and Nan-ping Weng. Accelerated telomere erosion is associated with a declining immune function of caregivers of alzheimer’s disease patients. Journal of immunology (Baltimore, Md. : 1950), 179(6):4249–4254, Sep 2007. ISSN 0022-1767. URL https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC2262924/. Garg R., Karpati A., Leighton J., Perrin M., and Shah M. Asthma facts, second edition. new york city department of health and mental hygiene. page 50. URL https://www1.nyc.gov/assets/doh/downloads/pdf/asthma/facts.pdf. Miguel A. Hernán. The c-word: Scientific euphemisms do not improve causal inference from observational data. American Journal of Public Health, 108(5):616, May 2018. doi: 10.2105/AJPH.2018.304337. URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5888052/. Sir Austin Bradford Hill. The environment and disease: association or causation? Journal of the Royal Society of Medicine, 108(1):32, Jan 2015. doi: 10.1177/0141076814562718. URL https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4291332/. World Health Organization. Tackling NCDs: ‘best buys’ and other recommended interventions for the prevention and control of noncommunicable diseases. (WHO/NMH/NVI/17.9), 2017. URL https: //apps.who.int/iris/handle/10665/259232. Accepted: 2017-10-12T15:09:59Z. Rachel Levene, Daniel M. Fein, Ellen J. Silver, Joanna R. Joels, and Hnin Khine. The ongoing impact of COVID-19 on asthma and pediatric emergency health-seeking behavior in the bronx, an epicenter. 43: 109–114. ISSN 0735-6757. doi: 10.1016/j.ajem.2021.01.072. URL https://www.sciencedirect.com/science/article/pii/S0735675721000759. Xiaochen Li, Shuyun Xu, Muqing Yu, Ke Wang, Yu Tao, Ying Zhou, Jing Shi, Min Zhou, Bo Wu, Zhenyu Yang, Cong Zhang, Junqing Yue, Zhiguo Zhang, Harald Renz, Xiansheng Liu, Jungang Xie, Min Xie, and Jianping Zhao. Risk factors for severity and mortality in adult COVID-19 inpatients in wuhan. 146(1):110–118. ISSN 0091-6749. doi: 10.1016/j.jaci.2020.04.006. URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152876/. Page 37 of 40 DRAFT K Moses Kate Linthicum. Mexico’s new racial reckoning: A movement protests colorism and white privilege. Los Angeles Times, Oct 2022. URL https://www.latimes.com/world-nation/story/2022-10-20/ mexico-anti-racism-movement-protests-colorism. Harald Mangge, Markus Herrmann, Gunter Almer, Sieglinde Zelzer, Reinhard Moeller, Renate Horejsi, and Wilfried Renner. Telomere shortening associates with elevated insulin and nuchal fat accumulation. Scientific Reports, 10(11):6863, Apr 2020. ISSN 2045-2322. doi: 10.1038/s41598-02063916-6. URL https://www.nature.com/articles/s41598-020-63916-6. Fernando D. Martinez. Asthma in the time of COVID-19. 203(7):785– 786. ISSN 1073-449X. doi: 10.1164/rccm.202102-0389ED. URL https: //www.atsjournals.org/doi/full/10.1164/rccm.202102-0389ED. Publisher: American Thoracic Society - AJRCCM. Timo Mathys, Fábio Teodoro de Souza, Demian da Silveira Barcellos, and Ingrid Molderez. The relationship among air pollution, meteorological factors and covid-19 in the brussels capital region. Science of The Total Environment, 857:158933, Jan 2023. ISSN 0048-9697. doi: 10.1016/j.scitotenv.2022.158933. URL https://www.sciencedirect.com/ science/article/pii/S0048969722060326. Kevin Moses. A compromised immune system in the era of sars-cov-2. May 2020. doi: 10.5281/zenodo.6620638. URL https://zenodo.org/record/ 6620638. Oliver T. Mytton, Emma Boyland, Jean Adams, Brendan Collins, Martin O’Connell, Simon J. Russell, Kate Smith, Rebekah Stroud, Russell M. Viner, and Linda J. Cobiac. The potential health impact of restricting lesshealthy food and beverage advertising on UK television between 05.30 and 21.00 hours: A modelling study. PLOS Medicine, 17(10):e1003212, Oct 2020. ISSN 1549-1676. doi: 10.1371/journal.pmed.1003212. URL https: //journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003212. Dean Ornish, Jue Lin, June M Chan, Elissa Epel, Colleen Kemp, Gerdi Weidner, Ruth Marlin, Steven J Frenda, Mark Jesus M Magbanua, Jennifer Daubenmier, and et al. Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study.The Lancet Oncology, 14(11):1112–1120, Oct 2013. ISSN 1470-2045. doi: 10.1016/S14702045(13)70366-8. URL http://www.sciencedirect.com/science/article/pii/ S1470204513703668. Page 38 of 40 DRAFT K Moses Mabel Padilla. Hiv stigma and health care discrimination experienced by hispanic or latino persons with hiv — united states, 2018–2020. MMWR. Morbidity and Mortality Weekly Report, 71, 2022. ISSN 0149-21951545861X. doi: 10.15585/mmwr.mm7141a1. URL https://www.cdc.gov/mmwr/ volumes/71/wr/mm7141a1.htm. David Penny. Charles darwin as a theoretical biologist in the mechanistic tradition. 1(1):e1–e1. ISSN 2036-265X. doi: 10.4081/eb.2009.e1. URL https://www.pagepress.org/journals/index.php/eb/article/view/eb.2009.e1. Number: 1. Carolyn Rydyznski Moderbacher, Sydney I. Ramirez, Jennifer M. Dan, Alba Grifoni, Kathryn M. Hastie, Daniela Weiskopf, Simon Belanger, Robert K. Abbott, Christina Kim, Jinyong Choi, Yu Kato, Eleanor G. Crotty, Cheryl Kim, Stephen A. Rawlings, Jose Mateus, Long Ping Victor Tse, April Frazier, Ralph Baric, Bjoern Peters, Jason Greenbaum, Erica Ollmann Saphire, Davey M. Smith, Alessandro Sette, and Shane Crotty. Antigen-specific adaptive immunity to SARS-CoV-2 in acute COVID-19 and associations with age and disease severity. 183(4):996– 1012.e19. ISSN 0092-8674. doi: 10.1016/j.cell.2020.09.038. URL https://www.sciencedirect.com/science/article/pii/S0092867420312356. Kamrunnahar Shanta, Kentaro Nakayama, Masako Ishikawa, Tomoka Ishibashi, Hitomi Yamashita, Seiya Sato, Hiroki Sasamori, Kiyoka Sawada, Sonomi Kurose, Hossain Mohammad Mahmud, Sultana Razia, Kouji Iida, Noriyoshi Ishikawa, and Satoru Kyo. Prognostic value of peripheral blood lymphocyte telomere length in gynecologic malignant tumors. 12(6):1469. doi: 10.3390/cancers12061469. URL https://www.mdpi.com/2072-6694/12/6/1469. Number: 6 Publisher: Multidisciplinary Digital Publishing Institute. G. Shen, J.-Y. Huang, Yu-Qing Huang, and YingQing Feng. The relationship between telomere length and cancer mortality: Data from the 1999–2002 national healthy and nutrition examination survey (NHANES). 24(1): 9–15. ISSN 1760-4788. doi: 10.1007/s12603-019-1265-z. URL https: //doi.org/10.1007/s12603-019-1265-z. Shi, Pan, Vasileiou, Robertson, and Sheikh. Risk of serious covid-19 outcomes among adults with asthma in scotland: a national incident cohort study. The Lancet Respiratory Medicine, 10(4):347 – 354, Apr 2022. ISSN 2213-2600. doi: 10.1016/S2213-2600(21)00543-9. URL https://www.sciencedirect.com/ science/article/pii/S2213260021005439. Anthony P. Sunjaya, Sabine M. Allida, Gian Luca Di Tanna, and Christine Jenkins. Asthma and risk of infection, hospitalization, ICU admission Page 39 of 40 DRAFT K Moses and mortality from COVID-19: Systematic review and meta-analysis. pages 1–14. ISSN 0277-0903. doi: 10.1080/02770903.2021.1888116. URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022341/. Paul D. Terry, R. Eric Heidel, and Rajiv Dhand. Asthma in adult patients with COVID-19. prevalence and risk of severe disease. 203(7):893–905. ISSN 1535-4970. doi: 10.1164/rccm.202008-3266OC. Christopher W. Tessum, David A. Paolella, Sarah E. Chambliss, Joshua S. Apte, Jason D. Hill, and Julian D. Marshall. PM2.5 polluters disproportionately and systemically affect people of color in the united states. 7 (18):eabf4491. doi: 10.1126/sciadv.abf4491. URL https://www.science. org/doi/10.1126/sciadv.abf4491. Publisher: American Association for the Advancement of Science. Toni Morrison. Playing in the dark: Whiteness and the literary imagination. 1992. Harriet Washington. Chapter 3poisoned world - the racial gradient of environmental neurotoxins. 2019. URL https://www.hachettebookgroup.com/ titles/harriet-a-washington/a-terrible-thing-to-waste/9780316509428/. Julia Wick, Robert Meeks, Salvador Hernandez, Summer Lin, and J.R. Lizarraga. Breaking down crucial moments in the racist leaked recording of l.a. councilmembers. Los Angeles Times, Oct 2022. URL https://lat.ms/3SQa5xK. Kenneth C. Y. Wong and Hon-Cheong So. Uncovering clinical risk factors and prediction of severe COVID-19: A machine learning approach based on UK biobank data. page 2020.09.18.20197319. doi: 10.1101/2020.09.18.20197319. URL https://www.medrxiv.org/content/10. 1101/2020.09.18.20197319v1. Page 40 of 40