Tag Archives: Cancer

Alarmed US doctors and scientists are investigating whether COVID-19 is to blame for spike of rare and deadly cancers

Hospital-Room

 

Important Takeaways:

  • The group of medical experts banded together to launch research studies and share data after concluding there was compelling evidence among their own patients to suggest a link between COVID and cancer diagnoses
  • “I’ve been in practice 23 years and have never seen anything like this,” Kashyap Patel, an oncologist in South Carolina and CEO of Carolina Blood and Cancer Care Associates
  • Patel, who is calling for a national registry to analyze trends, said he has already collected data from dozens of his own patients showing a possible link between unusual cancers and long COVID.
  • “Hopefully, we’re wrong,” Afshin Beheshti, president of the COVID-19 International Research Team, said. “But everything is, unfortunately, pushing toward that being the case.”
  • The US-based doctors are calling on the federal government to prioritize the research — given such answers could affect treatment for cancer patients, as well as management of the disease, over the next several decades.

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‘Forever Chemicals’ found in 99 percent of foods sold at the grocery store, even foods labeled organic

BPA-Products

Important Takeaways:

  • Startling new report finds hormone-warping chemicals in 99 PERCENT of food sold in American stores – which may raise risk of cancer, autism and infertility
  • ‘Forever chemicals’ linked to cancer are found in virtually every food product sold in American stores, a shocking report suggests.
  • The watchdog Consumer Reports tested 85 everyday items for the presence of phthalates and bisphenols, two types of PFAS chemicals used to make plastics.
  • The researchers tried to make their sample size as broad as possible – testing water, soda, cereal, bread, meat, fish, condiments, desserts and even baby food.
  • All but one product tested positive for the substances, which have been dubbed ‘forever chemicals’ because they are virtually impossible to break down in the body where they cause untold health problems.
  • It comes amid growing fears about the massive amounts of chemicals being ingested by Americans every year. A study earlier this week found water bottled contain a quarter of a million pieces of microscopic plastics.
  • The product with the highest amount of phthalates per serving in nanograms was Annie’s canned organic cheesy ravioli, which contained 53,580 nanograms of phthalates per serving.
  • Exposure to phthalates has been linked to asthma, ADHD, breast cancer, obesity and type II diabetes.

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Young people are being diagnosed with cancer at a higher rate and researchers aren’t sure why

Luke 21:11 There will be great earthquakes, and in various places famines and pestilences. And there will be terrors and great signs from heaven.

Important Takeaways:

  • Vanessa Chapoy had just turned 24 when she felt the lump in her breast. It was “huge,” she remembers, “like the size of a walnut, or a big marble.” She went to the first in a series of doctors that night to have it checked out. Two-and-a-half weeks later, she was diagnosed with breast cancer. Stage two, she would learn.
  • “And my whole world flipped upside down,” Chapoy says.
  • She entered a gauntlet of treatments: a lumpectomy to cut out the tumor and a portion of surrounding breast tissue, fertility treatments so she could freeze her eggs, five months of chemotherapy and then a double mastectomy to remove both of her breasts.
  • Three years on, she’s still undergoing hormone therapy — an experience she likens to “early menopause”
  • In the U.S., the rate of early-onset cases rose by almost 18 percent between 2000 and 2019, even as cancer declined slightly in older adults, according to data from the National Cancer Institute (NCI). Among Americans between 15 and 39 years old, an age group cancer researchers refer to as adolescents and young adults (AYAs), the surge was more pronounced still, topping 20 percent.
  • Why? Cancer researchers aren’t entirely sure.

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Facing new COVID wave, Dutch delay care for cancer, heart patients

AMSTERDAM (Reuters) – Dutch healthcare officials said on Friday they have begun delaying operations for some cancer and heart patients to free up space in intensive care units during a record wave of COVID-19 infections.

“These are cancer patients that should actually be operated on within six weeks of diagnosis, and that won’t be met in all cases. It’s also heart patients,” said a spokesperson for LCPS, the national organization that allocates hospital resources.

“It’s horrible, of course, for the patients.”

The National Institute for Health (RIVM) reported a record of more than 23,000 new cases in the previous 24 hours on Thursday, compared with the previous daily high of around 13,000 reached in December 2020.

With 85% of the adult population vaccinated, both hospital and intensive care unit (ICU) admission rates have so far remained lower than they were at the height of the initial wave in April 2020, although there is a delay between the date of infection and the date of admission to hospital.

With fewer than 200 beds remaining in Dutch ICU as of Thursday, hospitals are scrambling to add more capacity.

The government at the start of November reintroduced mask-wearing in stores, and last weekend it reimposed a partial lockdown, including closing bars and restaurants after 8 p.m.

But the impact of those measures has yet to be seen in the daily case numbers.

Parliament is divided over a plan proposed by Prime Minister Mark Rutte’s government to limit access to indoor public venues to people who have a “corona pass,” which shows they have been vaccinated or already recovered from an infection. Critics say the move would be divisive and discriminatory.

Schools remain open, and virologists on Thursday proposed extending Christmas holidays to slow infections, which are rising most rapidly among children.

(Reporting by Toby Sterling; Editing by Mark Heinrich)

New kidney problems linked to ‘long COVID;’ loss of smell may be followed by other smell distortions

By Nancy Lapid

(Reuters) – The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that have yet to be certified by peer review.

‘Long COVID’ tied to higher kidney risks

COVID-19 symptoms that persist long after infection, known as “long COVID,” has been tied to a higher risk for new kidney problems, according to a new study. Analyzing data on more than 1.7 million U.S. veterans, including nearly 90,000 COVID-19 survivors with symptoms lasting at least 30 days, researchers found the “long haulers” were at higher risk for new kidney problems compared to people who had not been infected with the coronavirus. This was true even when survivors had not been hospitalized, although declines in kidney function were “more profound” with more severe infection, they reported on Wednesday in the Journal of the American Society of Nephrology. Roughly 5% of the Long COVID group developed at least a 30% drop in a critical measure of kidney function known as the estimated glomerular filtration rate, or eGFR. Overall, people with long COVID were 25% more likely than uninfected people to develop a 30% decline in eGFR, with higher risks in survivors of more severe disease. While kidney function often declines with age, the damage in these patients “was in excess” of what happens with normal aging, study coauthor Dr. Ziyad Al-Aly, of Washington University in St. Louis, said in a statement. “Our findings emphasize the critical importance of paying attention to kidney function and disease in caring for patients who have had COVID-19,” he said.

Loss of smell may be followed by smell distortions

Many people who lose their sense of smell due to COVID-19 eventually regain it, but some survivors later report smell distortions and unexplained smells, a new study found. Researchers analyzed survey responses from 1,468 individuals who had been diagnosed with COVID-19 between April and September 2020 and had suffered loss of smell and taste at the start of their illness. Early on, about 10% also reported smell distortions, or parosmia, and unexplained smells, known as phantosmia. At an average of six to seven months after becoming ill and first reporting loss of smell, roughly 60% of women and 48% of men had regained less than 80% of their pre-illness smell ability, and rates of smell distortions and imaginary smells had increased, the researchers reported on Tuesday on medRxiv ahead of peer review. Roughly 47% reported parosmia, saying, for example, “some things now smell like chemicals.” About 25% reported phantosmia. “Sometimes I can smell burning but no one else around me can,” one respondent reported. Persistent smell problems were seen more often in survivors with more symptoms overall, “suggesting it may be a key marker of long-COVID,” the authors said.

Vaccines induce antibodies despite cancer, immunocompromise

The mRNA COVID-19 vaccines trigger protective immune responses in most cancer patients with solid tumors and in many people taking immunosuppressive medications, two small studies suggest. In Israel, researchers found that six months after the second dose of the vaccine from Pfizer Inc and BioNTech SE, 79% of 154 patients with solid tumors had developed antibodies, as had 84% of 135 similar people without cancer, a difference that was not deemed statistically significant. Antibody levels were similar in the two groups, the researchers reported on Thursday in Cancer Discovery. Separately, U.S. researchers studied 133 adults taking immunosuppressive medications for chronic inflammatory diseases and 53 healthy volunteers. At three weeks after the second shot of an mRNA vaccine from Pfizer/BioNTech or Moderna Inc, nearly 90% of the immunosuppressed participants had developed antibodies, although many had lower responses compared to the control group, according to a report published on Tuesday in Annals of Internal Medicine.

Antibody therapy cuts hospitalization rates

People with mild-to-moderate COVID-19 who were treated with a monoclonal antibody “cocktail” had lower hospitalization rates than similar people who did not receive the treatment, researchers reported on Monday in EClinicalMedicine. They looked at nearly 1,400 such patients, roughly half of whom had received Regeneron Pharmaceutical Inc’s combination monoclonal antibody therapy. Among those who received the treatment, about 45% were older than 65, and many had high blood pressure, obesity, diabetes, lung disease and other risk factors. By four weeks after the treatment, 1.6% of them had been hospitalized, compared to 4.8% of patients not treated with the monoclonal antibodies. The study was not randomized and cannot prove the treatment caused the better outcomes. However, it “suggests that when patients who are at high risk due to a range of comorbidities contract a mild or moderate case of COVID-19, this combination of monoclonal injections gives them a chance of a non-hospitalized recovery,” study leader Dr. Raymund Razonable of the Mayo Clinic in Rochester, Minnesota in a statement.

(Reporting by Nancy Lapid; Editing by Bill Berkrot)

Breakthrough COVID vaccine tech could help defeat other diseases

By John Miller and Ludwig Burger

ZURICH/FRANKFURT (Reuters) – Breakthrough technology that transforms the body into a virus-zapping vaccine factory is poised to revolutionize the fight against COVID-19 but future pandemics and even cancer could be next, scientists say. The initial success of so-called messenger ribonucleic acid (mRNA) vaccines in late-stage trials by Moderna as well as Pfizer and its German partner BioNTech is the first proof the concept works.

Both experimental vaccines had efficacy rates above 90% based on interim findings, which was far higher than expected and well above the 50% threshold U.S. regulators insist upon for vaccines.

Now scientists say the technology, a slow-motion revolution in the making since the discovery of mRNA nearly 60 years ago, could speed up the development of new vaccines.

The traditional method of creating vaccines – introducing a weakened or dead virus, or a piece of one, to stimulate the body’s immune system – takes over a decade on average, according to a 2013 study. One pandemic flu vaccine took over eight years while a hepatitis B vaccine was nearly 18 years in the making.

Moderna’s vaccine went from gene sequencing to the first human injection in 63 days.

With BioNTech and Pfizer’s COVID-19 candidate on a similar trajectory, both could win regulatory approval this year, barely 12 months since the coronavirus first emerged.

Other companies are pursuing the technology such as Germany’s CureVac also has an mRNA vaccine candidate, though has yet to start a late-stage trial and is hoping it will get the green light after July 2021. “We’ll look back on the advances made in 2020 and say: ‘That was a moment when science really did make a leap forward’,” said Jeremy Farrar, director of the Oxford University Clinical Research Unit, which is backed by the Wellcome Trust.

THE LAST LAUGH

Discovered in 1961, mRNA carries messages from the body’s DNA to its cells, telling them to make the proteins needed for critical functions, such as coordinating biological processes like digestion or fighting disease.

The experimental vaccines from Moderna as well as Pfizer and BioNTech use lab-made mRNA to instruct cells to make the coronavirus’s spike proteins, which spur the immune system into action without replicating like the actual virus. Back in 1990, scientists managed to get mice to generate proteins by injecting mRNA, an early sign of the technology’s potential.

But early proponents such as Katalin Kariko, a Hungarian-born scientist and senior vice president at BioNTech, were hampered by obstacles such as mRNA’s instability in the body and its propensity to cause inflammatory responses.

A breakthrough came around 2005 when Kariko, along with colleagues at the University of Pennsylvania, figured out how to deliver mRNA without kicking the immune system into overdrive.

Still, it took another 15 years – and a pandemic that brought the world’s economy to its knees – to reach the cusp of success. Kariko said her years of dogged pursuit once made her the butt of jokes for some university colleagues.

“The last time they laughed at me and ridiculed me was when they learned that I was going to join BioNTech seven years ago and they realized this company (didn’t) even have a website,” she told Reuters. “But now, they learn of BioNTech and that we can do good things.”

Kariko said her life’s work could pay dividends, not just against COVID-19, but other diseases.

“It could be easier sailing for the next anti-viral product, a vaccine for influenza and other infectious disease,” said Kariko, whose daughter is a U.S. Olympic gold medalist rower.

CANCER NEXT?

Moderna and BioNTech, for example, are also applying mRNA technology to experimental cancer medicines.

BioNTech is testing an anti-melanoma mRNA with Swiss pharmaceutical giant Roche in a Phase II trial.

Among Moderna’s most advanced projects, besides its COVID-19 vaccine, are mRNA compounds to treat ovarian cancer or Myocardial ischemia, which are also in the second test phase.

None of the potential mRNA cancer therapies have reached the critical large-scale Phase III trials, however, and Kariko acknowledges that cancer presents a bigger challenge.

While a virus is a foreign intruder, cancer cells, however malignant, come from within the body, making them tougher to seek out and expose so they can be attacked.

“Sometimes cancer is just caused by gene and chromosome duplication and then everything about it looks normal and the cell is just dividing more than it should,” she said.

For vaccines against infectious diseases, the pharmaceutical industry’s traditional approach has been to whip them up in large bioreactors, a time-consuming, expensive process in facilities that can cost up to $700 million to build.

By contrast, Zoltan Kis, an Imperial College London researcher who models vaccine manufacturing, estimates that one five-liter bioreactor inside a $20 million facility could make a billion doses of some kinds of mRNA vaccines a year.

Drug manufacturer Lonza, enlisted to make ingredients for 400 million doses of Moderna’s vaccine annually at U.S. and Swiss sites, is due to start production this year with manufacturing lines costing $60 million to $70 million each.

“We are producing mRNA at smaller scales and in smaller facilities when compared to traditional larger-scale equipment and facilities,” Andre Goerke, Lonza’s global lead for the Moderna project, told Reuters. “The manufacturing ramp-up is quicker and more economical.”

‘ULTRA-FAST RESPONSE’

Raymond Schiffelers, of University Medical Center Utrecht in the Netherlands, who heads a European Union program for mRNA therapeutics, said the major advantage of the technology was that vaccine developers could mount an “ultra-fast response”.

“Within weeks, testing can start, a major advantage over conventional vaccines,” he said.

The moment a pathogen’s genomic sequence is known, synthetic mRNAs can be designed that encode key parts of the virus, such as the coronavirus’s potentially lethal spike protein.

Risks and challenges for mRNA remain.

Some candidates must be stored at extremely cold temperatures, making delivery potentially difficult in countries with limited infrastructure. They also may be fragile to transport, Schiffelers said.

BioNTech’s vaccine, for example, must be transported at minus 70 degrees Celsius, though Moderna said on Monday it can ship its candidate in normal refrigerators.

Francis Collins, director of the U.S. National Institutes of Health (NIH), which funded Moderna’s vaccine development, also said mRNA vaccines may not be a silver bullet for flu, since it mutates so swiftly that reaching 90% efficacy is unlikely.

But for COVID-19, Collins said mRNA is likely to be a revolution.

“It’s clearly several months faster than any of the other methods,” Collins said. “In a crisis moment, several months really matter.”

(Reporting by John Miller in Zurich, Allison Martell in Toronto, Ludwig Burger in Frankfurt, Kate Kelland in London, Michael Erman in New York, Julie Steenhuysen in Chicago and Marton Dunai in Budapest; Editing by Josephine Mason and David Clarke)

Johnson & Johnson to pay more than $100 million to settle over 1,000 talc lawsuits: Bloomberg

Reuters) – Johnson & Johnson will pay more than $100 million to settle over 1,000 lawsuits that allege the company’s Baby Powder caused cancer, Bloomberg news reported on Monday, citing people with knowledge of the pacts.

J&J faces more than 19,000 lawsuits from consumers and their survivors claiming its talc products caused cancer due to contamination with asbestos, a known carcinogen. The company has maintained that its talc is safe.

The drugmaker declined to comment on the Bloomberg report but reiterated that its talc is safe, does not contain asbestos and does not cause cancer.

“In certain circumstances, we do choose to settle lawsuits, which is done without an admission of liability and in no way changes our position regarding the safety of our products,” the company said in a statement.

In May, J&J said it would stop selling its talc in the United States and Canada after demand had fallen in the wake of what it called “misinformation” about the product’s safety amid a barrage of legal challenges.

J&J has faced scrutiny over the safety of its baby powder following an investigative report by Reuters in 2018 that found the company knew for decades that asbestos lurked in its talc.

(Reporting by Dania Nadeem in Bengaluru; Editing by Saumyadeb Chakrabarty)

COVID-19 can wipe out health care progress in short order: WHO

By Emma Farge

GENEVA (Reuters) – More than 90% of countries have seen ordinary health services disrupted by the COVID-19 pandemic, with major gains in medical care attained over decades vulnerable to being wiped out in a short period, a World Health Organization survey showed.

The Geneva-based body has frequently warned about other life-saving programs being impacted by the pandemic and has sent countries mitigation advice, but the survey yielded the first WHO data so far on the scale of disruptions.

“The impact of the COVID-19 pandemic on essential health services is a source of great concern,” said a report on the study released on Monday. “Major health gains achieved over the past two decades can be wiped out in a short period of time…”

The survey includes responses from between May and July from more than 100 countries. Among the most affected services were routine immunizations (70%), family planning (68%) and cancer diagnosis and treatment (55%), while emergency services were disturbed in almost a quarter of responding countries.

The Eastern Mediterranean Region, which includes Afghanistan, Syria and Yemen, was most affected followed by the African and Southeast Asian regions, it showed. The Americas was not part of the survey.

Since COVID-19 cases were first identified in December last year, the virus is thought to have killed nearly 850,000 people, the latest Reuters tally showed.

Researchers think that non-COVID deaths have also increased in some places due partly to health service disruptions, although these may be harder to calculate.

The WHO survey said it was “reasonable to anticipate that even a modest disruption in essential health services could lead to an increase in morbidity and mortality from causes other than COVID-19 in the short to medium and long-term.” Further research was needed.

It also warned that the disruptions could be felt even after the pandemic ends. “The impact may be felt beyond the immediate pandemic as, in trying to catch up on services, countries may find that resources are overwhelmed.”

(Reporting by Emma Farge; Editing by Mark Heinrich)

U.S. Supreme Court’s Ginsburg undergoing treatment for cancer recurrence

By Andrew Chung

(Reuters) – Justice Ruth Bader Ginsburg, at 87 the U.S. Supreme Court’s oldest member, said on Friday she is receiving chemotherapy treatment for a recurrence of cancer – the latest in a series of health issues – but indicated no intention to retire.

In a statement released by the court, Ginsburg said that a periodic scan in February, followed by a biopsy, revealed lesions on her liver. She said she is tolerating the chemotherapy treatment well and that it is yielding positive results. She said she began her chemotherapy on May 19.

“I have often said I would remain a member of the Court as long as I can do the job full steam. I remain fully able to do that,” Ginsburg said.

The health of Ginsburg, the court’s senior liberal member, is closely watched because a Supreme Court vacancy could give Republican President Donald Trump the opportunity to appoint a third justice to the nine-member court and move it further to the right. The court currently has a 5-4 conservative majority including two justices appointed by Trump – Brett Kavanaugh in 2018 and Neil Gorsuch in 2017.

On Wednesday, Ginsburg was released from a hospital in Baltimore after treatment for a possible infection. She underwent a procedure at Johns Hopkins Hospital to clean a bile duct stent that was inserted last August. Ginsburg said recent hospitalizations to remove gall stones and treat an infection were unrelated to this cancer recurrence.

Ginsburg experienced a bout with lung cancer in 2018 and pancreatic cancer in 2019. She had previously been treated for pancreatic cancer in 2009 and colon cancer in 1999. In May, she underwent non-surgical treatment for a gallstone that had caused an infection.

In this latest cancer fight, Ginsburg said, immunotherapy proved unsuccessful, but with chemotherapy her most recent scan on July 7 indicated “significant reduction of the liver lesions” and no new disease.

“Satisfied that my treatment course is now clear, I am providing this information,” Ginsburg added.

Ginsburg said she has been able to keep up with her work at the court, including writing opinions in cases, throughout the treatment course. “I will continue bi-weekly chemotherapy to keep my cancer at bay, and am able to maintain an active daily routine,” she added.

Ginsburg is the second-longest serving among the current nine justices behind Clarence Thomas, having been appointed to a lifetime post on the court by President Bill Clinton in 1993. She was the second woman ever named to the court, after Justice Sandra Day O’Connor was appointed 12 years earlier.

A trail-blazing lawyer who won gender equality cases at the Supreme Court in the 1970’s, as a justice she has provided key votes in landmark rulings securing equal rights for women, expanding gay rights and safeguarding abortion rights.

(Reporting by Andrew Chung; Editing by Will Dunham)

New U.S. health crisis looms as patients without COVID-19 delay care

By Sharon Bernstein

(Reuters) – A Texas man who waited until his brain tumor was softball-sized; a baby who suffered an ear infection for six days; a heart patient who died: The resurgence of COVID-19 is creating another health crisis as hospitals fill and patients are fearful or unable to get non-emergency care.

With U.S. coronavirus infections reaching new heights, doctors and hospitals say they are also seeing sharp declines in patients seeking routine medical care and screenings – and a rise in those who have delayed care for so long they are far sicker than they otherwise would be.

“I had one lady who had delayed for five days coming in with abdominal pain that was getting worse and worse,” said Dr. Diana Fite, who practices emergency medicine in Houston. “When she finally came in, she had a ruptured appendix.”

After the pandemic was declared a national emergency in March, many states banned non-essential medical procedures, and the number of patients seeking care for other ailments took a nosedive. Hospitals and medical practices were hit hard financially.

Emergency department use dropped by 42% during the first 10 weeks of the pandemic despite a rise in patients presenting with symptoms of the coronavirus, data from the U.S. Centers for Disease Control and Prevention show. In the same period, patients seeking care for heart attacks dropped by 23% and stroke care by 20%.

As the initial outbreak leveled off in the weeks that followed, healthcare experts planned to handle primary care differently should infections rise again, making sure minor procedures like cancer screenings were still allowed and assuring patients that hospitals and clinics were safe.

But the recent surge in cases has swamped hospitals in many states, including Texas, Arizona, Florida and parts of California.

CANCER MORTALITY RATES

Texas has again banned many non-emergency procedures, though cancer surgeries are still allowed, and a hospital in California’s San Joaquin Valley for several days admitted only COVID-19 patients.

Patients without COVID-19 – either out of fear, confusion or because of difficulty in obtaining the care they need – are again staying home.

The result is a healthcare crisis in the making, said Austin oncologist Dr. Debra Patt, who said she expects mortality rates from cancer to skyrocket in the years after the pandemic because patients have delayed their care.

“They’re scared to go in the hospital unless they absolutely have to,” said Patt. “And even when the patients are willing, it’s hard to get things done.”

Patt in recent days treated a man who waited to come in for headaches and dizziness until he had lost 35 pounds and had a softball-sized tumor in his head.

Fite, who is president of the Texas Medical Association, cared for a baby whose parents waited six days before bringing him in with a severe ear infection.

Patt said screening mammograms are down by 90% in Austin, where she specializes in breast cancer and serves as executive vice president of Texas Oncology. That means some tumors will be missed, and women who develop aggressive cancers might not know about it until the disease is more advanced and more likely to be deadly.

“It’s an impact we will see on cancer survival for years to come,” she said.

Dr. David Fleeger, a colorectal surgeon in Austin and a past president of the Texas Medical Association, said he has had numerous patients cancel colonoscopies in recent days.

“The delays in colonoscopies that are occurring right now ultimately will lead to more cancers and more deaths,” he said.

‘IN A HOLDING PATTERN’

Patt’s patient Helen Knost had to put off surgery for breast cancer in early spring because it was considered non-emergency in Texas and barred at the time, and she was treated instead with the medication Tamoxifen.

“It’s very strange to know you have cancer and you’re just hanging out with it, just in a holding pattern,” said Knost, who did ultimately undergo successful surgery.

In California, doctors at the 150-bed Adventist Lodi Memorial Hospital in the San Joaquin Valley were determined that a second surge in coronavirus cases would not bring a repeat of the pandemic’s early days, when emergency room visits dropped in half. Emergency medical technicians also reported a 45% rise in the number of heart patients who died before they could be brought to the hospital.

Hospital CEO Daniel Wolcott led a campaign to inform the community that the medical center was open and safe, even speaking to people about it in the grocery store.

But with new COVID-19 cases swamping the hospital, sickening nearly 30 staff members and forcing it to divert non-coronavirus cases to other facilities for several days, Wolcott fears that again patients with heart conditions and other illnesses will stay away.

“We won’t know for years how many people lost their lives or lost good years of their lives for fear of coronavirus,” he said.

(Reporting by Sharon Bernstein in Sacramento, California; editing by Bill Tarrant and Cynthia Osterman)