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Section 4: Plausible Mechanisms
Pages 17-33

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From page 17...
... DIRECTED RADIO FREQUENCY ENERGY Sources of Information The committee relied on open source data from published literature as well as firsthand reports from clinicians, researchers, and affected DOS personnel shared in person at its December and February meetings, to evaluate the plausibility of directed RF energy exposure as a cause of both the acute and chronic clinical signs and symptoms discussed in Section 3 (Clinical Findings)
From page 18...
... Based on a review of these information sources, the committee finds that many of the acute, early phase symptoms and observations reported by DOS employees are consistent with RF effects, including a perceived clicking sound within the head even when the ears were covered, a perceived force/pressure sensation within the head and on the face, perceived spatial localization and directionality of these perceived phenomena and other loud sounds, hearing loss, tinnitus, impaired gait and loss of balance, as well as the absence of heating sensation and absence of observed disruption of electronic devices in the immediate environment. In addition, many of the chronic, nonspecific symptoms are also consistent with known RF effects, such as dizziness, headache, fatigue, nausea, anxiety, cognitive deficits, and memory loss.
From page 19...
... However, if these effects exist, this unusual form of vestibular stimulation could lead to very confusing perceptions, as central vestibular pathways do their best to resolve the non-physiological pattern of end organ stimulation resulting in perceptions of physically impossible motions, unexpected reflexive postural responses to them, and faulty inferences about external forces causing them. Affected individuals could report different sensations in response to the same external stimulus; thus, it is consistent with this scenario that the early phase reports of the perceptions of affected individuals varied from one individual to another, and may have been difficult for the individuals to describe.
From page 20...
... to quantify the biological effects, but would be ethically difficult to justify. In the absence of such data, it is difficult to align specific biophysical effects within the potential RF exposure regime that could explain specific medical symptoms reported by DOS personnel and the variability in specific experiences and timelines of individuals.
From page 21...
... Embassy personnel. The Dalhousie University research team presented data they believed demonstrated significantly decreased AChE activity in at least a subset of Canadian Embassy personnel and Canadian tourists who were in Havana during the same time as affected U.S.
From page 22...
... OP-associated neurotoxic effects, which may or may not be associated with AChE inhibition in affected individuals, include hearing loss, tinnitus, dizziness, headache, fatigue, motor incoordination, nausea, insomnia, anxiety, memory deficits and inability to concentrate (Anger et al., 2020; Ashok Murthy and Visweswara Reddy, 2014; Choochouy et al., 2019; Crawford et al., 2008; Dassanayake et al., 2007, 2008, 2009; Dundar et al., 2016; Edwards and Tchounwou, 2005; London et al., 1998; Richter et al., 1992; Roldan-Tapia et al., 2006; Ross et al., 2013; Teixeira et al., 2002)
From page 23...
... that caused the Embassy personnel cases. Alternatively, differential exposure to insecticides amongst affected individuals may have contributed to the clinical heterogeneity of the acute symptoms noted in Havana cases, since OP and pyrethroid exposures are associated with a subset of these acute symptoms (see Appendix D)
From page 24...
... Summary In summary, the committee considered possible infectious etiologies that might explain the clinical features reported in DOS employees and focused on those infectious agents known to be prevalent in Cuba and capable of causing neurological manifestations. Among those agents, Zika infection received attention from the committee because it was epidemic in Cuba in 20162017 and is known to be able to produce relevant neurological findings.
From page 25...
... Individual patient-level data were not provided to the committee, other than what the committee learned from direct interviews with a small number of affected DOS personnel. Assessment and Findings Acute Symptoms The committee carefully considered three possible roles for psychological and social factors in the morbidity experienced by DOS employees: (1)
From page 26...
... . Most individuals affected by mass psychogenic illnesses do not have pre-existing psychiatric disorders.
From page 27...
... . Nonspecific dizziness, lightheadedness, and fatigue have been described commonly in mass psychogenic illnesses, but complaints similar to the directional audio-vestibular symptoms reported by affected individuals from Cuba have not (Bartholomew et al., 2012; Cole et al., 1990)
From page 28...
... The significant variability and clinical heterogeneity of the illnesses affecting DOS personnel leave open the possibility of multiple causal factors over time and place, both for individual cases and for the population. Like other mechanisms reviewed by the committee, psychological and social factors could exacerbate other forms of pathology and have to be considered as contributors to morbidity in some of the cases, especially for individuals with chronic symptoms.
From page 29...
... In Biological Effects and Medical Applications of Electromagnetic Energy, edited by O
From page 30...
... 2016. Outbreak of mysterious illness in a hospital poisoning or iatrogenic induced mass psychogenic illness.
From page 31...
... 2019. Systematic review of long-term neurological effects following acute exposure to the organophosphorus nerve agent sarin.
From page 32...
... 2000. A comprehensive review of the research on biological effects of pulsed radiofrequency radiation in Russia and the former Soviet Union.
From page 33...
... 2020. Association between pyrethroid pesticide exposure and hearing loss in adolescents.


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