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ICE detainees suffer preventable deaths − Q&A with a medical researcher about systemic failures

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theconversation.com – Cara R. Muñoz Buchanan, Physician and Clinical Fellow in Policy and Social Emergency Medicine, Harvard Kennedy School – 2024-06-28 07:37:35
The ICE Health Service Corps suffers from outdated systems and a lack of translation services, despite a federal mandate to provide them.
ICE Health Service Corps

Cara R. Muñoz Buchanan, Harvard Kennedy School

The 2024 Homeland Security appropriations bill increased funding for U.S. Immigration and Customs Enforcement operations to handle an anticipated daily detainee population of 41,500, up from an average of 34,000 in recent years.

Yet recent studies have exposed cracks that call into question the agency's ability to medically care for the detainees it is entrusted with, including inhumane conditions, high suicide rates, structural problems such as the use of prisons to hold detainees, delayed or interrupted medical care and overcrowded conditions. Research also shows that the pandemic years further exacerbated these inequalities.

One recent report by a trio of nonprofit advocacy groups blames preventable deaths of people detained by ICE on inadequate investigations and flawed systems at the agency. The report, Deadly Failures, released on June 25, 2024, by the American Civil Liberties Union, American Oversight, and Physicians for Human Rights, documents inadequacies in diagnosis, treatment and emergency response. It points to suicides that might have been prevented with appropriate mental health care and properly managed medication. And it details underlying issues – understaffing and a lack of interpretation and translation services.

asked Cara Buchanan, an emergency physician and clinical fellow in health policy and social emergency medicine at the Harvard Kennedy School, whose research the report cites, about research in this area by her team and others, ICE's track record on detainee medical care and what needs to be done to improve medical care for people in ICE custody.

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What have you and your colleagues found in studying medical care for detainees in U.S. Immigration and Customs Enforcement custody?

Our research shows that preventable deaths of people in ICE detention are often preceded by lapses in a standardized, consistent and competent approach to medical triage, including identification and escalation of the need for emergency care.

What has other recent research uncovered in this area?

Research across many disciplines, including medicine, law, policy, criminal justice, health economics, human rights and public health, correlate structural design features of immigration detention facilities to adverse health outcomes for detainees. This includes the use of solitary confinement, which is linked to an increased risk of self-harm for detainees in ICE custody.

The COVID-19 pandemic highlighted significant health disparities in immigration detention facilities. Many facilities failed to provide adequate basic, preventive and emergency medical care.

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Studies also demonstrate a persistent lack of transparent information about conditions in ICE facilities that continues to prompt ongoing calls for increased oversight and accountability to address the systemic sources of poor health outcomes.

The ultimate failure of the immigration detention system to protect the health and safety of detainees is the outcome of preventable death. Publicly available ICE detainee death reports provide basic details about timelines preceding death. However, independent investigations and analyses into the circumstances surrounding these deaths have demonstrated pervasive and systemic negligence.

Billions of dollars of congressional appropriations continue to pour into the expansion of ICE detention facilities, and private prisons contracted to provide services for immigrants in detention report profit margins in the billions of dollars.

How did your work fit with the recently released report?

Deadly Failures expounds on our prior research with a depth and breadth of context.

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The report provides clear policy recommendations for major stakeholders – the Department of Homeland Security, the Department of Justice, Congress and local and state governments.

These recommendations range from feasible to ambitious in detailing actions that would eliminate preventable death for those in ICE custody. Proposed interventions include prompt disposition of detainees who have medical and mental health vulnerabilities, limiting the physical and fiscal expansion of detention facilities, investing in community-based services, banning solitary confinement, passing legislation to ensure accountability to standards of care in facility contracts and establishing mechanisms for regular public data reporting. The report also calls for ICE to dismantle the mass immigration detention system at large.

I was particularly heartened to read the second line of the Deadly Failures executive summary, which highlights the most striking finding of our research – the troubling trend of ICE releasing people from custody immediately prior to their deaths.

Why does this happen?

ICE regulations specify that when a detained noncitizen dies in custody, the agency will conduct timely notification, review and publication of the death. But the regulatory language about people who die immediately after release from ICE custody is vague and doesn't include a reporting timeline or proposed mechanism of accountability for such deaths.

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When we investigated the total number of deaths in ICE custody from fiscal years 2021 to 2023, our research team cross-referenced published ICE death reports with releases issued by investigative journalists and immigration advocacy groups. Our review of public records and available legal documents confirmed four deaths that were not accounted for in the 11 death reports ICE published from those years.

Through this investigation we found a pattern of detainees who, while hospitalized, were released from ICE custody after being deemed critically ill, with death clinically imminent. When we reviewed these detainees' medical records we found deaths that could have been prevented. In one such case, a detainee contracted COVID-19 while in custody and suffered a series of complications, including multiple hospitalizations for recurrent infections. Concerns raised by the facility medical director about the patient's persistently critical condition went unaddressed, and after ultimately suffering a stroke the patient was placed on life support. ICE released the unconscious patient from custody just prior to his death. This technical release from custody allowed ICE to avoid mandatory public reporting of this case and its details.

Officially, ICE has said that it is continuing to evaluate its enforcement of health standards and is looking for ways to improve medical care delivery.

Our research team's key recommendation, also highlighted by the authors of Deadly Failures, is that all deaths of individuals that occur within 30 days of release from ICE custody be included in mandatory public reporting of ICE statistics and death reports. This is a critical measure of transparency and accountability.

ICE detainees suffer preventable deaths − Q&A with a medical researcher about systemic failures
The Port Isabel ICE detention center in Los Fresnos, Texas.
Veronica Gabriela Cardenas-Pool/Getty Images

What should Immigration and Customs Enforcement be doing to prevent unnecessary deaths on its watch?

Time in ICE custody is related to preventable death. People detained in ICE facilities should be released as quickly as possible so their medical needs can be transitioned to more consistent and long-term care.

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Triage should also be standardized. Detainees who show signs and symptoms of serious medical conditions should be rapidly assessed and quickly transferred to local emergency rooms for further evaluation and treatment. Rigorous oversight and accountability should be established for all workers at ICE facilities and for clinical outcomes of detained patients.

Are you still seeking answers to questions you have about detainees? If so, what are you looking for?

ICE's collection, recording and sharing of high-quality data regarding the capacity of ICE facilities, the scope of health services available and metrics of health outcomes for people detained in ICE custody is markedly limited. The dearth of data leaves a barrage of unanswered questions regarding the conditions that contribute to poor health outcomes. In my view, ICE detention facilities should be held to standards of transparency and accountability to federal and public reporting, as are other large systems of medical care.

Is there anything that has surprised you in what you've found over the past few years?

The instances of deficient professional language services, including interpretation and translation, for people detained in ICE custody is surprising. It is at odds with a federal mandate that stipulates a patient's right to receive health information in their preferred language at no cost. This right is exercised daily in U.S. hospitals and clinics across the country for the nondetained with in-person interpreters or readily accessible technology.

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Woman in white coat examines man in orange jumpsuit
An ICE Health Service Corps photo shows a detainee in an orange jumpsuit receiving care.
ICE Health Service Corps

Ultimately, it is disheartening but not surprising that extensive research continues to demonstrate a diminished standard of care experienced by people detained in ICE custody.The Conversation

Cara R. Muñoz Buchanan, Physician and Clinical Fellow in Health Policy and Social Emergency Medicine, Harvard Kennedy School

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

How high school athletes can safely prepare for the start of practice, and the warning signs of heat illness

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theconversation.com – Samantha Scarneo-Miller, Assistance Professor of Athletic Training, West Virginia University – 2024-07-19 07:30:16
The first two weeks of practice are hardest as the body acclimatizes.
Derek Davis/Portland Portland Press Herald via Getty Images

Samantha Scarneo-Miller, West Virginia University

High school sports teams start practices soon in what has been an extremely hot summer in much of the country. Now, before they hit the field, is the time for athletes to start slowly and safely building up strength and stamina.

Studies have found that the greatest risk of heat illness occurs in the first two weeks of team practices, while players' bodies are still getting used to the physical exertion and the heat. Being physically ready to start increasingly intense team practices can help reduce the risk.

I am an athletic trainer who specializes in catastrophic injuries and heat illnesses. Here's what everyone needs to know to help keep athletes safe in the heat.

Why should athletes restart workouts slowly?

One of the biggest risk factors for developing dangerous exertional heat illnesses is your physical fitness level. That's because how fit you are affects your heart rate and breathing, and also your ability to regulate your body temperature.

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If an athlete waits until the first day of practice to start exercising, their heart won't be able to pump blood and oxygen through the body as effectively, and the body won't be as adept at dissipating heat. As a person works out more, their body undergoes changes that improve their thermoregulation.

That's why it's important for athletes to gradually and safely ramp up their activity, ideally starting at least three weeks before team practices begin.

How high school athletes can safely prepare for the start of practice, and the warning signs of heat illness
Taking breaks – ideally in the shade – and staying hydrated can help athletes avoid heat illnesses.
Ian Spanier/ImageSource via Getty Images

There is no hard and fast rule for how much activity is right for preparing – it varies by the person and the sport.

It's important to remember not to push yourself too hard. Acclimatizing to working out in the heat takes time, so start slow and pay close attention to how your body responds.

How hot is too hot for working out outside?

Anything that is hotter than normal conditions can be risky, but it varies around the country. A hot day in Maine might be a cool day in Alabama.

If it's significantly hotter outside than you're used to, you're more likely to get a heat illness.

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To stay safe, avoid exercising outside in the hottest periods. Work out in the shade, or in the early mornings or evenings when the sun's rays aren't as hot. Wear loose clothing and light colors to dissipate and reflect as much heat as you can.

Hydration is also important, both drinking water and replenishing electrolytes lost through sweating. If your urine is light-colored, you are likely hydrated. Darker urine is a sign of dehydration.

Football teammates, without pads or helmets, take a break around coolers of water on a hot August day.
Players need to stay hydrated and start practices slowly, without heavy equipment, to allow their bodies time to acclimate to the exertion and heat.
Shawn Patrick Ouellette/Portland Portland Press Herald via Getty Images

What does acclimatization look like for teams?

Once team practices start, many states require heat acclimatization processes that gradually phase in activity, though their rules vary. Some states require 14 days of heat acclimatization. Some require six days or none. Some only require it for football.

Athletes who get a head start on acclimatization can help their bodies adapt faster and more efficiently to the heat. Regardless of what your state requires, all athletes participating in all sports should acclimatize carefully.

Heat acclimatization involves adding more strain during the workout every few days, but taking care not to add too much.

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For example, instead of starting the first day of practice with full pads and full contact in football, players might start with just the helmets for the first few days.

A line of linemen practice tackling while wearing helmets and pads.
Contact practices generate body heat, and full pads and helmets hold that heat in. More than 50 high school football players died from heat illnesses between 1996 and 2022.
AP Photo/Rogelio V. Solis

Acclimatization is also about limits: Holding practice only once a day in the beginning and capping how many hours players practice each day can help avoid putting too much strain on their bodies too fast. Coaches and athletic trainers must also keep an eye on the wet bulb global temperature – the combination of heat, humidity, radiation and wind speed – to gauge the heat risk to players and know when to limit or cancel practice.

This isn't just for football. Whether it's soccer, track and field, softball or baseball, heat illnesses do not discriminate. A Georgia basketball player died after collapsing during an outdoor workout in 2019 – she was accustomed to practicing indoors, not in the heat.

What are warning signs an athlete is overheating?

If a player starts to slow down or gets lethargic, that may be a sign that they're overheating. You might see evidence of central nervous system problems, such as confusion, irritability and being disoriented. You might see someone stumbling or trying to hold themselves up.

Most of the time, someone with exertional heatstroke will be sweating. They might have red skin and be sweating profusely. Sometimes a person with heat stress can lose consciousness, but most of the time they don't.

Illustration of an athlete shows symptoms of heat exhaustion and heat stroke
Signs of heat illness in athletes and what to do about it.
Alexander Davis for Arizona State University, Korey Stringer Institute

What should you do if someone appears to have a heat illness?

If someone appears to be suffering from heat illness, cool them down as fast as possible. Find a tub you can put the person in with water and ice. Keep their head out of the water, but cool them as fast as possible.

Immersion in a cool tub is best. If you can't find a tub, put them in a shower and put ice around them. Even a tarp can work – athletic trainers call it the taco method: Put the patient in the middle of the tarp, put some water in with ice, and hold up the sides to oscillate them slowly so you're moving the water from side to side.

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Every sports team should have access to a cooling vessel. About half the states require it. As that expands, these safety practices will likely trickle down to youth sports, too.

If a player appears to be suffering from heatstroke, cool them down and call 911. Having a comprehensive emergency action plan ensures that all personnel know how to respond.

What else can teams do to prepare?

Exertional heatstroke is a top cause of sports-related death across all levels of sports, but proper recognition and care can save lives.

Athletic trainers are vital for sports programs because they are specifically trained to recognize and manage patients suffering from exertional heatstroke and other injuries. As hot days become more common, I believe all sports programs, including high school sports programs, should have an athletic trainer on staff to keep players safe.The Conversation

Samantha Scarneo-Miller, Assistance Professor of Athletic Training, West Virginia University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The Conversation

Fewer bees and other pollinating insects lead to shrinking crops

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theconversation.com – Rachel Mallinger, Professor of Entomology, University of Florida – 2024-07-19 07:30:29
Insects are the primary pollinators of most flowers and crops.
Niklas_Weidner/500px via Getty Images

Rachel Mallinger, University of Florida

Many plants, from crops to carnations, cannot bear fruit or reproduce without bees, beetles, butterflies and other insects to pollinate them. But the population of insect pollinators is dropping in the U.S., due in part to pesticides, climate change, invasive plants and diminished habitats. Rachel Mallinger, assistant professor of entomology at the University of Florida, explains why these insects are in decline and how homeowners can create yards and gardens that are good for pollinators.

Rachel Mallinger discusses insect pollination.

has collaborated with SciLine to bring you highlights from the discussion that have been edited for brevity and clarity.

What kind of insects pollinate?

Rachel Mallinger: A lot of different insects pollinate. Insects visit flowers for many purposes, often for food, to get nectar or to get pollen. Sometimes they'll visit flowers to mate or to lay eggs or as refuge. Bees are the primary pollinators for a lot of plants, but flies, wasps, beetles and butterflies also play an important role.

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How ecologically critical are insect pollinators?

Mallinger: A small percentage of flowering plants are pollinated primarily by wind, but new research suggests that as much as 90% require animal pollinators. Although birds, bats and other mammals also pollinate, insects are the main pollinators for the vast majority of those plants.

Without insects and their pollination, these plants would not be able to reproduce, and we would see a dramatic decline in plant diversity and abundance. Without insect pollinators, these plants wouldn't produce the seeds and the fruit that feed many animals – including people.

Have insect pollinator populations declined?

Mallinger: Recent studies have shown pretty dramatic declines in insects generally, and this has been shown even in conservation lands. So we think that in highly developed areas, insect declines are probably even more dramatic.

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I study primarily native wild bees. Here in North America, we have between 4,000 and 5,000 species. For many species, we don't know if they're declining. Of the ones that we do have some information on, it's estimated that about half are declining and about a quarter are imperiled and potentially on the road to going extinct.

The insect pollinators that tend to be most at risk are ones that are specialists – those that require really unique, specialized food or nesting resources. Also ones that already have a limited range. For example, maybe they are found only on islands or in a small area.

Although many bee populations are in danger, there's much you can do to help.

What about the economic importance of insect pollinators?

Mallinger: Crops pollinated by animals, primarily insects, make up about one-third of our agricultural production in terms of acreage. A study in the state of Georgia found over US$360 million per year in crop pollination services provided by insects in that state alone.

What do insect pollinators need to be healthy?

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Mallinger: Aside from pollen and nectar, some insect pollinators require additional food sources. For example, butterflies in the caterpillar stage need foliage from their host plants.

Other insect pollinators, like wasps and flies, are carnivores in the larval stage, so during that time they need to eat small arthropods – like spiders and centipedes – and insects.

Beyond that, they need nesting habitat. The majority of our insect pollinators nest below ground, and so they need ground that is relatively undisturbed, bare and accessible. Other pollinators nest in woody debris, stems and reeds. And some pollinators, like butterflies, just lay their eggs on host plants.

Additionally, pollinators need environments that are free from toxins. So they need environments that are not regularly sprayed with pesticides, including insecticides.

What stressors are leading to declines in insect pollinator populations?

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Mallinger: I would say there are five main stressors.

Land use change is one. This can be the conversion of wild lands to agriculture or to development.

Climate change is another stressor. It changes the average temperature that these pollinators are experiencing and increases the chance of extreme temperatures and weather events. Hurricanes and flooding can be really detrimental and destroy the habitat for pollinators.

Third, pesticides and other chemicals in our environment that are toxic.

Invasive plants can be really detrimental for pollinators. They can take over an area and replace the native plants that pollinators depend on. That's four.

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And finally, pathogens and parasites.

All five of these stressors can interact. For example, climate change may increase the likelihood of invasive plant species, pathogens and parasites thriving. Land use change can also increase the likelihood of invasive species.

What can homeowners do to help pollinators?

Mallinger: Planting a diversity of flowering plants for pollinators is one of the best things you can do. Aim to have at least three plants flowering at any given time, and look for a diversity of flower colors and shapes. Different pollinators have different preferences. You can have flowers that are yellow, blue, purple, pink, red and white.

In terms of floral shapes, plant some flowers that are flat and are accessible for pollinators with small mouthparts. And also plant some flowers with medium-length tubes, and some with long tubes.

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Focus on native plants and try to seek out plants that might not just be the common types that you find in the big box stores. Go to native plant nurseries and seek out resources online.

Additionally, try to have nesting habitat in your garden. If the space allows, have some woody debris around for the pollinators that nest above ground. This can include things like logs, stems and reeds. Also manage your area to be as chemical-free as possible. This includes reducing pesticide use.

Keep in mind that many pollinators that nest below ground are not aggressive and are solitary. It's just one individual pollinator and her nest.

Watch the full interview to hear more.

SciLine is a free service based at the American Association for the Advancement of Science, a nonprofit that helps journalists include scientific evidence and experts in their stories.The Conversation

Rachel Mallinger, Professor of Entomology, University of Florida

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Long COVID puzzle pieces are falling into place – the picture is unsettling

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theconversation.com – Ziyad Al-Aly, Chief of Research and Development, VA St. Louis Care System. Clinical Epidemiologist, Washington University in St. Louis – 2024-07-18 18:02:37
Researchers are gaining key insights into the ways that the SARS-CoV-2 virus can lead to long COVID symptoms.
Catherine McQueen/Moment via Getty Images

Ziyad Al-Aly, Washington University in St. Louis

Since 2020, the condition known as long COVID-19 has become a widespread disability affecting the health and quality of life of millions of people across the globe and costing economies billions of dollars in reduced productivity of employees and an overall drop in the work force.

The intense scientific effort that long COVID sparked has resulted in more than 24,000 scientific publications, making it the most researched health condition in any four years of recorded human history.

Long COVID is a term that describes the constellation of long-term health effects caused by infection with the SARS-CoV-2 virus. These range from persistent respiratory symptoms, such as shortness of breath, to debilitating fatigue or brain fog that limits people's ability to work, and conditions such as heart failure and diabetes, which are known to last a lifetime.

I am a physician scientist, and I have been deeply immersed in studying long COVID since the early days of the pandemic. I have testified before the U.S. Senate as an expert witness on long COVID, have published extensively on it and was named as one of Time's 100 most influential people in health in 2024 for my research in this area.

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Over the first half of 2024, a flurry of reports and scientific papers on long COVID added clarity to this complex condition. These include, in particular, insights into how COVID-19 can still wreak havoc in many organs years after the initial viral infection, as well as emerging evidence on viral persistence and immune dysfunction that last for months or years after initial infection.

Long COVID puzzle pieces are falling into place – the picture is unsettling
Early on in the pandemic, the SARS-CoV-2 virus seemed to be primarily wreaking havoc on the lungs. But researchers quickly realized that it was affecting many organs in the body.
Uma Shankar sharma/Moment via Getty Images

How long COVID affects the body

A new study that my colleagues and I published in the New England Journal of Medicine on July 17, 2024, shows that the risk of long COVID declined over the course of the pandemic. In 2020, when the ancestral strain of SARS-CoV-2 was dominant and vaccines were not available, about 10.4% of adults who got COVID-19 developed long COVID. By early 2022, when the omicron family of variants predominated, that rate declined to 7.7% among unvaccinated adults and 3.5% of vaccinated adults. In other words, unvaccinated people were more than twice as likely to develop long COVID.

While researchers like me do not yet have concrete numbers for the current rate in mid-2024 due to the time it takes for long COVID cases to be reflected in the data, the flow of new patients into long COVID clinics has been on par with 2022.

We found that the decline was the result of two key drivers: availability of vaccines and changes in the characteristics of the virus – which made the virus less prone to cause severe acute infections and may have reduced its ability to persist in the human body long enough to cause chronic disease.

Despite the decline in risk of developing long COVID, even a 3.5% risk is substantial. New and repeat COVID-19 infections translate into millions of new long COVID cases that add to an already staggering number of people suffering from this condition.

Estimates for the first year of the pandemic suggests that at least 65 million people globally have had long COVID. Along with a group of other leading scientists, my team will soon publish updated estimates of the global burden of long COVID and its impact on the global economy through 2023.

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In addition, a major new report by the National Academies of Sciences Engineering and Medicine details all the health effects that constitute long COVID. The report was commissioned by the Social Security Administration to understand the implications of long COVID on its disability benefits.

It concludes that long COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include new onset or worsening:

Long COVID can affect people across the lifespan from children to older adults and across race and ethnicity and baseline health status. Importantly, more than 90% of people with long COVID had mild COVID-19 infections.

The National Academies report also concluded that long COVID can result in the inability to return to work or school; poor quality of life; diminished ability to perform activities of daily living; and decreased physical and cognitive function for months or years after the initial infection.

The report points out that many health effects of long COVID, such as post-exertional malaise and chronic fatigue, cognitive impairment and autonomic dysfunction, are not currently captured in the Social Security Administration's Listing of Impairments, yet may significantly affect an individual's ability to participate in work or school.

Many people experience long COVID symptoms for years following initial infection.

A long road ahead

What's more, health problems resulting from COVID-19 can last years after the initial infection.

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A large study published in early 2024 showed that even people who had a mild SARS-CoV-2 infection still experienced new health problems related to COVID-19 in the third year after the initial infection.

Such findings parallel other research showing that the virus persists in various organ systems for months or years after COVID-19 infection. And research is showing that immune responses to the infection are still evident two to three years after a mild infection. Together, these studies may explain why a SARS-CoV-2 infection years ago could still cause new health problems long after the initial infection.

Important progress is also being made in understanding the pathways by which long COVID wreaks havoc on the body. Two preliminary studies from the U.S. and the Netherlands show that when researchers transfer auto-antibodies – antibodies generated by a person's immune system that are directed at their own tissues and organs – from people with long COVID into healthy mice, the animals start to experience long COVID-like symptoms such as muscle weakness and poor balance.

These studies suggest that an abnormal immune response thought to be responsible for the generation of these auto-antibodies may underlie long COVID and that removing these auto-antibodies may hold promise as potential treatments.

An ongoing threat

Despite overwhelming evidence of the wide-ranging risks of COVID-19, a great deal of messaging suggests that it is no longer a threat to the public. Although there is no empirical evidence to back this up, this misinformation has permeated the public narrative.

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The data, however, tells a different story.

COVID-19 infections continue to outnumber flu cases and lead to more hospitalization and death than the flu. COVID-19 also leads to more serious long-term health problems. Trivializing COVID-19 as an inconsequential cold or equating it with the flu does not align with reality.The Conversation

Ziyad Al-Aly, Chief of Research and Development, VA St. Louis Health Care System. Clinical Epidemiologist, Washington University in St. Louis

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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